What is Better to Cure Prostate Cancer? Surgery or Radiation?
ฝัง
- เผยแพร่เมื่อ 18 ต.ค. 2020
- Title:
What is Better to Cure Prostate Cancer? Surgery or Radiation?
Text:
Surgery and radiation are the leading treatments for prostate cancer, but which one has a better chance of curing prostate cancer? Here were dive into the newest studies answering exactly that question and you'll be surprised by the results. Many of these studies were published just this year in 2020 and most doctors still don’t know this information.
Our goal at Cancer Better is to provide people with the best possible information to help them make the right health decisions. When it comes to big decisions like cancer treatment, you should know the facts so you can be in control of your health.
Creating these videos takes many hours of research by experts in their field.
To donate please go to: cancerbetter.com/donate
For more cancer related videos go to: cancerbetter.com/videos
To learn more about Dr. Ahdoot go to: www.michaelahdootmd.com/
It seems like a good time for me to update. Almost a year later after radiation, I have had plenty of time to reflect on this path. I just had a periodic checkup and my PSA is at 0.39. This follows levels of 0.09, 0.05, 0.05. My testosterone is back at 239 after 6 months of ADT. I have been low for many years, compared to a normal adult male. Usually I ran at this level. I no longer have ADT symptoms such as hot flushes. Doctor is happy with my scores so far. BTW, my Decipher score was .14.
Thank you Dr. for taking the time to make these videos. I’ve never had cancer or surgery before so having this kind of up-to-date information on the state of the art really helps one make an informed decision.
Thanks for a very clear and balanced overview of PC treatment and the perspective on long term "cure" rates. I had a mildly elevated PSA for some years between 1.8 and 2.8, then it jumped up to 3.4 at age 67. My doctor then ordered the more sophisticated PSA test showing the percentage of free PSA. This was initially 25% then fell to 15% about 6 months later. He then immediately referred me to a urologist with a recommendation for a mpMRI. The MRI showed a 7mm lesion (PIRADS 4) in the Peripheral Zone. I then had a targeted biopsy which scored Gleason 3+4 =7. The biopsy was positive in 6/16 cores.....so I have intermediate risk PC. Fortunately due to the screening and the competence of my doctors it is a very early diagnosis...which as per your commentary is crucial to curative outcomes. I have a urologist and radiation oncologist who are a very experienced team in LDR Brachytherapy and I think I will be going with that option but I am due for a PSMA PET scan before making the final decision.
So for those new to this complex area, the journey may look like this:-
PSA elevated > extra PSA test for level of "free PSA"> referral to urologist> mpMRI > (if lesion found) BIOPSY > (if intermediate or high risk found) PSMA PET scan > TREATMENT Decision
Thank you for sharing your experience. I know people appreciate it
Thank you doctor your the best! This is helping me with my decision!
Thanks. I'm 70, currently "under surveillance", and also have BPH, a 6 french urethra by a 2 cm stricture in my urethra, but I feel fine with some urinary delay.
Excellent explanation with all graphs etc.
Thank you for this educational video. A complex field for non-medical men with PC to assess their own demise. Especially when a multi-faceted approach can be taken. Assessing side effects, in consultation with both radiation and surgery experts, I chose ADT (testosterone deprivation), high dose brachytherapy followed by two dozen applications of external radiation. Why? Although no metastasis, my biopsy showed cancer outside the gland (perineural and periprostatic). Surgery, and in particular laparoscopic, robotic prostatectomy is most often a case of how much margin to take. Too little? Mortality is a risk. It comes back. Too much? ED and incontinence. Maybe for life. However, one size does not fit all. Do the math before submitting to anything. Watching videos like this shows you are on the right path.
Makes sense. For men with extraprostatic extension surgical cure rates are lower and for this reason some people elect for radiation. Other people elect for surgery followed by radiation. We actually don’t have good data saying if one is better than the other yet. I’m currently doing a retrospective review of our patients to attempt to answer this question. I hope to publish this work in 1 year. (The research process takes a lot of time and energy)
Keep the knowledge coming!
Love your Videos!! Thank you
Thanks Brother!!!
