PSA in 2024 for
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- เผยแพร่เมื่อ 10 มิ.ย. 2024
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1:02 What is PSA used for, and how is it measured?
2:36 Is PSA the only way to screen for prostate cancer?
4:53 Is there any reason to get a Digital Rectal Exam?
5:47 What is PSA density, and how large is the average prostate?
7:13 How accessible and affordable are MRI's, usually?
7:38 How should a patient approach their physician about MRI's?
8:24 What happens next if an MRI detects a potentially cancerous spot?
10:29 What constitutes a "center of excellence"?
10:56 How much does a person's PSA usually fluctuate?
12:54 Can PSA be used to monitor the effectiveness of treatments?
15:43 At what rate does prostate cancer normally develop?
17:00 Alex's conclusions
18:14 If you have questions
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The interviewer is terrific. Yet, she is not identified. She deserves alot of credit for the excellence of these interviews, and should be identified.
It's a family run non-profit.
She is the daughter-in-law of Dr. Mark Scholz and is married to Peter Scholz who is the COO of PCRI.
Her name is Alex Scholz.
The PSA screen saved my life from aggressive prostate cancer. It did not help my father because he did it too late.
Same for me. My PSA jumped to 4.x in 2018 at 51. My PCP gave me a tactile examination and referred me to an urologist. We monitored it until May 2020. My PSA went to 5.x; in December, it was 7.x. Only then did we go to the biopsy, which was fortunate. I had a combined Gleason score of 10, with one of the biopsied nodes being aggressive.
Sorry 😢 to hear that and happy u have ur pc under control take good care friends u are not alone 😻👍
@@awshortclips I hope that you feel and get better.
Thank you Dr Schultz and Alex for this invaluable programming and information sharing. You help lot of people with this public service.
My GP asked me to do a PSA. The result of that seemed high, and he referred me to a specialist. An MRI and a biopsy later, I discovered I was a 49 year old living with a Gleason 6 prostate cancer. I'm so grateful that my GP took action, knew that there was a history of prostate cancer in my family and encouraged me to do the test. I now can do active surveillance and get on with my life. Sadly, guys don't really sit around and talk about prostate health so I encourage all my male friends that I care for to go and get a PSA as part of their check up - it might be simply an enlarged prostate but it could also be something that helps you to get on top of a problem before it becomes too late.
Hi there, they are debating now if to even call gleeson 6 cancer they say it would never metastases outside the prostate, so wouldn't cause you any great problems.
@@frederickrich7393 Yes, I've been reading that too and the research that I've read has given me enormous optimism that this is just something that needs to be watched and to treat myself well. I still encourage my friends to get checks though because while I'm lucky to only be a Gleason 6, I'd hate for any of the people I love to be a Gleason 7-10 and just not know.
@@frederickrich7393 I agree, there has never been a case of a 6 metastasizing. Cancer that does not spread is called a benign tumor right?
at 57 my psa went from 2.3 to 5.2 with a annual drs visit , he referred me to a urologist and both dre s felt normal so i asked for a mri , came back with a pirads 4 lesion tumor , recommended a biopsy which i thought would be a targeted one but the dr doing the procedure didn't get direct instruction and went and did a random 17 core biopsy , i took the 3 days of antibiotics but within 2days i was in emergency for 2 days on drip for a severe infection and after finishing 7 days of heavy antibiotics 1 day later had another infection in my bladder the lab found ecoli , i would do things a lot differently with the biopsy if i had to do it over , so the Gleason is 3+4 =7 , so i am at the stage of deciding on treatment plan leaning towards seed implant , very grateful for all the helpful direction and comfort these videos can bring, being newly diagnosed with the big bad C
thanks PCRI Mark.
Hello Mark,
We are so sorry that this happened to you. Thank you for sharing your experience. We would love to help if you need it. Here is the link to our Helpline. They can give you information and help you through the process: pcri.org/helpline
I agree a MRI should be performed if you have a elevated PSA. My PSA was 5.6 so the normal biopsy was performed and they found cancer Gleason 3+4 which was nonagressive. I choose active surveillance. So they suggested an MRI to check the entire prostate because the normal biopsy that is performed only checks the bottom of the prostate because that is where the cancer is usually found. The MRI found 4 spots on the top of the prostate so a MRI biopsy was performed and the 4 spots were 4+3 Gleason. I had the prostate removed but cancer was found in the cavity with a Gleason score of 3+4. All of theses procedures were over a 2 year span. If the MRI would have been performed first after the PSA reached 5.6, the cancer could have been treated 2 years earlier. The MRI saved my life and extended my quality of life.
PSA test 22.5 by two different labs. I asked my doctor for a MRI/PET scan and he rejected those (said w/my insurance they would not pay) and wanted to go straight to biopsy, hence, I'm going to a cancer treatment center (Moffitt) next week to see what they say. I told said doctor, you don't even know where your looking if in fact you miss something etc.
Great video and I'm still going to push for the MRI etc.
The VA sent me to Wesley Chapel FL for a MRI which showed 4 spots on the top of my prostate. They then performed a MRI biopsy which showed 4+3 Gleason score. The normal biopsy which I did have never showed the cancer because it only looks in the bottom of the prostate where the cancer is usually found. I had it removed and if it was not for the MRI I would more then likely be fighting cancer in the bone now.
