Gleeson 7 3+4 AS

User

Posted 05 Jul 2025 at 18:30

Hi all,

So after coming out of the meeting in on AS.

I wasn't offered any other options, I've asked and received my biopsy results.

I wanted to ask about other things on the biopsy which might have had an effect on the AS decision. Whether I am borderline for AS I suppose. Though not listed on the NICE PAGES.

% of positive cores 42%

8/19 positive

PSA density 0.15

Clinical stage t2c

PiN present.

Cancer in 4 areas of the prostate and pin in 5th. My full details are below.

Age: 52

PSA: 4.9 ng/mL

PSA Density: 0.15 ng/mL/cc

Prostate Volume (MRI): 32 cc

Clinical Stage: T2c (bilateral, organ confined)

1. Biopsy Results Summary

Total positive cores: 8 out of 19 (~42%)

Overall Gleason Score: 3+4=7 (<5% pattern 4)

Bilateral disease involvement (right and left sides)

Details by site:

Right Anterior: Granulomatous inflammation, no cancer

Right Posterior Medial: Adenocarcinoma, Gleason 3+3, 2/4 cores positive, up to 70% cancer in core, 5mm length

Right Posterior Lateral: Adenocarcinoma, Gleason 3+3, 3/3 cores positive, up to 35% cancer in core, 6mm length

Left Anterior: Adenocarcinoma, Gleason 3+4 (<5% pattern 4), 1/3 cores positive, 20% cancer in core, 3mm length

Left Posterior Medial: Adenocarcinoma, Gleason 3+4 (<5% pattern 4), 2/3 cores positive, 10% cancer in core, 1.5mm length

Left Posterior Lateral: High-grade PIN and granulomatous inflammation, no cancer detected

User

Posted 06 Jul 2025 at 11:54

Originally Posted by: Online Community Member

to be honest I don’t think AS is for me as I feel as if I am constantly looking over my shoulder and at some point I will have to have treatment anyway, would sooner just get it done with.

Hi Niko,

Deciding on a treatment option is difficult. Everyone's goals are different. It's a question which treatment is most likely to best for you. You do need a certain mindset to cope with active surveillance.

I was on AS for two years, but the disease 'appeared' to progress. I then thought like you, I'll have surgery, and that'll get the job sorted. So far, It appears that I may have been lucky, and my cancer seems to have been 'cut out'. I no longer have natural erections, but that's a price I'm willing to pay for being cancer free.

However, like most who've had any radical treatment, your pre treatment worries, of 'will it get worse?', are simply replaced, post treatment, with 'will it return?'

My Gleason was high 9(4+5) with capsular breach, EPE, T3a. In my case, I was far more anxious about the cancer returning after surgery than I was about it developing whilst was on active surveillance.

So looking over your shoulder is not confined to AS, mate. It can continue for many months and years after treatment. In fact it can be so prolonged that you feel like you need a neck brace. 🙂

User

Posted 06 Jul 2025 at 12:12

Originally Posted by: Online Community Member

There are no tumour visible on the mri.

But the biopsy says about the cancer n the cores being 6mm , 5mm , 1.5mm length etc

Does this mean there are tumours there which have had a core through them ?

It's all so complicated

It certainly is complicated Steve. I don't see how you can be a T2c staging, a lesion/s in both lobes when the tumours cannot be seen by the MRI scan?

If a tumour is so small that it cannot be detected on an MRI scan it is classed as T1.

The cores relates to the samples, they are called cores. The lengths are just a measurement of how long each core sample was.

Edited by member 06 Jul 2025 at 12:17 | Reason: Additional text

User

Posted 08 Jul 2025 at 08:45

Hi Steve,

I was diagnosed in 2016 at 70 with PSA 2.19 Gleason 3+4=7 with 5 out of 20 cores positive and was not offered AS and had the choice of Robotic surgery or Brachytherapy and went for brachytherapy as i felt it was less invasive .I can not advise you on your treatment but be careful that you keep on top of AS as some of the members on here have left it to long and regretted it,These are the people you need to speak to. Don't worry about the 3 but watch the 4.

I am coming up to 9 years in September after being signed off in 2020 ish.

Good Luck John.

User

Posted 08 Jul 2025 at 09:14

Originally Posted by: Online Community Member

I am coming up to 9 years in September after being signed off in 2020 ish.

That's fantastic John. What's nearly as great, is, despite you being ' long out of the woods', you still bother to post on here, to help others.

