Your Gleason Score Matters |
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- เผยแพร่เมื่อ 5 มี.ค. 2024
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2:07 What is the pathology process, and what does a Gleason score mean?
4:54 How should a patient broach questions about treatment with their physician?
9:27 Should patients seek out their pathology report? Can they trust it?
11:22 Can Gleason 6 ever metastasize?
13:04 How likely is a Gleason 3+4 cancer to metastasize, vs a 4+3?
16:27 Are Gleason 8 cancers more likely to spread than Gleason 7 cancers?
17:12 How likely is metastasis with Gleason 9 cancer?
17:36 How likely is metastasis with Gleason 10 cancer?
18:14 What Gleason score is the most common in active cancer patients?
19:06 How dangerous is a cancer with a higher Gleason score?
20:59 Alex's conclusions
22:16 If you need more help
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How I wish I could have Dr.Scholz as my oncologist. The man is brilliant. Everything he says resonates and makes absolute sense.
I was diagnosed in 2018 - Gleason 9 … I was terrified and told by the urologist that my life expectancy was around 3 to maybe 5 years. I had a radical prostatectomy in July, 2018. By the end of the year my PSA had returned to 0.2 again. I was very disappointed and worried. I live in Canada, but went to California for an axiom PET scan and they could only see a very faint uptake in the prostate bed. They suggested laser ablation of that spot, which I did. Back in Canada I was put on hormone therapy as well. After a year or so, my PSA again rose to 0.2 and, in a few months got up to just over 1.0 - I was sent to Montreal for a Gallium PET Scan. Again, it showed a small uptake in the prostate bed. I did 5 weeks of low dose radiation and my PSA again went to undetectable for a year or so. Then, it started to rise again - got to 1.5 … back to Montreal for another PSMA - one small lesion was found on my hip bone - luckily my radiation oncologist is a progressive thinker. I had 2 doses of high dose radiation and once again my PSA went down to undetectable. A few months ago, it started to rise again. I went to Edmonton for a PSMA scan and they found a small spot on my right femur. The areas of disease previously found in my prostate bed and hip bone had not returned. I again had high dose radiation in December and my PSA is on its way down again.
I’m at a loss as to why it keeps coming back, and am also worried about a recurrence that is more than just one small, localized spot. It seems to pop up and say hello every couple of years. (btw, I have been on lupron injections and enzalutamide during this time).
Am I unlucky enough to be in the small percentage that will never be cured? Will the roller coaster ever end?
I guess if I just have to monitor and get treated every couple years I can live with that. I know my oncologist had to fight with the cancer board to be allowed to treat me this way. Usually in Canada if you get bone mets it’s just hormone therapy, maybe chemo and palliative radiation to bones. That is definitely NOT what I want.
Do you have any comments with regards to my situation?
I am 64 now and feel fine and am otherwise healthy - how concerned should I be?
Hi, I'm an electrical and mechanical kind of guy, but have been doing some reading. Your post struck a note with my thinking, so I'll share my thoughts below.
The root cause of "biochemical recurrence" is metabolic, which is the same reason for the cancer to occur in the first place. (Aside from the "insults" to cell mitochondria from carcinogens in our diets and the environment, electro-magnetic exposure, hypoxia, etc)
But instead of addressing the metabolic roots of cancer, the SOC (standard of care) clips the dead leaves off the tree, so to speak, without making the tree healthy "from the roots" first. So "of course" there will be a biochemical recurrence. Read Dr Thomas Seyfried's book- "Cancer as a Metabolic Disease".
The first thing that should be done with any early stage cancer patient is to put them on a tailored Keto diet. This reduces serum glucose, which removes one of the two energy sources for cancer cells (any type of cancer cell, anywhere in the body) The second and final source of energy for cancer cells is glutamine, which can be reduced through fasting. Even intermittent fasting helps reduce glutamine. Also, glutamine reducing drugs such as "DON" may used, when it becomes available.
Reducing glucose and glutamine removes the fuel source for cancer cells to produce ATP thru fermentation, and the cancer cells become weakened. (Normal cells with healthy mitochondria are like "flex fuel" vehicles, making energy thru oxidative phosflorylation. They can use glucose and even make ATP with the ketones from burning fat, but cancer cells cannot, because of their damaged or mutated mitochondria)
After the cancer cells are weakened thru this targeted "starvation", relatively small doses of SBRT or chemo may be used to further damage the cancer cells, without toxifying the patient. This is done gradually, to avoid dumping an abundance of dead cancer cells into the body, giving time for them to be eliminated naturally.
The patient actually becomes stronger on the Keto diet. Contrast this with the emaciated patient receiving chemo, with their hair falling out and constant sickness. Then the hospital kitchen brings them a meal high in carbohydrates and sugar! Exactly the fuel that cancer thrives on! WHAT'S WRONG WITH THIS PICTURE?
Reduce carbs to about 50 grams max a day, and reduce sugar to 5 grams max a day! Eat healthy fats like salmon, avocados, cruciferous veggies like cabbage and broccoli, real food! Stay away from processed foods. Doing this will weaken any type of cancer cell, slow, stop, and possibly reverse tumor growth. Then if further action is needed, radiotherapy or chemo can be used in a "one, two punch" to eradicate or manage a tumor.