These videos from Alex and Dr. Scholz are to me some of the best and informative explicative videos anywhere on the net, specially of course for people with prostate cancer issues like my self. The information I get here strongly reinforces my Urologysts logic and procedures and gives me tremendous peace of mind. Thanks so much.
When I was sixty years of age I was going through a frequent urination period,
I visited my doctor and got a internal examination and was diagnosed with a enlarged prostate,an arrangement was made for a psa test that came back as 3.4 I was then sent for a biopsy which proved to be negative for cancer,From that time on I got psa test every 12 months,over the next 5 years my levels increased to 4.8. 5.5. Then I got two consecutive 6.4.The final test around 18 months Argo was 7.4 I was again sent for mri scan and a further biopsy,The result was cancer Gleason 6. I had three opinions
Removal of prostate.Chemotherapy.or active monitoring i chose active monitoring.that’s PSA every three months.
Go with a Proton beam therapy in Loma Linda medical center.Also read the book of Robert Marckini.You’ll thank me later.
Excellent overview! So glad you mentioned PSA trending. It isn't just a onetime test (unless the PSA is very elevated) Mine went from 3.7 to 7.2 in eighteen months, and then up to 11.9 six months later. I was VERY fortunate to get an MRI/ultrasound guided biopsy with resulting Gleason 8, Stage 3b. I referenced the info gleaned from PCRI in ALL my conversations with Radiation Oncology at the Dartmouth Cancer Center. Your info was ABSOLUTELY indispensable, and I frequently impressed the oncologists and technicians with the knowledge about treatments and procedures that Dr Scholz gave me in my communication toolbox! Thank You all at PCRI
My own experience supports the view that an MRI is a better diagnostic than PSa. I read an article in BMJ Oncology (2023) that suggested that PSA > 3 only picks up 50% of PC, the rest needing an MRI. Eventually my physician agreed to an MRI even though my PSa was below 3. The MRI showed lesions and I had a localized 3-4 (48%) cancer,treated with RT and ADT. Next task to convince the urologist to start testosterone replacement, based on numerous articles. . By the way I live in France.
66 yrs oldI had PSA 13 , 12 of 12 cores aggressive cancer I've had 28 sessions radiation and 1 yr ADT (Eligard) so far. my PSA now is .023 , hopefully I've done all the right things.
Sounds like you have had good treatment and a good outcome, has you testosterone recovered to a normal level yet?
@@frederickrich7393 remains to be seen , I am just so relieved from the stress I can't even say how I feel right now. Dr Schollz and PCR has been so much support with information it made this so much easier for me.
Hi Dave how did you tolerate the adt?
@@carlchappell6383 So far I'd say well , the fatigue is the gorilla in the room but exercise is helping.
Ok, I've been on it a year and a half and struggling a little now, I exercise to try and minimulise the effects which are quite a few
I really love you guys!! I jumped at a targeted Random biopsy several years ago with a 3.7 PSA. Wish I’d never done this biopsy because of the cascade damage and reaction my body presented.
So very glad I found you guys!!! Big fan, thanks for being our champions
What was your situation what happened
3.7 psa not really a very high number?
What damage/reaction? 🤔
Thank you Dr. Scholz and Alex. This information and series has been so amazing in helping me navigate my journey. We are so lucky to have you both.
Thank you
Really good stuff. Thanks!!!!
Thank u all ur valuable information again 🇨🇮👍
Thank you! Very nicely done! Extremely informative 🙏
Thanks
I had symptoms of prostate cancer for about 3 years and i did not know . And i was visiting urologist every month. And one day, they did psa test and it was high:7.1
Thank you so much for your education!
PSA 3, MRI found two PIRADS4 lesions. Biopsied the two lesions + 14 other samples and all negative. Five samples showed cronic inflamation. ExoDX resulted with a score of 44.
I had a PSA of 10.8. I moved to Ecuador as a missionary. As a result of the food and walking around in the Andes, I lost 68 lbs. My next PSA was 10.1 and then an 8.5. I am due for another PSA screen within the week.
An MRI did show a 1.5 cm lieson. But I have opted not to do anything invasive. I said no to a biopsy, and surgery is out of the question. I have chosen "Active Surveillance."
They must have given the MRI PIRADS. That score should help you make a decision about a biopsy.
@@MM-sf3rl As Dr. Scholz noted, PIRADS 4 and 5 need to be targeted for biopsy. My last 2 MRIs showed a PIRADS 5, and "evidence suggesting BPH and prostatitis." PSA has creeped up to over 16. But, I've had 2 targeted and one random biopsy which only shows small amount of Gleason 3+3 around the PIRADS 5 lesion. I asked oncologist for liquid biopsy, but I'm over the cut off PSA level. So, still on Active Surveillance for now. BPH and prostatitis really complicate things, but could be part of the reason for the alarmingly high PSA.
Thanks to Dr. Scholz and Alex for these very informative videos. They definitely help in navigating through my journey down a road I never wanted to be on. But who does?
