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- เผยแพร่เมื่อ 13 เม.ย. 2023
- Patients with Gleason 3+4=7 represent one of the largest "grey areas" in the world of prostate cancer. For patients with Gleason 3+3=6, the medical community knows that active surveillance is the recommended course; for patients with Gleason 4+3=7, oncologists will almost always recommend some form of treatment (there could be some exceptions, for example, the very elderly). However, for patients with Gleason 3+4=7, whether a patient should choose treatment or may consider active surveillance depends upon confirmation of the pathological interpretation, other features of the cancer, and other factors related to a person's general health. In this video, medical oncologist Mark Scholz gives a survey of Gleason 3+4=7 and discusses some of the factors that determine whether a person with Gleason 3+4=7 can consider active surveillance, focal therapy, or whether they would be best served by radical treatment with radiation or surgery.
0:06 Can you explain the situation of a man who has been diagnosed with Gleason 3+4=7 prostate cancer?
2:42 How much Gleason 4 is too much for a Gleason 3+4=7 to consider active surveillance?
3:33 If a person with Gleason 3+4=7 is doing active surveillance, are you waiting to see if there is an increasing presence of Gleason 4 and then treating it?
4:57 What time frame do you use for follow-up MRIs?
5:05 What PSA do you expect to see with a Gleason 3+4=7 when there is a small amount of Gleason 4?
6:56 What is a safe active surveillance protocol for someone with Gleason 3+4=7?
7:46 How often should men with 3+4=7 be seeking a second opinion on their pathology report? Should they seek out genetic testing?
8:43 What level of risk do you think precludes someone with Gleason 3+4=7 from doing active surveillance as opposed to having treatment?
12:08 What is "focal therapy" and how is it relevant to Gleason 3+4=7 prostate cancer?
13:13 Are there cases of Gleason 3+4=7 that would not be good candidates for focal therapy? For example, if the cancer was on both sides of the prostate?
13:43 Is there a certain form of focal therapy that you prefer for your patients? For example, cryotherapy, HIFU, etc.
16:11 How many procedures do you think a doctor should have performed to suggest proficiency with any one kind of focal therapy?
17:27 How involved is focal therapy for a patient compared to surgery and radiation?
18:32 What are the side effects of focal therapy and how do they compare to radical treatment like surgery or radiation?
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Possibly the best site for PC on the net, many,many thanks.
90 days out from IRE “NanoKnife” focal treatment of 9mm focal lesion….3+4=7 at initial diagnosis 150 days ago. No ED or incontinence side effects. Second, more 21:27 recent MRI just revealed a 7mm, and two 5mm lesions…none of which are in the void left where the previous 9mm was located. Scheduling another biopsy in 30 days. Some or all of these lesions could be benign…so still happy I chose focal therapy at 74. The many options still remain, if needed.
This is the best most comprehensive video I've ever seen and I've watched many!
Would you please consider adding a video session on the question: "who is an excellent candidate for focal therapy?". I've watched well over 60 of your videos, which are all superb. I've not been able to find one that addresses this specific question. If you can point me to one, that would also be great. Thank you so much for all you have done and are continuing to do. I would have been absolutely lost without the knowledge you've enabled me to gain. But I am left wanting when it comes to this question. I'm in the grey area: Had a targeted biopsy of 3 samples, plus 12 random samples. Gleason 3+4=7, 10% Gleason 4, 2 of 15 cores with cancer, 35% in each core, a lesion about 1.75cc that did not show up on a3TMRI two years ago and now is PI-RAD 5 in 2024. Decipher Score: 0.78. My issues are: I have an 80cc prostate. I have some restricted urine flow, but not to the point of it affecting my life or my sleep (get up once per night, which I'd assume is not unreasonable for a 77 year old). I think there is only 1 lesion. Anterior transition zone, mid-gland. I'm assuming I should have a PSMA-PET scan to confirm. I'm torn between Active Surveillance and some form of treatment..............HIFU, Cryotherapy, Focal LDR Seeds, LDR Seeds for entire prostate, SBRT for entire prostate. I need some help. My urologist said I'm not a candidate for surgery which is fine by me............he then referred me to the Radiology Lab...................I'm not ready to go there............yet.
Thank you for your thoughts, Paul! We will film a video in this next.
@@ThePCRI Slight update on my situation. I sent my pathology slides to Johns Hopkins Reference Labs. They came back slightly different and better. 5% or less Gleason Pattern 4. So now I'm really wondering what I should do. I have an appointment on June 13 at Mayo Clinic in Rochester, MN. I'm looking forward to hearing what they all have to say and advise..................
I was on the brink of prostate removal with a gleason of 3+4=7 in only 1 core at a size of 1mm, PSA of 8.....i am so glad i found these videos in time.
May I ask what treatment you decided to go with, if any?