My husband‘s doctor told him that prostate cancer grows very slow and just watch it. So not to worry about it. Well here we are six months latermonths later and hin the intermediate group group with a Gleason score of 3+4 = 7. CAT scan shows 70% of the prostate is malignant and there’s some malignant cells around the nerves in the prostate which I understand to mean it could spread faster now
@@lindamastropietro4429 Most, but NOT all, prostate cancers grow slowly.
Excellent and informative review.
Happy I can be helpful
Useful, thanks Dr.
My pleasure
Thank you this video was really helpful in making my decision 👍👍👍
Glad to hear that!!!
Very helpful video thank you
My pleasure. It’s my goal to help people have good information to make decisions about their cancer care
This guy is right on point. This young man definitely knows what he's talking about. Wish he would have been my doctor. He is definitely not in it for money.
I appreciate this comment very much. My goal is to educate people and I’m happy I’m helping people.
Wow. A video by a doctor who’s not pushing for intervention.
One of the critical factors for me is the down time caused by surgery. If I need someone attending me for a week or more, that means my wife loses leave time from work. And the risk of infections, dealing with a catheter, and learning to gain continence again after surgery is just too much for me to psychologically handle. Finally, going from "happy endings" to "not even invited to the party", all from a 2 hour surgery is just mentally unbearable. My depressive state would be crushing. I know me all too well.
This is where I am at, going for another biopsy in 2 weeks, symptoms have increased, I'm not happy
@@Justme85857 Hang in there, Paul. Why another biopsy?
The MRI showed the nodule grew 2 MM, it's now 12MM
@@Justme85857 was your first biopsy negative? If so, same story with me here. Hopefully, PSMA-PET scans will change the future.
I had 13 core samples and 3 came back positive for Prostatic Adenocarcinoma. 6%,5% and 4%.
Just ran across this video. I had radiation for PCa in 2008 and according to my Uro they missed a part of the gland. Therefore I still have PSA although it has slowly trended down, but never below 1.5. This is why I would recommend having surgery and saving radiation as a salvage. I do realize that in older patients radiation is a less invasive option, but NEVER for younger guys.
I'm a radiation oncologist, and have treated thousand of prostate patients. Just because the PSA is not as low after radiation as it is after surgery, that doesn't mean your recurrence rate is higher, as the data in this presentation shows. Also, our technology and imaging have improved tremendously since 2008, and that's assuming you had a state of the art treatment in 2008.
A detectable PSA after radiation is not necessarily a sign of cancer. Rather we look at where the PSA level bottoms out and then see if it rises repeatedly from that area to call radiation a failure. Usually the next step is a PSMA pet scan to see where the cancer might be and sometimes a prostate biopsy may be needed to make a definitive diagnosis.
@@cancerbetter My PSA has consistently dropped from about 5 to the current 1.4. My Gleason was 3+3 6. About a year ago it increased to 1.9, but I had a severe case of Shingles on my right abdomen and leg all the way to my ankle. My URO said we would toss out the 1.9 and at my last appt it had decreased to 1.6. My brother was DX'd last year at 75 and the targeting they used for him was so much more advanced than the six tattoos-small black dots-that were scratched and inked into my lower parts. I appreciate the reply.
🎉🎉😢😊😊
Looking again at the figures, there is a higher risk for metastasis in AM compared with treatment but in absolute terms there is according to the figures a 94.4% possibility of no metastasis - do you want these side-effects to reduce the risk by 3%? metastases are also treatable in PC. Disease progression is higher but this could be anything from GG1 to GG2 [still relatively low risk] to GG3-GG5. It's not clear what the term "progression" means here. Would you necessarily treat for low rate of progression? Finally one of the most critical points glossed over by doctors is what is meant by "cure"? To the layman this surely means eradicated. Period. So far as I can see to the medical fraternity it seems only to mean "PC non-mortality" or more commonly "years of PC biochemical free survival" studies typically referencing 5 or 10 years.
Thanks for taking the time to create this series of videos.