Very informative video
Here is what I did with my increasing psa from 2012 to the present, absolutely nothing. In 2011 it was 4 but I decided no biopsy for me. It increased to 28 in 2022 and dropped to 26 in 2023. As of today I have no symptoms that affect my quality of life which does not mean that I may not have an incipient prostate cancer. I’m now 71 going on 72 years old and I’m happy with my decision. I may yet begin to have problems with my prostate and I’ll cross that bridge if and when that happens. According to recent data I’m only 8 years from the cratering average lifespan anyway and it doesn’t appear that prostate cancer is going to be the proximate cause of my demise. I consider myself to be a very healthy 71 year old.
Very well explained, it's knowledgeable and educational, as well as beneficial video
Thanks a bunch 🎉
great info! i had elevated PSA (7) on my first lab test for it at age 50. i saw Urologist, had DRE, then MRI, then fusion biopsy with ultrasound....all negative. also had the ExoDX test, urine testing/genetically for risks for high grade cancers. it was negative as well. family hx of prostate cancer in my father at an older age 70's. he was treated, still living at 86 yo. my most recent PSA 4 range. getting continued Urology follow up and PSA levels. glad they have better testing and treatments for prostate cancer.
Great tie
I want to give a shout out to you guys for being an invaluable source of information as I navigated this journey the last year. Because of these videos, I was able to realize that my urologist most likely wasn't giving me the whole truth in terms of my real options, instead pushing me, almost rushing, into surgery. I was diagnosed with a G3+4, and after coming across your video on Brachy with Dr Kurtzman, ended up just last month doing that. So far no issues. It's a bit hard to pee due to the swelling, but I'm told completely expected and seems to be getting better. Just glad I didn't do the surgery route, because if it weren't for Dr Scholz, and Alex doing these videos, all I would have had to rely on was my doctor's advice.
So glad we were able to help! Thank you for the feedback. We wish you there very best!!
I agree the psad is cost effective the only downside is the trus exam 4:41 4:42 4:42 4:42 4:44 4:44 4:45
@66 yrs young, my PSA went from 4 to 5.6. Biopsy showed 3 out of 12 cores had non aggressive cancer, no metastatic cancer. Pet scan backed those findings up. Gland size 79 grams or 128ml. Currently, on 3 months of lupron, during which having 5.5 weeks of photon therapy. Thank you for your most valuable channel. It's a Godsent!
Please check with Proton beam Therapy. Loma Linda Medical Center,great testimonial.Read book of Robert Marckini.You’ll thank me later.
Just curious, what was your Gleason score? I can't see treating a Gleason 3+3, but you must have had at least some Gleason 4 for them to recommend treatment, although a lot of urologists still want to treat Gleason 3+3.
Thank you for your continual information on this platform.
I’m from the UK so treatment costs are less a factor of consideration.
I had a PSA of 4.61, l am 67 with a prostate size of 35cc
I have been fast tracked and had an MRI within 2 weeks and now awaiting an Ultra Sonic guided Biopsy.
I have been following your presentations and learnt a considerable amount of information.
Many thanks.
Best regards
So what did your MRI reveal
@@mactheslovac8673 two areas of concern approx 11cc
Good question.
In April this year I was diagnosed with prostatitis (enlarged prostate). Went for PSA which was found to be at level 4. I haven't gone for biopsy to establish cancer cells. In the meantime I am under nutritional supplements of BF Suma called Prostat Relax capsules. What advice can you give with regards to going for BIOPSY?
Grateful to Alex and Dr Shultz for the wonderful work being carried out.
Recently got radiation treatment done on a MRLINAC machine. The PSA was 5.2. The Biopsy 16core was done as a localized lesion was seen on the MRI without contrast and the Gleason score was 3+4 =7. After radiation I am on RELUGOLIX 120mg - adviced to take for a month.
Question. Is when should I get the PSA checked ?
And How long should I be on RELUGOLIX?
In my part of Canada my experience has been being actively discouraged from having a PSA test. I have had to insist on it. Last year it paid off (rising number, 6+) and I was referred to a urologist who did a random needle biopsy and luckily found it. I had told my GP that my father had had PC and I knew half a dozen guys whose PC was found as a result of PSA testing - to no effect however my request for a PSA test was granted. Multiple scans later and a fusion targeted mri biopsy (3+4, Pirads 4) and I am now to finally receive SBRT starting in approx a month. Age 70.
Good segment. It would interesting to do one on cutting edge screening, using PSMA and PMri. I read there was a small sample study out of Germany that correctly diagnosed all participants with cancer. Not sure of the stages.
I have kidney issues and was told by my urologist that’s I couldn’t have an MRI with contrast so had a biopsy and am Gleason 2+3. My PSA was 14.5. Are there any mri scans that don’t use contrast? Enjoy your channel. Very informative.
three PSA's over 4 in one year concerning (age 62), then MRI shows 80cc gland......lot less stress thanks to Dr Scholz reemphasizing prostate density.
My PSA bounced around 1.8-4.4 for several years. It hit 5.3 and my urologist suggested a biopsy. I was reluctant but did not want to pay for a MRI so I did the biopsy thinking cancer probably wouldn’t be found with such a low psa and no issues with the digital exam. I ended up having Gleason 7 4+3 cancer. Moral of story. If your psa is higher than normal get a biopsy.
