Managing Gleason 4+4=8
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- เผยแพร่เมื่อ 22 ม.ค. 2023
- Gleason 4+4=8 (Epstein Grade Group 4) is the lowest Gleason score that is considered "high-risk prostate cancer." Despite the ominous terminology, the cure rates for Gleason 4+4=8 are still very high and the "high-risk" refers to the cancer's potential to spread if left untreated. Here, medical oncologist Mark Scholz, MD, discusses everything a man needs to know if he has been diagnosed with Gleason 8 prostate cancer. He explains how PSMA PET scans have changed the process, optimal treatments, and the factors to consider when making treatment decisions.
0:06 What does Gleason 4+4=8 mean?
1:15 How does a patient confirm that their prostate cancer is truly a Gleason 8?
2:05 What kind of survival rate does Gleason 8 cancer have?
3:46 What are the optimal treatments for different types of Gleason 8 prostate cancer?
4:52 How has PSMA changed the staging process for Gleason 8?
9:02 Will doctors universally recommend a PSMA PET scan when it is appropriate or should patients be prepared to ask their physicians about it?
11:35 What is brachytherapy and why should prostate cancer patients be aware of it?
12:38 The two forms of brachytherapy are temporary or permanent seeds. Is one better than the other?
12:54 Is focal therapy feasible for focal therapy?
13:48 What is the role of MRI now that we have PSMA PET scans?
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So far I’ve had my Gleason 8 for more than 3 and a half years. 93 PSA in the lymph nodes have had all those treatments. I’m getting my first PSMA PET SCAN in two weeks at Mayo since I keep failing the treatments. The quicker they find it the longer I stay alive and as long as I’m feeling okay and doing what I like I’m willing to keep on fighting. It does get old getting treatments and going to Mayo every 3 months or sooner but I’m only 68 and if I make it to 75 I’ll have 10 years to enjoy my retirement and get to see my great grandkids become teenagers what more could I ask for. Thanks for the video’s and all the information you put out. 😁
Do you believe in afterlife?
Great attitude!
@@koof1776have to!
I was diagnosed with a Gleason 9 (5+4) w/ a PSA 17 (T1C). So I hope you found a treatment good for you. Peace
The value of these videos are immeasurable and it's a pity that more people cannot find them. Even doctors don't seem to have this knowledge or care not to know. Great job guys. Thank you!!!
This Doctor is a dang genius. If you've been recently diagnosed with ANY Gleason score cancer, I HIGHLY recommend educating yourself prior to taking action.
In March, I’ll have been on hormone therapy for 4 years. However, my Gleason score was 9. I’ve also had surgery & radiation, was placed on a secondary hormone therapy & June 2022 started a clinical study with Lu-177. At the start of the study, PSA had jumped from 1.96 in March to 5. PSA started coming down to 2, then .77 & then at the end of the infusions, .55, with no disease progression (it had made a spot on my pelvis, but the bone biopsy was inconclusive a few months before the study). Hormone therapy has given me brain fog & ED & fatigue, but it seems I’m on HST for the long haul. I know this video is about Gleason 8, but wanted to share what I’ve had with Gleason 9 & coming up next month with being 4 years on my PC journey. I’m hoping that more effective treatments come along to where I can find one that can cure my cancer (although my urologist keeps stating I had bad pathology so much so, on my last visit with him, I turned to him and said, “you know, i’m tired of hearing that sh*t.”). Just gets hard to keep being positive sometimes, but I am pushing through & fighting.
Thanks buddy Karl, I also have Gleason 9 (locally advanced) no metastases from nuclear scan, recently diagnosed sept 22, adt from that point weight gain, brain fog etc as you described also I've just started on 37 radical radiation treatments it's informative and empowering to hear your journey, I've not had a psma scan yet, thanks for sharing and stay strong going forward, bless you
Thanks for sharing. I’m glad you spoke up to the doctor, it was necessary to vent the feeling.
My hormone therapy is nearing one year and I can barely stand it. The steroid meds really add to the horrific emotional bouts. I am physically exhausted but force myself to get things done. In my mind I say, if your going to feel like sh!t you may as well do something constructive. I’ll feel like sh!t either way.
