Who should get a prostate biopsy? | Peter Attia & Ted Schaeffer
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- เผยแพร่เมื่อ 26 ก.ย. 2024
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This clip is from The Drive, 274 - Performance-enhancing drugs and hormones-risks, rewards, & broader implications for the public
In this special episode of The Drive, Peter is joined by Derek, a fitness educator & the entrepreneur behind More Plates More Dates. He is also an expert in molecules commonly used & misused by bodybuilders & athletes.
In this clip, they discuss:
- Who needs a prostate biopsy
- What if an MRI shows a lesion?
- PSA density
- And more
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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
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I have had 2 prostate biopsies with no lesions either time psa was 7.2 and 10. That was 14 years ago. I have not gone back .
I’m 71 and in 2011 my psa was 4 but I did not get a biopsy. My psa rose to 7.1 two years later but I still did not get a biopsy. Three years later my psa was 21 but still no biopsy and three years later my psa was 28 and still no biopsy. Throughout this entire period I experienced no difficulty or discomfort passing urine or pain of any kind. My quality of life from my view was unaffected. My psa declined first the first time the following year to 26.7. I still have no symptoms that bother me or affects my daily routine. No pain or obstruction symptoms and still no difficulty passing urine. I will be 72 in June and at this point don’t think I will ever get a biopsy unless something drastically changes to affect my quality of life. I respect the decisions taken by others as they see fit but for me these are my decisions for which I’m prepared to take responsibility. I’m left to wonder had I gone in for a biopsy 14 years ago what would have been my situation right now health wise at age 71 with all the risks involved. I feel no different now than I did 14 years ago.
As an African-American. do you feel that the rising PSA levels are a concern? It sounds like your PSA was at the limit of 4 at the age of 58 and increased steadily over the years. Did you get an MRI?
That's good but of course it's all about statistics. Some smokers live a long time without getting cancer, but that doesn't mean smoking isn't dangerous. I hope readers don't take your experience to mean they shouldn't follow up if they have similar tests. Statistics of one case mean almost nothing.
The MRI will give you factual information and direct your next action: to have or not have the biopsy. The biopsy should be your second choice.
@@physicsprof.9639,,, Sometimes it is great to AVOID Doctors invasion of your person. I have proven that they're keen on saying "You need treatments " ..... Blah, blah, blah..... Sorry,,, BE your Doctor FIRST!!!!!!
@@thailandbuddy4451 What was your PIRADS?
PI-RADS 1 - Very low (clinically significant cancer is highly unlikely to be present)
PI-RADS 2 - Low (clinically significant cancer is unlikely to be present)
PI-RADS 3 - Intermediate (the presence of clinically significant cancer is equivocal)
PI-RADS 4 - High (clinically significant cancer is likely to be present)
PI-RADS 5 - Very high (clinically significant cancer is highly likely to be present)
I agree with comments below about Dr. Attia cutting off his guest mid-explanation. It's hard enough for us lay people to follow along so when it becomes a doctor to doctor shorthand conversation most of us can't follow along. This is a GREAT conversation, Dr. Attria is a stud for bringing so much valuable content to us but please who the audience is. Thank you.
Im 74, & dealing with the PSA roller coaster. God has done more through prayer than these urologits...
So you're relying upon your imaginary friend? Good luck with that one 😮
@@frannybgood I dont need luck. You will find out just how real God is, when you leave this life.
Tomato paste
😂😂😂
Same here.
Dr. Attia, when you interrupt your guest with the next question, you and he may be effectively communicating with each other, because you understand where the sentence he is speaking is going. But interruptions do not allow the guest to finish his sentences for those of us who need the whole sentence to be completed to know what he was going to say. The interview has to be for your audience, not for you and him.
All I have to comment on is , the repore that you have with your guests are extremely informative for anyone who has had the slightest fear of this subject matter.
I value all of your discussions!
timelston.... you were reading my mind. I found his interruptions annoying
Thats true he should let the other doctor to finish talking first resulting to interruption with what the other doctor is saying. As a viewer its hard for me to understsnd when dr attia intercept with the tslking
I don't see the risk calculator link mentioned at 3:57 mark??
