Predictors of G7 (3+4) upgrading

This Korean study found 44.5% of G7 (3+4) men were upgraded after RP. See the Figure, which shows the range (0% to 65.7% for 0 to 4 risk factors, respectively.)

Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance? (2020)

"Results
A total of 168 (44.5%) patients with GS 3+4 experienced an upgrade in GS. In multivariable analysis, advanced age, prostate-specific antigen (PSA) level, PSA density (PSAD) and Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2) score were significant predictors of GS upgrading. When structured into a predictive model that included: age ≥ 65 years, PSA ≥ 7.7 ng/ml, PSAD ≥ 0.475 ng/ml2 and PI-RADS v2 score 4–5, the probability of GS upgrading ranged from 36.4% to 65.7% when one to four of these factors were included.

Conclusions
A substantial proportion of patients with GS 3+4 prostate cancer were upgraded after radical prostatectomy. However, according to our model combining clinical and imaging predictors, patients with a low risk of GS upgrading may be eligible candidates for AS."

[Emphasis mine]

Speaking personally, I would not choose AS with a G7 (3+4) diagnosis. If you feel differently, I suggest confirming you are low-risk on a genomics test and have no risk factors as defined in this study. But, as the Visigoths used to say, Chacun a son gout.

Djin

As one of those who got a post-surgery upgrade from G6 to G7 (3+4)--and who didn't have an MRI or any other diagnostic scan--I recall what I was told then: That about 15% of surgical pathologies show an upgrade. I put a lot of it down to sampling error (I had 3 positive cores, all on the left side of the gland. My final pathology had about a 10% overall tumor load in all 4 quadrants of the gland.) Reality is that a TRUS biopsy only samples what, 1/2 of 1% of the gland or something smaller? Missing something is about as likely as hitting it.

The important thing, in my case, was no SVI, no EPE. A fully contained G7 is certainly a good surgical result--and now that I'm at 5 years undetectable, I'm as good as it gets.