I don't think that there is a better resource out there on the web that handles these sensitive and scary topics better than Alex and Dr. Scholz. My results will be made known to me this coming Monday and to say that I am now worried is an understatement. So a huge thank you to both of you for spending your precise time to help us men.
I really enjoy alex's advice at the end of dr scholz's talk on these videos, great format and so helpful! 🙏
These videos make me cry, every time. It’s the hormone therapy! - my case - Gleason 4+4 on two core samples 3+4 and 4+3 on six or eight others, and 0 on the remaining. Left seminal vesicle intrusion and left Lymph node metastasis. No bone metastasis. My MIR showed two tumors, or what they called lesions on both hemispheres of the prostate. The PSMA pet scan showed “the cancer left the building, but is still in the parking lot.” - PSA Friday was
Thanks for sharing. I’m Gleason 7. 2 cores 4+3 on one side and 1 3+4 on the other side. I’ve been on ADT for almost 5 months and waiting for EBRT. I think I’ll one more 3 month course and that’s it. 2 PSMA PET SCANS showing no spread. Drs are still talking 18-24 months. Not doing it.
@@EpiMetricsGF like I mentioned, the experience is monumental. I chose to do this therapy with the assurances from my doctors they are using a hammer and not a bag of beans. I’m doing this once for better or worse. My opinion is (not asked for) do it, get it done two years goes by quick. Says the guy tearing up…
George: Any discussion of HDR Brachytherapy + EBRT for your situation.
@@robertmonroe3678 There’s been no discussion on Brachytherapy only EBRT. As Dr Scholz indicated, brachytherapy is not getting the attention it should get.
@@EpiMetricsGF your case is similar to my dad’s case. Currently he receives hormonal therapy combined with EBRT 25 session. Have you done prostatectomy yet?
I don’t doubt that some, or most, men do not tolerate ADT well (especially long duration treatment). But my own experience with a 4 x monthly course of neoadjuvant / concomitant leuprolide with EBRT was that it was very tolerable. It did decrease libido but otherwise no hot flashes, negligible fatigue, etc. and my testosterone level was fully recovered about 3 months after the last monthly injection. I offer this info so men who are recommended ADT along with curative treatment do not fear ADT side effects. Consider a 1-month dose rather than a longer duration depot so if the first month is intolerable, the side effects will be quickly gone.
Great information, I'm a young 65 and just got a Gleason 8 score with a PSA of 6.8. I have also been healthy and never smoked. My Pet Scan is in 1 week, hopefully it's just in the Prostate. This runs in my Family. One of my brothers died from it, but he didn't seek treatment right away. He was the guy that denies he is sick! Not me, I'm leaning towards Radiation over 6 weeks. These videos are very helpful to me. Thank you very much.
Good luck! You are really on top of it, usually the ones that do the best!
@9cyrus540 @@perfectly22smith38 My husband will be turning 65 next year, and is an avid cyclist who sometimes get prostatitis. He gets regular PSA test, a biopsy 5 yrs ago was negative, was performed because he was concerned for cancer, since it's common in men.
His doctor ordered a PSA 6 months after the routine yearly, because of some irritations/prostatitis He went from a 1.7 PSA to a 4.2 PSA. Because the PSA double in 6 months the doctor was concerned. His urologist did his 2nd biopsy and that showed Gleason 4 + 4.
His Oncologist will be doing a modular test on that biopsy
My husband has 2 oncologists in 2 different states.
He is going get a pet scan at the oncologist office tomorrow--I will verify it's a PSMA pet.
His treatment will be ADT treatment for 6 months, 2 months into ADT treatment. A Highly skilled---considered the best in the nation Dr. Agarwal in CA will be performing the brachytherapy procedure. After that treatment, he will get beam radiation once a day for 5 weeks.
My point of commenting is his PSA never went over 5 !!. I see many comments about 9-10 or higher.
Maybe getting** PSA checks every 6 months should be the norm for anyone 60 and older**
Doing that extra PSA I believe has saved his life.
I had Gleason 8 3+5. PSA was at 10 MRI showed No cancer spread. I chose ERBT Radiation. Doctors wanted 2 years ADT. 4 6 month shots of Eligard. I took the first 6 month shot went back in and told the doctor No More. Side Effects lasted for about an year.