Get an MRI and then a biopsy. Hopefully you’re insured.
It is about time Dr. Scholz does a comprehensive comparison of various liquid biopsies and their usefulness in avoiding random/targeted biopsies. I believe they are the future of non-invasive and early cancer detection.
Another informative video. Is it also possible that some folks may have naturally high PSA readings? My PSA adventure has been interesting to say the least. Five years ago in the 6-7 range and now measured at 18-19 range and this is post TURP surgery in July 2023. Been on Active Surveillance and categorized as Pirads-3. Prostatitis has been ruled out, prostate size is now 36cc vs. 70cc, yet still have these elevated readings. Most recent biopsy showed 2 cores of cancer, but rated as Gleason 3+3. Speak with my urologist tomorrow and may get a PSMA scan to see if something else is going on.
😅]😊😊😅😅
Three years ago, my PSA jumped from 2.2 to 5.6 in a single year. My urologist suggested a random biopsy. I requested an MRI but was told that was not the process at my HMO. My 14 needle random biopsy was negative. Due to a family history (maternal and paternal), I recently convinced my urologist to authorize a 3T MRI. A 7mm lesion was found with a Pirad 3 diagnosis. Due to my stable PSA (4.6 to 5.6), my high free PSA (>20%) and my prostate size (74cc), the urologist recommended no further testing for one year. I’m not comfortable with waiting and I’m seeking a second opinion of the scan and further action (targeted biopsy).
Check with a Loma Linda Medical center.They have a great testimonial.Also read the book of Robert Marckini
My husband died after having PSA Digital Exam. He did not get an MRI during his treatments. Not all prostate cancer is slow growing. :-(
Sorry to hear of your loss when was your husband diagnosed
Thanks for the video! I'm diagnosed last year of Gleason score 3+3 of the left apex after the biopsy. I had to fight to get an MRI prior biopy, but the eurologist said he still needed to take 12 samples to make sure even the MRI did show the suspicious lesion of the left mid peripheral zone. Then he has me on active surveillance. My PSA went down from 4.09 March last year to 3.51 recently. I met with him last week and he still want to do a 12 core biopys again, said meed to do different spot to make sure not miss anything. I asked for MRI again and said no other option. I should look for another opinion per suggestion here.
You must be young for your provider to be recommending biopsy for PSA 3.51?
Any thoughts on Clarity's double radio ligand Cu67 treatment?
Should a Urologist do your biopsy or is, a senior radiologist good enough to get an accurate biopsy sample and therefore a more reliable report? Kindly guide. Thanks !
The psa is so hit and miss and the threshold 4 is ridiculous ive been as high as 7.5 and low 5.3 62 years old and im still alive and work every day
I got a pirad s 3 score
Thank you for the information. Can there be any correlation between thyroid hormone levels (TSH) and PSA blood levels?
What is your opinion on the ExoDx test and how frequently it needs to be performed if the PSA level goes up?
I am a 77 year old male who started having frequent urination symptoms in the early 2000's. I started seeing a urologist who
administered the PSA and DRE tests. At first, the PSA reading was low enough so that there was no concern about cancer.
However, the PSA later elevated to the 4-5 range and I wound up getting three biopsies between 2007-2010 with no findings of cancer.
For the next decade or so my PSA inched up to the 6-8 range but the results were relatively stable from year to year. The 4K score
indicated only a 5 percent chance of aggressive cancer. I had no family history of prostate cancer and the size of my
prostate was larger than normal
In June of 2023 I was shocked when my PSA went up to a sky high 18.6. My urologist recommended an MRI and fusion biopsy if necessary. The MRI showed a 113 cc prostate with a pirads 3 lesion in the right transitional zone. I later had the fusion needle
biopsy which was completely negative for carcinoma. The urologist prescribed the drug Finasteride to possibly alleviate my
symptoms.
I have taken the Finasteride for about six months but my bouts with frequent and uneven urination have not subsided. What is
the prognosis for this drug working? I am scheduled to see the urologist and take another PSA test this month. What is the likelihood
of the drug reducing my PSA level substantially? What if my PSA remains the same or even increases? Does it make sense to
do another MRI and fusion biopsy within this short period of time? It seems ridiculous to me because the symptoms are likely
the result of an enlarged prostate.
I read a study that showed finasteride in combination with ivermectin had good results. Good luck.
I'm going in a few weeks to see a specialist due to rising PSA.
Sorry, it a different drug, I just checked...
Fenbenzadole.
Good luck to you.
had an unnecessary biopsy driven by doc and wife, had problems after, The biopsy is a real torture with the 12 clicks, Wish I left it alone! 74
Another thing that might contribute to elevated PSA is Covid19, either the thing itself or the treatment, according to the clinical research at the NIH.
Hola Doc. soy de Argentina, 65 años, tengo adenocarsinoma localizado de 6 mlm, gleason 3+3 y PSA 4 ,55 libre y total mal, me recomendaron seguimiento de PSA y biopsia anual sin medicasíon, no tengo síntomas. Qué opinión le merece a usted? Saludos cordiales y Gracias.
