"One core at 4% is 4+3 and the other core 60% 3+4."
The percentages here refer to the length
of the malignant section(s) or the core compared to (divided by) the total length
of that core--this is a measure of how much of each core was cancer compared to benign tissue.
On the other hand, each Gleason score, 4+3 and 3+4 in this case, lists first the predominant (>50%) Gleason pattern (grade) within
the core's malignant section(s). In one core this was pattern 4, in the other pattern 3. Sometimes the pathologist will also specify the percentage of pattern 4
in each core, but it appears this wasn't done for your FIL. So the 4+3 core was 4% cancerous and grade 4 tissue architecture was estimated to account for >50% of the cancer seen in this core (as you know, grades go from 3 up to 5, the most serious.)
The percentages of cancer in the serves as a very approximate idea of the total tumor burden
--the amount of cancer in the prostate. The percentage of pattern 4 (for Gleason 7 cores) or pattern 5 (for Gleason 8 cores) may be specified to be more precise in characterizing the Gleason score, one measure of the seriousness of each core. The highest
Gleason score of all the positive cores is considered to be the overall score of a biopsy, since this is an important factor in treatment decisions. Since a biopsy samples only a tiny amount of prostate tissue, you really can't accurately know the tumor burden from the percent cancer in the cores. Likewise, finding only a small amount of serious grade cancer (4's and 5's) in a core doesn't tell you how much is really in that whole lesion or in the whole prostate--just as not finding any cores with 4's or 5's doesn't mean you don't harbor any in lesions that were not
We always highly recommend that you get a second opinion from the leading prostate pathologist, Dr. J. Epstein, at Johns Hopkins, since treatment decisions are based in large part on the (worst) Gleason score in a biopsy. Your FIL can ask his doc to have his slides and tissue sent directly to Dr. Epstein--this is a common practice
. Dr. Epstein's website is here
If surgery is advised as a valid treatment option for your FIL's cancer status/staging after full evaluation, and he is in otherwise good health, I wouldn't think his age is a problem.