3 + 4 = 7

[Aussieguy1]

Hi I am seeking some guidance

Diagnosed with Gleason 6 2019 have been under Active Surveillance.

Second biopsy attended in March 2022.

Two areas of 3+4=7. Grade group 2

Global ratio of Gleason pattern 3/4: 95/5

Left mid 1 of 8 cores 0.5 of 75mm

Left posterior 3 of 5 cores 8.5 of 40mm.

Right side no carcinoma in 22 cores

Left anterior no carcinoma in 6 cores.

Acinar carcinoma, cribriform pattern: Absent

Intraductal carcinoma: Absent

Prostate volume 50cc

PIRADS 4. Mild BPH. Last PSA 5.80.

62 years old.

So where to now, stay with AS, treat with radiation therapy or surgery? Need opinions, a little lost in making a decision. Will see urologist on the 20/04/2022. Family history of prostate cancer, both father and brother.

Thanks for your knowledge and opinions.

Ian

[Tall_Allen]

Looks great! Most every program I know of would recommend you stay the course with your very minimal pattern 4, but get another mpMRI-targeted biopsy next year.

[Aussieguy1 in reply to Tall_Allen]

Thanks Tall_Allen

I have been experiencing anxiety about this and it’s making me think it’s time to do something when what you say so makes sense to me. I practice mindfulness meditation and I am trying to remain focused and present.

Have you ever heard of a case of true 3 + 4 = 7 with metastasis? By true I mean no higher grade being present.

There is always the risk of course that higher grade could be present but missed during biopsy.

When does one request a PSMA Pet Scan? No doubt not related but for months now I have been having pain in my right rib area, I think it is referred pain coming from my thoracic spine. Anti inflammatory medication doesn’t touch the pain. I’m being paranoid and anxious about it I guess.

I guess also I haven’t felt very supported by the health care I have been receiving regarding active surveillance since moving to a rural area in another state. But I have found a new GP and will see a new urologist soon. Hopefully this new urologist will be supportive.

Thanks Tall_Allen for your help and reply.

[Tall_Allen in reply to Aussieguy1]

Pattern 4 cells can certainly change into cells that can metastasize, while pattern 3 cannot. But with such low amounts, the risk is small - this has been shown empirically. In fact there are some (e.g., Andrew Vickers) who claim that pattern 4 detected only by mpMRI-targeted biopsy and not be TRUS biopsy is less risky.

It is very normal to think that every ache is attributable to the cancer.

PSMA PET scans are only appropriate for high risk patients.

Yes, sticking with AS is psychologically difficult. Often, well-meaning friends and family say unhelpful things like "it's cancer! Why don't you just cut it out?" Support groups or a hospital program can help stay the course..

[Leeaussie5]

Hi Ian

I had 4+3=7.

I’m now also 62. This was when I was 59.

Everyone’s needs and experience is different but when I had that diagnosis, I got a few opinions and a PSMa pet scan (at that time with zero Medicare rebate).

I’d get at least two opinions before I made a decision about anything - including staying with AS.

I was hopeful that I might only need partial removal/destruction of my prostate but that was not to be. But you might be eligible for that treatment- minimising side effects..

The risk I faced was that my contained cancer could breakout.

I ended up with surgery in Sydney - and it worked well leaving me with minimal Ed (totally solved by drugs) and no leakage.

My diagnosis was all about the Gleason 3 and 4 but the after surgery path gave me some 5 as well.

I was happy with my decision.

But my sex rehab doctor warned me that gay guys will miss the semen. He is right: I do lament the loss of it. Everyone some guy tells me to give him my load, I miss that I can’t.

But I am really glad the cancer is gone and I can still play.

But I have heard and read horrible stories where things didn’t go so well.

All the best with the future

Keep safe

[Aussieguy1 in reply to Leeaussie5]

Thanks mate for taking the time to reply I appreciate it.

Good to hear about the minimal ED being totally resolved with medication. Your right about the loss of cum, it’s so part of the joy of sex. It’s a huge part of the decision making regarding treatment, but if a prostatectomy is your only option then it’s something that you would hopefully come to accept. Thank goodness orgasms although dry are still possible.

So yes I will attend an appointment at Royal Adelaide Hospital on the 20th of April, then I’ll have a better understanding of where I’m heading in my decision making.

There is a lot to consider, anxiety is my biggest downfall with Active Surveillance but hopefully I’ll get on top of it after a chat with some specialist, if not I’ll look into the treatments they offer.

Take care mate, thanks again.

[Leeaussie5]

Thanks. The only other advice I have is do not be afraid to seek opinions in melbourne or Sydney. I come from Canberra and the very best decision I made was to get my treatment in Sydney. Smaller cities and small hospitals just do not have the throughput to get truely good at a specialist problem.

[nacinla]

Hi. I was also 3+4, T1; more prevalent cancer (though I've forgotten the specifics); PSA 5.3 before treatment. I live in Los Angeles, and Tall Allen was very helpful. After visiting five different doctors, I chose SBRT. I hope you can stay on AS for a long while. But when/if the time comes, keep in mind that a prostatectomy is not the only option and do not be hastily railroaded into surgery by a surgeon. (Just a side note: 4+3 is not the same as 3+4. Keep that in mind when comparing others' situations.)

[Aussieguy1 in reply to nacinla]

Thanks nacinla

I will see the urologist on the 20 th of this month. I will also request an appointment with a radiation oncologists. I am going away to visit family for a couple of weeks to eat, drink and be merry.

I appreciate your reply. I am aware of the difference between 3+4 and 4+3 in Gleason scoring system. Just feel I am getting to the point of active Surveillance anxiety, worrying that in 12 months that my 3+4 next biopsy could find some 4+3 and it’s made a bolt out of the prostate.

Thanks again

Ian