I had a UTI (Urinary Tract Infection) back in November 2023 and my PSA level was at 4.31 and in only 8 months it went up almost double at 8.41. 2 years ago, I had a colonoscopy done and was told that everything was fine and asked me to come back in 10 years. When I went to the doctor for my UTI in November the doctor performed another prostate exam, but this time around was done by touching the bladder with his finger, again, I was told not to worry. What could be causing my PSA levels to rise so quickly? I don't know if I should be worried, but I already made an appointment to see a urologist just in case it's the bladder and not the prostate itself. I know that PSA levels could be high due to an enlarge prostate, but I am not experiencing any of the symptoms related to having an enlarged prostate so this driving me insane.
Hi ive been keeping tabs on my prostrate as 4yrs ago my psa level was 5.6... Then the last 2yrs it risen upto 14. My Urologist sent me for an MRI scan which showed inflammation (prostatitis) and also an enlarged prostrate. No cancer was showing. In the last year my psa has come down to 12.3, another mri scan was taken and still showed inflammation. Recently in January my psa came down to 9 and my Urologist told me to repeat the psa blood test in 3month. Last week my psa blood test showed it risen to 11.4. Its freaking me out and thinking i should need a biopsy. I have an appointment with my Urologist on Thursday. When i mentioned a biopsy at our last meeting he said their is no target on the prostrate as the mri is showing inflammation and enlarge prostrate only...
You are a little over the PSA cut off for EXoDX liquid biopsy, or one of the newer liquid biopsies. I'm in a similar situation with prostatitis and BPH, but my oncologist didn't recommend liquid biopsy at this time and said biopsy pathology results are the gold standard at this time. Last PSA over 16. My last two MRIs show a PIRADS 5. I've had two targeted biopsies and was talked into a random biopsy as well. All showed small amount of Gleason 3+3 in the area of the lesion. It also showed "evidence suggesting BPH and prostatitis." If you can get your provider to order a liquid biopsy of some kind, it might ease your mind, as it would mine, if we got negative results. It may be best to avoid a random biopsy, if MRI shows you clear, although some providers might want to do a random biopsy anyway. Prostatitis and inflammation could be responsible for your high PSA. Everyone is different though, and you have to take care of you. Dr. Scholz doesn't seem to be a fan of random biopsies, and he may be right. If MRI shows no targets, but shows inflammation, that might be the cause of your PSA rise. Best of luck in any event...
What do you suggest for people who has PSA out of wack but is allergic to MRI contrast (my doctor says MRI without contrast is useless)?
Thanks for the video. Perhaps you could make a video about the role of liquid biopsies when done in conjunction with 3T MRI. SelectMDX liquid biopsy showed 35% prediction of Gleason => 7 upon biopsy. 3T MRI found nothing suspicious. Does the MRI finding reduce the SelectMDX to irrelevance? If so, why do the SelectMDX if one will also be doing the MRI? Perhaps you could comment both about this and about whetn biopsy is to be done irrespective of MRI finding.
Great suggestion!
49 years old with a 56cc prostate. 3.7 PSA. My MRI came back negative. Would you recommend a biopsy to be sure ?
Is there more info for psa levels over 200?
My PSA "check engine light" had been coming on at level of 6 for last two years. Went to urologist, who recommended a biopsy. No MRI was offered. Had biopsy and came back with Gleason 9 cancer (4+5) score. Sent me to get a PSMA PET scan. C Looked to be contained. After consulting with radiation oncologist and surgeon, it was agreed that prostatectomy was the way to go. Got the RALP. No cancer found in margins or lymph nodes. Interestingly, the post surgery Gleason came back as Gleason 7 (4+3). If the original biopsy had been Gleason 7, I might have taken a different path. Is this a common occurrence? Wish I'd known about PCRI at the time. I've learned a lot from you guys. Unfortunately, I was kind of rushed into treatment due to the original Gleason 9 score.
That's exactly why folks on this site recommend a SECOND OPINION. Also, DO YOUR OWN RESEARCH--there is plenty of clear, concise, easily understandable information available.
@@sagrammyfour Agreed and I DID PLENTY OF RESEARCH, but when you get a call from your urologist that you've been diagnosed with a VERY AGGRESSIVE CANCER you tend to move pretty quickly. I DID GET A SECOND OPINION, BTW and he concurred that surgery was the best route for me due to tumor location (and that was coming from a trusted radiation oncologist). Fortunately, I am now cancer free, and that was the choice I made. Going other routes could have left me more at risk for recurrence on down the road and/or caused other issues. I'm just curious as to why the post-op biopsy was so different.
I’m sorry you had that happen. For about $350, you can send the biopsy to Jonathan Epstein at Harvard for a second opinion. He is a renowned doctor in prostate care.
Sorry to hear that happened to you. It happens to other men as well. Always get a second opinion on your biopsy pathology. Some pathologists over diagnose to cover their butts And some don't look exclusively at the prostate, so they make mistakes. Dr. Epstein at Johns Hopkins was considered the gold standard, but I hear he retired. There are probably pathologists at Johns Hopkins that trained under Epstein, so JH may be a good place for a second opinion on prostate pathology. I had my slides read by a pathologist at the UW that trained under Epstein, so I figure he's the next best thing. Correct pathology is key for making treatment decisions. Best of luck to you!