I just got surgery (radical prostectomy). The one thing not seemingly mentioned is nerve damage to the leg. It seems somehow I am experiencing some nerve damage where immediately after surgery, when I tried to lift my left leg straight up, it went at an angle to the left. It has improved a bit one week out, but difficult to move left leg laterally. Need my wife to lift and move leg onto bed when going to bed. Improving a bit, but also feel it when walking the hanging of the leg when walking forward really makes the nerve feel raw. I am taking two ibuprofen morning and night in hopes it helps. Do you have any thoughts or experiences on this issue?
This is not a normal or common issue after prostatectomy. You should discuss this with your doctor. The fact that you are making improvements is a good sign but again this is not typical and should be addressed.
Thanks, Dr Ahdoot, I appreciate your entire series here. One thing I've not seen addressed in the surgery/radiation choice is an enlarged (55g) prostate causing obstructive urinary symptoms. Even after successful RT would the size (perhaps continuing to enlarge as BPH) be an issue to sway a choice to surgery? (Or any pointers to resources, studies, or papers you know of on this?)
Yes there are actually many additional issues to take into account in selecting surgery vs radiation. When obstruction is present, radiation typically has a higher than average risk of urinary complications. Surgery would negate this risk but alternatively you could treat the obstruction with a transurethral resection of the prostate prior to radiation. Many ways to handle these details and a good urologist should be able to help you through the process. All cases are slightly different so having a thoughtful team of doctors to help in addition to your own research is a good idea.
Yes, when comparing active surveillance to any treatment and which type of treatment the issue of side-effects is a very important variable given that in the safer randomised trials the risk differentials are quite low. Yes you may be "cured" but do you want to live for 10 to 15 years with incontinence, erectile dysfunction or other side-effects rarely mentioned by doctors either through ignorance or because they have a vested interest in a particular form of treatment?
Radiation-caused side effects down the road (secondary cancers) should be seen as a possible side effect. This DR, to his credit, does mention that issue.
@@robertmonroe3678 Surgery can leave secondary cancer as well. They are limited on the amount of tissue they can safely remove. That's why they may follow up surgery with radiation.
Secondary cancer refers to non-prostate cancers that may occur due to radiation (he explains this 10 or 15 year post-radiation effect on the video).
It is correct that both surgery and radiation may leave behind cancer. Which is why adjuvant and salvage radiation is sometimes necessary after surgery. And salvage treatments after radiation.
I have a question on the two tables you show at 7:35 &7:41 where you say surgery has a 1.6 times {160%) and 2 times {200%} better overall survival, but could those numbers actually mean 1.6% and 2% (not 160% & 200%)? It might be more accurate to either add additional info for clearer context, because while 2% is 200% of 1% 2 percent is still a very small number, That may be why your following statement of "surgery may be SLIGHTLY better."
Gd bless everyone here as well as senior people.
I am 19 years old help please.
I want to do surgery.
As well as here in Nicaragua and many places of the world many people has it. I wish they be helaed.
7.4 score not sure how bad that is. My doctor wants to do surgery and radiation. I'm 69 in good health in very good shape so I decline surgery but I'm thinking over the radiation treatment but incontinence and E.D. is not for me. I may just ride it until the wheels fall off and not worry about it.
I'm not sure what you mean by 7.4. Do you mean Gleason 7 (4+3)? We usually do recommend treating that. You might want to investigate if focal therapy is an option to limit side effects.
The problem with surgery and radiation therapy is that there are side effects. As a result, the small additional risk of active monitoring might be worth it if you can live for many years without the side effects that you can have from treatment.
Great point and this logic contributes to our choices to consider observation when possible
Hi I been diagnosed with prostate cancer and my Gleason score is 8 and it’s localized . They are offering me surgery or hormone therapy for two years and radiation . Plz tell me what should I do ? My psa was 19.7 and now it’s 13.9 .
Depends on many factors include your age, MRI findings, location of the lesion, and your preferences. I've had people request consultations via telemedicine in the past which have worked out well. If you'd like to set up a consultation send me an email at michael.ahdoot@cshs.org.