DOCTORS ARE GREEDY
Amazing lecture! This is public service!
I was diagnosed with 3+4, PSA 5 with 2 lesions on my left side in mid 2022. The information you have been sharing with your videos has been invaluable, especially not rushing my decision. Because of your videos I had a PSMA pet scan and changed my diet. I learned about Focal therapies which had not been suggested to me at all by anyone I had seen. I am happy to say that in early 2023 I had the HIFU treatment and everything went very well and I have the same quality of life as before the treatment. Without your information I would of had surgery very soon after diagnosis. You have also taught me that this is not a cure yet. I still have a journey in front of me and need to be vigilant and steadfast with the lifestyle changes we should all incorporate.
Thank you again for what you are doing for all of us affected by Prostate Cancer
🙏🖖
Thank for your info. I was just diagnosed with the 3+4 also. Everyone's input is helpful. My doctor is pushing for robotic surgery and steering me away from HIFU. I know now not to be rushed.
I m From Turkey I have 3+4 lezyon you are good?after hıfu Please please give an idea for the treatment
@@m1976c1 hi, I had the HIFU treatment in February and everything is going well. I have an MRI scan in September to see if all the cancer is gone.
@@gregt872is your doctor a urologist? If so, your doctor is a surgeon only. They can have a bias. If your doctor gets upset or elicits a fear tactic if you ask for recommendations on an oncologist and radiation oncologist, fire that doctor.
People are waking up to the advances of non surgical therapies and the statistical significance that they are as good or better for prolonging life and fortifying the quality of that life.
Remains one of the most overtreated cancers and the patient has to navigate the options or hurt blindly trust one or three SURGEONS.
@@markgooch1715 you are absolutely correct. I have since moved on from that doctor, but I let him know that I didn’t believe that he was working in my best interest. I have since talked with two other surgeons, one with the record pretty good record of removing the prostate yet leaving the active nerves which would give me a 65% chance of erection and a 98% chance of no incontinence. I’m still looking into going to either John Hopkins or UCLA.
I really appreciate this video. Especially the wrap-up. Thanks
Gosh, I love the work you do! Such a public service.
Excellent videos. Many thanks to Dr. Schlz and Alex.❤❤❤
Excellent discussion, concise information...I hope this is shared widely. Good job.
I was there last year: Gleason 3+4, PiRad 5, PSA >9. I opted for surgery for a number of reasons, one of which was the location of the lesion as shown on the MRI. ”Transitional zone mid bilateral anterior...The anterior segment of the lesion abuts the anterior capsule with extension into the anterior fibromuscular stroma.” It was the extension into the lining of the prostate that bothered me the most, and in the surgical path report, they did find a corresponding extra prostatic extension. Also, several of the possible focal methods I asked about were less effective given the tumor's location. Therefore, I decided to have the whole gland whacked. So far, no regrets. (All PSAs post surgery < .01.)
I have exactly the same diagnosis and looking at prostate removal. How was your recovery?
@@georgewiel Not too bad. 99% continent, little if any ED. Physical recovery very good, doing exercise classes, etc.
@@gshenaut Thanks for the quick rep[y. Where did you have your surgery done?
@@georgewiel At the UC Davis Med Center in Sacramento
@@georgewielI’m good as well, recovery wise , only 3 weeks post surgery. Doing much much better than expected.
This talk was one of the most informative to me
Thank you so much for this, and all of your excellent videos. I’m 61 and recently diagnosed with 3+4. What a broad category! I’ve been told I have an “unfavorable intermediate risk” diagnosis because cancer was found in 67% of the random systematic cores (8 of 12 cores) and, of course, all cores (6 of 6) that targeted my tumor (which was indeterminate for extra-prostatic extension on my MRI, but did show at least 10mm of broad contact with the prostate capsule). On biopsy, the tumor was 4+3, as was one of the random cores. Positive cores were present on both sides of my prostate. Cancer involved anywhere from 10-50% of the positive random cores, and 50-60% of the tumor cores. So, overall, quite a lot of cancer found in my fairly small (20cc) prostate, and even though I am 3+4, the biopsy concluded I have >40% Gleason Pattern 4, which seems like a lot of 4.
I’m shying away from a radical prostatectomy because of the side effects related to sexual function and urinary incontinence. But I’m also concerned about the effects of radiation. My radiation oncologist is recommending a treatment plan that combines HDR brachytherapy boost + IMRT + 6 months of ADT. The IMRT would include targeting the lymph nodes. I’m worried about the increased side effects of combined therapy, and wonder if I could forego/postpone some element. I realize I’m probably not a candidate for active surveillance or focal therapy, but I’m thinking about getting my genomics score, and wondering if a low score could indicate not having to radiate the lymph nodes and/or not having to proceed with ADT. In short, I like to think that maybe I don’t have to go at it so hard with treatment, but I realize that maybe I’m underestimating the risks, given everything my biopsy revealed. Thanks again for the informative videos that empower patients to take some measure of control over treatment choice.