I’m 67 and was diagnosed with prostate cancer about 4 years. I also have an enlarged prostate gland. I have had one or two MRI’s and two or three biopsies. My last PSA was about 4.6 with a Gleason number of 6. The doctor plans on doing another biopsy in a year or so. Why are doctors so reluctant to simply remove the prostate gland rather than put us through surveillance (blood tests, digital rectal exams, MRI’s, and worse, biopsies).
I had a PSA of 4.8 in 2021 at the age of 57. I'm about to turn 60 and my PSA is slightly lower at 4.73. In a 3 year span, over 8 PSA tests, its fluctuated from as high as 4.8 to as low as 3.6. What's most likely to cause fluctuations? My physician advises watchful waiting and tests every 6 months, never had a biopsy or MRI.
Hi my father had RARP last year..now after 12months psa is o.3 micromets? Radiotherapy needed? Is it curative
Great information clearly presented! I am just past radiation and ADT, and have gotten an undetectable PSA result. A second PSA test is coming up. Does the MRI have any role in post-treatment monitoring or is it just for initial detection? Does a rise in PSA warrant an MRI of the prostate to see if tumors are still there and growing? Thank you and best wishes to all!
Hi there, you might find if/ when you testosterone levels start to recover your psa will go up a certain amount, was your testosterone checked before ADT started?. My psa Nadir was 0.01 6 months after radiotherapy, its now 0.43 but my testosterone is 20.5, been told that's why the psa has risen.
@@frederickrich7393 thanks I know my testosterone was ok prior to treatment but was crushed by the ADT.
I was a bit annoyed that my testosterone wasn't checked before my first ADT shot, so I knew my current level, that should be standard.
If you can have cancer without an elevated psa then what good is the psa density test,,in other videos here i have seen just meadure the size of the prostate and see if your psa denity is within a 10 to 1 ratio,,does that no longer apply
Is the normal PSA level age dependent?
You mention Pirads 4 and 5 need biopsy. If Pirad is 3 (UCSF) and a 10 mm lesion is seen, can this be managed by serial PSA and repeat MRI, rather than biopsy at that time?
Great question!
I went through all the comments and did find a few similar questions to add to my thoughts, why are you not mentioning to get a fractionated PSA after an elevated screening PSA?
Where is Dr Sholz located. I'm in Southern California and three urologists want to cut on me with a gleason 3+3. He makes a lot of sense with his discussion and would love a referral to a like minded MD.
See with Loma Linda Medical center.Robert Marckini.Hope you do well.Great testimonial from the patients
A lot of urologists recommend AS for low grade like Gleason 3+3 nowadays due to the more than likely undesirable SE's of whole gland treatment. But, there are many that still want to treat depending on your age. I was diagnosed at age 61 with 3+3 and urologist wanted to treat it due to my relatively young age. But, he was willing to go along with AS, if that's what I wanted to do. A lot of men just want it taken out when they hear the word cancer, based on understandable fear. As Dr. Scholz noted in the video, prostate cancer is usually slower growing than other cancer....There are also focal treatments that have less chance of SEs, since you keep most of your prostate while the lesion is ablated.
I’m 60 y/o. My PSA last year was 3.27 ng/ml with a normal sized prostate at 23g and documented 0.5mm cyst. These findings got me worried. A year later, February 2024, my repeat PSA went up to 3.84 but my prostate increased to 33.9 g. The cyst decreased slightly in size. Needless to say it’s been a source of constant concern. My urologist didn’t seem to worry but told me to repeat the PSA in 3 months. May I have your thoughts please?
I need your advice what medicine to take I have protate
What does one do that cannot have an MRI done??
i was treated for Lymphoma cancer and i was getting RCHOP chemo. Before chemo my psa was steady 3-3.5 the last few years.During chemo the psa elevated to 6.8 ..fews days after to 5.7 and couple of weeks later 4.8. I did a mpMRI a couple of weeks after my reading and one month after my last treatment and i got a boarderlinwe PIRADS 4. My question is , if chemo can raise psa and if chemo and the late side effects of chemo can alter the PI RAD scoring ?
I have PSA 10.3. After biopsy, my Gleason score is 3+4, my doctor ordered CT and bone scan, that’s the right ways?
Why don't you mention the "Free PSA" Test ? It helped me a lot ! Because it helped determine that I needed to have a prostate biopsy. From which I learned I needed to have my prostate removed. Which went very well thanks to doctor Mihir Desai at U.S.C. Norris Comprehensive Cancer Center.
Right, there is no mention of free vs bound PSA as the next step before Bx or MRI when one has an elevated PSA screening. Bizarre.
Good Dr. are you related to Charles?
I just had a 4k score PSA blood test. Came back as 10.7% Doctor said it was pretty eqivical. What does this mean?
My PSA is 0.006, am cured? possible to use Pet SCan?
What if you have clear MRI but you had a elevated EXODX test
Can prostata cancer effekt the libido,
I can't have aa MRI, I have metal in my eye.