My psa around 10-11 past five years two negative biopsy and then a negative MRI
Same here my friend. PSA of 10-12, 2 negative biopsies and multiple MRI's
Very good interview/discussion.
Where can the risk calculator be found? Thank you!
AT 65 I Had A Prostate Cancer That Was Gleason 4+4 And I Refused To Take The ADT Shot And I Got 4 Weeks Of EBRT And Permanent BRACHY SEED IMPLANTS .10 Months Later My Oncologist Said My PSA Was 0.3 And My Cancer Is Undetectble.
Are you on any therapy now, such as Lupton injections. Lupron may be a testosterone blocker also.
@thailandbuddy4451 No. I Refused To Go On ADT Hormone Therapy. But They Did Try To Get Me To Get On FIRMAGON Injections .All Have Brutal Side Effects.So Far It Looks Like I Definitly Made The Right Choice.
@@thailandbuddy4451 FIRMAGON Is The Testoterone Blocker That The V A Hospital Uses.
I had a PSA of about 2.2 - 2.5 every year. This year it was 3.8. To be cautious, the urologist had an MRI done. Suspicious lumps in my prostate were detected. A subsequent biopsy found 4+4=8 cancer in 10 out of 12 areas. This Thursday I have a PET Scan to determine if it has metastasized. The urologist doubts it due to the low PSA.
DO NOT skip your annual PSA test! And DO NOT let a doctor tell you it is probably nothing if it rises some!
Both the MRI and PET scans at Kaiser are the same price on Medicare. ($225) I would not want to damage the prostate further by puncturing it multiple before a PET scan. 😮
Where are the reference materials mentioned in this video?
So where's the data relating MRI results to Biopsy results which he spoke of with such reverence and which suggested that ALL PI-RADS 3,4 and 5 turned out to be csPC? My take on the most recent studies is that maybe around 20% of PI-RADS 3 lesions might have some form of PC but only around 5-10% would likely have clinically significant prostate cancer. I wouldn't want a biopsy with a PI-RADS 3 result and a low PSAD (which I actually have!) But Ted says he'd biopsy all pirads 3 regardless of PSAD. Show me the data he was talking about
Thanks for having these conversations, much appreciated - oh and I did buy your book sir :)
I am 74 and am concerned that with a PSA of 17.7 and a prostate 7 times original size, it was noticed in a prostate scan that I had a tumour in the left kidney, tumour removal scheduled for the end of July but the surgeons are not planning a biopsy of the prostate until after the kidney surgery. It seems a long time away.
Where is the risk calculator link mentioned at 3:57 mark? Thanks for sharing.
Where's the risk calculator guys?
please advise me where may I find all these figures and statistics mentioned in the interview....
The percent free PSAi s the ratio of the amount of free PSA compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not. So when my Urologist refuses to do this test and only does PSA total, how can I calculate the present free PSA myself or is it possible?
The makes no sense. If you have a high PSA and low Free PSA, but have a clean DRE, Pi-rad 1 or 2, and a low prostate density, you still need a biopsy. This process is starting to sound like witchcraft.
Yea i was going over and over again, like did he mean high prostate density over 0.15?
Dr. Attia, thanks for your excellent series to educate all of us. I wonder who your listening audience is- the public or health care professionals. It comes across as the latter. Please tone down your medical terminology to include more of us. Thank you.
You
What about PSA levels and TSH hormone? Hyperthyreosis might be associated with higher PSA levels. What about ExoDx Prostate test vs Prostate biopsy?
Dr. Schaeffer I would like to come see you but your staff will not give me an appointment. Mild left sided prostate assymemtry with PSA of 3. I am a doctor in Arkansas and would travel to see you! Thank you!!
My PSA was 2.3 in 2021 3.2 in 2022 and 5.7 in 2024. I was sent to a urologist who right away wants to do a biopsy. Very confused. Should I get the biopsy, very confused.
If you get a biopsy, what are the risks besides infection. Can the biopsy cause a spread.
Please let me know too, my father is in same situation
Do a mpMRI at a good urology center. If no lesion and psa density below 0.15 - maybe nothing to worry. Repeat psa in 6 months. Do an Episwitch pse blood test or ExoDx urine test to determine risk.
Get a MRI first.
Has anyone found the link for the risk calculator?