Dr Thomas Seyfried calls this the "Press/Pulse" method of cancer therapy.
If the metabolic origins of cancer growth are not addressed, the proverbial "can has only been kicked down the road", and of course there will be a "biochemical recurrence", because absolutely zero has been done to address the metabolic environment of the body.
Instead, after failing with radical prostectomy, the SOC moves to chemical castration, and after failing with that, the cancer has metasticized, and the SOC falls on its face again and then the patient dies. The SOC fumbles around with chemo, operations, etc, chasing cancer like they're herding cats.
To ignore the metabolic origins of cancer is unscientific and obtuse, and harmful to patients that need help.
You both are pure GOLD! Thanks for all you do.
PCRI is providing very important and NEEDED information.
It is imperative for men to be educated and not fall victim to the medical system.
I have learned firsthand that we must be our own advocate and NOT depend on what the medical system default “standard” of care involves.
hai perfettamente ragione. Dopo prostatectomia radicale il mio psa sta correndo ma dopo 3 pet psma gallio 68 con psa 0,24- 0.54 - 1,14 non viene fuori ancora nulla. Penserò ad eventuale terapia soltanto quando una pet psma evidenzierà qualcosa.
I must say that your podcasts over the last 3 to 6 Months have been excellent. Before that I thought you were speaking in generalities about the minuses of prostate cancer treatment. In short it's like the side effects of treatment were being swept under the rug. You are now hitting these issues head on.
Big props to you!
Great discussion, so timely for me. I’m 71 living in Cambridge, England. Thank you Dr Scholz for helping me understand my prostate cancer. After rising PSA over the past 18 months I had a mpMRI in January 2024 with a biopsy last month (March) Results show two areas of cancer contained within the prostate both 3+4=7
Dr Scholz you have helped me to understand what choices I have prior to meeting my consultant next week. I can now prioritise the next steps knowing I have time to make those choices. Although I have had a heart attack back in 2021 Royal Papworth fitted 3 stents and I am back to full fitness.
I would not want anything to affect our plans to celebrate our 50th Anniversary this June. And as I have no symptoms or effects I will request active surveillance for the rest of this year.
Thank you one again!
John
I was diagnosed gleason 10 in 2022 , on all cores , now in remission , i dd the tritherapy approach , chemo plus two hormone therapies , and a bit of radiotherapy , it had spread to the spine , hip and lympth nodes , all gone now -) thanks for hte videos , i was so well informed thanks to you guys
Yeah , my doctor knew of Dr. Scholz and said “stop doing research”. I should have told him, if it wasn’t for him, I would not have gotten a PSMA-Pyl PET/CT.
Everyone needs to be their own patient advocate!!
I spent days researching prostate ca and treatment for my husband. My husband was diagnosed with prostate cancer even with a normal PSA. Why? HIs PSA results from 6 months before that one was 2 points lower, and that is a big red flag for cancer if your PSA results changes by 2 points in 6 months.
We know of someone who said he waited to late, and was diagnosed with prostate ca years ago .First thing he had was a radical proctectomy. Off course the cancer was not gone, and it spread. He had salvage radiation and chemo., was told by his doctor-(not sure if it was an oncologist), that he has cancer somewhere in his body. I asked him what was the results of his PSMA Pet scan. He said they never did that exam. OMG why?? He said he is now on lifetime hormone treatment to remove his testosterone. I told him, he needs to strongly insist on this exam. How can you treat metastases if you don't know where it is in the body?
Definitely the PSMA pet scan should be done, along with other exams to confirm the correct staging of prostate ca, especially if a MRI prostate shows highlighted regions, and a high risk Gleason score is found. Always get a second opinion on the biopsy, which may change the Gleason score, and get a decipher test done as well. Extended PSA and testosterone tests. With all of this information a more informed decision can be made as to the different options to treat prostate cancer.
Yes, his urologist he's had for years, wanted to jump into surgery. You have to take a step back and understand all of your options, get recommendations, and try to seek out the best oncologist.
My husband now has a treatment plan, two oncologist from two different states has coordinated his plan. It does not include surgery. Thanks to God alone, my husbands is more into checking things out medically, and staying on top of routine exams and testing. I think he was told a 90-93% cure rate, and with yearly surveillance that he will not likely die from prostate cancer.
I am a doctor and I have never heard anything from Dr. Scholz that sounds crazy. Sounds like your doctor was insecure. Sorry you had that experience
You need to change Drs, that is absurd
My PSA levels gradually went up over two or three years. 5.56 but came down to 4.3 last blood work. I've been seeing a PA who works for an aging urologist and he advocated for me to get an MRI with contrast. I will get the results tomorrow from that scan. I've had several weeks to watch videos on the subject of prostate cancer since then. If the scan has found lesions, there's a good chance im heading for a biopsy. At my age (72), I'm still able to have sex and ejaculate. If something is found and is still in the prostate capsule, I'm leaning towards active surveillance, if its not an aggressive type of cancer. I know I'm putting the cart before the horse. Wish me luck. Prayers are appreciated. P.S. One of your best videos yet.
