Gleason 7 (4+3)
ฝัง
- เผยแพร่เมื่อ 11 ม.ค. 2023
- PCRI's Alex and Medical Oncologist Mark Scholz, MD, give a survey of newly diagnosed Gleason 4+3=7 prostate cancer in light of the recent introduction of PSMA PET scans into the staging process. Dr. Scholz discusses staging, treatment options, and the new ambiguity of whether hormone therapy is as important for this stage of prostate cancer if a person has a negative PSMA PET scan.
0:07 Why does Gleason 4+3=7 (a.k.a Epstein grade group 3) prostate cancer require treatment in most cases?
2:01 If a Gleason 4+3=7 patient has a negative PSMA PET scan, what should his next steps be?
3:27 How do the size and location of the tumor(s) factor into treatment decisions?
5:16 How would a patient find an expert practitioner of focal therapy?
5:39 Which side effects should a patient anticipate if they are undergoing radiation?
6:31 What are the side effects of a focal procedure like HI-FU?
7:36 Does Tulsa-Pro cause any scarring or urinary issues?
8:02 What are the survival rates for men with Gleason 4+3 prostate cancer?
8:45 Does the presence of seminal vesicle invasion affect the treatment protocol?
9:46 Does seminal vesicle invasion require the addition of hormone therapy to the treatment protocol?
10:50 Should patients have PSMA PET scans after treatment?
11:32 Why have you not discussed surgery yet as a possible treatment for Gleason 4+3?
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#ProstateCancer #MarkScholzMD #PCRI
I just came from my urologist today I found out that I have cancer gleason 9 he told that I have agressive cancer, I am a little bit angry because he didn't call me when he found out that I have this shit in me but I don't have time to argue. He told me my bone scan is okey they didin't find any cancer outside my prostate so chance to be cured are high¹ I will fight this shit, I have my kids who needs me. Now I have to options theraphy radiation or operation he told me to meet a coiple of expert in the near week or so I hope they will be rushing my threatment. Wish me luck and pray dor each other.
same here. But don't get a .... BIOPSY ( Im STILL sufferering from that THING). With the pet scan and m r I they can locate any tumors. I am going to have BRACHYTHEREPY and treat only the tumor !!!! AND... i AINT takin' no HORMONE THEREPY (ADT)!!!!! Changing g my DIET. research what to eat. Good LUCK , brother.
I'm 57, gleason score 4+4, PSA of 8.0 and some migration outside of prostate, not in lymph nodes. prescribed bicalutamide to halt cancer progression. Biopsy (ouch!) to confirm and find out type of cancer. CTscan, CT scan w/nuclear trace, PET scan, MRI scan and another PET scan. Treatment: Removed prostate but my PSA was still detectable at 0.08 then started climbing 0.12, 0.14. 0.19, 0.27, 0.32 and 0.44 . Radiation with 38 sessions was next accompanied with 6 months of Hormone therapy (Lupron shots). My PSA after 38 radiation sessions to the pelvic bed and 5 months of hormone therapy was < 0.02 ng Awesome! 1 month later PSA < 0.02 ng ! Whahoo! The side affects, mental and physical changes along the way are challenging. My advice: Prayer, family, friends support and1 month, 1 week, 1day or 1 hour at a time goals...whatever it takes. Definitely can be overwhelming and lonely feeling but keep your eye on the prize! Stay the course! God bless to all my afflicted brothers and remember you're not alone, hang in there!
It is good to hear that you have got through it so far. I am only part way through the same thing. The only difference is that if your god was so good to bless the sufferers then why did that omnipotent entity allow cancer to develop in your body or in anyones body ? Ohh, that's right, "god moves in mysterious ways". Please don't.
I had 4+3 diagnosis. I just had surgery at Cleveland Clinic (ROBOTIC NERVE SPARING). I have recovered very quickly and very well. I am 66yo
Husband 4 days in from radical prostectomy 72 years old healthy
This interviewer is so pleasant to listen to. Thanks for doing such an educational vid series. Dr. Scholz is so to the point. I've basically made my decision on what to do with a 4+3 diagnosis. You guys are the best!
what is your decision? SBRT?
I just want to take a moment to whole heartedly thank these wonderful individuals who put out such great info on this topic. You’re empowering the people with knowledge as well as comforting them during a time of distress. My dad has just been diagnosed Gleason 7 3+4 and based on all these videos we know this is good news, could have been worse. We are seeking 2nd opinions but he’s likely going with active surveillance for now.
What was your dad's pirad score from the MRI?
@@iamric23I’m not sure if they took the mri results into consideration but I thought it was only from the random biopsies of the prostate that were done.
@@tinamina2634 The reason for asking was I was trying to forecast my gleason score by knowing your Pi-Rad score. My Pi-Rad was a 5, the worst, so I am very concerned as what I will learn this Monday when I get the results back from the biopsy.
Thank you so much for this and many of your other related topics. 7 years ago, with a Gleason 4-3, I decided to travel to Florida for a Focal Laser Ablation. My local treatment option at the time was simply to remove it. Focal treatments were only just becoming available back then. I'm 75 now and after a rising PSA (upper 3s to lower 4s) I had a MRI guided needle biopsy with utlra sound. I am still waiting for results but the number of local treatment options have increased, so thank you for this timely video.