Hi you sound the same as me. I have Gleason 3+4 intermediate risk unfavorable extra capsular extension PSA 11.4. I have Cancer in both sides as well so stage 2c. My doc told me that because of that unless I had a world class surgeon that there would be more than likely cancer to be left behind with surgery and would result in radiation and hormone blockade anyway. He also mentioned to hit it hard while I am young and healthy rather than have it recur and hit it hard when I am much older . So I am on 6 month blockade and well into my radiation treatments. So far not too bad. I am exercising fairly vigorously and getting lots of sleep with lots of water high protein low carb diet. I actually feel quite well overall. Grumpy and hot flashes at times but I just take a big walk and feel ok. So not telling you what to do but just relaying my story as you sound very close to my diagnosis. Good Luck
Hi, Thanks for sharing your experience with me. I really appreciate hearing from someone who is going along a similar path. I just started working out fairly vigorously too. I’ve heard it helps with many of the symptoms of hormone therapy. Encouraging to hear it’s working well for you.
My radiation and hormone therapy will likely start in the next 6 weeks or so. One issue still to be decided is whether the radiation should also prophylactically target the whole pelvic area and lymph nodes, or if it should just focus on the prostate. My radiation oncologist says I’m close to the line. Would you mind sharing whether your radiation has targeted the lymph nodes in addition to the prostate?
Thanks again for your comment. Good luck, and all the best to you.
I’m starting to wonder if anyone gets a “favorable” intermediate designation. There’s no way mine could have been detected earlier and I still had to do hormone therapy. The first three months were not that bad but it really starts to wear on you the second half.
Let me ask you all something what if you do all and at the end it comes back you know you can't have surgery now you stuck where you are I had to think bout everything I went for the surgery and deal with what comes with it and I'm glad I did my prostate was 85% fill with cancer my psa since then is 01 so far almost a year has past all I am saying make sure it what you want yes it a risk to you I have the ipp put in me and my sex life is back on track it's your choice please make a good one for you I did god bless all
I was diagnosed with 3+4 PC seven years ago at age 54. Had surgery with +margins and focal EPE. Now my PSA is .2 and I start salvage radiation next week without ADT. The RO says I don’t need ADT. Totally bummed out here. 3+4 can progress apparently.
Thank you for this excellent video!
Great info. Thanks.
Thank you Alex and Dr Scholz. Im 74 and 3+3 on my biopsy two years ago, but my PSA is gone from 5.5 to 8.5 This talk is very helpful in my thought process.
Thank you!❤
Wonderful information as always. Thank you both!
Thanks very helpful
Another great video. I just got my biopsy results. I had two cores that were 3+4, and one core was 30-40% of 4. I was also told there is a 12% possibility that it has spread outside the prostate. My Dr. Is ordering a CT scan, bone scan and an MRI. The goal is to rule out that it has spread. He talked with me about surgery or radiation treatment. Both of those seem to be a little extreme. I have learned a lot watching your videos. Thank you.
Hoe about PSMA instead?
Dr. Scholz, thank you for the video of active surveillance vs Focal Therapy. What I am finding is insurance wont cover focal treatment. Is this the norm?
I was at 3+4 and was treated 6 months later it showed up In my left lymph node now cyberknife radiation and no sign of tumor on psma
Unfortunately spaceoar is not available in Manitoba, Canada. PSA test that started this was done March of last year. First biopsy last June was 3+3. 1 of 12 cores had cancer and 2 were questionable. Since then a CT scan and bone scan have indicated no spread. Initially i was being pushed toward watchful waiting. I then had 3 months ago a MRI that showed now 2 lesions and a PiRad 4 High. Last week I had a Fusion Ultra sound MRI biopsy and still waiting for the results which i am told may take a month. From my reading a PiRads 4 equals a 7 or 8 on the Gleason score. So until i get the results i am currently in the dark. The waiting has been a mental challenge. I'm 70 in decent health , never smoked, no alcohol in 25 years and in the gym 3 times +/- a week for decades. Retired pilot. I am not considering surgery. Quality of life considerations. I have found these videos helpful as well as comments from other men. Education is the key here for me.
What was the outcome of the biopsy results?
@@tims997p9 The Fusion MRI biopsy had one 3+4 and several 3+3. Favorable intermediate. Feb 2024 PSA was 7.12. I am choosing to pass for the HT as at 71 (next month) i am still OK physically and don't want to mess with the few good physical years i have left. The RO agreed stating he'll be monitoring me and if needed down the road we can do the HT. Radiation to start in about 6 weeks. 5 sessions.
