prostate cancer 3+4

[renegade70]

I was diagnosed with prostate cancer approx. 2 and 1/2 years ago. I was 68 years old at the time, and as the result of a physical exam, I was given a PSA test. The result was a 4. Three months later another PSA test showed results over 5. Within eight months it went up 9.

I was then given a 12-core needle biopsy. The results showed one 3+3 =6 cancerous core (33%). I was placed on active surveillance Since then I have had two MRIs showing nothing whatsoever although my PSA level rose up to 10.

Three weeks ago I had a second 12 core needle biopsy. This time my results showed four cores 3+3=6 and one core 3+4=7 ( under 10%). Initially, my urologist told me it was safe to remain on active surveillance, however, when I went into his office to discuss the biopsy results he told me he was very much on the fence about things and wanted me to visit a radiation oncologist. He said he wanted to get the oncologist's opinion. I checked out the oncologist and he has nothing but 5-star ratings.

I am aware enough to know that if sent to a radiation oncologist you will more than likely be encouraged to be treated with radiation.

I am 71 years old. I do not know of any blood relatives who have had prostate cancer although my Father and paternal Grandfather died in their 60s.

I would appreciate any related comments or recommendations.

[pjd55d]

get the opinion - accept treatment if and when you and your Urologist - and now Oncologist - feel that it is the appropriate action

[Bruins11 in reply to pjd55d]

I was 72 when I had my RP. My Gleason was 3/4-7. Surgery was successful, as my PSA ever since has been .001, that’s the good news. I’ve had ED and stress incontinence since the RP, that’s the bad news. I would strongly suggest that you seriously consider RT for your treatment . I ge have several friends that have done that instead of surgury and they are all fine with little or no negative side effects.

Good luck!!

[Lieto55 in reply to Bruins11]

Boy howdy, great advice here. My 3+4 biopsy happened at 65. After surgery, exactly same symptoms. Really life altering. Recurred and went radiation and ADT route two years later.Depending on aggressiveness (Decipher, etal) (mine was in the 60s), I would go ADT and radiation, realizing that no surgery can happen after radiation.

I was never on a watch/wait program, but it seems like waiting should have ended after the first 3+3 and PSA growth. My PSA was slow and only at surgery did it hit 4+, but it had already become meta (recurrence wasn't in local area, T11 very and pelvic lymph glands.)

ADT isn't fun but ain't as bad as I imagined up front.

Good luck on all fronts!

[renegade70 in reply to Lieto55]

thank you

[renegade70 in reply to Lieto55]

i was told that 3+3=6 does not ever spread.

[Lieto55 in reply to renegade70]

? That's just crazy. How would one know? At 3+4 on 12 cores, my cancer had already metastisized. At surgery, the margins were clear, no infiltration to surrounding tissues, seminal vesicles removed along with selected nearby lymph nodes, and apparently the bilateral erectile nerves (@#$_-;). PSA never went to absolute zero (.01-.02), and at two years it started migrating up with a defined doubling frequency. So the takeaway is that you can have cellular migrations, I believe, at anytime. Mine went all the way to T11 vertibrate while my PSA was at .1. "Never" just isn't a word I have in my vocabulary, "cure" neither. Delay? Sure. Never just sounds arrogant, like they actually know. It's a probability game. As someone smarter than me said on this board, you are speaking with the survivors (so far). Those with more aggressive cases left us before we heard their story. So it's a biased field. I'd be more aggressive if I could do it again. Radiation and ADT immediately, surgery...pfft. IMHO.

Good luck!!

[renegade70 in reply to Bruins11]

thank you

[renegade70 in reply to Bruins11]

thanks so much.

[renegade70 in reply to pjd55d]

thank you

[Tall_Allen]

Ask for a Decipher test of your last biopsy.

[renegade70 in reply to Tall_Allen]

Excuse my stupidity but what is a decipher test? Thanks for responding.

[conbio in reply to renegade70]

The Decipher Prostate Genomic Classifier is a genetic test that helps doctors determine the risk of prostate cancer spreading and the likelihood of a patient benefiting from hormone therapy

[renegade70 in reply to conbio]

thank you

[Ianrs]

Get radiation. The process itself is simple, but you may not feel well after a few rounds and that could last several months without being debilitating. But best to be precautious. I had 6 weekly of 6 gyes.

[renegade70 in reply to Ianrs]

thanks much

[mchale in reply to renegade70]

I just finished my second SBRT treatment today, yesterday was the first, tomorrow is my third...MRI guided Linac Electra Unity , two more next week....just got back from the gym 3 hour workout.

[renegade70 in reply to mchale]

thanks much, but a 3 hour workout is beyond my capacity being close to 72.

[aceace12]

good luck

[renegade70 in reply to aceace12]

thanks much

[CrackerOcala]

Certainly get that 2nd opinion but it does sound like your signposts are moving in the wrong direction. I had my cores submitted for Prolaris testing, similar to Decipher. Even though I had some 4+3 cores. I was borderline for hormone therapy. After research to my satisfaction I steered clear of that option (although doc preferred to do it, he acknowledged that the need was not overriding). Seemed to be more downside to surgery. Ended up going with radiation , that ended this past July. Keep us posted. Best wishes.

[renegade70 in reply to CrackerOcala]

thank you

[j-o-h-n]

The soup of the day:

"RT" in prostate cancer stands for Radiation Therapy which is a common treatment method used to kill prostate cancer cells by delivering high-energy rays to the tumor, often administered through external beam radiation therapy (EBRT) or internal radiation therapy (brachytherapy) depending on the stage of the cancer; it can be used as a primary treatment option or as an adjuvant therapy after surgery for high-risk prostate cancer.

