The Four Levels of
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- เผยแพร่เมื่อ 5 มี.ค. 2023
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In this video, medical oncologist, Mark Scholz, MD, explains the terminology used to categorize the four major categories of treatment for prostate cancer. Dr. Scholz explains "active surveillance," "local therapies" (to the prostate itself), "systemic therapies" (for the whole body), and "combination therapy" which can involve any combination of local and systemic therapies.
0:25 What is "active surveillance" and who is eligible for it?
2:49 How does a patient seek out a targeted biopsy if their doctor recommends the older random 12-14 core biopsy?
3:43 What is the meaning of "local treatments" and what are the different types of local treatment?
5:01 How is the Gleason score relevant to treatment selection?
5:53 What are systemic therapies?
7:32 what are the side effects of the different systemic therapies used in prostate cancer care?
8:57 How severe are the side effects of chemotherapy in prostate cancer?
9:58 What are some examples of combination therapy in prostate cancer, and when would it be used?
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Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website at pcri.org or contact our free helpline with any questions that you have at pcri.org/helpline. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
The information on the Prostate Cancer Research Institute's TH-cam channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
#ProstateCancer #MarkScholzMD #PCRI
Great info. Thank you. You give us so much hope.
At the risk of being boring and repetitive, you guys are a shiny light in the dark world for men with prostate cancer. It’s often a lonely time and hearing your encouragement of all the treatment options gives us that important will to press on. Thank you for your massive commitment in time and knowledge for blokes like us.
Dr scholz's information is invaluable and Alex's words at the end of these posts give us calming hope and reassurance and literally just make us all feel better! Thank you so much!
You are such good people. Doing such good in the world. Thank you.
That is the nicest tie/suit combination I have ever seen Dr Scholz wear. Very tasteful. 👍
One of the reasons I went with ADT + HDR + VMAT was from watching your videos G9 contained. Thank you for putting these out there. It ended my life when I was told I had cancer until I started to learn.
I had my prostate removed about 8 months ago, Gleason 9. Had a strong aggressive radiation treatment after surgery since my PSA was not down to zero. Had a PSMA PET scan which only showed a faint tiny spot in the bed of the prostate. Now four months after 40 rounds of radiation my PSA is still not zero. ( just found out the results today). I see my urologist in a week but anticipate another PSMA PET scan. I found this video reassuring that I still have more options left. Thank you for the information!
You guys are AWESOME!!!!!!!
Fantastic work you guys do, keeping us up to date with everything. I am on Darolutimide and zoladex at the moment, very stressful but you seem to relieve the anxiety,
Thanks so much, Glenn from Gold Coast Queensland Australia.
You guys are just super special. Your channel has been of enormous help to me since I was diagnosed 3 plus years ago with metastatic prostate cancer. Thank you
Just diagnosed.....thank you for helping me think clearly.
I have been following this channel for some years now, and I would like to thank Dr Schulz and Alex for their invaluable information. I was diagnosed with advanced prostate cancer in 2018. The factual information you give us help me understand my medical situation and teaches me about various forms of treatment. You make it so easy to understand. Sometimes I do not get all of what my doctors are saying. For that reason, I tune in to your program with eagerness. Thank you very, very much! Chris from Spain.
what was your psa when your were diagnosed ?
@@Chris031999 My PSA was 17.1 and 17.6 two weeks later
So much more information, explanation and encouragement on this site than one gets with doctors to whom you can be paying thousands!
Into this with stage 4 for the last 3 and half years the new videos always give me hope and helps me understand more. Keep up good work.
R u there??
The information and knowledge is awesome continue the great work. Thanks for all you do and stay safe much love team.
Greetings from the UK. Excellent presentation. Thank you.
Thanks for this uplifting video. It gives me hope for the future.
One of your best videos. Thank you so much.
Bravo! Great video.
Thanks for keeping us aware of latest technologies and making us feel positive and hopeful.
What a wonderful doctor.
Thanks Dr scholars and Alex for this edition of combination treatment of prostate cancer which is very informative and helpful. 15:22
Thanks for this video and the nice words in the summary. I'm currently undergoing combination therapy, Zytiga, Taxotere, and Lupron. Stage 4 57 years old
I am also doing the combination therapy, but I am doing Abiratone (1000 mg), Lupron and have gone past Zytiga and now I'm on Prolia every six months.
How is it going so far?
What are the side-effects have you been experiencing?
I am about to meet my oncologists about therapy.
The hormonal suppression therapy is the one I dread the most...
My doctor stop see me because i will not do the Surgery.
@@jb66young: I think you need to go see a different doctor. Not every dr wants to cut only surgens.