I'm going tomorrow for an MRI.... My PSA was 5.1......... I'm going to do the same thing you are..... I've talked to too many guys who had it removed and the problems they are having now are worse.
Quality of life is important.
I've also read articles of studies done.. one took 10 guys.....5 were treated with removal or radiation, hormone treatments.. long story short the 5 treated and the 5 not treated both groups lived another 10 years......
Pray for me, I'll pray for you....
This video is I think the best yet it puts everything in perspective and shows men there is definite hope whatever grade you have! Thanks
@@edwright4745 I'm praying for you. I got my MRI results and I have an 8mm lesion in the left anterior portion of the prostate. As far as they can tell, they don't see anything else in the prostate, lymphnodes or pelvic area. I found a report of an old full body CT scan I had done 15 years ago because of an auto accident. It showed a "calcification" of the prostate. It wasn't mentioned by the physician at the time, so I thought nothing of it and filed it away. I'm beginning to wonder exactly what they're seeing on the MRI. Haven't scheduled the biopsy yet. I'm trying to remain hopeful.
100 % my brother got downgraded from 3+4 to 3+3 on second opinion . His urologist was pushing for surgery. Thank god we got a second. I can't wait for PSMA to be insured for primary diagnosis and staging. Once again, an excellent segment.
I Was Just Treated For Glaeson 6,7,8 In Three Of 12 Cores ,9 Of The Cores Had No Cancer.All Was Still In Prostate ,PSA 4.5 I Under Went EBT Radiation Seed Implant .No ADT Hormone Therapy .I Refused That .Now 9 Months After Iam Now With My PSA Down To 0.6 And Feeling Great.
Great video as usual.
Such fantastic videos. Thank you
You guys are really great! What a blessing 🙏
Thank you ❤
I was diagnosed with Gleason 3+3 in 2019 and was put on active monitoring. Last year my PSA went up to 6 (from around 4 in 2019) and an MRI was conducted in June, which showed the cancer was well contained in the prostate. Subsequently a biopsy was done in January this year and the result was 4+3. As a result I went to see a radiation oncologist for proton treatment and he ordered pet scan and decipher score for me before we do anything. The result came back with big surprises. They showed that the cancer had metastasized to a lymph node with a size of nearly 2 cm, and the decipher score is 0.97 out of a max of 1. So it seemed like the cancer is extremely aggressive and spread to lymph node between July last year and January this year, on contrary to the understanding of slow growing nature of prostate cancer. I am starting to think in my case it might be better to treat earlier when it is still 3+3 before it got so aggressive. I don’t have a treatment plan worked out yet. I am wondering if a chemo maybe required. Anyone has experience with nymph node metastasis and had beef cured? Thank you.
brilliant interview
THANK YOU…. you have both been so supportive and helpful…
Very informative.
Million thanks for the informative content videos. I have so much on the PC in the past 3 weeks.
Amazing amount of valuable information. Thanks
I think this is your best video yet it puts everything in perspective and shows that whatever grade you have there is definite hopeI
As always a great video. Appreciate your efforts. Many thanks Alex and Dr. Scholz.
DX Sept 2021 Gleason 10, urologist, who is a friend, said " it doesn't get any worse than this " he said " i don't want to do surgery as i would be lying if i said i could get it all" recommended radiation. PSMA showed camcer still only in prostate. Did the research, found PCRI amd watched evey video. Radiologist thought microscopic amounts would likely have got to lymph nodes but were not showing on scan and suggested doing wholw pelvic area. Completed 39 fractions 78Gy. Zoladex ADT. Today two years later im PSA undetectable and feeling great. Radiologist thinks we may have got the bugger. Thank you PCRI for your time and videos, they made the difference, they gave me hope.
You did not have any surgery, just radiation and ADT. I was just diagnosed, 10 of 18 cores positive 1 3+3, 8 3+4, and 1 4+5. Bone scan, CT scan and PSMA CT PET all negative for spread. Most of the cancer is in the right lobe. Urologist presented 2 options surgery, radiation or radiation, and 2 to 3 years ADT. Seemed negative about the second option thought surgery was best, but because it is mostly on the right said ED 60 to 70% and incontinence 5 to 10. I currently have an appointment with another doc to see if I would be candidate for single port RP What were your side effects. Thinking I may be heading in the wrong direction.
Hi Ron, being G10 and highly aggressivei was advised to have the whole pelvic area zapped. PSMA is not perfect, it can detect cancer down to about 2mm, radiologist was very keen to zap pelvic area to make sure he caught any microscopic cells that may have escaped and were not showing on scan. He said you have one good shot at this do it all and do it hard.@ronwise4380
@@ronwise4380 hi Ron did you get my reply, old fart here may have messed it up.