Thanks. Big help at a tough time. Well done .
Another helpful video, thanks Alex and Doc
Beautifully said. Thank you!!
Thanks for the tons of infos regarding 4+3 which I have.
Thank you again for the excellent assistance. It is appreciated.
Such good information. Thank you both!
Thank you. I am learning much, much more from your discussions than I do from the doctors I've seen. The viewer comments are also helpful. I was diagnosed 3+3 at 71 years old. PSA fluctuating between 5 and 7.5, up and down again. At my age I feel like I can take my time. I want to keep the few years I have left for sexual enjoyment. Life is short at this point anyway and I would rather not suffer unpleasant side effects in the last stage of my life. Your discussions have convinced me that radiation will be my choice when the time arrives to take action.
What was your pirad score from the MRI you had?
Thanks for another informative video.
Thank you for a wonderful and informative presentation.
Thank you so much for your insight on treatments , I can make a decision now!
I have prostate cancer get video Alex you ask great questions
Everyone here has given great input about your experience with this cancer . Thanks again keep up the great work 👍
THANKS FOR THIS INFORMATION.
Thank you for all you do
Thanks a lot Dr. for your precious knowledge about proastate cancer. May God reward you. This is not only social service to humanity but also a charity to a patient in need of knowledge.
with your information i find my treatment is going according to your advice. Thanks
I appreciate this contents and it helps me a lot. I had a brachytherapy in Korea one year ago.
A Big Thank You for these informative video posts which have given me more understanding of my prostate cancer, I am now in a position to discuss it more clearly with the Oncologist and my doctor.
With a 7(4+3) & PSA of 7.976, I chose 28 sessions of proton radiation + Casodex & Eligard + SpaceOAR Vue. Side-effects from the radiation were insignificant; side-effects from the ADT were mitigated by strength-training. Now 20-months after treatment, PSA has hovered around 0.41 the last 5 tests.
Interesting. Proton & not the much more common photon ? Hope you are cured & the remaining, static PSA test is for normal remaining tissue. Blessings...
@@jeff6899 Yes. Protons have the Bragg-Peak characteristic, leading to fewer side-effects and fewer secondary cancers than photons (x-rays), yet no evidence that outcomes are any better/worse.
@@brianjarvis9280 Hi Brian ! First of all, I hope that your outcomes continue to improve with prayers following You ! Secondly, from what I recall, that is largely correct. There may be some benefit, but the reports i have largely seen are inconclusive for any real advantage. I had the most advanced photon machine on the market (supposedly) and am hopeful the results will be fantastic ! Of course, taking a full, integrated treatment approach. Cheers !
@@jeff6899STOP sugar~
So you're not ready to graduate~
great stuff people tks
Love your videos!
Someone should mention that that jacket crosshatch pattern + pixels on a screen interact to produce a moire effect, and essentially produces flashing lights. A bit distracting from the content.
It’s overwhelming at first ,my advice is stop and research your options and then chose what is best for you . If your urologist doesn’t explain clearly the side effects of surgery verse radiation therapy with you ,I’d find another doctor. I chose radiation therapy for mine so far so good . Good luck to you all ,it’s definitely a big decision.
How old are you?
I had 4+3 gleason score cancer 11 years ago with no spread. Decided to go for radiotherapy for 7+ weeks. Nobody discussed any sort of side effects. You are left on your own to come to terms with these effects which ranges from scared to confused to devastated. Talk it through first so you understand.
Yeah , initially my urologist didn't mention dry orgasm at all! In f a c t I had to ask him . He only mentioned a few in fact. Oh , high flashes, Catheter F o r O n E Week.
@@martintaylor4453 haw you doing now, side effects gone?
Great channel and videos and very helpful! My father, 62yo, just recently found out that he has prostate cancer. He had an ultrasound guided biopsy and took 12 samples. Out of the 12, 5 cores have a 3+3 gleason score, there is just another one core has a 4+3 gleason score, 40% of cancer cells. He has extensive amount of family history of prostate cancer: his father/ my grandpa got diagnosed with stage 3 at 84 yo, but he's still alive and doing great; his two maternal uncles have stage 3/4 prostate cancer both diagnosed after 75. My father has a PSA of 6. 44 and then the local doc suggested a mri and then biopsy and found out about the cancer. He's otherwise very healthy. I know he has 5 cores that are gleason 3+3 which indicates candidacy for active survalance. But this one single 4+3 makes me wonder what would happen if he just watches. My mother passed away from an ultra rare type of cancer a year ago and my father had been the best husband and caregiver any woman could find. He finally walked out of the dark zone of widowness and met someone new recently. I think they are serious about this new relationship. So I guess they will remarry at some point soon. My father lives in a small town in Asia and has limited access to up-to-date medical info. So I am learning everything for him to give him a better idea what to do next especially in finding a good doctor maybe in a capable hospital. Thanks!
