Gleason 9 and cT3 is not just high risk, it is "very high risk"
. Risk of what? Recurrence after treatment. You have all 3 NCCN high risk criteria (Gleason 8-10, PSA>20, and T>
3), and the linked study calls that "Very High Risk" due to the multiple factors.
The problem is that those type 5 cells are readily metastatic, no longer requiring the host environment of the prostate to survive. Their presence, even in minute quantities, kick the risk up. So much so that now they even mention it if the declared Gleason score is lower, say a 3+4. If they find some small amount of type 5 cells (like <5%), they'll call it a 3+4 with tertiary 5. It's that important.
I won't claim the breadth of knowledge some of our forum's cognoscenti have, but I don't recall in the last 4+ years on this forum ever hearing of focal ablation for a high risk case. There's just too much chance of missing tumor tissue scattered elsewhere within the prostate. Or, worse, as a cT3 with local advancement, it may be progressing beyond the immediate prostate and missed entirely. Others may have more information about
that, but I'm just sharing my humble perspective. I chose radiation because of a similar scenario.
I've added you to the G9 Crew roster, a thread meant as a gathering place for those of us sharing this diagnosis. You may find it informative to look at the signatures and threads of many other G9 & G10 cases there. I've placed links to the first posts of many. It may provide some perspective on the diagnoses and treatment decisions of folks on this forum. Here's a link to that thread, the third in a series:The Gleason 9 (and 10) Crew - Welcome and how ya doin'? (Part 3, continued thread)
All the best Bob, as you do your research.
Bx: 6/12 pos, G9=5+4 (80%, 60%), 4+5 (2@100%, 80%, 10%), PNI+
cT3a (3T mpMRI: Bilateral EPE, NVB+, SV-, LN-)
Date PSA fPSA
9/12 4.1 15%
3/13 5.2 12% PCA3=31
IGRT by IMRT, 44 done 8/28/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2 3 yrs: Lupron/Casodex, ended 3/16
PSA <0.1 : 8/13 - 5/16;
steadying! - 0.2-8/16, 0.5-12/16, 0.7-3/17, 0.8-5/17, 0.8-7/17, 0.7-10/17