A biopsy reading is essentially an opinion. Yes a highly skilled and trained pathologist's opinion. I say this because I was diagnosed with gleason 4+4=8. Treatment was Robotic Prostatectomy. Pathology of the removed prostate was now 3+4 = 7. A significant difference from the original diagnosis. So, get second opinions on your biopsy result if possible. It may be a determining factor on your choice of treatment moving forward.
Outstanding segment. The work you do is spectacular! ❤
When I resisted hormone treatment with 4+3 the doctor did not give me much push back. He said I was gaining only a 7% better chance of no spread with the androgen deprivation. After a course of EBRT the PSA is down from 6.5 to .5 and no sign of spread. The comments on this site come very close to saying they’d rather be gone the hormone therapy is so awful.
@ Ransom Coates, yes agreed the comments are saying that but these are people that have been on adt a long time and shows how bad the side affects can be for some, fortunately everyone will have a different reaction / tolerance outcome.
I am diagnosed. PC Gleason 4+4/8 in August 2021. I am on ADT with Dandelion root tea plus course of Banerji homeopathic treatment.
My PC is localized and stable(PSA falls down to Zero from 20 during all these times)
Through out my research during all these times I feel holistic approach is best for treating PC.
My oncologist recommended radiation with ADT but so far I withheld radiation therapy and monitoring my PSA closely.
3-prong strategy ADT+ herbs+ homeopathic remedies with PSA surveillance can reduce side effects of ADT alone.
While staying on ADT and using 3-prong strategy to beat my PC.
My psa showed 0.038 on Dec'22 and 6th March 2023 it is 0.068.
Looks like my PC went to remission.
Great news, thanks. Your help is appreciated.
Superb information, wonderfully explained. Thank you!
Just love your ties.
As always, thank you Alex and Dr. Scholz. Question: I have had 2 MRIs a year apart and will get another in about 6 months. Should I get both the MRI and the PSMA , or just get the PSMA at any time now?
Would Gleason 8 and Gleason 9 be treated similarly in regards to these topics... in particular the idea of using brachytherapy? Thanks!
Hello
Thanks to your coaching I just had a PSMA/PET after I was assessed as 4+4 at age 78 with PSA of 9.7 (subsequently 8.0) . The PSMA/PET shows presence in lymph nodes. Can this be treated with brachytherapy + beam therapy but without ADT???
Thank you for another great video. What is the PSM PET scan suggest possible involvement in specific part of the seminal vesicle but the MRI does not note mass lesion.. Which would be more accurate when both tests were done a month apart with the MRI preceding?
44 year old man. November 2022 psa 186, March 2023 psa 314. 10 days of elearda hormone therapy and psa has crashed to 21. Now starting g 10 sessions of radiation for pelvic spread. Gekeason 8 4+4
That's young. How are you doing now? Did you have to change your diet?
Thank you,
Thanks for the great educational videos !
How about Gleason 4+5 ?
How do I evaluate treatment centers. What are the best options within 300 miles of Mid Michigan.
I am 85 and have Gleason 9 and am in very good health. BMI 22, Plant based diet and very active. Had a PSMA pet scan that showed no metastasis. I decided on to do anything. What do you think?
I am living with relapsed PC after proton beam in 1997. Classified as Gleason 8 contained within the Prostate with PSMA scan. Current treatment is Lupron. My Recent PSA was .21 Should I seek additional parallel treatment? (lutetium- 177)
Hi-
I have a gleason 8 score. It's a 3+5 and a 5+3. I've had a psma with no cancer spread. What's the difference between 4+4 compared to 3+5 gleason 8? What should be my approach? My psa is consistently 15.
There is a mention of "short course ADT" but it is not expanded upon. I am hearing that 18 months is only marginally better than 6 months (1% better). Can someone comment further on this issue?
I have the same question. I am scheduled for 18 months but would like to see what studies are being done to see if shorter course would be ok. I have a Gleason 8 and no mets. 44 radiation treatments done. I am 78 years old and really want a reduction in my ADT.
Is there a resource for finding a Doctor who is not stuck on one course of treatment.
Review of the MRI images in our urology multi-disciplinary team meeting (MDT) r confirmed a PIRADS 5 lesion in the right peripheral zone with possible capsular breach and involvement of the right neurovascular bundle. There was also evidence of multiple pelvic side-wall nodes and a left groin node, making this clinically T3a,N1.Biopsy Gleeson 8 (4+4) .PSA 27 .What treatment options would be beneficial , I am 59 years old
Update??