Thanks for this video, I’m currently 64 yo with a 4+3 and I’ve been trying to weigh the decision about surgery over radiation. I was almost convinced to do surgery, and now after viewing this video, I think radiation therapy with a side of hormone therapy is how i need to attack this.
Surgery, radiation with 6 months of hormone therapy is the best option for 4+3 Gleason score. Optimal for getting cured!
Look into Soloblast HIFU
FOCAL HIFU
BRachytherapy
Or proton beam therapy
But no SURGERY
YOU’RE THE SAME AGE AS MY HUSBAND and he has the aggressive cancer 4+3=7 and we’re opting for HIFU
our dr is suggesting nanoknife but I’m not crazy about him so we’re currently going to see another Dr who specializes in HIFU
please don’t get surgery as your first option but do find a treatment quickly due to your Gleason score
Tomorrow I complete 28 days of radiation, and have 5 more months of adt (Orgovyx). I’m 64 as well. The radiation has gone well except inflamed urethra which makes for very painful urination. FloMax helps.
The adt is a different challenge. But testosterone is expected to return after some time. I work with a trainer on weight lifting and resistance training. It helps! Not fatigued. Also not getting serious hot flashes or mood swings. Take viagra occasionally even if not for sex, just to allow for blood flow and erections while asleep.
Good luck!
I was 4+3 when diagnosed. 3.5 years ago I had 1 session HDR brachytherapy followed by 25 sessions of IMRT external beam -- 60Gy total. While I have had PSA bumps along the way, I am now under 1 and trending lower. 2 PSMA scans and 1 recent biopsy w/ 16 samples show no sign of cancer. No guarantees of course. I did not want to do hormone, so i chose this course of treatment.
wondering why you did not try cyberknife, only 5 treatments.@@jeffw8616
This is one of the best channel for information on PC and treatment. However, I would like to know where can you find the latest survival rates for men who have had PC and been treated?
Write on google you do see the answer to your question
Very helpful video. I'm 72. I am recently diagnosed with a 4-3+7 gleason. I had an MRI and then a needle biopsy. The tumor appears to involve nearly the entire gland, but there is some reason to believe that it has not spread outside the gland - but unsure. I will have a psma pet scan soon. I just want to say that both the surgeon and the radiology oncologist concur that 9 weeks of daily radiation and 6 months of hormone therapy is the best course of action. No one is pushing me to surgery. In fact, quite the opposite. Also, unlike many stories I read, my docs each spent an hour and a half with me discussing my situation and answering all my many questions. I'm very happy with care I am getting. I live in a fairly rural area but we are fortunate to have a major regional cancer center just 15 minutes from our home.
How was your psma pet scan and what did you decide on. I am 4+3 and had MRI biopsy and a psma pet scan. I still have no treatment and very confused on what to do.
what was result of your PSMA scan? Have you had a Decipher genomic test? So damn many tests and things to consider before making a decision. Don’t be "bullied" or hurried until you are comfortable with and understand your choices.
@@tomjgrant I have had a PSMA pet scan and it was fine. Had my biopsy analyzed and it is the slow growth cell type. They said the cancer cells are in my seminal vesicle and therefore the top surgeon suggested surgery. So the cancer cells are still contained in the prostate except for some in the seminal vesical. He never spent more than 15 minutes with me and seemed rushed. The radiologist spent more time but never really explained much about technical things. I did not know what to ask. I felt like I was pulling teeth to ask questions. I later learned that they have a Tulsa department that was available to me on a trial basis but by the time I learned about it the trail had ended. They never mentioned the trial to me. I am still on active surveillance. Will get my PSA test. The surgeon suggested a book to read to educate me instead of him summarizing my particular case. This is a very confusing type of cancer after trying to read about the many various types of ways to take care of it. Anyone know of any great blogs, websites or zoom meetings to learn more from others going through this as I am?
I was 58 and diagnosed with 4+3. I had the option of surgery or radiation and opted for radiation and 9-months of hormone therapy. Over two years out my PSAs are under zero and all looks good. Statistically the cure rates seemed almost even but less significant side effects with radiology.
Thank you for providing these videos, she asks all the questions that I don't have to burden my doctor with, and he provides the comprehensive response - so greatly appreciated! I'm 4+3=7 with a genomic rating of .96, PSMA PET scan is next.
What was your pi-rad score?
Hey there, of all the research I've do over the last couple of months, I've never heard of a "pi-rad" score. What is this?@@iamric23
Thanks for sharing important info on prostate cancer therapy possibilities. What can you tell me about proton and cyberknife therapies. How do the compare and are they more effective than other therapies?
I had surgery 11 mths ago (4+3 psa 9). Radiation not recommended due to existing use of flomax due to BPH. Rad Onc said radiation will make urimary symptoms worse over time. My incontinence has almost fully recovered but my ED has not. I am comfortable witj my decision to have surgery.
Thanks
Thanks a lot. Great video as usual. As someone with 4+3 identified via biopsy and a PSMA PET scan it is good to know that the path I took with EBRT (25 treatments over 5 weeks) with Spaceoar was a reasonable one. At 4 months side effects are minimal and my PSA has fallen from 4 to 1.5. I would like it lower. Scheduled for another PSMA PET scan and PSA check at 12 months.
