Treatment options......

Hi Nick,

I'm sorry that you've had to join our Club, but welcome to the forum, mate.

Here's an excellent video on all treatment options and their possible side effects.

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

Whatever you chose, you'll gets lots of help and support here.

Good luck.👍

Nick, I am sorry I have come to this so late and maybe I am still in time to give you a contrary view. 
I have Gleason 3+4=7 too and the surgeon who did my biopsy advised removing my prostate or, second choice , radiotherapy. 
I refused. A friend had the same 3+4, the same surgeon, the same advice and refused too. He was 50 and went to another surgeon who suggested and strongly supported AS,  Active Surveillance, PSA twice a year and MRI once a year and this is now 7 years on with no change to his status and no treatment! Still continent, still erections etc!!

I have gone to the same second surgeon, top urologist and well known researcher etc who advised me to do the same thing, AS. 
I am 68 , so normal life for as long as possible and if signs of growing cancer emerge, then surgeon says we can zap one bit or more etc! He says I have a good chance of dying with this cancer rather than because of it. 
I hope this helps? R

Of course you’re scared, as I was and Adrian with his video and the other boys really helped but don’t be bullied by any doctor. Our 3+4=7 is exactly what has been in the press about the new thing is not to operate but to do AS. Higher than that they are not sure but for ours many doctors now recommend AS. So if you are told have it removed or radio etc, tell them you want to think about it and get a second opinion. Privately you can see top people for a one off £300, expensive in one sense but cheap when we are talking about our lives. You can see someone else without upsetting the first person - if it’s private for example, you book yourself etc. No one knows. 
Nick, I’ve had a quadruple heart bypass, refused the first surgeon who wanted to do a very invasive operation and researched myself and chose a surgeon specialising in keyhole surgery; I am the first person to have a quadruple heart bypass through keyhole surgery - now I have f… cancer and macular degeneration!!-  because I found the surgeon suitable for me. 
Adrian’s video opened my eyes, thank you so much to him and made me determined to find someone who read my notes, looked at my biopsy results and said yes, we should do AS. If bad luck hits again, I might have to be zapped here or there he said but normally he says it might grow so slowly if at all ( as we get older the cells grow much more slowly) that I should die with it. This is the latest way of thinking by some surgeons for 3+4. 
For this sort of thing, as the other Nick above says, a second opinion is of paramount importance. If you live in or near London, lots of choices. If I can help please let me know, I owe this forum and happy to pass on my bit!

Thank you again.

I will push back if offered removal. AS will hopefully be offered!!!!!

As a possible option from Adrian's video, I did like the option for LDR Brachytherapy. I am aware that this is London based. 

Take care & big thanks

Sorry to hear you are going though the same journey as it’s mind blowing initially.

It maybe prudent getting a second opinion from the top specialist > UCLH or London Bridge (Guys). Connecting with a high volume well respected robotic surgeon specialist is worth investigating maybe while you are relatively young and will potentially have prospects of good outcome while thought to be localised. 

Things to bear in mind is that Prostate cancer is usually a multifocal disease which  tends to appear in the anterior area of the prostate. Unfortunately this can mean  breaking out sooner than one would hope as was very much my case.

While scanning tech is coming on leaps and bounds it doesn’t always tell the whole picture plus biopsy can miss small amounts of potentially higher grade cells. Both factors were very much at play in my case and post RARP histology upgraded me to 3+4 T2C. (From 3+3) which was close to breaking out and becoming T3. In my case I’m so pleased I ignored the local team and MDT regarding AS and got a second opinion with a top London prof surgeon.

I’m now nearly 6yrs post op …fully continent, no significant ED issues and PSA undetectable thus far.

Hi

Just an update on my discussed action going forward for now.

My Doctor recommended Active surveillance & wasn't pushing treatments for now.

I was relieved that he said this, rather than me pushing for it.

Thank you all again for your words of comfort. 

Hope you are doing well

Nick.K

Good luck with it mate , just ensure they do regular PSA checks and if it was me I would be wanting MPMRI at least once a year 

Really wish you well with it mate but please for your own benefit keep an eye on it , I personally don’t have any faith in there AS methods but that’s just me , it didn’t help when my first scan showed tumour to be 6 mm , second scan showed tumour to be 8 mm , real life size of tumour after prostatectomy was 20 mm , they also said percentage of pattern 4 was less than 10% , real percentage was nearer 30% , I mean that’s really significant considering the pattern 4 is so much more aggressive than pattern 3 

All the best mate 

Everyone has there own reasons for there preferred treatment options mate and certainly not peed on my bonfire as I wouldn’t change a thing and stand by what I said 👍

If what your saying is right that 25% is upgraded ( and I have no reason to think that it isn’t right ) considering 3+3 is the main one where AS is the preferred option i wouldn’t be happy that there was a 25% chance that my gradings could be more severe than initial diagnosis 

we will also have to agree to disagree on the MRIs and biopsy’s improving as despite me having 2 MRIs one of which was a MPMRI performed on a 3.0 machine which is double the tech of the standard scanner neither showed the true size of the tumour , nowhere near, the biopsy also advised  a third less percentage of pattern 4 than what was actually there so for me and my own actual experience It certainly isn’t a great endorsement for AS which I was offered 

