What is the prognosis and typical treatment approach for prostate cancer with a Gleason score 3 + 4 = 7?

Prognosis for Gleason 3+4=7 Prostate Cancer

Gleason 3+4=7 prostate cancer has an excellent long-term prognosis with 10-year prostate cancer-specific survival exceeding 92%, and in carefully selected patients with favorable features, active surveillance is now an acceptable management option. 1, 2, 3

Understanding Your Cancer Grade

Gleason 3+4=7 represents Grade Group 2 disease, characterized by predominantly well-formed glands (pattern 3) with a lesser component of poorly formed glands (pattern 4). 2 This is critically different from Gleason 4+3=7, which carries significantly worse outcomes. 1, 4, 3

The distinction matters substantially:

• Gleason 3+4: 10-year prostate cancer-specific survival of 92.1% 3
• Gleason 4+3: 10-year prostate cancer-specific survival drops to 76.5% 3
• Gleason 4+3 carries 2-3 times higher risk of cancer-specific mortality compared to 3+4 4, 3

Risk Classification and What It Means

Your Gleason 3+4=7 places you in the intermediate-risk category, but this can be further refined into favorable versus unfavorable subgroups. 1

You have FAVORABLE intermediate-risk disease if ALL of the following apply: 1

• Gleason 3+4 (not 4+3)
• Less than 50% of biopsy cores are positive
• Only ONE intermediate-risk factor present (not multiple)
• PSA less than 10-20 ng/mL

You have UNFAVORABLE intermediate-risk disease if: 1

• 50% or more biopsy cores positive, OR
• Multiple intermediate-risk factors present (such as T2b-c stage PLUS elevated PSA), OR
• Primary Gleason pattern 4 (meaning 4+3)

Treatment Options Based on Life Expectancy

If Your Life Expectancy is Less Than 10 Years: 1

• Observation or active surveillance is appropriate
• Treatment may cause more harm than benefit given competing health risks

If Your Life Expectancy is 10 Years or Greater: 1

For FAVORABLE intermediate-risk (3+4 with <50% cores positive): 1

• Active surveillance is now an acceptable option with close monitoring
• Radical prostatectomy with pelvic lymph node dissection if lymph node risk ≥2% 1
• External beam radiation therapy ± 4-6 months androgen deprivation therapy 1
• Brachytherapy alone or combined with external beam radiation 1

For UNFAVORABLE intermediate-risk: 1

• Definitive treatment is strongly recommended (not active surveillance)
• Same treatment options as above, but observation is not appropriate

Expected Outcomes with Treatment

After radical prostatectomy: 2

• 5-year biochemical recurrence-free survival: 88% for favorable intermediate-risk
• Recent data shows Gleason 3+4 without cribriform or intraductal features may have outcomes similar to Gleason 6 5

Important prognostic factors beyond Gleason score: 4

• Preoperative PSA level (most important)
• Seminal vesicle invasion
• Lymph node involvement
• Surgical margin status
• Percentage of Gleason pattern 4 present

Critical Caveats

Tertiary Gleason pattern 5: If your pathology shows even a small amount (<5%) of Gleason pattern 5, this significantly worsens prognosis and should upgrade your risk category. 6 This would place you at intermediate risk between standard Grade Group 2 and Grade Group 4.

Active surveillance considerations: 1, 7

• Only appropriate for favorable intermediate-risk with informed decision-making
• Requires close monitoring with regular PSA testing, repeat biopsies
• 6-year treatment-free survival for selected Gleason 3+4 patients is approximately 59%, meaning many eventually proceed to treatment 7
• Should be approached with caution and is not recommended for unfavorable intermediate-risk disease 1

Post-treatment monitoring: 8

• PSA should fall below detectable levels within 2 months after radical prostatectomy
• Rising PSA indicates potential recurrence requiring additional therapy

The Bottom Line

With Gleason 3+4=7 disease, you have over 90% chance of being alive from prostate cancer at 10 years. 3 Your specific prognosis depends heavily on whether you have favorable versus unfavorable features, your PSA level, and the extent of disease on biopsy. If you have favorable features with life expectancy >10 years, both active surveillance and definitive treatment are reasonable options requiring shared decision-making. 1 If you have unfavorable features, definitive treatment is strongly recommended. 1