@@mikeorjimmy2885 try to find one in nyc is very hard.
Thank you for a clear, common sense, honest education on cancer prostate. My two urologists and radiologists need to get updated into 2024 reality. As a 78 year old CPA, I know how to investigate a new area of a problem. .
Excellent video. This is such an great place for information. It has really helped me.
Thank you for sharing
I really enjoy these Q&A sessions. Both speakers have a nice delivery that can be easily understood by a patient or a clinician. Great work!
clear pertinent information , tks
These are excellent video’s. I had prostrate cancer since 2008. I currently Getting ready to take my 5th treatment of 177. Been a struggle . Seems like it’s . working, got my fingers crossed. Your video’s are very informative.
Have been following you for quite sometime very good topic covered for prostate cancer grade.
Which stage of cancer do u have??
I started watching your videos in 2017 and have read some of Dr Scholz books because I knew I had double the risk for prostate cancer because my Dad had it. Besides yearly PSA tests I also had 4k, PHI, and mpMRI. Last year the MRI showed an area of concern and it was a Pirads 4. I contacted PCRI whose advisor said to have a targeted transperenial biopsy. The biopsy was a Gleason 3+4=7 and it was considered a Group 2 T1c and considered favorable. Thanks to PCRI I already chose SBRT treatments instead of Active Surveillance because I knew my Dad's pc was aggressive. I would have preferred a combination treatment even though my pc was favorable because I didn't know if my cancer would behave like my Dad's but the radiation oncologist said over treatment is not good. Thanks Dr Scholz and PCRI for providing information that made my decisions much easier.
Did you consider Proton or Brachy therapy in your analysis? I'm at that point where I need to decide. Just wondering. Thanks!
@@wsweger
My urologist thought I'd be a candidate for Brachytherapy even though my prostate was larger than 60cm (mine was 69) but the radiation oncologist felt the Brachytherapy would not be as effective because of my prostate size. Also with Brachytherapy they said I would need to lay on my back for 10 hrs while having the treatment which would prove difficult for me. Proton therapy for me wasn't an option only because no medical facility in Iowa offers it. I chose the high dose SBRT radiation treatments for convenience because it was 5 treatments every other day (not counting weekends) so they were finished in less than two weeks. There were some preparations before each SBRT treatments which I'm not sure if they'd be the same as IMRT treatments. Best of luck in you treatment decision.
duane.... reading this is almost like reading my own situation right down to the numbers and my father having had PC. I have chosen SBRT and opted to pass on HT. I was offered 6 months of HT and after discussing it with the RO he was on board with my decision. I'm 71 in May and my SBRT starts near the end of May.
@@davewilton3101
Dave,
I don't know if you have an enlarged prostate or BPH symptoms. I had both and I would urinate several times, couldn't hold it, and urgency. I had a concern because I had to drink 20 ounces of water an hour before treatment and I worried about being able to hold it for the hour and then an additional 25 minutes for the treatment. And a couple times even after getting on the table for treatment, even after drinking 20 ounces, I had to drink about a additional 8 ounces more. Thank God they gave me a penis clamp that kept my bladder full (which is very important) and it kept me from going!! So if you have the same issue as me, ask about the penis clamp. It will help!! Best of luck with your treatments.
Best
Duane
Excellent videos! Thank you for educating me! I am overwhelmed with gratitude & not as fearful. I am the spouse of a wonderful man that has begun his pathway on healing modalities for prostate cancer. After a few good fearful cries, I wiped away my tears & decided to educate myself on the ways to provide love & support! Both of you are rock stars & have helped my understanding 🎉
How effective is sucking ice and dipping your finger nails in an ice bath during chemo infusions which typically lasts 1 1/2 hours? The cytotoxic poison that is in your system typically takes up to one week to be "expelled" from your body. The chemo infusions put me off a lot of foods, even tap water tasted horrible. My finger nails turned brown and became slightly deformed. Half of one thumb nail detached from the thumb. All worth the pain if the microscopic metastasis still in my body are hammered into oblivion! (I am stage 4, Gleeson 4+5, with distant metastasis to lymph nodes in the para aorta and clavicle regions. So far I am recovering well to ADT, Chemo and radiation. Original PSA was 38 and my last reading was 0.06. Hopefully still dropping as treatment is still in progress). Love your educational videos.
That really doesn't sound like "mild" - even relatively - side effects they mention in this video. However I'm glad it's having a marked effect and wish you well.
Update please 🙏
PSA has been uindetectable for past 6 months and hopefully forever!@@perfectly22smith38
Another great summary, thanks. I am having a very rough time with the combination of radiation and hormone therapies. Another 18 months to go on the latter. Don't think I'd do it again if the cancer comes back.