Are you on hormones shots?
What was your pirad score?
Greetings, Everyone:
I am a 67-year-old male diagnosed with Stage 3 Prostate Cancer with a Gleason Score of 8 and a PSA of 29.
I am so depressed and confused about what to do.
Please keep me in your prayers, and any suggestions will be very much appreciated!
Thank you so very much!
PS: WONDERFUL video!
New follower 🙏🏼
You are in my prayers. You have many good and active years ahead of you since I'm confident you'll consult with a center of excellence who will clarify your confusion and send you to best routes of treatment. Don't be afraid of chemotherapy if that's what's recommended as the chemotherapies used for prostate cancer are quite tolerable. Get plenty of exercise, spend time with the people you love.
My husband was diagnosed with a Gleason 8, (4/4)an aggressive prostate cancer in Feb. 2022, with lesions detected in pelvic area and rib. We understand your stress. After treatment options were given, we opted for a robotic prostatectomy that was preformed by a skilled urologist in April 2022. Serious concern was not given to those lesions in the pelvic and rib, so we sought a second opinion with an oncologist in early June 2022 who immediately identified the lesions as cancer and started hubby on Lupron. Oncologist referred him to a radiation oncologist the following month who immediately ordered a PSMA Pet Scan, the lesions were identified as oligometastases (4 areas) by the radiation oncologist. In August 2022, SBRT was given to one area in pelvic that had fractured. When my husband first saw the oncologist, his PSA was 23. After radiation PSA was 3, and then went undetectable. In November of 2022, oncologist added Xtandi to his treatments. Lupron injections are every three months. On Jan. 10, 2023, PSA is 0.014 well below reference range of 1.000-5.000. Both oncologist and urologist say my husband’s cancer is in remission. My husband had incontinence after surgery but has improved immensely in control. I want you to know that there is hope! Please, as Alex says, be your own advocate or get someone to be yours. My husband is a quiet man and I’ve immediately jumped in and have researched and ask the questions. Our oncologist is wonderful, she listens and explains if I question. I’m praying for you!
@@mtnfolk3reyes543 my father was also diagnosed with prostatic adenocarcinoma with 4+3 and going through surgery. But after 6 month of surgery the PSA rises to 0.22 now. Can you please suggest.
@@rajashreeswain3766 Get him immediately into adjuvant /early salvage treatment. Where I was at. Initially a 4 + 3 but growing on the edge of my prostate. I had a really good radiation specialist map me post prostatectomy---and one of the newest type, yet standard photon technology machines was used. Doc thinks with everything I am doing via him (and to keep it simple, I am doing a lot of homeopathic /integrated options too) I may have an 80% chance of so-called cure where I am still undetectable in 6 to 7 yrs.
We will pray for each other you are not alone. Out there me I haven't diagnos yet but under go some check up my psa is 3.8 I'm 62 this yr. dre and altrasound good but my MRI they found 2 tumor in my protate and one in my bone but the dr. Still telling me its only suspicious, its already affected my daily life can't sleep and eat well. This friday I'm gong to have a bone scan and next week will be my biopcy. I hope and pray that this wiöl still curable. Hang in there.
Could you comment on the risk of bladder cancer as side effect of radiation ?
In France I have not heard of multifocal MRI or scan PSMA...😢
Hot flashes after radiation treatment I would and guess others too need more info on this issue thanks
Male, 71 years old. PSA in 5-7 range ove the past four years (creeping up). Urologist did a grid biopsy and found one node @ 3-4 Gleason. Radiologist said he would do a 5 dose radiation as long as he was certain he knew where the node was and could target the dose. Did an MRI and second biopsy to map the node. New Gleason score came back at 3-3.
Is active monitoring appropriate in my case and if so what would that consist of?
Did you get a second opinion on the first biopsy?
@@robertmonroe3678 No. Have decided to take the high dose radiation five treatments over ten days.
Thanks for so much info! I am trying to decide between 5 sessions of Viewray MRIdian ( SBRT radiation) in my hometown of Miami (Sylvester Center) or going to Mayo Clinic in Jacksonville for Tulsa Pro focal therapy. I just received a new biomarker test result (Prostox from Miradx) that said I am 70% likely to develop late GU symptoms grade 2 or above from any radiation treatment. I had previously thought I would just be doing the Viewray. I am 61 and unfavorable intermediate risk, 6 positive cores only 1 core of group 3 , others group 1 and 2 . Considered local but high volume with all positive cores mostly on left side away from neuro bundles. PSA 6.03. 25 ml prostate. Father and brother had PC but I a Neg for BRCA 1 and 2 and low risk on Decipher test. PSMA scan negative outside prostate and activity only on left side. Any suggestions? Seems like Tulsa is similar to HIFU but way more precise because performed in an mri machine...just not tested as much yet.
Hello, I’m sorry to bother you. But I’m curious how have you fared. I have somewhat similar numbers and characteristics. I just got a one-year follow up and I have a little bit more 3+4, but fairly low percentages, very low Decipher score, and negative for BRAC 1 and 2. I’m not sure if I do anything, or, of course, wait until it gets worse.