Two prostate biopsies for me. I would not do it again. First, biospies only gather samples from half the prostate. Second, painful and expensive. Third, while most doctors would disagree, psa is a better overall indicator of a problem. Fourth, I wil go on Tippens Protocol before chemo, radiation or surgery. Fifth, inflammmation is not your friend is you have cancer. A biopsy creates a lot of inflamation in the prostate.
Can I ask how old you are please?
Doesn't a Psma pet scan, combined with a 3T MP MRI give you most of the critical information you need to go forward, without punching numerous holes in someone's prostate? Gleason scores are great, but are they absolutely mandatory?
In addition, the biopsy procedure itself seems rather random and unreliable....."hit and miss".
agreed
where's the slide mentioned at 1:54 ?
My MRI showed several lesions, so I had the biopsies done. Six of them showed cancer. I have 2, 4+5s. 2, 3+5s. 1, 4+4. And one 3+4. On the Gleason scale. My doctor told me I need to take care of this as quickly as possible.
Take care how? Removal or chemo? Or both?
@@crpunks I consulted with both, and in my situation, opted for surgery knowing there's still a chance of needing radiation therapy down the road.
@@markfll hope everything goes smoothly and turns out well!
@@crpunks Thank you.
@@markfllhow are you doing now
Whatever you do, don’t let anyone do the Urolift procedure on you, the metal implants cause an MRI to be totally useless (my personal experience).
I refusedca biopsy with a uroligist when i was only 62 nothing since either at now 85 is thjs luck?
Why he wants to do a biopsy? High PSA? etc?
PiRad score of 2-3 with a 9mm lesion shows mild hypointense and mild hyperintense. Psa density of 0.063. Of a 83 cc prostate?
Is it difficult to find a medical staff that will give general anesthesia before biopsy or do you have to really “ shop around” to find one?
Wish that the urologists were as forward minded as Dr Schaefer implies. Sadly, lots of surgeons and radiation specialists still recommend treating Gleason 6
I had a psa of 4, got an mri, found I might have something,got a biopsy (not pleasant), and discovered I have mostly 95% 3+3, 5% 3+4…Dr suggested for active surveillance (with future biopsies and psa tests), this was a week ago, not sure what to do since the big C is a shock, radiation and surgery both have effects so ..?. I’m 66. Thoughts, opinions?
Surgery is okay but stay away from chemotherapy go with dog dewormer.
I thought 3+4 still in the safe side unless it is 4+3. I may consider your doctor recommendation, do AS for now.
@wapickle1 biopsys are no good they make the cancer spread I had a biopsy and got poked 10 times when they tell u need a biopsy it's means multiple biopsy I left never went back ,used my own system that God give me and I am healed, Herbs mixed with Dog dewormer it killed the cancer.
Any issues with delaying prostate biopsy a couple of months? In my area, earliest appointment is about 2-3 months out.
PSA up to 7 octogenarians is designated within normal by Kaiser.. What is going on with PSA with age?
I had a biopsy and got sepsis. I’ll pass. I do MRIs now
I like to know whether the prosted gland can be removed or not?
It would be helpful if you would let your guest answer the current question before interrupting with a different question.
💯 What a douche!
I have a question. Is there any side effects from the Biopsy.
I believe infection in a small %
I am surprised he did not mention localized treatment of the cancers that preserve the rest of the prostate.
He is a urologist. They just want to remove the entire prostate all the time. Butchers.
@@schmingusss Well, I don't know how long this has been done, or the parameters of when this is an acceptable treatment, but it is done. Should be mentioned. And I should add it is surgery that a urology surgeon can also perform.
I attended a talk by Dr. Scott Eggener of University of Chicago!
I've had 3 negative biopsies and I was scheduled for another in October. My PSA has gone from 5 to 11.5. Will I need a biopsy immediately?
Sometimes it might be due to Prostatitis that cause a high jump in PSA. Get check, maybe doc treat with antibiotics and hopefully go down and/or mpMRT. How old are you, you already have 3 biopsies coming to the fourth? I am contemplating whether i want a biopsy with PSA 7.8, Negative (Pirad 1--2) MRI with no lesions and mild BPH. The urologist recommend one but I felt like he is always pushing for biopsy $.
