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    Gleason 4+4
    An_246387 posted:
    My husband age 62 has PSA around 15, Free PSA Ratio 4%. Gleason 4+4. What to expect?
    az4peaks2 responded:
    Hi, - According to the numbers that you quote in your Post, your Husband has relatively aggressive form of Prostate Cancer (PCa) and should be weighing his treatment options. Most experts would agree that a Gleason Score of (4 4)=8 suggests a "high risk" malignancy, which is likely to progress unless intervention is made.

    Which of the treatment options he wishes to pursue is subject to the review of the complete findings shown in the Pathology Report from his Biopsy. Depending on the source of that original Pathology Report, you may wish to have the Biopsy slides reviewed by a recognized expert in the examination of Prostate tissue.

    There are several, usually found at major University teaching institutions and/or the recognized 'Centers of Excellence". Dr. Epstein at Johns Hopkins and Dr. Bostwick at Bostwick Laboratories are two Pathologists that immediately come to mind.

    Good luck and become educated about the disease, so that you can make INFORMED decisions. - (aka) az4peaks
    Basir U Tareen, MD responded:
    The first step is to rule out distant/metastatic disease. While most men with low risk prostate cancer don't require routine bone scans or MRI/CT scans, I almost always do some sort of staging studies in high risk disease. (anyone with Gleason 8 disease or higher)

    In general, if the disease is truly localized than most experts would suggest multi-modal therapy. (ie, radiation with hormone therapy or radical prostatectomy and lymph node dissection followed possibly by adjuvant radiation).

    There is however, good data from several large institutions showing durable cancer control with surgery alone.

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    For more information, visit the Duke Health Prostate Cancer Center