I regularly watch the PCRI videos and have found them very informative and helpful. Any thoughts to a video of a 3+3=6 Gleason score? Thank you for the videos......it is much appreciated!!
3+3? You go on active surveillance until something changes. No treatment and no side effects. 3+3 is a big win!
My dad first diagnosed Gleason 3+3 by the result of biopsy. We chose to treat than to watch and wait, After the pathology report from prostatectomy show it Gleason 4+3. I think you should not trust much from result of biopsy as I am before. My expectation for localized is too much while the result is extra prostatic is seen😞
I was diagnosed with prostate cancer 20 years ago. I basically did nothing. Now I get big PSA numbers, 30, 23, 58, and now 19 in the last 4 months. I had a nuclear bone scan and the ultrasound showed nothing outside the prostate. Now the doctor wants MP MRI but the radiologist refused because I had Urolift. I am now 71. What can I do?
David you have lived with it for 20 years, no spread, and the PSA coming down slightly by your account, do you just keep soldiering on, I mean unless you are getting bad symptoms etc it seems you can cope with regular PSA tests, just keep going as you are.
It looks like i will have some big decisions soon, fingers crossed for you and me🤞
I have never even been told about this cancer rating system. My cancer is in my lymph nodes so I guess hormone treatment is all I have been given. Makes life misserable. Not told how long I have but pain is terrible.
Hope you have found the info and getting the treatment you deserve! Update?
I just had TULSA PRO whole gland treatment for my Gleason 8 Prostate Cancer. They actually went over the left side (cancer side) with the TULSA device three times during my procedure and the right side once. The PSMA PET scan showed the cancer was strictly limited to the inside of my prostate. I don't believe the doctor would have considered me without the PSMA PET scan showing the cancer was limited to my prostate gland.
My procedure took considerably longer than normal due to the three swipes of the aggressive cancerous side. I figured my prostate has shown a propensity to grow prostate cancer so I wanted the whole gland ablated. I also found a doctor willing to perform focal laser ablation too. It was about the same price but I thought treating the whole gland offered the most opportunity for success.
Of the 12 core biopsy, 2 of my samples had Gleason 8; one with 8 percent and one with 16 percent. I also had a 3+4 and a 4+3 on the same side. My PSA density was .09 and my Free PSA was 23 to 28 pre biopsy. Considering the low PSA density and higher Free PSA levels, the numbers suggested the initial odds of high grade prostate cancer were pretty low. Some calculators stated 4 percent or less and other 6 percent or less. I read study stating that elevated creatinine levels in the blood can throw off the Free PSA levels. My creatinine levels have been at times outside the upper end of the normal box and I believe that study may be valid.
I personally requested the initial MRI since the PSA was up to about 5. Since, my free PSA was not extremely low and the DRE was normal other than his estimate my prostate was about 60cc they weren't leaning toward a biopsy. I called my doctor to request the MRI. I merely wanted to verify the actual size of my prostate with the MRI. Unfortunately, it showed two PiRAD 4 lesions on the left side of my prostate. My prostate size ended up being about 57 cc. So, the doctor was very close on his guess. I am glad I didn't wait another year to visit my urologist.
I still have the catheter in for about another week. I am not sure if I could find a doctor who would prescribe hormone therapy for a period of time...but, it is something I would consider if I could do it for 4 to 6 months just for insurance. I am sure that sounds crazy...but some think it is crazy to treat Gleason 8 with TULSA PRO.
Maybe I am oversimplifying things, but to me TULSA does in a couple of hours what it might take radiation months to do in terms of ablating cancerous tissue. In the end, you maintain your functions at a much higher percentage than other procedures.
I recognize the risk I am taking with a new procedure. I also recognize that I am looking at quality of life vs quantity of life. I read the stats of Gleason 8 returning at various points in time regardless of the procedure. Dr Scholz mentioned these newer therapies are capable of killing high grade cancer cells as well as the lower grade cancer cells that are often used in the trials. Dr. Scholz suggested you find an experienced professional to perform the procedure. I am not saying this is for everyone. For me, it is a path I am willing to take. I turned 65 the day after my procedure and consider myself healthy other than the prostate cancer. I hope to live many more years and wish everyone on this page the very best of health and happiness.
