The latest guidelines by the three medical organizations that offer clinician advice for treatment of prostate cancer no longer have a "very high risk" classification. So, high risk is now defined as:
"PSA ≥20 ng/ml OR Grade Group 4-5 OR clinical stage ≥T3"
Personally I'm rather glad to lose the VHR category, as it was a bit too complicated anyway with the "more than four cores grade 4 or higher"... T3b and PSA>20 put me up there anyway. High risk is scary enough.
BTW regarding 4+5 vs 5+4, I've observed that some of the 4+5 G9's may have had RP, while 5+4's rarely do. To me this is one of those "there but for the grace of god go I" situations, where if my Dx had been postponed any longer my PCa may well have morphed to the next level, and would be an entirely different story.
I still cringe when I read about
SDM or "shared decision making" as my original Uro told me nothing.
2014-15: PSA's 9, 12, 20, 25, Neg DRE's, false neg TRUS biopsy
6/16: MRI Fusion biopsy, 6+ Right Base, 2x40%, 2x100% G8(4+4)
8/16: DaVinci RP, 3 foci EPE, PNI, 11 LN-, 53g gland 25% Gr4, BL SVI, pT3b
1/17: started 18 months Lupron, PSA's ~.03
5/17: AMS800 AUS implanted, revised 6/17
8/17-10/17: RapidArc IMRT 39 tx (70 Gy), 4/18 Dx Radiation Colitis
1/18, 4/18, 7/18: PSA's 0.0, T=9