Hi, It is no bother at all. I had forgotten about this post. Most of my attention and time has been directed at my father as he has fallen and been in and out of hospitals for the past 7 months or so.
My doctor (Allen Pollack at Sylvester Center in Miami) has not been very responsive to our appointments as he seems extremely busy as head of the dept. So I have not really taken too many steps toward a standard treatment yet. I did connect with a dr online who had received the Tulsa Pro treatment himself and he absolutely did not recommend it. He suggested the Viewray instead. Unfortunately or fortunaltely the company is that makes the machine is now bankrupt so I am not sure what the status of those treatments is at this time and may need to delay treatment. I hope the tecnology/machine will be bought out by another company. I think many drs don't initially recommend it and instead try to get patients into more extensive treatments because of the bigger profits for them. My dr tried to have me believe I did not qualify for the 5 SBRT treatments and should get 28 IMRT instead. Based on my own research and communications with other noteworthy drs such as Amar Kishan at UCLA I do qualify for the viewray treatments. SO I am not so confident in my present dr at Sylvester but he seems to be the best option available to me based on my location and insurance. I have been buying myself time I believe by fasting though. I know many people rank it up there with UFOs and paranormal activity (ghosts) but it has been a valid approach for me. My PSA has gone down and the latest MRI I had performed showed a 50% decrease in one of the lesions. I have not been able to keep up with the prolonged fasting of 1-3 days but still do the intermittent fast of eating just once a day. Exercise is also important to reach autophagy but I have been remiss because I spend so much time looking after my parents. On a side note, Supplements can maybe help but certainly can hurt too. My endocrinologist suggested I take massive doses of Methyl B12 to help with my autoimmune issues but I was resisting it until my PSA dropped to 5.5. I then tried it and PSA soared to 8 in 3 months. Luckily I read online and knew it was a possibility based on other peoples experiences so I stopped it and the PSA came back down luckily as stated in articles. No drs ever acknowledge this can happen with B12 so I worry about all the other PC patients who may be rushed off to an enhanced form of treatment fearing they have an aggressive cancer. I tried fasting to help because my best friend also greatly benefitted from fasting when she had thyroid tumors. Her tumors also reduced by 50% but she ultimately had surgery because she could not maintain the fasting over the period of years. You should avoid animal proteins and sugar and processed foods, etc so hard to do in our culture and country. I also noticed over the past decade my PSA went up and down in line with my weight and eating habits so I thought it a good idea to try fasting. May not work for all but is helping in my case it seems. I would like to do more prolonged fasting but recommendations are that we keep it at 3 days max unless medically supervised. My friend did 14 days but she was younger then and could probably not do that now.@@MM-sf3rl
I think MSholz has said that good diet with little animal protein along with exercise does markedly (80%) improve chances of surviving PC but more recently said it may also help delay the onset of PC cancer too. So in my mind it may mean indirectly that in some cases we might be able to delay treatment if we can keep it at bay with the right lifestyle while we wait or search for the right treatment. Probably not a good idea for more aggressive cancers.
What was your 1 year follow up? Biopsy or just 3TMRI? Did you get a PSMA pet scan? I think it is important new scan in US (previously available in other countries) that can help you decide what type of treatment you should get and when. I was lucky to have no sign of PC outside of gland. Sholz says it is 90% accurate for Gleason 7.@@MM-sf3rl
@@RobertO-dv2fh Robert, Sorry for taking so long to reply. I hope you are right. I have a little more 3+4 since my biopsy first week of December, buy the doc said really little change. I core was 15%, another 10%, another 5%. The other core was 3+3. Right or wrong (now wish we had), we didn’t take cores from the right sign as that was all previously benign. So, track PSA and to back for another biopsy 12/1/24 unless the PSA rises fast. I am doing my best working out for 1.5 hours every day other day; and not, 2024 resolution, 45 minutes on off days. I live in Thailand, so you walk 8-10K almost every day. I eat a pretty clean diet, low meat, no process meat, fish, fruits and vegetables. Unfortunately I have always had a sweat tooth but I do my best. My doctor is Matthew Cooperberg at UCSF. Good guy but with case load and many other obligations in his professional life I wonder I wonder how much quality care I’m getting. He has some good TH-cam videos and was an early advocate for active surveillance. He’s not a diet advocate but he also thinks it’s a better choice in life in general. If the time comes for treatment UCSF offer HIFU. The doc thinks most of the oblation methods are somewhat the same, but the doc should use the tool they’re good with. I recently save a TH-cam video from Yale. There, the doctor is very specific on what oblation method should be used depending on the location within the prostate. I hope you’re well. Regards
Dr Scholz can you please say your opinion on cure rate for patient dx. with GS 4+3, 70% pattern 4 with intraductal carcinoma and cribriform pattern?
Hi, I was just diagnosed with Gleason 7 (4+3). I was thinking of radiation, I was told I need a 6 month hormone treatment with this. The doctor told me he would only be treating focal and partial seminal vesicle radiation. I had all the available test for spreading. The PSMA showed no invasion but my cancer was so very close he wants to make sure. Would I be better off with surgery or should he treat the whole prostate?