Tony, I take it you are having a tough time with hormone therapy, I can totally understand it, I have massive decisions to make very soon regarding RT + ADT
Personally I don't want ADT, the list of negatives are all wrong for me, I've looked at at least 4 major studies that suggest recurrence after 10 years that says there is maybe a four to seven per cent advantage with RT and ADT, and in one large study it actually said RT alone was better percentage wise, these were for intermediate prostate cancer, your looking at 92 percent v 85 per cent in some of the studies that the cancer won't return, I think an 85 per cent chance of the cancer not returning for 10 years with solely RT are fantastic.
You have a quality of life, and being castrated just for starters is all wrong given the percentages. Add the rest of the negative side effects and it's a nightmare imo!
@@daveyeddie8176
Thank you sir. I am in the same boat.
My diagnosis is agressive prostate cancer with bone metastasis.
I will get a better picture next week.
Then on April 4th, the treatments will be discussed.
The hormonal therapy seems like the most terrible form of treatment...
Hang in there brother
@@cwalker3783 They will push you heavily for ADT if you have bone metastasis, I am not saying under no circumstances don't have ADT of course not, they give you medications to offset some of the side affects, my dear old friend got PC when he was 65, he used to get his Hormone therapy as it had spread to his bones, he passed away mid 80's but not because of PC,other causes. All the very best with any decisions you make, you can still get on with your life for years and years to come.
@@daveyeddie8176
Thanks for the advice. I have read a lot on the subject.
However, I prefer hearing from other men who have first hand experience...
I had external radiation treatment in 2011. My PSA dropped from 25 to 1.6. However in the last 12 years my PSA has slowly risen..to 35. I have never had a symptom of any kind. I am 73 years old and am very active: swim every day, walk every day, ride mountain bike every other day. Recently, I had a PET scan that showed my cancer is still local in the prostate. My doc says I should get this treated with brachia therapy HDR. I am scheduled for this treatment next Monday and 11 days later on Friday a second treatment. I know the risk of side effects need to be balanced by the risk of this local cancer jumping ship, matasticizing out of the prostate into bones, etc. Should I be considering anything else before I get the 17 needles.???
Any side effects of the treatment?
are there a standard set of questions to ask your urologist so that a fuller understanding of your particular choices of treatment can be arrived at?
How do you choose a urologist as many seem to have a particular background for example, surgery/radiation/active surveillance/a particular hospital etc etc
I would love a video on the belief touted on credible sites that TRT exacerbates prostate cancer.
My father (Gleason score 9 & PSA 226) had a CT scan and bone scan. Both showed no spread ohter than 2 illiac lymph nodes and a suspicious spot on pelvic bone. He redid the bone scan and CT Scan 5-6 months later and still no change. He did 5 months of full pelvic floor radiation with booster to lymph nodes and continues to be on hormone treatment. Does this count as combination therapy which gives the best chance at a cure? his team said they are aiming to cure but said chemo is not needed at this time
Interesting that the new trial suggests only doing a new biopsy if a new lesion presents itself. I have (4) 3+3 and (1) 3+4 and two lesions. However, the 3+4 (cancer) is outside either lesion. Wouldn’t that suggest that lesions are not always cancerous? Or is the study saying that there are so few cancers found within the men in the study that the biopsy is unwarranted because it finds so few men with clinically significant cancer. I hope Dr. Schulz with speak to the NEJM trial: Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only.
I empathise with this. I've had two MRIs suggesting significant disease in areas where biopsy showed no cancer. What I've never had a proper explanation for is what these "significant" areas of concern DO represent!
If going with localized radiation treatment, how does the radiation effect (in the future) current symptoms while urinating, such as slow start, flow rate variation, use of flow max and finasteride, constriction of urethra, future possibility of having to surgically remove prostate tissue to enlarge urethra channel? Looking forward to reply, thanks.
PSA was high. MRI showed nothing. Second MRI one year on showed a spot of concern. Fusion biopsy yielded Gleason 3+3=6. Active surveillance is my preferred treatment. Next appointment is with a radiation oncologist.
I have Stage 3 Gleason 7 & 8 going for a pet scan next week. They are recommending radiation for 6 weeks and hormone shot monthly two to three years. Just wonder if i could hold off on the hormone because of the side effects
What about treatments for reoccurrence prostate cancer. If your PSA goes up to 0. 24 in four years. Pet scan shows .very small in the bed of were the prostate was .66year old
My dad who is 82 now had radiation for metastatic PC Gleason 8. His recent PSMA pet showed some uptake along the shaft of penis. Doctors did FDT pet and ultrasound to confirm it. His PSA has been consistently low and he is on ADT and enzalutamide. This is rare for cancer to differentiate in penis as per advice.