Brett, I have similar situation 4+4 but localized. Who did your tulsa pro?
Thanks🙏
@Jim Powers Scionte in Sarasota... I had a PSMA PET scan that showed that it was localized.
I found several doctors who were willing to treat localized Gleason 8 using that method. I felt they were all well qualified... I was happy with my experience at the Scionte Prostate Center. I'm very hopeful that they were able to eradicate all of the cancer. I did so much research and felt this made sense for me.
@brettm7597 I had radiation in 2010 for colorectal cancer. As a result I don't think I will be a candidate for radiation of any kind for my PC.
So far there's a lesion on mri and biopsy is next week.
Did Medicare pay for TULSA?
I live in Stlouis but my nephew lives in Sarasota so I am very interested in your story.
Hope you are doing well.
@@thomaslehmann5981 I wish you the best with your biopsy results. Sometimes, the lesion shown on an MRI isn't cancer. I had two PiRADS 4 lesions on my MRI and it was cancer. PiRADS 4 and PiRADS 5 lesions have a higher probability of it being cancer. If your biopsy indicates it is cancer, let's hope that it is a lower grade and confined to the prostate.
As mentioned, I had a PSMA PET scan that showed my cancer was in my prostate. From what I understand, those scans are about 80 percent accurate. If you do have cancer, I'd push to have a PSMA PET scan. Other scans just aren't accurate enough to show if the cancer has spread. It is still too soon to determine if my procedure was a success in terms of ridding my body of the cancer. My PSA was reduced by about 90 percent on my 3 month blood test. I was hoping for a 95 percent reduction. With this procedure the PSA will not be eliminated because you still have the outer shell of the prostate....even with whole gland treatment.
There is a newer high dose radiation treatment being offered that is covered by insurance. From what I understand it is under MRI guidance and takes about 5 doses/treatments with results similar to other treatment methods. It might be something you want to look at.
Sadly, medicare and insurance did not cover the TULSA procedure. Apparently, they want long term data to cover it. Again, I wish you good health and happiness.
@@brettm7597Target 14mm lesion on MRI turned out benign however on the same side on random was found a single core of 4+4.
My faith in MRI is diminished.
I am trying to get in with the RO to discuss RT but you are lucky to get a call back much less an appointment. These people are swamped here in Stl.
PSMA PET scan is this coming Monday (had to ask for it).
Mri didn't show any of the bad stuff like extracapsular extension etc so hoping this scan shows prostate involvment only.
If scan is clear I may be headed for Sarasota.
Did he get you in fairly quickly?
Thank you for reply.
I have a question for Dr. Scholz: when he speaks about the hormone therapy length, does he count from the very beginning, before RT starts, or from the moment RT has finished and the patient is only on hormone therapy?
How does a low carb and Ketosis along with Intermittent fasting autophagy impact someone with Gleason score of 8? I really enjoy your videos and they are very information. Thank you.
It has been difficult to find any direct info on the relationship of keto/carnivore and prostate cancer. Lots of info with other cancers (mostly positive) but with PC the info seems to be a bit more elusive.
I was a Gleason 8, psa 75 48 years old.
After beam radiation and just finished 15 months of ADT I have just recently had a psa of .3
I have in the last couple weeks implemented a ketovore diet seriously and aiming to be in ketosis as much as possible over the next year.
Guess we’ll see.
What does 'contra lateral side' mean ?
I’m newly diagnosed gleason 8 with psa 5. 1 core gleason 6 with psa 4 two yrs ago. I have one good size lesion in right side but left is clear. HMO Kaiser Urologist says I’m ideal for radical protatectomy. I want to prioritize quality of life and continuing an active lifestyle at 62 yrs old. What do I do?
Update????
My dad has a psa of 202 he has been put on zoladex injection, casodex, zytiga, neutas and zolendronic acid Gleason score 8 (4+4) it has metastised to the lymphnodes and pelvis girdle, do think the treatment is enough? The oncologist says will be on hormonal therapy for 3 months then once tumor burden has reduced he will start on radiation
Hi, Rukia Amin. I'm not a doctor and I don't know all those drugs. However, my doctor has me on ADT to shrink my tumors and prostate in preparation for radiation treatment next month. It sounds like a similar approach to the one your doctor is using.