@@user-pj2wn9ch2c Just read it thanks for getting back. Have decided to go radiation route rather than surgery. Looking for a good place to go near me
My psa went 7.2 to 12 to 27.1 over 3 months. The MRI was bad and they told me radiation was needed right away. Nothing ever said about what type of cancer it was, how fast it grew, or what options I had except surgery wasn't an option
I would love to see this Doctor
this is your best video yet greetings from ireland
78 year old. 2 MRI past 5 years Pirad 1-2, Decipher.51, negative PSMA, Gleason 4-3 in 2 cores 5% & 15%, 2 cores 3-3, 8 cores benign. Seriously considering no treatment due to age.
Four months ago I thought I was healthy, 1-12-24, we diagnosed with G9, and a biopsy bone scan showed Met. in five areas. Was just apposed for a PSMA scan. I'm hoping for the best. So glad I found this channel. Thank you for all the info.
Well wishes and positive thoughts sent…be well!
Good Luck John. Keep spirits up. Husband G score 9 - two tumours in the prostate and it had got out to surrounding tissue. Had robotic surgery (oldest patient this surgeon had operated on). Recovered quickly. Bladder good. PSA not as expected post op. Doubled twice fairly rapidly. Went on to do 36 radiations to pelvic floor (shot of hormone to help radiation but no hormone since). PSMA scan following radiation - no detectible cancer. Last two PSA tests since - 0.008 and >0.008.
Dr.Scholz and my urologist do reason exactly the same way. I really feel that I am taken seriously by this. Love the great conversation.
in 2016 my gleason was 3+4 and 4+3 I don't know the percentages, my PSA was 48 I was age 50. I recently talked to someone whos father is 81 with a psa 5 and gleason 10. I didn't realize that gleason 10 was so rare. I was glad to hear what you said about it not being the kiss of death. Thanks for another information packed video.
Another excellent video. Gleason 6 myself, been on Active Surveillance for years. Recently had a PET scan only to see if anything has been been missed, as my PSA level is still significantly elevated after TURP surgery last July which seems unusual; reassured by my urologist today that there was nothing to be concerned about from the scan.
You guys have helped me tremendously in my prostate cancer journey , im in south africa and there is very little you are told here about the disease , my treatment for my gleason 9 prostate cancer was well under way when i came across you guys and through what i found out from your articles im pretty happy to say that my Urologist and oncologist basically gave me the treatment that was 100% bang on with what you people recommended , thanks again for an insightful and easy to understand series on this disease
4+5 and PSA 57.9 and only have Medi-cal. Now I see how insurance dictates survival. 🤒
I was gleason 6, (3+3). Four months later after surgery the pathology was T3 as it had grown to the prostate wall so yeah, no. The surgeon said that if I had waited 5 yrs, I'd be in real trouble. No one pushed surgery on me, I went to see a radiation oncologist and then an out of town surgeon and made my own decision.
Thank you for all your videos! What i have found is you can ask 100 doctor's and oncologist/radiation specialists the same question and get 100 different answers. That's a problem! I watched a lot of people in my life die of cancer. My position is, if you have cancer, get it treated now, then later. And yes, I am currently being treated for prostate cancer at 65 years.
So glad to have found these videos with some sanity about the situation. As forewarned, my urologist immediately suggested after the biopsy that I have radical treatment as intermediate favorable (3+4) "usually metastasizes" according to him and would be a danger to me if not attacked right away. The amount of "4" in my 3+4 cores was very small and only in a very few cores.
Did the Prolaris genomics test and it says my genes in the biopsy samples are pretty good at not generating aggressive cancer. The various nomagram web sites that I entered my data into also helped give me a saner perspective of what I'm facing. Radical treatments (RP or EBRT) will have only a very minimal life saving benefit vs. AS (only 3% less mortality danger in 10 years when I'm 80!) and the side effects risks of radical treatments are at least at the moderate levels. Plus, buying time for better treatments in the future sounds logical to me when I observe what's coming down the pike. Once you take the radical treatments you can't undo the damage they inflect on you. They are called "radical" for a very good reason.
I cannot emphasize enough, talk to additional doctors, get second opinions (even with your biopsy readings), etc. Prostate cancer is unique. Walk into this situation with your eyes wide open in terms of the risks vs. the benefits. Don't assume that your doctor has fully analyzed the situation you are facing. It's up to you to get up to speed on your situation and the risks vs benefits your are facing. Don't ignore the real risks but also don't blow them out of proportion. Thank goodness that getting fully informed is much easier these days. All those hundreds of thousands of men back in 2005-2014 who had their prostates suddenly removed for the minor situation of Gleason 3+3.... just wow! Take that lesson to heart.
I just met with the doctor Chan in flushing queens New York
Absolutely a gem like this Dr shcolz
Thankyou for both of your. It calm me down right away.
2019 my Gleason score was 9. I got radiation and 2 years hormone therapy. Now my total psa less than 0.05 undetectable.
Your information is valuable for me and others for sure.
in harmone therapy which tablet you used with in 2 years please help me
My Dr. told me I had cancer, you need surgery I can get you in next week. He didn't offer any other treatment options. I brought up radiation, he talked that down. He gave me a folder telling me what to expect, didn't tell me anything. I didn't see your channel until it was too late. I enjoy watching your channel. Just to find out all information in case I see anyone else with prostate cancer. Thanks for you channel.
