So, getting straight to the point, what is the major difference between 3+4 and 4+3?
I know a lot of people are kind of thinking, "that's the same thing," does it really matter
that those numbers are switched?
So the staging system that the PCRI has developed is to help people understand that there are
different types of prostate cancer and the different types that we talk about—the different
colors and whatnot—are heavily dependent on what the Gleason score is and the Gleason
is what the cancer cells look like under the microscope. So, they're assigned numbers,
so, 3,4, or 5. 3 being low, 5 being high, and 4 sort of being in-between, but people
can have, on their needle biopsies, more than one type and so the Gleason system addresses
that problem by putting the more common type first, followed by a plus sign, and then the
second most common type. So if it's a 3+4 that means that the 3 (the low-grade type)
is the most common on the biopsy. If it's a 4+3, the order being different, then you're
looking at the higher grade type being the most common. And the story, in terms of how
prostate cancer behaves over time, is driven by the higher grade type, and so, in some
sense, you almost ignore the lower-grade type. So, if you look at the difference between
3+4 and 4+3 then it's just a matter of how aggressive the cancer is and how likely is
it to spread. When we talk about cancer being aggressive, we're really worried about metastasis.
So, the 3+4's, there's basically in the staging system that we have for Teal we talk about
Low, Basic, and High Teal, so the Low-Teals are the ones that have very small amounts
of 4 and those are favorable enough to consider active surveillance. The men that have more
4 than 3, they're going to be the High-Teals and they're gonna need combination treatment
(short course of hormones, seed implant, radiation), and then the people that are in a 3+4 situation
but they don't have very small amounts of 3 (but still less than 50%) those are the
Basic-Teals and they can do a lot of different treatments. Their chances for metastases are
very small, but not negligible, and so focal therapy, seed implants, different types of
radiation, different types of hormone therapy all could be considered as a form of monotherapy.
So, bottom line, 3+4 is a lower grade, less concerning process. 4+3 is becoming a more
serious, consequential type of prostate cancer.
Okay, so what type of cure rates are you seeing with the 4+3? I mean, are they still on a
pretty okay zone. I know a lot of people get really freaked out when I talk to them on
the phone and they're realizing that they have that higher grade.
Yeah, with modern therapy, combinations of, as I mentioned, seed implants, radiation,
and 4 months of hormone treatment, cure rates will range from—in the most favorable 4+3
situations you can be up to 90-95% cure rates. And then, in the very unfavorable 4+3's, people
with high PSAs, lots of needle biopsies positive, still, the cure rates are going to be pretty
decent—probably in the 75-80% range.
If you have questions about anything that we've talked about today when it comes to
seeds, our helpline can definitely assist you with that. So you can go ahead and head
to our website, PCRI.ORG, and under "our services" you'll see helpline, and you can submit your
question in email form or give us a phone call. We're here for you and it's honestly
an honor to do it. So, thank you so much, Dr. Scholz, for just answering our questions
once again. Again, if you would like to submit a question that you would like Dr. Scholz
to answer, you can go ahead and put that in the comment box of this video, and we really
appreciate your time, and we hope you have a great week.