After my initial MRI came back showing a Pi-Rad 5 in left side, I had a biopsy which came back G 7 (3+4). Two cores were (20%, 30%) and two others were (5%, 60%) - all on left side. Evidence of perineural invasion.
JH came back with a G 6 (3+3): two cores were (30%, 40%) and the other two were (5%, 60%). So they upped the amount of low grade cancer in two of the cores, but found no evidence of grade 4. They did confirm perineural invasion.
So a huge sigh of relief at this point, and am shocked at the JH findings of no G 4. I have read that many pathologists take a very conservative approach to grading and will often over-grade, but how common is it to to from G6 to G7 when you have JH take a second look?
I guess that it is quite possible that I have some G 4 in there but the biopsy just didn't capture it, based on my Pi-Rad 5?? I am also concerned about the PNI and the potential for this to turn into a G7 down the road after it has spread outside the prostate.
I meet with my urologist tomorrow to discuss next steps. I live in Bend, OR and there is a highly regarded cancer institute over in Portland that I am thinking I should connect with to determine what the AS plan should be moving forward, and when I should plan to have another biopsy done. My doc here only does Trus and while it went fine, I want to go with trans-perineal from now on to avoid infection risk, and to also find someone that is highly skilled in MRI-based biopsies.
Any other suggestions/perspectives are greatly appreciated.
Trying to decide if I will continue ADT after 9 months. 
Gleason grade 8 (4x4) Next move in progress
Fathers biopsy reports 
2nd Opinion Recommendation for North Carolinia/Virginia/DC