There aren't that many on here, that had brachytherapy and I've seen how your experience has shown those considering it, how successful it can be

I doff my cap to you sir. 👍

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User

Posted 06 Jul 2025 at 01:17

Steve,had your biopsy come back at 3+3 then AS would seem the right way to go. The difference between 3+3 and 3+4 could be quite minimal. I am not medically trained like your consultant but I often wonder how they make their judgement calls. I had some terminal dribbling at 50 ,but didn't really give it much thought and didn't consult a doctor about it. At 59 unknown to me I had a PSA test and the result was 6.9 , unfortunately it got filed and no action was taken. At 62 the PSA was 7.7 ,the Gleason was 4.3 and following RARP the histology wasn't great. Detection Techniques have changed since 2013. When is the right time to take action? Make sure your AS is active, delaying the side effects as long as possible is good,but how long is too long .

Perhaps speak to one of this sites nurses on Monday, the number is at the top of the page.

Thanks Chris

User

Posted 06 Jul 2025 at 09:56

Hi again Steve.

We've already spoken on another thread regarding T2c and it's suitability for active surveillance.

https://community.prostatecanceruk.org/posts/t29997-T2c-disease-and-active-surveillance

Despite my concerns over T2c disease, in your circumstances, if active surveillance was offered, I'd give it a go, so long as my condition was being correctly monitored.

Now, all T2a, 2b and 2c disease groups are just classed as T2. However, my research still suggests that you are more at risk of active surveillance failure if you have T2c disease and should be extra careful that your monitoring is done correctly.

Please ensure your PSA checks are taken regularly and if they remain relatively stable, double check your condition and have a follow up MRI at the appropriate time.

Your 7 (3+4) grading classes you at low/intermediate risk, because they've deemed the 4 part is low enough, you've met the criteria for active surveillance. However, I suspect that you would have been offered all options.

This is an excellent film on treatment options, including active surveillance, the risks of each and the possible side effects.

https://youtu.be/zYTU94-8pTc?si=1Z29_l8rbTwF6DHl

It's well worth watching, mate.

Best of luck. 👍

Edited by member 06 Jul 2025 at 10:15 | Reason: Additional text

User

Posted 06 Jul 2025 at 11:14

Hi Steve

I was also 3+4=7, T2ANOMO, 2 cores out of 26 showed cancer , the Gleason 4 was less than 10% ,PSA was 4.8 in Jan then 4.3 in late March , I was diagnosed in March and had just turned 56

I have seen quite a few specialists now both privately and through the NHS and main guidance was AS or surgery , my first MRI was done in January so I decided to have another MRI done in June along with a new PSA test , I paid to have a much clearer MPMRI done on a 3.0 scanner , results came back that everything is still contained but worrying for me the tumour has increased in size from 6mm to 8mm , my PSA has also increased from 4.3 to 5.8 in 3 months , surprisingly my surgeon still didn’t seem to fazed by it , he questions whether it has increased in size by that much or if it is just a much clearer image, he did though seem to be much more open towards surgery which before he wasn’t so it is now booked , to be honest I don’t think AS is for me as I feel as if I am constantly looking over my shoulder and at some point I will have to have treatment anyway, would sooner just get it done with

all the best mate

Nick

Edited by member 06 Jul 2025 at 11:17 | Reason: Not specified

User

Posted 06 Jul 2025 at 11:43

Thanks Nick,

There are no tumour visible on the mri.

But the biopsy says about the cancer n the cores being 6mm , 5mm , 1.5mm length etc

Does this mean there are tumours there which have had a core through them ?

It's all so complicated

User

Posted 06 Jul 2025 at 11:54

Originally Posted by: Online Community Member

to be honest I don’t think AS is for me as I feel as if I am constantly looking over my shoulder and at some point I will have to have treatment anyway, would sooner just get it done with.

Hi Niko,

However, like most who've had any radical treatment, your pre treatment worries, of 'will it get worse?', are simply replaced, post treatment, with 'will it return?'

So looking over your shoulder is not confined to AS, mate. It can continue for many months and years after treatment. In fact it can be so prolonged that you feel like you need a neck brace. 🙂

User

Posted 06 Jul 2025 at 12:12

Originally Posted by: Online Community Member

There are no tumour visible on the mri.

But the biopsy says about the cancer n the cores being 6mm , 5mm , 1.5mm length etc

Does this mean there are tumours there which have had a core through them ?