In general for any consultation for prostate cancer I'll need the pathology report, lab results including PSA, a copy of the actual MRI(often copied onto a CD or sent digitally), MRI interpretation, and any recent urology clinic notes. Attempting to give personal suggestions without having all the data would do you no service, but if you want help I can be available. -Michael Ahdoot MD
Just be aware of the serious side effects of chemical castration.
Do not believe the BIG PHARMA sales pitch that these quality of life destroying effects are "generally well tolerated". They are not.
And be forewarned that there is a 20 percent chance for older men that you will NEVER recover your testosterone level above castrate level.
That is, you could end up castrated for life with all the lethal results .
Big pharma and your doctor will never give you ALL THE FACTS and they try to force these toxins on you.
Of course, chemical castration also referred to by it's promoters as ADT, may be the right decision for many patients but you need to be aware of ALL THE FACTS in order to be able to weigh the small benefit of extra overall survival time against the cost of years of terrible quality of life destroying effects.
Good luck with your treatment choice.
Gleason 6 widespread. Radiation treatment offered. Active surveillance not promoted but acceptable. Foregoing radiation not encouraged. Thinking of getting a second opinion.
Widespread Gleason 6? I wrote a paper about 3 years ago showing people with very large volume of Gleason 6 prostate cancer (I.e. more than 4 cores positive) have a high risk of having some GG2 (Gleason 7) disease. High volume GG1 is the only exception for which you might consider treatment of GG1 prostate cancer.
Hi, my initial stats were: 58 yrs old, fairly healthy, psa 124, 3+4, T3b locally advanced into seminal vessels. PSMA PET scan showed no further spread.
37 RT sessions (prostate and nearby lymph nodes) and 2yrs HT.
I'm sure you're asked this all the time, but, what is my 15 year outlook and chances of being cured?
UK based.
Thank you. Clive Linton.
I can’t make comments about individual cases on this platform unfortunately. The main thing to be looking for would be how low your psa goes after treatment. Lower the better
May be we can conclude that surgery is operator dependent, hence the outcome could vary from center center, whereas radiation is machine ( technology) dependent.
This is somewhat true. More expert surgeons have superior outcomes. That being said there is a skill set to high quality radiation.
I was sixty when I was diagnosed with prostate cancer. I got two opinions, both doctors recommended surgery. I had a PSA of 15, Gleason 4+3. The biopsy found 6 tumors, the cancer was encapsulated; one tumor was close to the prostate wall. That was 21 years ago. Did I do the right thing?
Sounds like it! 21 years and I’m assuming no signs of cancer. Good chance this cancer could have killed you.
Just saw your video. 54 year old healthy male with localized prostate cancer, gleason scores 6 and seven in different cores. Would you recommend proton therapy or surgery?
Impossible to say without a lot more information. Would it be helpful if created a series of videos where I discuss examples of patients and how I think about selecting treatment?
Are you familiar with the TULSA Modality using radiofrequency ablation on the prostate? How does it compare with radiation therapy and surgery? I have been offered the option of all three modalities. I am 68 years old and in generally good health. I am trying to weigh the risks and benefits of each. Thanks.
I found your video on focal therapy which discussed TULSA. It was very helpful. Thanks.
What about an 84 year old man with a PSA of 13? Who is being treated for Crohn’s disease and suspected to be in early stage of dementia ?! Please give your perspective. Thank you
Usually prostate cancer screening is not done in men in their 80s due to the very low risk of prostate cancer related death when cancer is diagnosed this late in life. In other words even if a man in his 80s develops prostate cancer he's very unlikely to die from it because prostate cancer usually is slow growing. There are exceptions but in general this is true and supported by numerous studies.
Hi doctor, my father is now 72 y.o and he was diagnosed with a prostate adenocarcinoma. He's in a bad shape like his back is in pain so bad, the dctor here in the philippines advsd him to have a bone scan, chest scan with contrast and other some lab. Right now after those test and lab, we are waiting for the result of what cancer stage he is right now, the doctor provide an option to have a medication for 6 months just to stop the cancer in spreading to other organs that has no cancer yet and also to have an intraveins injectable fluid once a month for 6 months, 2nd option is to undergo surgergical operations removal of testicles which secret testosteron, a fluid which caused cancer cells to spread.