Thanks. As always very informative and easy for a layman to understand. I had 3 positive samples of a guided biopsy. One 3+3 and two 3+4. My % of the 3+4 were 40 and 45%. I had HIFU at Duke in Jun 23. I have had 2 PSA tests since the procedure and am MRI scheduled for next June. My pas before the procedure was 6.7, up from 4.7. My PSA after the procedure was 2.4 and 2.9. Basically the procedure took out a third of my prostate. Hard for me to judge what the PSAs mean now and what numbers to pay attention to. From this talk it sounds like PSA numbers are less important and the MRI is the most important. Right?
Thank you for sharing your story. I also have 3+4 and am considering HIFU as a treatment option at some point. You mentioned you had success with HIFU. Can you recommend the doctor's name and contact information? THANK YOU!
I've heard that different forms of focal therapy are more suitable for different areas of the prostate e.g. you'd use say IRE for apical cancer and other forms for peripheral disease. Very difficult decision for me. On AS for 3 years, then I core 3+4 less than 5% of 4. MRI shows no growth from very small tumor. However small prostate and in apex near urethra, so this was the deciding factor as if it grows there might not be enough margin to treat with FT. However very difficult decision. I'm concerned about ED, however compared with whole gland side effects the prognosis is better I understand semen production may go down or cease.
Would you be willing to do a comprehensive review of IRE focal therapy? From my amateur research IRE appears to be the best focal therapy option?
Why don’t you like Decipher ? I used them for my genomic test and it came back as my prostate cancer is on the low end of the low grade cancer chart. I have 3+4 Gleason score. I believe it was only 5 percent of the 4. 2 small lesions . I’m doing active surveillance. Based on my genomic test it looks like I have a 1.4 percent chance of spreading in the next 10 years. Is there a problem with Decipher that I should be concerned about ?
This is a great post as i and probably a lot of other men have 3+4 (5% 4, two cores in my case) And this is so informative! Thank you🙏
Have you decided on treatment yet?
No, have you?
Dr. Scholz - could I get your thoughts on using the right physician in a scenario where a military veteran will use a VA Hospital’s urology department? The primary physician to be used is normally a resident, if it’s a teaching hospital. This dynamic concerns me because the skilled physician (that’s referred to in this excellent video) is not the first go-to physician. How can I get both physicians involved in that first important conversation right after the biopsy? Thanks so much for your detailed explanations.
At 57 I was diagnosed 3+4 after a 12 core biopsy. Over the next 4 months I attend "Its A Men's Thing" meetings at my local hospital with about 15 to 20 men before & after treatment. My personal choice was for full open surgery which turned out to be the best choice during the surgery. Was back to work in 6 weeks and now 12 years later all is fine. No other treatments needed after surgery just monitored for the next 10 years. Did it change things, yes but I can live with the side effects, my issues got better over the next few years. I agree 100% this is a very personal choice. I would likely make the same choice today 12 years later. Why I picked surgery was because many (not all) of the men in the "Its A Men's Thing" meetings that waited or did non surgery treatments seemed to regret the choices made years later.
Im in exactly the same boat Ken. I'm in the UK so will be using the NHS. I saw the nurse last week and she gave me the biopsy results and then the choices of treatment and to look at alternatives. None are ideal but I want to get it sorted and move on with the rest of my life, I'm also 57, fit, healthy and with a 3+4=7. Do I wait and hope for something better to come along or do I take a deep breath and go for surgery and hope that the ED and leakage is minimal. Im not keen at all on hormone therapy and the nurse said I would still have to have some hormone therapy if I were to opt for radiation therapy. I have a consultation with the surgeon on 21st November, I have so many questions for him. I know one thing, I'm not going to be rushed.
I think one has to take into consideration is that 12 years ago Hifu was not advanced as it is now. Plus most importantly the doctors are much more experienced. And Tulsa-Pro (if u can afford it) wasn’t even an option.
@@bobbrinkman1613Did you choose conventional treatment or did you find another alternative like oblation theropy.
Had open non-robotic surgery 10 years ago at age 53, for 3+3 (3 sites) with perineural invasion. I said to he l l with nerve-sparing, I wanted no regrets. So far so good. I know many might have recommended or chosen surveillance, but there’s no substitute in life for undetectable PSA after 10 yrs. Wife wants me alive and not battling recurrent tumor either. Life serves you tough choices sometimes.
@bobbrinkman1613 did you end up having surgery? I am 57 fit and healthy 3+4=7 in 10% of 1 core and opted for temporary HDR Brachytherapy at Stanford by Dr Buyyounouski. Dec 7th and 14th were the two treatments so far so good no inconcontinence and no ED at this stage.