I have learned from the videos presented by PCR. I do not only question my urologist, but also my oncologist about the variety of treatments, and how I should proceed.
I am 81 years old and still sexually active with a Gleason score of 4+4 = 8, and the decipher score of .62. Because of my age and the fact that the cancer is a 4+4 it was critical to pick the right therapy. I have acted out for an SBRT radiation regimen of only the prostate utilizing true beam for 26 treatments with no hormone therapy to maintain my quality of life after treatment. Thanks to PCRI I have been able to fashion the treatment that is acceptable to me and my future.
I appreciate the videos and Dr. Schollz Various videos by other medical experts, presented by PCRI!
Hello and thank you. I just had my targeted biopsy two days ago. I am currently waiting on my pathology report. Your information is invaluable to me and many others.
@ericb547 I had my biopsy about a month ago that revealed Gleason 4+4. I have a bone scan, pelvic MRI and PSMA PET scan in the coming weeks. I spoke to a couple of friends that had it. One went the surgery route, the other did radiation treatments. It was good to get their insights.
I wish you the very best outcome.
best of luck
@@brockjennings The PET scan is the best. My Gleason score is 4+4 with limited bone metastases. I've just finished ten radiation treatments on a rib, and next week I start twenty radiation treatments for prostate. I hope yours has a great outcome.
@@mrbr549 Thanks for the information. Good to know their other 4+4 folks going through treatment. Best of luck to you as well 👍
I can't quit commenting on this video it's everything I discover pretty much on my own confirm by someone I really respect and yet on most of the prostate cancer forum boards people just rushed to get surgery. They can't even explain why other than the statement I want it out. I've been very fortunate every doctor I've talk to said you could watch it even though I'm at 3+4 and I do have 40% but it's a very small lesion my radiation oncologist and I discussed a hypothetical, pretending I said what if I was against any form of medical care, religious reasons or what not what would my particular cancer look like in your best guess he said probably 6 to 7 years it would metastasize, and then we could treat another for five years probably it shows you why so many men rush in the surgery is not potentially wise choice, considering ED and incontinence in a mental health associated with those things
I love this thank u is there a way to verify my score with a second Gleason test
I live in the Uk so healthcare is free at point of use but as you say there is still a system which can complicate matters as was suggested. Interestingly I had a Gleason 4+3= 7 pre treatment score and decided to go for surgery based on my own specific care needs. The results of surgery were good, no cancer spotted after 6 months, no leakeges but erectile issues which I’m fine with as I’m 75 and single. However, my post Gleason score was 3+4=7 which a previous video suggested would be an observation situation.
Decisions. 4+3 Gleason...3 positive cores of Gleason 4...Cancer completely Contained after PSMA Pet Scan...Urologist insisted on Radical Surgery (I'm 65). I got a second opinion from Radiation Oncologist And they said Perfect for SBRT Therapy...No one has told me about Life Long Side Effects???? All we need in Full Information from Specialists! Love your Podcasts.. Thanks from Australia.
Please check with a Proton beam therapy.Best hospital for this treatment is Loma Linda medical center,California.Hope this will help you
These videos are super helpful, and reassuring. Well done. One question: Dr Scholz, at about 15:15, says "if a tumor is not unduly large..." What would be considered unduly large, please?
I have Glisson 6 but stage pT3a R1
I was diagnosed with prostate cancer in July 2023.A Gleason score on left prostate of 3+4 and on right side prostate of 3+3.I underwent treatment with a great Radiologist in NYC named Dr. Michael Zelefsky. He recommended SBRT. After nearly 4 months no impotence and no incontinence. PSA dropped from a 5 to 0. Just a little irritation when urinating. Follow up soon with MRI.Other than that feel great.
How old are you? Some say tradition have long term effects like bladder or kidney cancer after 15 years. Is it true?
I'm 69.I wanted active surveilance,but the Dr. recommended treatment.Surgery or Radiation.I opted radiation.But I selected a very good Radiation Oncologist,from NY Memorial Sloan Kettering.If you skip treatment chances are it's going to metastize.Get regular checks for early detection of other cancers that may occur.But it's important to treat it.
Why is diet not talked about more as a way to lower psa and use food to help heal the body. My husband is on ADT and the side effects can be really bad. I was shocked at how quickly he lost muscle mass. Through research I have changed his diet drastically and believe it plays a super large roll in any disease including prostate cancer.
I'm one of the lucky ones with a Gleason 10🤗
What are your treatment plans Tommy?
@@keithcolegrove2924 radiation and hormone treatment 🥴
Wish I'd seen this 6 years ago,
What does Gleason score 3 + 4 with tertiary pattern 5 along with extracapsular extension mean?
Hi I was diagnosed with a gleason 6 in 3 spots the percentage in the 3 spots are 1% 1% 5%. Group 1
I was diagnosed with a Gleason 9 13 years ago. My urologist freaked out. My attit😅 was and is a if it’s word to nt one thing it’s another. I my psa. Currently controlled with lupron.