I’m sorry to hear about his diagnosis. I hope he responds well to the treatment.
Look into taking ivermectin for this
Hello Doctor, a 4+ 3=7 confined with no spread means you caught it in time..? Or is there still a high possibility of a recurrence?
Sounds like your odds of cure are high. Considering a pre op PSMA PET scan to confirm no cancer spread.
After surgery if your PSA is undetectable you are very likely cured.
@@cancerbetter wasn't offered a pre op psma scan..but a mri showed no capsule extension, no svi and no pni..and psa was 6 pre op...post op pathology confirmed this..just waiting for first psa in Oct, crossing my fingers.
@@cancerbetter thank you Doctor
Wish you the best of luck in your recovery!
I have a question regarding Gleason scores; but first a little history. I have a history of high PSA numbers anywhere from 5 to slightly over 20 (one time) and it seems to vary widely. I had four standard biopsies that all came back negative or indifferent. After moving the local facility used MRI guided biopsy and found some low grade cancer determined to be a GS 6. I was monitored for a year when I got the really high PSA number indicated above. So the Dr wanted a revised MRI and biopsy. The MRI showed no significant change but the biopsy was scored at GS 3+4=7. So to my question...how subjective are the scores...could one pathologist rate it higher or lower based on knowledge/experience or perhaps a best guess? Thanks.
Yes there can be variation of interpretation in Gleason scores. If in doubt or at a smaller hospital you can request your pathology slides be sent to another hospital or doctor for review. Dr. Epstein at Hopkins is probably the best known pathologist in the country but most modern trained pathologists specializing in Urologic path will doing a good job.
In summary if in doubt get a second opinion at large academic center that treats a lot of prostate cancer.
They are a bit on the expensive side but here is the link to get a path review done at Hopkins. I doubt Epstein himself reads these slides anymore but presumably people he trained now do these path slide reviews. pathology.jhu.edu/patient-care/second-opinions
I was diagnosed low intermediate risk with a Gleason 3+4, a negative PSMA, a negative 1.5 T MRI and a PSA of 3.2 but my Oncotype dx score is 42. Does the genomic test result override the other parameters and now make me hi intermediate/hi risk re treatment?
Thanks
Your Gleason score and genetics make you a person who usually would get treatment. Watch the video on what happens if you don’t treat prostate cancer and maybe the video on focal therapy. You probably would want to discuss with your urologist
I am getting LDR brachytherapy but do you often intensify the treatment by adding ADT or EBT in addition if the genomic score is hi ?
Thank you @@cancerbetter
@user-mx6tc9em7o I do not do radiation therapy so I would defer to one of my rad onc colleagues for this question. In principle external radiation is often added to brachytherapy to address issues of imperfect spacing of brachytherapy beads which can lead to low radiation dose between improperly spaced beads
Should radiation or surgery be used before a MRI to even see what your going after and where it’s located….That’s the way the Nashville VA is trying to treat me now. I asked for MRI 1st….they didn’t like that..
I would be curious to know if genomic testing helps provide a clearer view of things. Some of these companies that do that imply that if high risk is shown, you'd better get treatment.
Short answer is genetic tumor testing is marginally helpful. It’s mostly used when people are considering surveillance for cancer and they want to be more confident the cancer does not show genetic signs of being aggressive.
@@cancerbetter So you're saying that if there are genetic signs of aggressive cancer, surveillance is not the best option? Thanks for your response.
Somewhat controversial but generally that is true. If someone has unfavorable tumor genetics the risk of worse outcome is about 3x higher than those with a favorable genetic profile.
This is all in reference to tumor genetics which are a different thing from germline genetics.
@@cancerbetter How do these tumour measuring genetic companies give their assessments back to you? A simple favourable/unfavoourable or 1 to 10 score etc.? Most appreciated Sir!
@Jack-2day most give a risk of metastasis scores.