Go to Dr. Patel in celebration Florida immediately.
Have the surgery. He is the best in the world
Her closing comments were the best! Don't leave everything to the doctor; they literally can have hundreds of patients. You are the CEO of your health and your team of great doctors are your professional advisors. Research, prepare, develop questions, then listen carefully to what they say. This respects their time and their other patients who may be way worse off than we are.
What about bowel disturbances post radiotherapy?
My own experience as an otherwise healthy 66-y.o. with 3+4 and peak PSA = 13.6 who had SpaceOAR prior to EBRT/IMRT has been no bowel disturbances during or after treatment (I'm presently 9 mos. post-radiation).
Thanks for the great info.
Pathology report after RP if your Gleason score is 8 (3 + 5) with a high-grade component comprising 60% of the carcinoma
- Positive for intraductal carcinoma
- Positive for (focal) extraprostatic extension, negative for bladder neck invasion or seminal vesical invasion, and Regional Lymph Nodes (pN): pN1.
Is it still curable?
Yes; but monitor it very closely. If it comes back, get into low dose radiation quickly. lucky you did not get vesical invasion. It often matters how many lymph nodes they extract. Often it is as little as 10; I had 26 & unfortunately one (though just one) with some positive cancer. My cancer did come back & with early intervention & a negative PET scan, doc thinks I have at least an 80% cure rate---better, because as it grows on the edge, they more likely know where it first starts back up. (simple explanation). I am also on low dose casodex now---but doing many other treatments also.
I had HIFU in 2016 and it failed miserably. Cancer came back in same area.
One 4+3 but chose surgery 7 yrs ago today. Post op biopsy showed svi. Monitor psa bounced around .02 to .04 persistent at .04 for over a year.no rising...but now maybe radiation?
And No side effects from surgery.
@@jeffdavis4898 Hello from France
G4+5
pT3aN0R1
PSA
Please give info as to how to get a other opinions without redoing biopsies with just records being sent. My husband is a Gleason 7 (4+3). Also we would like more info about the SBRT. We live in a rural area of West Texas and my husband is not retired so the (5) short term radiation would be better for him. How do we find someplace that does that?
Dr. Jonathan Epstein at Harvard will re-read the biopsies. It cost about $350.00. You can find the form online and also find his telephone number. He’s absolutely a leader in the industry.
Just told I have a Gleason score of 7 (4+3) PSA 9.8, 71 years old. I had a PSMA scan and looks local. I am given the choice of surgery or radiation.They want to radiate part of my seminal vesicle because tumor is so close and 6 month hormone treatment. I'm still undecided what I will go with. I had a stent put in my heart 18 years ago. I have been passing all my stress test. Should I just go radiation and not to worry? Also had perineural invasion on my biopsy.
Immediately go to Dr. Patel in celebration Florida.
Have the surgery. He is the best in the world.
I have a 4+3, Gleason 7, 69 yrs old, having a PET scan in 7 days, one Dr. says to do surgery but then another suggest radiation - ProstRcison. I'm leaning toward radiation. Also getting a second option from Emery's Winship Prostate center. here in Atlanta. Any thoughts on this type of radiation treatment, Thanks
I was diagnosed with prostate cancer have Gleason 4+3 have had MRI biopsy and PET scan . Had a choice between surgery or radiation. I chose radiation and hormone treatment. It’s a choice on quality of life .
@@donaldpiper9763 Thank you!
@@Schoer53 Your welcome . Good luck to you .
@@donaldpiper9763 Hello from France
13/09/2022 surgery for me
Résultats pT3aNOR1
R1 for me Bad very difficult
I goto IMRt
With RT WE had no R1!!!!!
Bad work for Doctor !!!
I have viewed many of your presentations and enjoy them all. After many years of monitoring my PSA it finally hit 4.5. Went to Urologist some months later and it was 5.9. Did the biopsy with 3 positives out of 12 - two 6s and one 7 (4+3). Started hormone therapy monthly back in Sept. In January changed to 3 month injections. Hot flashes were in the extreme range and I was given Rx for Megestrol Acetate (it has done wonders for greatly reducing the hot flashes). Started radiation two weeks ago. I am scheduled for five days a week for 6 weeks with a dose rate of 250cGy per visit. Is this dose rate in the normal range of radiation?
caused by vax
Greg, thanks for sharing. I'm curious about that hormone you are on and any negative symptoms.
Thank you for sharing and God bless!!! What kind of radiation treatment that you getting?
I guess my doctor is way behind on prostate cancer. Never talked about a Gleason score. If it has already spread to my lymph nodes then I guess this score system is not used.
Hi..My PSA came back as 6.3. Urologist sent me for an MRI..It came back with Localised 4+3 Gleason score. My Urologist has suggested Radical Surgery to remove Prostate.(Im 65). Doing Laparoscopic Surgery. I have been sent to have a PSMA Scan. I got a second opinion with a Prof of Radiation and he was confident of a resolution but wants to use Hormone Treatment as well as Radiation...I am seriously worried about side affects and rehab...Im fit and Healthy and a regular sports person. Would really appreciate your thoughts on going forward..Thank You.