I personally prefer to listen to real life scenarios so Can’t really comment on overall statistics  as I haven’t looked at them in detail although My surgeon did advise that unsuccessful surgery is more likely if the cancer isn’t contained and has broken out 

I know 2 friends who have had prostate cancer 3 if you include me and all of us have seen worse upgraded  diagnosis after prostatectomy 

as you say PSA result time will be worrying but for me not a patch on how I was before when it was the first thing on my mind from waking up and last thing at night 

everyone’s different and I imagine most will stand by there treatment decisions , I certainly wish all the best for Anyone going down the AS route and agree it obviously works for a lot of people who’s cancer has been diagnosed correctly in the first place and hasn’t changed , as you and I both agreed on key is to ensure PSA and MRIs are kept up to date , given my own first hand experience though and seeing the actual true result I’m glad it wasn’t an option I took 

Hi Niko.

By saying, "I don't want to pee on your bonfire" I wasn't critising anything in your post. It was directed at your optimism of after surgery,  waking up 'knowing it had gone'  RARP isn't a certain cure. A lot of men think it is, but about 30% still get BCR.

As you say, people make their own decisions on treatments. Personally, I'd rather base mine on the scientific data of huge samples of patients, rather than individuals on here who dismiss treatments because they didn't work from them.

In fact, if anyone should be critical of active surveillance, it should be me. I went on it when I was diagnosed with PSA 5.5, Gleason 6 (3+3), T2a, (safely prostate confined). Only 20 months later, my PSA was still only 7, but my Gleason score was 9 (4+5) and the cancer had breached the prostate capsule, T3a. It left me in quite a precarious situation.

However, knowing what I now know about the disease, I realise that my AS failure was caused by an inaccurate intial biopsy, which missed the aggressive cancerous cells, and very poor follow up monitoring. It was during Covid restrictions and during the ensuing chaos,  my follow up MRI scan was delayed by 14 months.

Despite my own personal AS 'horror story,'  I wouldn't tell others not to try it.  Statistics clearly show that generally it is a safe and successful treatment option.

Our own site says

Active surveillance has been shown to have the same 15-year survival benefits compared to both surgery and radiotherapy for men with low risk localised prostate cancer. Actively monitoring these cancers instead of treating them immediately, may give men the option to delay or avoid the potential side effects associated with surgery and radiotherapy. 

https://prostatecanceruk.org/for-health-professionals/resources/active-surveillance-hub/evidence-based-resources

Active surveillance is increasingly becoming the gold standard treatment for men with low grade prostate confined cancer.

https://www.cancer.gov/news-events/cancer-currents-blog/2022/prostate-cancer-active-surveillance-increasing

Edited by member 29 Sep 2025 at 11:04  | Reason: Add links.

Thank you Adrian, really useful. I had the MRI guided biopsy which hopefully is the most accurate where the surgeon overlaid the MRI scan over the space between my testicles and my anus( trying to be technical here!) so that his 24 needles where inserted exactly where the cancer ‘dots’ where for very accurate sample taking. He also took samples of healthy areas. 
I wonder if for those where the biopsy let them down they had the MRI guided operation? 

I agree that MPMRI and biopsy can miss the true extent of disease. My husband was correctly diagnosed with a lesion that following biopsy was graded as 3:4 20% grade 4. T2A. After surgery this lesion was measures as .91 3:4 with 25% pattern 4. However following surgery three further tumours were found. Admittedly they were small. One was .22cc and 3:4 with 5% grade 4 one was .09cc and was 3:3 but more importantly another small tumour. .14cc 4:3 with 65% grade 4 was missed. 
AS was never recommended but it seems increasingly this is the case for 3:4 tumours. It of course is a personal choice but I think it wise to be aware that the grading, size etc could be under represented.

In my opinion, for this day and age, biopsies are woefully inaccurate.

Here's an extract from a research paper on biopies, highlighting their infallibilites:

The researchers also determined that combined biopsy provided more accurate diagnosis than MRI-targeted biopsies alone. Among the men who underwent prostatectomy, the researchers found that systematic biopsy alone underdiagnosed about 40% and MRI-targeted biopsy alone underdiagnosed about 30% of the cancers, while combined biopsy underdiagnosed 14.4% of the cancers. In addition, while systematic biopsy underdiagnosed 16.8% and MRI-targeted biopsy underdiagnosed 8.7% of the most aggressive cancers, combined biopsy missed only 3.5% of the most aggressive cancer cells

https://www.cancer.gov/news-events/press-releases/2020/combined-prostate-biopsy

We all know how crucial biopsies are to formulating treatment plans. It's a shame that our options are based on a bed of uncertainty. They are particulary important when opting for active surveillance. However,  I don't think their unreliability should overly deter men from AS.

I've said many times before, that I don't think AS gets fair press on this forum. Recently I posted this conversation on how it is becoming a safer option. I thought it was good, uplifting news. No-one responded. 

https://community.prostatecanceruk.org/posts/t31897-Has-active-surveillance-become-a-safer-treatment-option

PS:

IDK2. It's great to see you again. I was beginning to think, that like many others, the 502 error had got to you. 🙂

Edited by member 30 Sep 2025 at 11:25  | Reason: Additional text