This is great information, but does it still apply to someone like me, who had surgery 14 years ago and now has a detectable recurrence at the base of the bladder? A biopsy of the recurrence "nodule" was diagnosed as 3+4 (10% GP4), but my PSA doubling time has been consistently over 2 years. The advantage of continuing active surveillance after biochemical recurrence is that technology will continue to improve, resulting in better diagnostic tools and safer treatment options. The medical community's "knee-jerk" solution of salvage radiation for biochemical recurrence does not play well when considering the potential long-term impacts to quality of life that won't manifest for ten years.
I had 6 samples with 3 of 3 + 4 and 3 of 4 + 3. The decipher was at 95%. Just curious why do you not like decipher?
Very interesting guy.
One issue bothers me a little. The general views expressed give an impression that prostate cancer is not really that serious. They don't seem to address that it kills many, many people. I'd like a video on the fatal cases. Otherwise, this seems to be an excellent channel.
Clear point prism neuro laser theraphi system, , have some one use this,
So my Mri showed 2 lesions one was pirads 4 and one was pirads 3. But on biopsy these two lesions were benign? But 2 of three other cores on left were 3+4 with 10% 4. The other 3 cores on right were benign. My psa is 4.8 now. Just had biopsies a few weeks ago. How does Mri show lesions but they are benign? Im learning all i can about this before i do any treatment. Altered my diet extremely. No sugar no bread no sweets. No meat just salmon vegetables and fruits nuts and seeds and legumes.
P.S. PET scan showed that is has not metastasized. Also, urologist says it is hard to tell how big the cancer tumor(s) is in the PET scan, but believes it is small.
Is there a connection with Prostate cancer and myeloma detection?
I have 3+4=7 favorable adenocarcinoma in the Right Apex. Disease found in 2 cores from APEX, 10% of 4. PSMA GA68 CT/PET scan, no metastasis outside the gland. Doctor recommended 28 IMRT/IGRT radiation treatments. Currently completed 13 of 28 treatments...slight, but hardly noticeable side effects. I'm 73 and don't care about sexual function...didn't want incontinence, Bladder problems or Bowel issues. I did not want, and was not offered surgery.
⁷⁷8⁸
Please discuss the option of HIFU treatment
from PARVEZ MUKHTAR
i have 4+5 cancer at Gleason scale and of categery II.
Why don't you like the Decipher test?
Had RP exactly 2 years ago. Pathology showed positive margins and one lymph node affected. PSA went from
Thanks! This is great information for me, as I was diagnosed 3+4 after a 12 core TRUS biopsy last year, and decided to go AS with the low volume of 4 in one core. I'm scheduled for a targeted biopsy next week as the last MRI was inconclusive, so the next biopsy should be informative on next steps, hopefully AS for another year. I suspect I could be a candidate for focal therapy, but not sure if the VA or Tricare will cover it.
I'm in a similar situation. If you were exposed to Agent Orange you can put in for claim with the VA. I began the process a few months ago.
@@bobtoner9820 I'm currently a VA patient, but the issue with focal therapy is that it's not considered 'standard of care' for Prostate Cancer. I have read that TriCare won't cover focal therapy, and probably the same with VA, per my discussion with my urologist. Finding more Gleason 4 probably would lead me to treatment, and I'd probably just do radiation, I'd rather not, but then again, I'd rather not do another biopsy next year too. Being 3+4 with low 4 volume is almost a coin flip, but at least the docs aren't insisting on immediate treatment.
@@Ben..E I'm actually a new patient of Dr Scholz. Gleason 7 but more 4 than 3. I've completed the psma pet scan, TRUS slides sent to John Hopkins and I have a 3tmri scheduled. Probably looking at brachytherapy. Best of health
@@bobtoner9820 similar situation 2 cores of small volume(10%of core) with 10% of that pattern 4. I'm leaning toward Brachytherapy when I decide to get treatment. Which center of excellence location will you have the Brachytherapy treatment?
@@marka9073 Hi Mike. I have some 3+3, 3+4 and 4+3. Gleason 7. The 4+3 is 95% 4. My psma pet scan indicates the trouble is located on the right but it has not spread outside the prostrate. I have a 3tmri scheduled later this month. Once the mri is completed I have to meet with Dr Scholz to discuss treatment. I think he will recommend brachytherapy in the LA area , possibly UCLA where I'm having the testing done.
MRI revealed one small lesion 10x9x9 mm. PI Rads score 4, intracapsular. Is there any risk that a biopsy would disturb or 'break' the capsule (so to speak)? Can the needle rupture the shell of the capsule, hence releasing cancerous cells that were otherwise contained. Does that happen?
I think it would. It's called common sense. I made the big mistake of having to buy abc a few months ago and I totally regret it. Biggest mistake of my life. In my opinion. Depends how big your tumor is with mri. The pet scan shows if it's spreading.