It's all so complicated

It certainly is complicated Steve. I don't see how you can be a T2c staging, a lesion/s in both lobes when the tumours cannot be seen by the MRI scan?

If a tumour is so small that it cannot be detected on an MRI scan it is classed as T1.

The cores relates to the samples, they are called cores. The lengths are just a measurement of how long each core sample was.

Edited by member 06 Jul 2025 at 12:17 | Reason: Additional text

User

Posted 06 Jul 2025 at 12:18

Conclusion:

Diffuse non-specific bilateral prostatic peripheral zone

findings (PIRADS 2, LIKERTS 3) can represent prostatitis and

or prostatic intraepithelial neoplasia.

levated PSA density (0.15 ng/ml/cc)

Correlation with the serial patient's clinical risk factors,

the digital rectal examination findings +/- laboratory

investigation results (e.g.setial prostatic specific

antigen PSA) levels) is suggested to determine whether

further work up (e.g. prostatic biopsy) and follow up (e.g.

contrast-enhanced prostatic MRI) are required

Very mildly enlarged prostate (32 cc) related to tiny

bilateral transition zone hyperplastic nodules (PIRADS 2,

LIKERT 2).

User

Posted 06 Jul 2025 at 12:19

Hi Steve sorry mate I’m with you and don’t understand all of the measurements they gave you, as far as I can recall the only info I got was there were 2 abnormalities shown on my MRI, one was classed as Pirad 3 and one was classed as pirad 4 , the 3 was benign and the 4 had the cancer in it and is just in one side of the prostate, I was told 26 cores were taken and only 2 out of the 26 showed cancer , have no idea where all these cores were taken from, as you say it’s complicated

User

Posted 06 Jul 2025 at 12:35

Hi Adrian

thanks for pointers mate and get where your coming from, for me personally though I just feel that with AS the longer it goes on the more the Anxious I would become especially given that the tumour already has potentially increased in size , I feel I would just be waiting for the inevitable day to be told treatment is now needed , with surgery as you say it’s going to be worrying when waiting for PSA results but am hoping that if all good for a year or so then that worry will gradually diminish especially if all is contained upon removal, I have a few friends who have had the surgery some years ago and both say they haven’t thought about it for a long time, you would know better than me though mate and only time will tell

all the best

Nick

User

Posted 06 Jul 2025 at 12:57

Hi Steve.

Your biopsy results are more significant than your MRI scan results. The MRI scan detects any suspicious areas of concern the biopsy usually targets these areas and random areas too and confirms whether or not the areas are cancerous.

What I can't understand is you say that the tumour(s) were not visible on the MRI, so I can only assume that the biopsy samples were not targeted but all taken randomly.

Whatever, the biopsy shows that you have cancer in both lobes. As some of it is grade 4 this makes you borderline for AS. In your case they have deemed the grade 4 is low level enough for AS to be an option.

I'm not medically trained, but I'm a fan of AS. However, as you are Gleason 7(3+4) low/intermediate risk, as opposed to Gleason 6(3+3) low risk, and you have cancer in both lobes, there is a greater risk of AS failure.

It doesn't mean that it will fail, it doesn't mean that at some time you will need future treatment, it just means there is a slightly bigger chance that you might do.

Niko, I fully respect the decision you made, and I wish you well, mate. As you say, AS can cause extra anxiety, the disease could progress and being young, you are better able to recover from any possible side effects.

On the other hand, there will always be a bit of anxiety even after radical treatment, the disease might not progress, you may never need further treatment, and you're guaranteed no side effects.

You can also flip the benefit of being younger, in favour of AS. It gives you more time to avoid any risk of side effects. I'd have been more bothered about the risk of incontinence and ED issues when I was 56 years old than when I was 66 years.

It's a case of weighing up risk against reward. There's never a right or wrong answer.

Treatment options come down to personal decisions, that's why most clinicians leave it to you to decide which way to go.

Edited by member 06 Jul 2025 at 13:25 | Reason: Additional text

User

Posted 08 Jul 2025 at 08:45

Hi Steve,

I am coming up to 9 years in September after being signed off in 2020 ish.

Good Luck John.

User

Posted 08 Jul 2025 at 09:14

Originally Posted by: Online Community Member

I am coming up to 9 years in September after being signed off in 2020 ish.

That's fantastic John. What's nearly as great, is, despite you being ' long out of the woods', you still bother to post on here, to help others.

There aren't that many on here, that had brachytherapy and I've seen how your experience has shown those considering it, how successful it can be

I doff my cap to you sir. 👍

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