My husband's tumor is Gleason 6...we are looking into capsol-t supplement as an option.....do you have anything to add about capsol-t?
I'm 72 this year, been on active surveillance since 2008 , high psa reading then ,had several biopsies since and Mri scans , but nothing other than elevated psa between 12 and 14 now up from around 7 of 8 initially.
Never heard of Gleason , only figures I've had are PSA,until this year after an MRI scan I was told I had a density figure of 0.24 , haven't a clue what that means maybe someone can shed some light on that , next appointment is May .
Not a doctor. I've read that the density measure has to do with PSA levels as they relate to prostate size and the size of the mass targeted. Generally, lower is better and 0.24 is fairly high. 0.16 is low.
@@1dariansdad
So that means tge bigger the prostate the bigger the psa reading
Latest reading is 9 but 14 last year, so seems my prostate is small compared to psa reading , I wonder how much of an indicator
And thanks!
... Question: Are PSMA rsults "Definitive"? My PSMA showed re-current cancer in the prostate and a cavial lymph node. Yet... both were biopsied afterward and both were Benign?... My Urologist is confused and prescribed a course of anti-biotics and another PSA after to rule out Prostatitis. Your thoughts?
Watch Niall Mc Connell's podcast about what's happening in Ireland, the same as is happening in the U s.
My husband age 75 has been diagnosed with Gleason score 7 (1 core of 12 was 4+3) we find that most Radiology docs we’ve interviewed say that ADT is mandatory for a good result. Knowing the side effects of the hormone blocking pills/injections for 5 or more months are drastic, we both are hesitant to agree to this approach. Can you address this?? Thank you for your website. It’s very helpful.
Please check with Loma Linda Medical center.Proton beam therapy they have a great testimonial.Also Read the book of Robert Marckini.
What about Gleason 3+3, pathology report afterprostatectomy in 2006. In 2021 PSA starts rising now at 0.2, biochemical recurrence, is the Gleason of 6 still reliable?
I do know of a couple of folks who got second opinions on post-RP pathology. The same idea that drives many folks to get second opinions on needle biopsy samples.
6 years ago my PSA reached 5.6 so a biopsy was performed and my Geason score was 3+4. I chose active surveillance which was an option offered by my doctor. He suggested that I have an mri to check the whole prostate because the original biopsy only checks the bottom of the prostate. The MRI showed 4 tumors on the top of the prostate so they then performed a MRI biopsy on those tumors and they were 4+3. Active surveillance was not a option anymore. So I had the prostate removed. They sampled the prostate cavity and found that the cancer had spread out of the prostate with a Gleason score of 3+4. It is possible they got all the cancer with the sample taken from the cavity but those odds are low. But the 3+4 showed it is a slow growing cancer and now at 70 years old my PSA is still at 0.0. I am so thankful my doctor suggested the MRI to check the whole prostate because the the normal biopsy they perform only checks the bottom of the prostate because that is where the cancer is usually found. My cancer in the bottom was 3+4 and the cancer in the top part was 4+3 which required removing or radiation.
Trying to decide whether to start treatment in the following situation. PSA has been 6. Last year just 1 biopsy core was positive: 10% 3+3. This year 5 cores were positive (highest 20%), all 3+3. Is this spread a sign that the cancer is aggressive even though all samples are 3+3? Urologist seems to think that surgery (or rad) now is the prudent course.
Hello , If the Gleason score is 5 can the cancer metastasis and should you have radiation treatment?
My Gleason score was 6 and I never did anything about my prostate cancer.
What about 3 + 4 with perineural invasion ?
Good question
I would like to know how Dr. Scholz feels about IRE. Does he believe that this type of focal therapy can be as successful as brachytherapy or other forms of radiation?
Also, you can slow things down with exercise diet lifestyle changes that can work in your favor
Agreed with that 200% .
As soon as I found out I had prosthetic cancer I started juicing eating steamed tomatoes and no more tapioca which is high in carbohydrates.
We did A PSMA pet scan on Feb 15 and it show more then 6 metastases in the bones and the lymph nodes around the prostates and the neck area and with Gleason 4+4. He is 63 years old. 1st time diagnosis with PC.
We have consulted with 2 urologists and 3 Oncologist in the past 3 weeks. I Urologists and 2 Oncologist advocate Hormonal therapy plus Chemotherapy. The rest advocate only Hormonal therapy. Radiotherapy options has been ruled out by all the consulted doctors.
Urologist has started the hormonal therapy with Casodex on Feb 17, and followed by Lucrin on Feb 29.
The last visited Oncology took over the above treatment scheme but stopped Casodex and started on Erleada immediately. He will use Zoladex instead of the Lupron on the May 20th.
Please advise is this the correct treatment and what is the survival rate?
Should we consider the Chemo too? And does Chemotherapy enhance the survival rate?
Is there other treatment options that will increase the survival rate?
Thank you so much.