MRI suggested 3 areas of concern. Resultant Biopsy of 21 samples showed 20 with 3+4 at 20%. Class 2. Question: is hormone + radiation recommended or is rad alone sufficient?
My MRI showed PI-RADS =3, my doctor did a targeted plus 12 cores from systematic biopsy. It turned out the targeted was benign, while 2 out of the 12 cores are 3+4 (both less than 5%). Do you still recommend MRI as the tool for active surveillance, since MRI didn't find the ones with 3+4 to begin with?
I'm the exact case he describes 3+440% one cord lesion isolated to one side of the prostate active surveillance not much of a consideration but still available researched research to find a great focal care doctor and found one at Mayo clinic who did cryoablation destroyed about 30% of the right anterior lesion. After catheter removed couldn't urinate so I had to soak Catherine's for three or four days now it's back to normal, holding off whether ED is present for three weeks to repair and heal.
Do you have an e-mail address that I can use for my concerns? I have an appointment at Mayo Jax in less than 2 weeks. Do you have information on their ability? I am 3+4. Thanks
Can you spell the name of the doctor Jeff Dumonus at UCLA?
I am aged 66 . My PSA is 4.1 The MRI prostate w wo contrast RAD showed 4 and the biopsy report from 12 samples showed one RA , biopsy 3+3 and one RMPZ biopsy 4+3 . The bone scan showed no spread . Am i considered as Intermediate Risk Prostate Cancer ? Should i do Radiation therapy with or without hormone therapy ?
I've been recently diagnosed with 3+4 both sides, prior had taken the 4k blood test = 68.5 ranked and psa of 11.42 had mri the the target parametric biopsy. Next month surgery = removal .. my question is ? Is possible that biopsy can or may increase psa??? Iam currently 22.5 psa???? Psa of wich I had concern just to get a reading a month after biopsy??? The 4k blood test was taken a month prior to biopsy 11.42???
Dude, you have to google when you can take a p s a test after a .... Biopsy . It says six weeks at least!!! Your DOCTOR didnt.... TELL YOU THAT? !!!??!! WTF!!!
how about seeds experiment
Can the biopsy component of active surveillance be satisfied with a urine-based test, such as ExoDx, rather than a needle biopsy?
No
SHUN NEEDLE BIOPSY. USE MRI
I have been getting my Elligard 22.5 ng /ML injection since 2015 after radiation therapy and don't know when it will stop. I take it every six months when my PSA gets to 4. My oncologist is not trying to suggest any other treatment.
HE NEEDS CASH. AT PSA 4 YOU ARE SAFE
I never get a clear answer to which PSA should be considered???
...Actual PSA or PSA DENSITY that factors in gland size????
That can make a big difference for men with larger prostates
Probably both.
Hello Dr. Scholz I am 59 years old and was diagnosed with prostate cancer last fall. My PSA went to 4.5 and that prompted a MRI early last year. MRI showed nothing. In the fall of last year PSA went to 7.4 which prompted biopsy. Biopsy showed two cores with cancer. One 3+3=6 and one 3+4=7 (80% total of cancer, but only 5% of that was a Gleason 4). Went on active surveillance and 3 months later PSA went up to 9.1. Urologist said the prostate looked normal and was maybe slightly enlarged, but within normal ranges, so we were both surprised I was positive for prostate cancer. What would you suggest I do? My urologist suggests I have it removed. I received a second opinion from the Mayo Clinic and they agree that I should have it removed. Everything that I've been reading says that it is perfectly acceptable to continue active surveillance even if my PSA was 10-20. What do you think? Thanks in advance.
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
from PARVEZ MUKHTAR
Can side efects of Hormone therapy like Nerve System Agravation can be reduced or eliminated?
i have taking Lorelin Depot Injection 11.25mg for six months at 3 monthly freqyency on doctors advice and under suoervision. Can a month dose of 3.75 potency reduce the side efect of nervous sysem agravation and hot flashes.
SHUN HORMONES IF SIDE EFFECTS ARE BAD
Thank you so much for these videos. They have very informative and comforting since my diagnosis last month. Quickback ground information, and then one major question...
I am a week shy of 49 years old. With a PSA of 4.8 on a 27cc prostate, my urologist recommended a biopsy which showed 7 cores of (3+3) and 1 core with (3+4) with 20% pattern 4. I subsequently sent my slides to Dr Epstein @ Hopkins, who diagnosed one of my previously indicated (3+3)s, as a (3+4) with less than 5% pattern 4. My urologist's initial reaction due to my age was to for surgery, but recommended I see both a surgeon and a radiation oncologist. The surgeon agreed and recommended surgery (not surprising), but the radiation oncologist also felt like surgery was a better option due to relatively young age. I did receive a call from my urologist that my Prolaris testing came back "positive" but I have not yet had my appointment to review the specifics of that report. I'm going to another urological oncologist next week, and I'm scheduled for a PSMA Pet scan at the end of the month - just trying to gather as much information as possible.
