I'm sorry, but it doesn't work the way you imagine. You can't "dilute" a Gleason 4+4 tumor by including all the rest of Gleason pattern 3 within your prostate. The Gleason scoring system has proved to be highly prognostic. When your pathologist diagnosed it as Gleason score 8, that means that 95% of the single tumor sampled in that core was Gleason pattern 4. It means that you have at least one Gleason 8 tumor within your prostate.
That also does not mean it's the only Gleason 8 tumor. mpMRIs can't find any tumors smaller than about
4 mm. That doesn't mean they're not there - just that they are probably too small for the MRI. It also makes them easy to miss on biopsies. Prostate cancer is almost always multifocal - that means that there are most likely small tumors distributed throughout the prostate.
Unfortunately for you, the volume of cancer within the prostate is less prognostic than Gleason score, PSA or stage. Volume of cancer is not used in most risk stratification systems, other than to help with sub-classification.www.redjournal.org/article/S0360-3016(01)02670-0/fulltext
This is why prostate cancer is characterized by only the highest Gleason score. It has been found that only the highest Gleason score is prognostic for risk.
There is no amount of convoluted reasoning that can get you out of this. Your risk level is "high risk" according to every risk stratification system that is used. The whole point of risk stratification is to help find the most appropriate therapies. But that doesn't mean incurable - 83% of high risk patients seem to have been permanently cured with brachy boost.
I give your RO a lot of credit in accommodating your wishes. However, that puts more responsibility on you to really understand this stuff before making a decision.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEsmy PC blog
Post Edited (Tall Allen) : 11/10/2017 6:12:49 AM (GMT-7)