I have a psa of 21 and a gleeson score of 3+4
High PSA. 3.320 67 years old
Standard ultrasonographic evaluation of the prostate was performed and compared with a prior similar study dated September 20, 2021.
The prostate is borderline enlarged, measuring 39 mL (was 34 mL), and demonstrates persistent mild parenchymal heterogeneity and scattered faint foci of calcification
Please your recommendation
thank you dr Schultz
I am taking Imburvica for CLL, in 2017 my PSA was 4.0. After starting this Med in 2019 my PSA has rose to 11.0, do you know if CLL or this Imbruvica would effect my Psa score? Thanks
Another thing might be mast cell activation syndrome. MCAS, at least that's what the clinical research on the NIH states.
I’m confused about PSA scores bouncing around - both up and down, but in the “elevated” range - over a period of years (5 or so). In 2020, I was at PSA 4.4. Since then, I’ve been as high as 5.75. My most recent PSA was, again. 4.4. ExoDX from 8 months ago came back 14.4 (low risk vs. 15.6 cutoff). Is it correct to think that the existence of aggressive prostate cancer is incompatible with PSA levels going down (multiple times) over a span of years?
Good question!
No sure. The best thing to do is have an MRI. They will give you a PIRADS score and tell you if significant cancer may be found. Then, consider doing the biopsy and continue to look at your options.
Hi I am Tony and I am 68 years old .my PSA is 2.5 and I just had blood work two weeks ago but my prostate is enlarged and I get up about at least 3 times at night...but this urologist I saw couple of weeks ago without spending any time with me he scheduled me for the biopsy in couple of weeks...I was very uncomfortable with him the way he was rushing and didn't even spend 3 minutes with me...I have no family history of prostate cancer .my PSA last year was close to 3 and now is 2.5 . And my own doctor didn't see anything in my blood test .so do I really need that painful procedure? Thanks so much you guys are great and I just subscribed to your wonderful channel ...thanks again......by the way my testosterone is very good my doctor told me...
Hi. Same place as you. I'm 59 yo and PSA has varied between 2.22 and 2.8 in the last year. I met with 3 independent urologists in Montreal, Canada and all 3 have advised to simply monitor PSA for now. Even an mpMRI is overkill for now according to them as my 2.5 PSA at my age is normal. I monitor my PSA every six months and for now do nothing. I am meeting with my urologist next August after another PSA and I would like him to agree with me that I will do the required tests (MRI or TRUS) to determine my PSA density and verify that my slightly ''higher'' PSA is coming from an enlarged Prostate and not cancer. FYI, I need to pee 2 times a night and my urine flow is slightly lower than before. I also have no history of Prostate cancer in my family.
Hope this helps.
@@louisc5882 thanks so much for your respond you are a good man and yes definitely you helped me and I really don't understand why some of these urologists want to do that procedure on you right away....I guess for an obvious reason $$$$$$$ thanks again and good luck to you...stay strong live long
56 years old,have had chronic Lyme disease for 8yrs.Have been the sole caregiver to my 91 yr old mom with Alzheimer’s for the better part of a decade and I also smoke.Between the lyme&caregiving I stay stressed with high anxiety.My PSA has been steadily going up over the the last several years.Had an non targeted biopsy 5-6 years ago when my PSA was 7.4 came back negative for cancer.Last March it was 9.1,just had blood work and it’s 13.1.Can the stress of being a full time caregiver and chronic infection be causing my numbers to be so high.I also know I’ve got to quit smoking but it’s hard under so much stress and anxiety.Thanks for any info or advice.
Surprised your provider didn't recommend MP3tMRI. Stress can elevate PSA levels. I'd request the MRI and go from there.
I am 55 I have a PSA of 21.32 and aT2b stage and Gleason score of stage 4 cancer nothing spread to my limp nose only on the left rib is that possible skip limp nose
Lymph nodes, not limp nose. Hehe
I am 45 years old and my results are as follows:
PSA density = 0.66 (Ref range: 0.0 - 2.5 ng/ml)
Free PSA = 0.24 ng/ml
% Free PSA = 36%
I am told I have to worry and must see my doctor ASAP. Is this concern correctly placed?
Can HoLEP surgery affect PSA values?
Yes, it typically does, especially in large prostates. Here is a video on HoLEP from one of our previous conferences: th-cam.com/video/BDpfkhQvdH0/w-d-xo.htmlfeature=shared&t=1535
My psa recently jump fir .9 to 1.38 I as k to be sent to a Urologist my GP resisted but I insisted as I have 15 years of less that .9 test long story short after a MRI and a fusion biopsy I have cancer with a 3/4 gleason score and will have it removed in 3 weeks.my Dad died of Lung Vancer and my distor if breast cancer so there will be no delay in getting cancer out of my body
PSA T time of biopsy was 1.5
Hi there, after a gleeson score of 4+4 =8 , M0, N0. I had 18 months of ADT prostap hormones, then 20 radiotherapy sessions, after less than 6 months my psa was 0.01 Nadir.After stopping ADT hormones my psa 2 years after my last radiotherapy my testosterone is 20.5 and my psa is 0.43 is this normal? . I have been told this is because my testosterone is near normal level now .Thank you for any advice. 15:38
Does the Free to Total PSA ratio improve the usefulness of PSA testing for screening purposes?