MY ONE QUESTION - is the fact that I'm relatively young (almost 49) reason enough to forgo any number of radiation options (brachytherapy, SBRT, IMRT, Hifu), and move straight to surgery as my urologist, surgeon, and radiation oncologist have suggested, or does that just seem to be the bias of that organization? (They're all with the same facility). Thanks again for all you do!
@arl16 hope ur doing well. Would it be possible to give an update as to which path you took & are there any major side effects? Thank you
@@Jack-2day Hi Jack - thanks for the well wishes. After going to two more institutions to get advice, (and finding out that a relative of a family friend was affiliated with urological oncology at Harvard teaching hospitals), the consensus was to go ahead with surgery, again primarily due to my relatively young age. Everyone seemed to be concerned with long-term damage from radiation and the side effects that may emerge/get worse at a later age, while surgery would present the side effects up front and (hopefully) get better with time.
So I ended up getting the prostatectomy on September 19th @ Johns Hopkins. (I'm in Maryland). Surgery was successful, and amazingly, within about a month, I was over the side effects. (The "plumbing is working!") It was definitely a less than pleasant experience, but now about 10 weeks out, so far I'm pleased. I go back for my first PSA test in a couple weeks, so that's my next hurdle.
If you'd like to hear more detail about my experience, or have any other questions, let me know and I'm happy to message with you directly.
@@andrewleedom5875 hey Thanx 4 getting bck! Good to hear you’re doing well. Definitely would like to here more as I have a question or two..(is it possible to receive my email on my account here?) Cheers
I lowered my PSA from 6.55 to 5.47 in 6 months with a vegan diet. I am 3+4=7 and my psa continues to drop. Please do your homework you may not need radiation!
What does your diet look like now. Im basically 1 or 2 meals a day with intermittent fasting 18/6. No alcohol or sweets, no milk or bread or pasta. Lots of homegrown leafy greens and tins of sardones. Paul Stametts mushroom powders.
@timpye6162 Please elaborate more on your diet. I am changing my diet also but maybe not that much like you.. Steamed broccoli, steam tomatoes. No.
Carbohydrates. I was eating a lot of tapioca. Ha ha. But no more. I am gleason seven. Is too radiate or surgery is the question. I don't like either one of course. But I have to decide. I sure wish to die alone could fix my problem. But I have a nasty ... ZPI-RAD five tumor! please. Please respond, !!!
SHUN GREEDY DOCTORS
PSA BELOW 10 IS EXCELLENT
Could you please do a video of gleason score 9?
Hello Marcus, here is a video we did on Gleason 9.
Gleason 9 & 10 Prostate Cancer: Cure Rates, Treatments, New Approaches:
th-cam.com/video/5GCEylhYlw0/w-d-xo.htmlfeature=shared
@@ThePCRI thank you so much
I am 72 I have 3+3 =6 less then 5 percent in one core, my radiologist says if I want he can do 5 treatments of radiation and no hormone therapy. and that would take care of the problem. I have never heard of this could you do a video on 5 treatment radiation
Yes cyberknife 5 treatments high intensity
Has anyone found a doctor that will do focal care on a higher grade lesion higher Gleason score say 4+3,4+4 that is small and fits the criteria Otherwise, I've seen Dr. Scholz talk about conceptually they should be able to do this, but I'm not sure if anybody has done it yet. I know at the information gathering stage of vocal care. They are very selective and who they want to take on his clients but I've seen Dr. Scholz question the same thing I'm questioning about if the technology works for a 3+ for its contained, and in one part of the prostate smaller lesion, why wouldn't conceptually they be able to do it to a higher Gleason level tumor the same way they do for a 3+4
Undetectable levels of Prostate Specific Antigen (PSA) have been reported from the first patient with metastatic castrate-resistant prostate cancer (mCRPC) to ever receive two cycles of Clarity’s 67Cu-SAR-bisPSMA at the 8GBq dose level. PSA is a marker of tumour burden, clinical response to treatment and an indicator of the recurrence of disease for prostate cancer.
The conversation is aways about cancer treatment. We need psychiatrist treatment. The patient's mental state also needs to be treated.
DOCTORS NEED MONEY. NOT YOUR HEALTH
Go to a therapist. He's not one.
Your marvelous Treatment towards my infection is incomparable. You assured me of getting healed and surprisingly after 14days of taking the medication I went for a test & i was completely free, God bless you Dr igho, I will keep letting the world know about your TH-cam channel.
What dr and what treatment?
Leaning towards TULSA treatment. I got a phone call on a Sunday from the inventor Dr Chopra. I was impressed! It’s not covered by Medicare until January 2025. Roughly $35k as self pay. What’s your life worth?