I can only explain what my husband is doing. Testing: biopsy Gleason of 4+3, decipher test, MRI prostate and PSMA pet, only showed highlights in the prostate. Treatment: 1 shot of hormone treatment, which lasts 6 months(Lupron), 2. and 1/2 months later... radiation seeds by one oncologist who does 500 or more of these procedures-most in the country. Then wait a few more weeks , then do radiation treatment once a day for 5 weeks. After all of this, he will be placed on active surveillance.
His urologists' wanted to jump to proctectomy. After urologist recommendation for a oncologist, he has two oncologist in 2 different states.
The one shot hormone treatment is first because it remove testosterone which feeds the cancer. It knocks it the cancer down, like sticking it in a freezer, should slow/stop growth. Then treatment with radiation seeds in the area of the cancer-highlighted by the MRI prostate, along with a ultrasound of the prostate. After the radiation seeds starts wearing off, then start with the localized radiation treatment-5 min a day for 5 weeks. He was given 90-93% cure rate.
My husband is lucky, both oncologist coordinated his treatment, everything was discussed in detail, before he started. Being 65 he wanted to make sure the first battle with cancer was the strongest.
Every cancer case is different, I hope you both get the answers you seek and get the best treatment for the cancer.
I have 3+4, 15 cores where taken in a biopsy 5 of the 15 came back with 3+4 and of those 5 cores they had 20% 4, i got a mri done last june should i get another done now and see if there is any growth in the tumers, iam told there are 2 one each side, could i just moniter these with mri's to see if they are growing.
If the mri showed two spots then they should do a mri biopsy showing what the Gleason score is for those two spots.
Hi Alex. With a diagnosis of Gleason 5+4, PSA at 310 and metastasised to bones, spine etc. do you have any idea as to how long I have been living with the disease ?
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
I know Dr. Scholz is not a fan of surgery such as radical prostectomy and carefully justifies this with the statistics of cure rates and side effects. But there are several newer "surgical" treaments which don't involve removing the entire prostate. I'm thinking here of such procedures as Holmium Laser Enucleation of the Prostate (HoLEP). I have had this treatment in the UK, which was "sold" to me on the basis of the fact that by simply removing (most of) the internal tissue of the prostate and leaving the enclosing capsule intact, the nerves and blood vessels associated with erection etc. are spared.
I just wondered if Dr. Scholz had any comments specifically about the HoLEP procedure especially with regard to his valid concerns over radical prostectomy?
In my own case I was Gleason 3 plus 4, had Deca-Pentyl Androgen Deprivation Therapy (18 months) before and after Radio Therapy, (20 focussed cycles over 4 weeks 37 Gray total). I'm now 9 months after completion of treatment and my PSA has been steady at 0.02. I'm on a six monthly PSA monitoring regime (next one in three weeks time - fingers crossed!) and my likleyhood of cure was given to me at the start of treament as "upwards of 90%". Thank you for your outstanding presentations.
HoLEP is not indicated for cancer.
Glasgow University is adding mebendazole, (Ivermectin and Fenbendazole's cousin) to Docetaxel, and it's not for nothing.
I took it on myself to take a course of FenBen.
@@bruceharkness4497Please share your method and results.
PS. I can no longer afford the Abilaterone. Now what??
I do not want a biopsy. If you tell me tat the odds are that I will live to 85 then that's enough. I have lived enough. How many more years of quality life do I have left? I am a 70 year old man that is fairly healthy but I had a heart bypass 15 years ago and I have diabetes . Two years ago I had an MRI with a PIRAD 2.
This was very helpful. I just got my result back from my fusion biopsy. Grade one3+3=6 . I have my follow up next week. I feel much better prepared. Thank you..
I am 58 years, and healthy with 10.8 PSA score I was recently diagnosed with Gleason score 7, 3 +4, comprising pattern 4 in 10 to 20%, and 50% core. My PET Scan is negative with no evidence of PSMA avid metastasses. My doctor is asking to go for either surgery or radiation and hormone therapy. What should i do? How long will it take to metastases
My husband was on hormone therapy for 2 years till now. PSA readings were less than 1. But suddenly it is 12.7. Why is that so? Pl confirm. Thanks.
Dr. Scholz mentions to double check your Gleason score at a University Center.. how is this done? A new biopsy? By University Center, does he mean a National Cancer Institute?
can the biopsy itself cause the cancer to spread ?
Thanks for your informative videos, they are great. A quick question: I've been diagnosed Gleason 3+4 about 6 years ago through a pathology report after TURP. I've had two MRI since and my PSA has never gone higher than 1.9. My doctor has never treated me in any way as he says that as long as my PSA stays low, we don't do anything. Never had biopsy aside from the chips that were removed during TURP Am I doing the right thing ?
I am not a doctor.....Is your doctor a urologist or an oncologist? Was a biopsy recommended?
Do you do PSA testing every 6 months or yearly? Have you had extended PSA testing, or testosterone testing? If you don't have an oncologist who specializes in prostate cancer, I would suggest you at least have one visit, just to have an over view of your medical/cancer history and medical tests scores to see where you stand today.