Dr i have a digital and MRI confirmation of prostate cancer, i want to use fasting,diet and alternative therapy, i fear a biopsy it will spread? , im 65 ,and plan maybe to skip byopsie, your thoughts?. PSA last test 5 Please some common sense advice, if i can live another 5 or 10 and monitor id be happy,
Speak with your doctor about the merits of a biopsy. Your mri will give information about your risk of cancer
@@cancerbetter Is there a risk that a biopsy will spread the cancer?
@@user-bk2xm2nx6t I sure hope not, I just had one two weeks ago. My PSA was 4.9. He took 12 samples 4 of which are cancer. All 4 sample were rated 3+3=6 on the Gleason score and my Clinical stage is T1c. I'm set up to see a radiation oncologist tommorow. I'm 75 years old so active monitoring is where I'm most likely headed, although I would like to have an MRI to see if there is a tumor.
These studies all seem to be based on 10 year time frames. How do the two treatments compare beyond 10 years?
There are limited studies looking beyond 10 years. There is one with 15 year follow up.
Hi I’m Dan,, I am 52 just diagnosed with prostate cancer,, I have had a MRI done which had a good report prostate size normal and no suspicious spots,, got a 12 pt biopsy and found a couple of sides of prostate with Gleason 6 , And my PSA has been 7 for about 4 yes now.. what should I do?
*Years
I'm not a doc, but depending on your grade of cancer aggressive,a gs 6 should qualify you for active surveillance, just be diligent about that psa 7..
Activate surveillance could be an option. Discuss with your doctor! Most academic centers will have a prostate cancer expert in their urology department. See an expert.
Thank you
What if someone you know has it; but they were told that since they have stage 1 that there is nothing the doctor could do about it but active surveillance. They were told they are too young for surgery; but what about radiation? If there any foods that this person can eat? I have been seeing papaya, pomegranate, ginger, cayenne pepper; what do you think?
I have never heard of being too young for surgery. Generally the younger the person the better the surgical outcome.
I have never seen evidence that suggests the dietary changes you suggested would treat cancer.
I was suffering from similar issues in the past but I’m glad it has been fixed by dr oiwoh....
Are there any studies that separate Low risk, intermediate and High risk Pca? Clumping them together is misleading.
Yes many, just smaller studies with shorter follow up.
I had radiation SBRT about a year and half ago. PSA dropping which is great however my side effects are only now getting bad. I have strictures and have almost been totally blocked from urination and now need dilation surgery and that may not work. I am not in great health and am 70 years old so I do not want to undergo major surgery-so, was I right to have treatment?
Difficult to say. It really depends on your cancer grade group, location, size of the prostate, presence of a median lobe, and if you had an appropriately skilled surgeon in your area. Strictures are radiation are a challenging problem and I’m sorry to hear that you will need a repair. I hope the repair is not too challenging and you can move on with a high quality of life after.
@@cancerbetter Thanks. Dr Gegory Joice dilated the stricture and I am voiding okay but two days after I removed the catheter it started to bleed once I took my Xaralto. Too bad because I have Afib. I am okay with hematuria but fear clots.
Bleeding is common early after dilation. Be patient. Check in with your doc.
@@cancerbetter The bleeding stopped then i went back to my Xaralto and yep! Bleeding started again so I stopped a couple of days now. Still have some minor bleeding but some voids are clear. Good news is my stream force has increased. I will speak to cardiologist abut blood thinner.
@@glenbearh9109 I had AFIB and had my LAA isolated to shut it down, but I had to stay on Xarelto for life. I just had Dr Natale best EP in the world who did my ablations also implant the Watchman device which allowed me to get off Xarelto to get a biopsy. A stroke is no joke.
Good afternoon Dr. I went to a urologist who found a lump on my prostate. I went to a second urologist and he found no lump. I then went to a third and fourth urologist to "break the tie" and neither of these urologists detected a lump. My PSA is 1.32. Would you have any suggestions as to how I should proceed?
About 3% of prostate cancers are found in people with a normal PSA and a prostate nodule. If in doubt you could consider an MRI of the prostate.
@@cancerbetter Very good evening Dr. Ahdoot! Thank you very, very much for getting back to me with this very valuable information and suggestions! Best!!