I think it should however am surprised to not hear more about it. It is the logical step after a screening total PSA before jumping to a Bx or MRI.
ugh...that last bit of info was like a punch to my face. I had my prostate removed in 2021 because my biopsy proved one of the four core samples was aggressive. I asked about putting the surgery off until next year. For me, it was a question of insurance. In 2020, when I was choosing my insurance electives, I actually chose cancer coverage, but before submitting my choices, I discarded that coverage. I wanted to wait until 2022 for the surgery where I could put the coverage on, but my surgeon told me, "I wouldn't wait that long," as if the cancer could go wild before then.
What is the percent of cancer for a Pirad 3?
i was told by my Dr. about 20%.From what I've read of those about 10-15% would be aggressive types of cancer.
@@jojogun1957Thanks for the info!
Why do so many urologists move directly to a random template biopsy when the PSA is elevated without a 3TmpMRI? How do you advise the patient whooved from elevated PSA to random biopsy that reports a GL6? Can that biopsy be believed? Does an MRI need to be done after the diagnosis is made? Is ExoDX or other biomarkers offer guidance?
My PSA value when I'm diagnosed prostate cancer was 64.3
Afterwards MRI , biopsy and psma pet scan were done ..
I was advisd to go under surgery by my oncologist .. After coming to know that I had cancer I went on zero carb and zero sugar diet and prolonged fasting
Recently my when my PSA was checked it was 12.7 /...
What is significance of this ?.. Is my cancer gradually going away ?
Hello, we are not able to answer case questions on our comment section but we can help you through our Helpline who can speak with you either by phone or email. Here is the link to contact them: pcri.org/helpline
Hi my husband was diagnosed with Gleason 6 after mri and psa of 7.21…dies anyone know if that Gleason 6 can het higher over time? So scared if they put him on active surveillance and then maybe we’re gonna be to late if the cancer gets more agressive
My psa went below 0.10 stopped hormones after 6 months was in my prostate and metastasis to pelvic lymph node left side is it safe for me to of quit the hormones. Psma says no cancer is present
Hi, good question, did you get an answer from anybody?
I am 68 y/o, PSA 6.6, volume of prostate 32 cc. Under active surveillance. Diagnosed with T1c, Gleason 3+3 cancer in Sept. last year. My urologist said it was a T1c stage cancer based on DRE. However, I am worried that it might be T2b or T2c because the lesion shown in the MRI is 2.5 cm diameter. Volume of lesion 8 cc at the apex.
NCCN Guidelines for patients states
“T1 tumors can’t be felt during DRE and aren’t found on imaging tests ….....….”
Therefore, it might not be T1c based on DRE that is subjective, only part of the prostate is in contact with the rectal, not the whole prostate can be felt. I consider MRI imaging to be more reliable because ' seeing is better than guessing'. I think my case is in the gray area. My urologist says he does not interpret MRI. It is a matter of life and death to me. I might miss the opportunity to cure the cancer and suffer from great pain if it becomes advance stage cancer.
After watching your video, I think there might be an opportunity for me to make sure of my Tumor Stage. I think it is no harm asking for help to confirm it so that I can at ease continue active surveillance.
July 2023, MRI findings:
Lesion 1, ROI 2, 2.5 cm diameter within the left anterior peripheral zone at the apex. Bulges the capsule. T2: circumscribed homogeneous moderate hypointense focus/mass; ??1.5 cm greatest dimension; PI-RADS 5;
Lesion 2 - RA lateral peripheral zone PI-RADS 4.
Aug 2023, random biopsy findings:
1/14 cores (1 mm in 11 mm core); Stage 1 Gleason 6 Prostate Cancer; non palpable T1c
Then, I got an MRI guided biopsy after I queries about the two large lesions shown in MRI that there is a possibility that these areas were not sampled during the random biopsy.
Sep 2023, MRI guided biopsy findings:
Gleason 6 involving 2 of 3 cores (6mm of 13mm core; 3mm of 10mm core) and small focus of atypical glands on another core, suspicious for carcinoma.
Gleason 6 involving 2 of 3 cores (6mm of 17mm core; 4mm of 15mm core; 1 mm of 15mm core)
Your help in offering second opinion on my Tumor Stage would be very significant to me to decide the way forward. I would ask for radiation treatment if it is not T1c. Do you have any advice. I am your fan on treatment of prostate cancer. Your prompt response is greatly appreciated.
Thank you so much for commenting and sharing your journey. The best way we can help you would be through our Helpline. They can go over your details with you and give you information. You can contact them here: pcri.org/helpline
So it is possible to have Gleason 6 with a PIRADS 5 MRI?
I don't know what I'm going to do I'm scheduled to have a biopsy March 6th 2024 even though I had MP Tesla MRI that revealed nothing October 1st of 2023 other than 41cc prostate and I'm 53 years old this year
Is your PSA crazy high or something?I would ask about some of the other blood tests they have for cancer.
M.R.I.for prostate, is invasive?😮
No.