In my husbands case he had a normal PSA test, but it was a red flag because his PSA 6 months before that was 2 points lower. Biopsy came back a Gleason 4+3, Decipher test of the biopsy tissue, MRI prostate showed highlighted areas in the prostate. PSMA Pet Scan only highlighted in the prostate. He is now going through cancer treatment. All the urologist wanted to do was surgery, remove the prostate. After he declined surgery, the urologist recommendations was to see an oncologist due to the positive cancer diagnosis.
The 2 oncologist reviewed all results, came up with the best treatment for the cancer.
Any cancer diagnosis should always be followed by an oncologist. Research and get the best.
I'm in the Philippines with stage 4 prostate cancer. There's no Gleason test available but my last PSA was 14.4 after one month of Abilaterone, monthly Zoledronic Acid and Leuprorelin every 3 months. Any suggestions? Bless you all❤
The Gleason score is determined based on the analysis of a prostate biopsy. So you should be able to get that score from your urologist if indeed you had the biopsy. Because you are in treatment, your Gleason score is at least 3+4, and higher, but honestly, you probably have metastatic PCa, and knowing the Gleason score is less relevant.
Seems like you are hormone resistant. With the medication you are on, your psa should be undetectable. You need a second ontological opinion. Discuss more aggressive therapy.
Isn’t part of the problem with biopsy about the accuracy? The score can’t be relied on 100%. With a Pirads 5 tumor, which claims a 85% accuracy on the diagnosis with MRI, why would you do a less accurate biopsy? Asking because I am seeing a doc tomorrow. A PSMA PET seems like a better next step. I am allergic to the flouroquinolones, so the risk of an infection is a potential life threatening problem.
On 1/11/24, my PSA was 11.65, referred for MRI and Biopsy. MRI on 2/4/24 yielded Impression results, "No multi-parametric MRI evidence of clinically significant prostate carcinoma." PI-RADS Assessment: "Very Low (Clinically significant cancer is highly unlikely to be present)." Biopsy on 2/13/24 provided a "Gleason Score of 4+3=7" with 2 of 18 cores showing 3% and 10% "Adenocarcinoma of the prostrate" and "Grade Group 3." Decipher test results, "High risk - .67." Next on my agenda is a PSMA-PET scheduled for 3/18/24.
I’m utterly confused.
I don't know if I have prostate cancer but my doctor says that my PSA is 24 and he gave me antibiotics to treat me????.😅
Back in the day, the first thing that would be done for high PSA is to give antibiotics in case it was caused by an infection then they would redo the test after a month or so. But, nowadays they understand that antibiotics can be a hell-hole and can really mess people up. So, the standard of care now is to first do a urine test of some sort to see if an infection is present. Only AFTER they determine an infection do they prescribe antibiotics. If there is no infection present, antibiotics should not be prescribed and the patient should go to MRI. I would not touch an antibiotic unless I was diagnosed with an infection!
Is taking the antibiotics do anything to make prostate better if you don't have any infection, because I have already taken 14 days treatment and my doctor didn't say anything about infection.
@@eliasalmendarezsr.1918 I'll start with saying I"m not a doctor but if you have no infection in your prostate than there is nothing there for the antibiotic to work on so I don't see how it can help with anything. I don't know how many more days of treatment you are facing or what type of antibiotic you've been given but I do know this: it is not good practice for a doctor to prescribe an antibiotic for a prostate infection when the patient doesn't have a prostate infection. But, maybe your doctor has reason to believe you DO have an infection. But, even then, they need to know the type of bacteria to treat and that's done through a lab. It is mostly e coli and they normally prescribe Cipro for that but that's the always the case.
Ciprofloxcin 500mg and Doxazosin 2mg for 14 days, which I have finish yesterday so I will go to visit him and see what he says. And I'm also on treatment for ablation until my surgery appointment in May. Thanks for sharing your experience.
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
At the end he didn't mention the 8 Gleason, 4+4 with metastasis to the public bone chances of survival.
He didn't discuss any specific metastasis; he gave general rates of metastasis and survival statistics.
It seems the options are the same as 40 years ago when my mom passed from lung cancer. Cut it out, radiation or chemo. Not much advancement in treating cancer
If you have been diagnosed prostate cancer, ask lots of questions of your doctors. The PSMA pet scan is very new, and very helpful for decision-making. Be sure you understand your options before deciding what to do.
Not really. Look at his earlier videos
There is PLENTY OF NEW ADVANCES & NEW TREATMENTS
Focal therapies didn’t exist, there seems to quite a few options now.
I’m sorry but all cancer treatments are much more refined than they were 40 years ago
Are you the most hated doctor around? You are talking yourself out of a job because you actually care about the patient rather than our pocketbook. Someday all your patients will be on active surveillance and you will have to go into teaching to earn a living
Yeah, he's definitely not suggesting that but he must be irritating a lot of people and there's really nobody in the world that has more experience than he does. I post his videos, and then individuals who didn't take their time, rushed into it know that fear overwhelm him see his videos and almost reject it because they rushed off for surgery, and then brag about penile implants come on
Gleason score 3+3
MP MRI Stage 3b
PSA 82
Age 58 years
Best Treatment??