A book entitled:
You can beat prostate cancer
Written by Robert J Marckini
Get it if you can / Amazon
Fantastic info there
What is 4 + 4 please
It really depends how aggressive it is and how old you are plus current health conditions. If you’re in good health look at all options because any treatment will have side effects and you will have to live with that for the rest of your life. Depends how important quality of life is to you
I'm 4+3, my PSA was 25 2 years ago, been taking BICALUTAMIDE for over a year, PSA now 16, turned down surgery 4 years ago and radiation treatment 3 years ago.
I decided on surgery after biopsy of 4+4. The after surgery biopsy showed 4+3. Very localized, one pea sized tumor . 9 days after surgery, major regret
Please don’t be having regrets this early. It takes time to get over the surgery. Give yourself an opportunity to heal and recover and stay positive.
Good information.
With a 4+3=7 Gleason and high Decipher score I am dead-set against any hormone therapy but am wondering what the impact of this decision if I just choose radiation without the ADT which I would refuse.
Thanks again for these videos.
God Bless you..
Last month, my urologist, and a recent second opinion obtained independently through Teladoc Health, both recommended surgery for a Gleason 4+3 and PSA 10, since the cancer cells are localized and did not breach the lining of the prostate glands, after having performed mpMRI, biopsy, and PSMA PET scan of the whole body. The advice is that surgery provides certainty and peace of mind, while there can be recurrence (and side effects) with therapy, but do get an experienced surgeon. The cancer cells can spread easily (like dandelions) forming metastases throughout the body that will aggravate the problem and pose further challenges to treatment in future. The effect of incontinence is standard for all options. I have been scheduled for robotic surgery. Praise the Lord!
@@jtkfoch how did it go?
@@rockobill7637 I have completed the robotic-assisted radical prostatectomy late February 2024, after a three-month wait for the right resources to be available, including passing the stress echo with the heart specialist to ascertain that I am fit to undergo surgery. The urologist and surgeon took 5 hours to remove the prostate glands and a further hour to remove the lymph notes; a total of 6 hours with the new Davinci Xi machine! I had to stay two nights at ICU until I had farted or passed gas naturally, and a further two nights at normal ward for observation and released after I requested for an induced motion (excrete). I carried the catheter with me for a further week to avoid infection and to ensure adequate healing to the stitched parts. I continued with brisk walking (but not run) to maintain a healthy body. I can see remarkable progress in managing incontinence, with a significant reduction in the usage of disposable diapers and pads, and am hopeful in addressing the erectile disfunction through exercise. The biopsies of the lymph notes are free of malignant cells, with the tumour in the prostate glands appeared completely excised, notwithstanding the tumour has touched the lining of the prostate glands! I am scheduled for a PSA test early May 2024 to ascertain the score. Praise the Lord for a remarkable surgeon who had performed the surgery with exceptional care! And, there is no tablets or supplements to take following surgery, and with the pre and post surgery bills covered by personal medical insurance (around USD15,000). With the Lord's blessing, I am looking forward to a full and speedy recovery sooner than later. Shalom!
@@rockobill7637 I have completed the robotic-assisted radical prostatectomy late February 2024, after a three-month wait for the right resources to be available, including passing the stress echo with the heart specialist to ascertain that I am fit to undergo surgery. The urologist and surgeon took 5 hours to remove the prostate glands and a further hour to remove the lymph notes; a total of 6 hours with the new Davinci Xi machine! I had to stay two nights at ICU until I had farted or passed gas naturally, and a further two nights at normal ward for observation and released after I requested for an induced motion (excrete). I carried the catheter with me for a further week to avoid infection and to ensure adequate healing to the stitched parts. I continued with brisk walking (but not run) to maintain a healthy body. I can see remarkable progress in managing incontinence, with a significant reduction in the usage of disposable diapers and pads, and am hopeful in addressing the erectile disfunction through exercise. The biopsies of the lymph notes are free of malignant cells, with the tumour in the prostate glands appeared completely excised, notwithstanding the tumour has touched the lining of the prostate glands! I am scheduled for a PSA test early May 2024 to ascertain the score. Praise the Lord for a remarkable surgeon who had performed the surgery with exceptional care! And, there is no tablets or supplements to take following surgery, and with the pre and post surgery bills covered by personal medical insurance (around USD15,000). With the Lord's blessing, I am looking forward to a full and speedy recovery sooner than later. Shalom!
@@rockobill7637 I have completed the robotic-assisted radical prostatectomy late February 2024, after a three-month wait for the right resources to be available, including passing the stress echo with the heart specialist to ascertain that I am fit to undergo surgery. The urologist and surgeon took 5 hours to remove the prostate glands and a further hour to remove the lymph notes; a total of 6 hours with the new Davinci Xi machine! I had to stay two nights at ICU until I had farted or passed gas naturally, and a further two nights at normal ward for observation and released after I requested for an induced motion (excrete). I carried the catheter with me for a further week to avoid infection and to ensure adequate healing to the stitched parts. I continued with brisk walking (but not run) to maintain a healthy body. I can see remarkable progress in managing incontinence, with a significant reduction in the usage of disposable diapers and pads, and am hopeful in addressing the erectile disfunction through exercise. The biopsies of the lymph notes are free of malignant cells, with the tumour in the prostate glands appeared completely excised, notwithstanding the tumour has touched the lining of the prostate glands! I am scheduled for a PSA test early May 2024 to ascertain the score. Praise the Lord for a remarkable surgeon who had performed the surgery with exceptional care! And, there is no tablets or supplements to take following surgery, and with the pre and post surgery bills covered by personal medical insurance (around USD15,000). With the Lord's blessing, I am looking forward to a full and speedy recovery sooner than later. Shalom!