Gleason 3+3 but Decipher and MRI both show High Risk.
Dr Scholz can you address 3+3 but High Risk? Is that still a candidate for AS?
Don’t put to much weight on Decipher or MRI. The PSA density may be even more important.
AT YOUR SCORE... DO ACTIVE SURVEILLANCE
Mine must be in the small capacity as I’ve had it for years and now 94 and still feel ok and except for biopsy and mostly PSA nothing else, PSA very high but don’t worry and over 20. At my age I’m not bothering about it, I still here and will probably make it to 100. It might be spreading but don’t feel any thing. Hate to say it but some doctors may be making money out of it?
BIOPSY IS BARBARIC. TRY MRI
Why not offer nano knife IRE for small tumours? And still keep on active surveillance.
4:11 I find his reliance on MRIs odd because in my case at least even with 3+4 disease, the MRIs (3T) show nothing.
Would he not treat until the MRI shows something?
One of the big issues is WHERE did you get your MRI, WHO read it, and how much EXPERIENCE do they have reading PROSTATE MRIs? He recommends that if we do an MRI, we do them at a Center of Excellence like UCLA, UCSF, etc. If you go to UCLA, his approach will be dependant on the report. If your PSA is not out of line with your prostate size and the Radiologist sees no suspicious lesions, he may just monitor. He has never said that MRI are 100% perfect; he is saying they are better than random biopsies which some studies have shown have a false negative rate in the area 30%. Can an MRI miss a cancer. The answer is yes. Is it better than having someone randomly stick 12 needles into your prostate. That answer is yes also.
I thought the false negative rate for MRIs was somewhat similar to be honest.
I get that all things being equal an MRI is preferable to a biopsy, and that clearly, an MRI should be done before a biopsy. And of course, we should strive to prevent unnecessary biopsies.
But if someone has a high PSA density, and a negative MRI, showing no suspicious lesions (let's say from a center of excellence), would he say "Even if there's cancer, I'm not worried about it until it shows on an MRI?" Or would he say, "MRIs aren't perfect, let's get a biopsy". My urologist said the latter.
@@noahd1 Well, I can't speak for the doctor but I know he doesn't say, "nothing on the MRI so I'm not worried." Here are some of the things he'll review. First, he will want to know WHERE you got your MRI and WHO read it. If the MRI came from a center of excellence, he'll be more confident in the results. If it came from UCLA, he has a long relationship with many of the doctors there and that will help him. If the MRI shows a large prostate, BPH, and some signs of prostatitis, he'll let you know those can effect your numbers and may be partially or totally responsible for a high PSA. He'll look at PSA density, family history, and some other more routine markers like free PSA, 4KScore, etc. If your PSA is very high and your prostate is small, he may even consider PSMA pet scan. But, in the end, he won't take your decision from you. He will tell you the pros and cons of proceeding with the random biopsy and allow YOU to make that decision. Your prostate care is a joint effort between you and your medical team but you are the CEO so you decide. For me, I'm not doing a random biopsy; I've already decided that. I'll do a targeted one if something is found. Others decide differently. We all have different risk thresholds and quality of life priorities and that's why it should be our decision.
Why does focal therapy not good for the young?
I have a 3+4 in a single core, less than 5%. Three cores Gleason 6 ( Two from targeted area ). Oncologist says Active Surveillance is reasonable. Does anyone in this group have 3+4 while in AS?
Yes. 3+4 with 10% in one core. I will be getting the one year biopsy next week. My Decipher score was 0.24. But I think PSA density is just as important was any other value. You should also get the BRAC1/2 test which is $250 or insurance may pay for it.
The new treatment , is laser who melt down the tumor, swed comp CLS have this i think it is possibel to use this in US
Please expand on why Dr. Scholz doesn't care for the Decipher DNA test. That's the DNA test my doctor used.
Why no answer to an excellent question?
If money is no object why not take a psma pet scan instead of a biopsy?
I think it's because the biopsy determines the existence of cancer. If the biopsy yields a negative result, a PSMA PET Scan may no longer be necessary.
I have the same question
Dr. Sholz. I am a family doc in Missouri. I am having trouble finding information on PC with very low PSA. The patient has PSA of only 0.68, stable for several years, but new bx of 3+4 in 2 cores. Interestingly, the positive cores corresponded with digital exam, but not with the only area the radiologist identified as an area of interest on MRI. Is that likely to be a unique type of PC, more or less likely to advance, and would genomics likely clarify the questions?
from PARVEZ MUKHTAR
CONTINUED from previous
I am 71 and taking hormone therapy for last 6 months. Radiation therapy has been carried out for 21 sessions in 30 days.
How are you sir , can youbshare your details, psa? Gleson score?