Please tell me what are the treatment options suitable for him? His radiation oncologist think that if he radiate penis then it can leave him with permanent catheter. I live in Australua Please advise should I get second opinion if Yes, then what specialist should I contact ?
His PSA is 0.2. He had urinary symptoms of dysurea throughout but now his symptoms have improved but scans deteriorated with new finding along the shaft of penis
always get second opinion from best specialist you can afford I think
Stage 4 and on 1st and 2nd generation hormone therapy, I have 2 bone lesions
Is there evidence that radiation to the prostrate and lesions would extend survival time ?
Hi, please reach out to our Helpline team so they can help you regarding your specific case: pcri.org/helpline
So if you had ADT and 9 weeks of Bean Radiation treatment in 2023. Let's say it was successful. How long on average before the cancer returns in a Gleason 8 patient, if at all? 10-15 years?
I received an infection from biopsy for prostate cancer I can’t get rid of. Can you help me?
Tell me more about it , how did it happen.
We're are you located.
Your videos are extremely helpful and so many of us rely on your accurate information!
I was diagnosed in 2015 and had focused radiation treatment and was on Lupron for 24 months.
My PSA began to climb in 2021 and in September of that year had a PSMA Pet scan done at U of M and a metastases was found in my left lymph node which was treated with radiation.
My PSA stayed low all of 2022 but climbed slightly from 1.9 to 2.4 in February so another PSMA Pet scan was performed this time at Henry Ford Cancer Center in Detroit last week. I’m delighted to report no metastasis was found so I will get another PSA TEST at the end of April and continue to monitor.
Thank you again for your support!!
What about a PSM a pet scan?
Instead of the random biopsy .
Million dollar question is there help for those who don't have health insurance or the ability to pay for treatment.
I wonder why powerful country does not provide healthcare to their people. That should be the leaders' first goal as well a the first subject to invest in: health.
@@Lola.1952 Well for one the governments priority appears to be more willing to spread money on wars and influence in other countries. I would call this gross mismanagement and corruption of the handling of taxpayer money.
@@Lola.1952 You are right. Healthcare should be a primary category paid for out of your income taxes. Spending trillions$ on arms whilst ignoring Healthcare for its citizens says a lot about the Govt!!
Sometimes govs' interest is focused on showing off their richness and power rather than investing in the wellbeing of the citizens who make up the country 😏😢.
What does psa
My husband was diagnosed with stage 4 Prostate cancer a year ago. He receives a Lupron injection every three months and had Xtandi added 4 months later. His PSA continues to be under zero with last months level at 0.014 which is under zero and cancer is considered undetectable.
Under zero would mean negative number, get it?
Watching many of these videos you would think nobody ever suffered or died from prostate cancer. If that's the case I am not sure why 30,000 men die each year in the US from prostate cancer.
@@baddmatt1 So you are saying that if you die/suffer from prostate cancer it is your own fault.
What about many doctors and medical organizations that advocate against getting PSA checks.
What about men who have no symptoms until it is too late.
What about men who get treatment using hormone therapy and/or chemo therapy which causes the prostate cancer to mutate to neuroendicine or small cell prostate cancer for which the average prognosis is 12 months.
You are your uncle may have been fortunate to have a non aggressive form of prostate cancer .. but not everyone is so lucky.
I respect the discussions on this channel. The information is, in my judgement, accurate.I have recommended the channel to other men who have be diagnosed with PC. However, when you talk about "exercise" while receiving radiation and ADT it is so very hard to do. Those two treatments knocked me on my butt. I tried to exercise but it was a Herculean task and I don't think, given the weight I gained that I was successful. Please let men know that when you say "exercise" that you understand how difficult that may be.
Qi agree! It even a 5-10 minute walk makes a nice difference
My husband has his prostrate removed 17 years ago it has now come back and is sitting in the prostrate bed he and been on casadex but his PSA has started to go up so he is now having luprin hormone injections very 3 months and they are trying to keep the PSA below 2 it’s at 2.1 at the moment he is very anxious all the time
He is depressed mainly because his breasts have grow enormous he was never offered any medicine to keep that from happening when he started casidex 17 years ago it is to late to try and reduce the breasts now!
He is on a plant based diet also using turmeric garlic and
Moringa and is exercising but probably not enough mainly walking and no weights his age is 76
Would like to add your videos.have given us hope and we have gathered a lot of support from them
No weights is fine. A little more walking will make up for it. Hopefully he will get back to normal.
Ive had radio now im on hormone therapy for a year ,see what happens ?