I am 69 yrs old was diagnosed last April2023 My psa rose to 6.1 in Jan2023 My gp asked me to see urologist March9 2023 psa was2.34but other things tested for Dr to want MRI MRI pirads was Apr11 2 places were4 Significant cancer likely Biopsy was Apr24 Report show 10 samples 7 negative & 3 positive 2 had 4+3 w60% 4 tumor 1was 3+4 about 30% 4 I believe my stage was 2 T1c Localized not detected outside prostate I had ADT therapy Lupron Jun27 &Oct27 I had 20 sessions of IMRT Aug16-Sept14 As of Nov15 follow up psa 0.01 All this led to huge costs I have trouble paying but I now have subsidizes housing & am trying to get Medicaid which may fail I am not sure what % of prostate was cancerous but I believe it was small area affected I wonder if active surveliance would be a better choice in my case & have treatment if scans shoe signs of spread Thank you for your informative videos They are helpful God bless you 14:26
👌
Prostate cancer gleason 4+3=7 and 2 mets, 1 in T10 and ilac bone. Did VMAT,28 FRACTIONS AND 5 ON T10.
what other treatment will follow?
I had a reaction to SpaceOar or too much inserted causing Bowel inflammation and restriction…… Radiation has no been ruled out or delayed….. any thoughts?
You might want to look into Barrigel. I've used neither product.
@@poohpup580 if you used nether. How did they protect your rectum from radiation burn or damage? What type of radiation was used?
Im 4+3. 70 years old. Radiation plus lupron recommended. I think I'll take my chances with radiation only.
What is a ‘maven’ ?
an expert!
an expert
I had and still have very bad hot flashes after hormone therapy from the shot I was given almost six months ago. Now I am getting radiation for 4+3. The main side effect is that I cannot urinate at all without the self catheter.
is l-arginine bad for prostate and cause cancer ?
So, with all that said, which procedure has the least chance of causing erectile dysfunction, surgery or radiation? There is no way they can have the exact same risk, because nothing works like that. Their risks are going to be different because they are completely different approaches. Why won’t anyone just come out and say which one has the greater risk of causing erectile dysfunction?
Husband 72 years old Gleason score 4+3 =7 aggressive type
No cancer on bones had a total of 7 lesions total thru out prostate he chose radical prostectomy he just wanted it out
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
Prostate cancer awareness is vital, and this channel spreads the word so effectively. Planet Ayurveda's guidance has positively impacted my friend's treatment journey!
Kanchnaar guggal from Planet Ayurveda is best for its treatment
Does radiation therapy cause constant diarrhea???
No! Just recently completed radiation no diarrhea..
@@mauricedudley2674 My 4+7 , I had 5 weeks rad. and 6 mo. hormone , after a year no diarrhea , but have to eat well not to constipate .
That is my dilemma, I am 75 yrs and quality of life is very important to me.I can't seem to get any info of the % of people who end up with incontinence or severe bowel problems.That is holding me back right now.
I had one 4+3 biopsy. I did radiation because there was no way I was able to do surgery. 63 and Orgovyx has destroyed me ability to get an erection
It was almost 2 years after eligard injection before my husband returned to normal. I think the hormone takes some time to dissipate but my husband does have erections now. Hang in there.
He also received radiation as well.
how long have you been off orgovyzx
@@jeffreysteinberger2568 a month.
Do you see patients doctor?
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.?
im 61 and totally underatand what you are saying
🙏🙏🙏😎💪🙏🙏🙏
BAT
Fall of 2020 I was Gleason 4+3. My options were (1) surgery or (2) beam radiation PLUS seed radiation PLUS testosterone blocking.
Surgery seemed less risky for side effects and cure; I AM cured but incontinence permanent drives me crazy. Horrendous. Erection 100% with injection or 70% with Viagra.
I wish I had the newer options mentioned by the good doctor here.
Perhaps you will have some permanent incontinence but I do know for many, it can take beyond 2 yrs to get close to full results.
Dr. Patel in celebration Florida is the best in the world.
Just get the surgery if the cancer is not spread outside the prostate and then the cancer is gone.
Maybe , no guarantees.
Absolutely no guarantees ever!!!
How do you know if the cancer (microscopic and otherwise) has spread from the prostate? If all indications (GG, PSA, MRI, PSMA PET) are that there is no spread in a GG 2 (3 + 4) case that is the best (IMHO) situation for surgery.
@@robertmonroe3678 your pathology report after getting the prostate removed should tell how spread the cancer is.
My point was in regards to the pre-treatment decision process.