Very good evening Dr. Ahdoot. Thank you very much again for the previous most valuable information. Just so I am clear..when you say "normal PSA," are you referring to PSA levels below 4? My most recent PSA two months ago was 1.32
@@jeffreywaldman8032 the normal cut off for PSA changes with age and race. In general the PSA cut off that is considered normal is 4.0 but for Asians for example above 3.5 is abnormal. Also for people less than 60 the cut off is lower and for people over 70 it's higher. It's so complicated that in practice most people use of cut of 3.5 to refer to a urologist then we take over from there.
Very good evening. Dr. Ahdoot. I strongly need your very respected opinion. If one urologist (the first urologist who examined my prostate) found a lump, but subsequently, three other separate urologists and one internist/pulmonologist, each physician independent of each other, found that my prostate did not have lumps, in your very valued and highly respected opinion, should I (still) get a prostatic MRI or believe/follow the opinions of the "majority" four doctors who reported not feeling any lumps?
My father 74 age 3+4=7,grade 2,psa 8,8,biopsy 4 of 12 positiv all left and left centar 1 and 2 (6%-10%) 3 and 4(11%-20%)
Surgery or radiation
I’d recommend speaking with your doctor about this. The decision is more complicated than just surgery vs radiation based on side effects. Individual anatomy, prior surgical history, use of anti coagulation, and general health should all be considered.
@@cancerbetter Thanks, his psa 1.11.2022 is 8.8 and 31.1.23 is 7.9 its good or no.
It seems to me, that any man over the age of 80 is likely to have prostate cancer.
Probably the same for 77 year olds.
Given that, one can assume almost every male over 77 has prostate cancer and is living with it.
Probably most are oblivious to the fact and just get on with their life.
If every male, (younger and older), were to get treatment, obviously the NHS would be overwhelmed.
As it is, it appears that younger men who are working today, have private health care because their employers provide this. ( I worked for an American Company when I was in my 50's and the first thing that they provided was health care and I was invited for a health screen/test wherebys they picked up the PSA at 5).
So I would think that many of working men are being screened for cancer and are possibly being treated in their 50s and sixties....probably the same throughout the UK...Private Companies...Private Heath Care.....Find high PSA levels.....Find Cancer...Get treated by the NHS or by private treatments.
This is a huge enterprise obviously.
Now back to the older generation.....
Most men over 70, probably don't know that they have prostate cancer, until of course it exhibits itself in some nasty form and then it probably is too late and/or they pass naturally with old age or some other ailment.
But I guess almost every man over the age of 77 will not die of prostate cancer treated or not treated?
So you see where I am going with this......
Why get the treatment at all, if I am most likely to die of old age or other ailments like heart disease and where the cost of treatment will most certainly outweigh the benefits and I should just let nature take it's course, as it has for generations before.
Lets face it, not many men will reach the age of 90....For me that is only 13/14 years away.
Should I suffer the consequences of the Radiation and Hormone treatments during the last few years of my life.?
Your post draw attention to a very important central tenant in prostate cancer: you must consider life expectancy and the aggressiveness of a persons cancer before offering treatment. The most common prostate cancer is grade group 1. This kind of cancer is extremely low risk and therefore we rarely treat it. Conversely grade group 4 and 5 cancers are highly dangerous an warrant treatment.
Generally speaking if your life expectancy is less than 5 years treating prostate cancer often does not lead to a large change in life expectancy. This is why we usually do not screen for prostate cancer in people over 80.
If death occurs at 10 to 15 years then get more data on that group, 10-15 years out from diagnosis and treatment. Why stop at 10 years getting data?
At some point it’s just irrelevant because your risk of dying from other things becomes more likely. Longest follow up any prostate cancer study was 23 years which means one doctor spent their entire career running this same clinical trial.
How about neither surgery nor radiation. How about stop drinking milk and consuming added sugar?
While there is some weak evidence that reducing diary consumption might reduce prostate cancer risk, once prostate cancer has developed these forms of lifestyle modification will not stop prostate cancer.
Generally the best time for lifestyle modification is prior to development of any condition.