I just had a biopsies when i went he said it was enlarged but my result came back nomad
Why don't you use a PET scan after the MRI scan before you do a biopsy?
Because PET scans are expensive in the US and insurance may not cover.
@@samkumar8062 In California my PET Scan was hard to get approved by insurance even after I had a biopsy proving I have cancer!
I think i missed the conversation. If i have PIRAD 4 with,0.004 cm and PSA density of 0.07, PSA 2.5 on Finasteride, will require biopsy?
PIRADS4 indicates that “clinically significant cancer is likely to be present”. However, the PIRADS could be downgraded or upgraded. You should have an institution that deals with PC read the MRI. I would believe that a prostate doctor would tell you to have the biopsy. Only in the pathology report do you get the most clear evidence of how “significant” the cancer is that is present.
Dose a Psa 0.02 mean non detectable
Very helpful, thank you! Pardon if I missed it but what is PSA?
Blood test for prostate specific antigen.
Prostate Specific Antigen. The test for PSA is standard.
www.cancer.gov/types/prostate/psa-fact-sheet
I'm not a doctor but I had prostate cancer. Prostate-specific antigen, or PSA, is a protein produced by both normal and cancerous prostate cells. Its main role is to keeps semen in liquid form so that sperm can swim. A simple blood test can measure how much PSA is present in your bloodstream. In almost all cases of prostate cancer the PSA level increases. It should be less than 2.5 ng/ml. Mine was 4.7.
@@creez1 What age were you? Mine at age 30 is 1.3
@Maiden4eva1995 I was 58. My PSA was increasing year over year and I was finally referred to a Urologist. They say one in nine men get Prostate cancer. It is among the most treatable and curable and like most cancers the earlier it is treated the better.
Well, I have been invited to get a Biopsy, should I just give no less than twenty medical people something to do in Australia?
Very confusing
What about 3+4=7? Inquiring minds want to know!
Those 3 + 4 = 7 are a part of the biopsy pathology report and are for determining the Gleason score which is the aggressiveness of the tumor.
The best is 3+3=6 because Gleason 6 never grows.
Gleason 7 is by two ways: 3+4 and 4+3.
3+4 Gleason 7 means that the tumor is mostly Gleason 6 but has some aggressive Gleason 8.
4+3 means that it’s more of a aggressive Gleason 8 with a bit of Gleason 6.
4+3 types need surgery to treat their cancer.
@@ИгорьИжщенков Your explanation is a generalization from person who does not specialize in cancer, your explanation "4+3 need surgery to treat cancer" is so absolutely incorrect.
Gleason Score 7 =3+4---Grade 2--Risk Group Intermediate (favorable)
Gleason Score 7 =4+3----Grade 3--Risk Group--Intermediate (unfavorable)
A Decipher Test-is a tissue-based genomic test that helps in treatment decision-making for localized prostate cancer. It uses the tissue samples from the biopsy.
You can get a 2nd opinion of the pathology of the biopsy to check the accuracy of the Gleason Score
Your oncology can order a 3TMRI of the prostate
When it comes to the possibility of cancer a doctor never says it will never grow
Gleason score 6 is the lowest grade of prostate cancer. This rating means that the prostate cancer is considered to be low- or very low-risk disease, or group 1.1 Most of these tumors are found during routine prostate cancer screenings.
Gleason 6 prostate tumors grow slowly and may never cause a problem-or even need treatment. Still, they should be monitored
@@threeftr3349 YOU ARE CORRECT. The statement “4+3 need surgery to treat cancer.” Is TOTALLY FALSE.
Is having a bald head another indicator, or should sack all of the female medical people that I am going to meet briefly during the next two years in Australia
The best solution of ANY kind of tumor in prostate if if it is 3+3 is to remove it immediately...the longer you wait the bigger and worse it becomes.Forget monitoring with treatments available today.I have plenty of experience with tumors talking for the sake of talking And gor sure I would NOT use this expert. Hahaha.
Gleason 6 3+3 is not cancer
@@johnmchale8308 I can guarantee you that in time it will be!
@@johnmchale8308 that is true.
I can’t spot the link to the calculator mentioned in the talk, am I not seeing something?
Thank you for explaining so clearly!!
psma pet with MRI will be the new gold standard before biopsy?