Greetings, Our support is with you...

Good Luck, Good Health and Good Humor.

j-o-h-n

[renegade70 in reply to j-o-h-n]

thanks much

[j-o-h-n in reply to renegade70]

You're welcome,

In the good ole days, surgery was the way to go, now it seems that radiation is best. Keep researching and asking for information here and elsewhere.

Good Luck, Good Health and Good Humor.

j-o-h-n

[renegade70 in reply to j-o-h-n]

thank you...

[paladin7]

I got opinions from a second urologist and a second oncologist, for a total of four opinions. I also listened carefully to the excellent folks who comment in this HealthUnlocked community.

All of these helped me reach a decision that I was satisfied with, and that's very important to me.

So I encourage you to take the time to get as many opinions as you need to be able to reach a decision that you are at peace with.

[renegade70 in reply to paladin7]

thanks much

[janebob99]

I highly recommend doing SBRT radiation treatment. It's only 5 sessions of X-ray treatment, and is very effective at reducing PSA. I had very few side effects from the treatment and they were very minor.

[renegade70 in reply to janebob99]

thanks.

[Thunderball1 in reply to janebob99]

May I ask if any ED side effects?

[janebob99 in reply to Thunderball1]

None for me. I still have erections and orgasms, but without fluid, due primarily to the ADT treatment.

[Thunderball1 in reply to janebob99]

Thanks, and glad to hear it!

[MrOz]

I had these exact same numbers except I was 57. I had my prostate removed, 2-years later with rising PSA, I had 45 course of radiation. I am now 68. I have never been to zero for PSA. My PSA continues to rise. I've had two PET scans , one year apart, last one 3-months ago. No cancer has been found. Last visit PSA was 1.45. Looks like hormone treatment is coming. Possibly in March. All you can do is trust your doctors and scour the Internet for information. I have been using AI to ask questions. You can't actually trust that completely but AI sends back info that you can corroborate at other places but you still get interesting info. For example I learned a guy lived 35 years on hormones. (sidebar- he was also castrated right at the beginning.) A question one has to ask himself, how long do you think you would have lived if this disease didn't show up. Is the patient healthy, weight under control, longevity in family members, all those things? Treatment is a slog and my experience, you'll never be same physically. But if think you got years ahead of you, get treated. Good luck friend...

[renegade70 in reply to MrOz]

thank you.

[CancerConcierge]

It’s worthwhile to get a second opinion on your biopsy samples .

We had my husband’s bladder and prostate cancer biopsy samples sent to Johns Hopkins for second opinions.

Getting an accurate Gleason score helps in designing the best treatment plan for your prostate cancer.

[renegade70 in reply to CancerConcierge]

I am scheduled for a 2nd opinion at Massachusetts General Hospital's Prostate Cancer Treatment Center. Mass General is one of the best hospitals in the country. So most likely I will go with the treatment they prescribe.

[Androgel123]

My friend. I think you have nothing to worry about. For sure you’ll die from something else, you’re 71 and prostate cancer is SLOW growing. If I were you I’d enjoy the rest of my life and not even worry about it. They play on your fears you know, to guide you towards treatment. The system is geared that way to make money.

[renegade70 in reply to Androgel123]

thank you

[renegade70 in reply to Androgel123]

thank you so much.

[renegade70]

so many differing opinions. just like the doctors.. guess i have to make my own decisions. this is a disease very different from most others. i truly appreciate everyone's viewpoint but basically it is my decision without any particular way to go except what i decide.

[Mgtd in reply to renegade70]

You hit the nail on the head. Both surgery and radiation are equally effective according to research. ADT for some is terrible for others it is a walk in the park. For some surgery is terrible for some radiation is a nightmare.

There is no “truth”. You pick one and hope for the best but the big thing is once you make the decision it is useless to look back. Moving forward is the only approach.

I am 80 with 4+3 and doing great.

[renegade70 in reply to Mgtd]

thanks so much,

[Thunderball1 in reply to Mgtd]

May ask what treatment you had?

[Mgtd in reply to Thunderball1]

ThunderBall I had 26 sessions of radiation to the prostrate and also as a precaution they did my pelvic area to kill any microscopic cells there. In addition I had Lupron - one month prior and 5 months post radiation.

Tolerated both reasonably well. Maintained my daily use of the gym and hiking with the dogs as well well as my care giver activities. Minor fatigue but a short nap solved that.

[NanoMRI]

Recommendations - based on my experiences since my Dx ten years ago at 57 and four treatments. Before treatment decision, I would: have second opinion on pathology; have genomic testing of biopsy samples (OncotypeDx or Decipher are two); discuss mpMRI and PSMA PET findings with urologist(s) and radiation oncologist(s), specific to their respective treatment method (mpMRI findings steered me to surgery). And I agree, "...if sent to a radiation oncologist you will more than likely be encouraged to be treated with radiation"; not just a urologist thing).

My 3+4 was actually 4+3 after surgery - turned out biopsy missed the worst bits. More concerning than that, my cancer had spread further than all docs I consulted with "thought". All the best!

[renegade70 in reply to NanoMRI]

thank you for your advice.

[Androgel123]

Good luck … try not to worry so much. It will hinder the good life you have left.

[renegade70 in reply to Androgel123]

thank you for your good wished.