I’m 39 and was diagnosed back in September with gleason 6. Multiple cores in Biopsy, I think 5 of 12. My PSA bounced around between 3.5-4.5. I went to Vanderbilt and chose active surveillance. Did a confirmation Biopsy this week and got my results. 8 of 23 cores positive ranging from 30-80%. I’m mow 3+4 with less than 5% of each core having pattern 4. A couple cores said perineural invasion present. Should that be a big concern? I’m concerned with the upgrade, but relieved it was less than 5% per sample had pattern 4, but perineural invasion? I can’t find straight answers on it. Some articles say it’s not a big deal others say it’s an indicator of spread.
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Golfer45
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Yes, we face many disparities on diagnosis and treatment paths. Too many 'may', 'might', etc. You have not mentioned multiparametric MRI, genomic testing of biopsy samples nor second pathology opinions; I found these additional investigative methods very informative in addressing my level of concern. The findings elevated my concerns. All the best!
Not sure what your battle plan includes, but if doing surgery - I recommend you find the best surgeon for the procedure that you can find with excellent results. (thousands of successful surgeries) They are out there - you are young and have a long life ahead - plan accordingly for it. The side affects of this could really suck no matter what route you take - some doctors are more capable than others. You have time to do research and find the best.
I have or had invasion also with a 4+5, seminal gland invasion then it took two urologists five months to finally schedule me for a telehealth visit another 2 months out. Fired them and went to a "Center of Excellence" Big cancer centers can be found in most any very large cities. I chose Fox Chase Cancer Center in Philadelphia, "They only do Cancer." They jumped right on it. I chose radiation. Your most important information source is "Prostate Cancer Research Institute." PCRI.org on Youtube. You can contact them for helpful information. Sorry, enjoy sex while you still can. You will probably be on the needle not long after treatment. Wish you the best of luck.
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Biopsy 8-month Change - progression or sampling differences?
Gleason score change from 3+4 to 3+3 with perineural invasion noted under Active Surveillance 
Post Radical Prostatectomy on 5/9/17
Opinions requested – biopsy pathology report
Prostate Biopsy Results