Update!! Please look to the first time I shared my story below. The facts are the facts I do not want to mislead anyone. Shortly after that post four weeks ago I had a pET scan PSMA w a t t c t s u b s q t x . The results are in. I have two positive lymph nodes sUV 8.0 and 5.6. Left mesorectal one of them is closer to the sigmoid colon. My urologist tells me that they are too small and too hard to get to for a biopsy???? At this point we do not even know for sure if they are cancerous??
The scan is not perfect but the scan of usually right. Ask your doctor if the nodes seen make sense with the diagnosis or if s/he rings the findings are a false positive. If they are truely positive you might want to consider radiating the area.
i set up a video visit with you for this Friday. I hope I sent you all the information you need. My name is James Collins@@cancerbetter
Surgery has more side affects
Some people would look at the data and make the opposite conclusion. That’s why it’s helpful for you to understand some of this data so you scan determine what side effect profile is less concerning to you.
@@cancerbetter thanks for answering my comment most don't it's appreciated. I'm about to decide what treatment I'm doing, one thing I wonder about is how many radiation treatments are there? and surgery is a one time thing. Mine is localized
Surgery really only has two side effects. Possible incontenance and loss of sexual function. Urinary control usually resumes pretty quickly. Sexual function might take a year.
@robertheinkel6225, correct the total number of side effects of radiation on average is higher but the types of side effects are different
@@robertheinkel6225 "Sexual function might take a year"...............or in my case ,NEVER.
You missed something extremely important at begin this literature review. The subjects studied had LOW RISK prostate cancer at randomization. These data cannot be extrapolated to intermediate or high risk patients. Misleading video and can be dangerous for other patient populations if they believe the study results also apply to them.
Indeed, while I tried to be explicit about the people in the patient cohort the majority of these patients were intermediate or lower risk patients. This is typical of the incidence of prostate cancer. It should be noted that high grade cancers demonstrate similar rates of cure on average between surgery and radiation but given the higher risk nature of these cancers they have a higher risk of metastasis. If a cancer has spread usually localized treatment like surgery or radiation are not curative.
What happens if a man is in the intermediate level? He is going to to get radiation and his oncologist is going to lower his testosterone? His Gleason score is 3+4
Radiation is far superior to surgery. If you want ED and Incontinence...go for surgery.
You can lose bladder control with radiation also with radiation you have bladder Burns and have constant diarrhea I had surgery I'm gaining bladder control back.... with radiation you'll definitely have secondary cancer from the radiation so if you want radiation you can have it surgery is the way to go
You must like shiting your pants cuz that's what you get with radiation
No cure for prostate cancer
Cure is possible but after a prostate cancer diagnosis doctors will recommend at least annual PSA checks to make sure it never comes back. In the event of recurrence early diagnosis and treatment does make people live longer.
Boring.
Thanks for the opinion :)
I find it very interesting!
Thank you Dr for the very informative video.
Im really confused as to which way to go, and I have to make a decision NOW.
Im 60 overweight with low testosterone (4.7)
Diagnosed with low tier intermediate PC. cT2, PSA 5.8 - active surv. til now.
MRI P4 lesion, fusion biopsy shows single core 3+4=7 in left apex
comorbidities, diabetes, obesity, persistent hypogonadism
PSA 14.9 ( 2.1 in 2014, slow increase to now 15)
MRI now shows progression of anterior leson to P5
I have talked to all applicable experts, but no one has said which way I SHOULD GO just offered options.
I would like to avoid both surgery and hormone treatment.
I am currently offered SABR with hormone
Or HDR Brachy as monotherapy.
Or should I add something else to the HDR Brachy?
I would love to hear your thoughts on this, your opinion would certainly help settle my mind
Thank you again for sharing your knowledge and time
doctor my brother is stage 4 he has mestatasis in his hip and a one glandule and he is 58 ?..the doctor gonna do radiation 😞
Sorry to hear that but treatments for metastatic cancer are getting much better. I hope he does well.
Also for people with very few mets (i.e. less than 5 total areas in the body) new data is showing improved outcomes with radiation to those areas. Discuss that option with your radiation oncologist or urologist.