@@brentvanfossen Hi yes it is the same
Do you advise a GL 3+4 to do PSMA PET?
I'm 3+4. PSA was 5.48. Went plant based & hired Dr Scholz. He had my biopsy slides reevaluated, after five months plant based PSA is 4.13, Dr Scholz has me on active surveillance-no treatment:)
Yes, and yes.
sounds like gleason score and PSA levels are not as important as PET scan if the cancer has not spread outside the gland then it can be treated regardless of numbers.
I am Gleason 7a which was diagnosed at a Biopsy (T1c). There are no metastases or nodes infested. During the biopsy 19 cores has been done where only 2 of them showed cancer at the same spot/lesion each 15% and the cancer-relation is Grade 3 (80%) + Grade 4 (20%). All 19 cores together showed only 1,5% cancer from the whole biopsy. That means that only 0,3% of the whole biopsy is Grade 4 cancer, which is pretty less. During my researches I found out that if you have less than 5% Grade 4 it is possible to chose Active Surveillance. Can you give me any recommendation ?
Do successful treatments repair the prostate and produce new healthy prostate tissue?
Are PSMA Pet scans covered by Medicare?
Some places in melbs are!
Yes if after a aggressive biopsy score
Great videos. I’m 69. I had aRARP 3 years ago. My biopsy was a 4/3 Gleason 7. My path report was 4/4. All of my lymph nodes were negative and no extra capsular spread. Seminal vesicles were negative. All post surgery psa have been negative. My preop psa was 6.4. I have not had a PSMA pet scan. Should I request one?
I'm 4+4, psa 9, cribriform adenacarcinoma... psma scan good... seen all your videos but nothing on cribriform pattern which seems to be major variable in biochemical recurrence. Comments?
Thank you for another excellent and morale boosting video. I am hoping though that you might do a companion talk on the advances coming out of the STAMPEDE Trial in late 2021 which showed that the earlier use of Abiraterone (supplemented with prednisolone) together with radiation and ADT can help a significant number of patients with "locally advanced' or relapse prostate cancer. Many, but not all, of those individuals would have Gleason 8 scores. The Trial results showed that standard measures of survival (overall, progression-free and metastasis-free) improved by over 10 percentage points when "Abby" was used in conjunction with radiation therapy and ADT. Most encouraging of all, the Trial found that early use Abiraterone plus prednisolone halved prostate cancer specific death rate amongst patients with relapse cancer or newly diagnosed cancer that had spread to the nearby lymph nodes. There's an excellent summary of the findings in The Lancet at: www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02437-5/fulltext (For non medicos such as myself, the four survival rate graphs pretty much tell the story.) From my own reading, it also appears that combining Abiraterone with standard radiation and ADT treatment produces better results (with less toxicity) than combining chemotherapy (Taxotere) with radiation and ADT.
Adding brachytherapy to external beam has much higher toxicity and the overall survival rate is not significantly better than external beam alone plus androgen deprivation (hormone)
Shitty to hear my doctor pushed the beam over brachy. Grrr
Thank you for this segment. My cancer was a 4+4 Gleason and had spread to lymph nodes. Treatment included Docetaxel (6 sessions) and radiation (45 sessions), along with Lupron and Zytiga ongoing for the last 2.5 years. PSA has been
Im 55 diagnosed with stage 3 gleason 8 September.
My PSA is 49
CT Scan indicates no spread, and bone scan also no spread.
I have prostatectomy booked for December 8th.
Now im really confused to hear this doctor saying 18 months of hormone is better than surgery.
I dont know what the hell to think 😢
Hi, Ed Havers. I am 58 and going through a similar though lesser situation (Gleason 3+4, PSA 5.5). I think the video said that Dr. Scholz prefers radiation treatment over surgery, as many surgery patients end up getting additional radiation treatments anyway. ADT can be added for both options.
I consulted two surgeons and one radiation oncologist, and have chosen radiation. I would suggest you have time to seek a radiation opinion. I just began ADT in prep for my treatment the end of November.
I wish you the best.
@@brentvanfossen I just began my ADT on Friday 20 october with a surgery booked for the 8th.
I just worry that they say if you go woth radiation alone with ADT then late down the line surgery is taken away as an option.
It's such hard decisions to make. Wish you all the best too friend 👍