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 hope you are OK. What was your treatment and was it successful. I was just diagnosed 4+3 and urologist wants to do surgery. I am in shock now and trying to sort my options that are possible. Thank you and I hope you are well.
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!
Thank you so much for this video. My father has two 4+3s on the Gleason score. (That's from 26 samples they collected) He has been waiting months to find out. He has two or three spots with other numbers, too, but not 4+3. Doc said the 4+3 need RX. Dad chose radiation. He has done much research. He's waiting for the call for the placement of radiation type pieces (?) put into the prostate for when he gets the radiation. The call can't get here fast enough. This information you've shared is invaluable and has put me a bit at ease. Every bit helps. Moment by moment. Understanding. Love. Support. And just being there not saying a word is needed for the patient. Build them up. Some beliefs may make you wonder and even get in the way of healing. I understand being angry and beyond. I was angry and its not my illness. But that will make it all so much worse. And again, slow the healing process. Even MY anger can effect HIS healing. So I keep the vibe up and try to lift his Spirit and make him laugh. Hearing him laugh makes us forget about the illness for a second, but that second os a second with higher quality of life. He deserves such. Blessings, love, healing, strength, light, and hope, to all who have encountered this dis-ease in one way or another. As it is not an easy road to travel. Please don't travel alone. Though you may want to at times. Support and love are what we need to give our family, friends, and ourselves, in such a situation. And, a stellar team of Doctors! 💞👩⚕️👨⚕️🫂🙏 thank you both. So much.
@@MrKitty-zv3dl this is why I chose NOT to have my prostate removed. My diagnosis was almost identical to your. My own extensive and painstaking research determined a much better recurrence with HT/HDR Brachy and Radiotherapy. I have my Brachy op on 15th Nov
@@yurydash1828 I don't know specifically about their Urology Dept, but I'm in health care, and the Cleveland Clinic has a world class reputation in the world of medicine
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!
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.
@@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.
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.
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.
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.
Thanks a million for these videos...Alex & Dr.Scholz. Remember that office MDs don't have time to educate patients. Prior to my evaluations I reviewed PSA history, staged my cancer with PCRI, and reviewed the biopsy burden, then prepared specific questions for consultations. The EXPRESS LANE to surgery was always there.
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 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
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.
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 !
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.
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.
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.
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.
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.
I was diagnosed with 4+3 a year ago. No family history and no symptoms. DRE was always normal and prostate was of average size. PSA 5.7 I first went to UH in Cleveland where I was (IMO) strongly pushed in RP. The only other option I was given was Radiation and hormone therapy. PSMA PET revealed no spread. The surgeon told me that "no one does Brachytherapy anymore. Which sent up red flags. Through further search I found a Brachytherapy specialist at the Cleveland Clinic. I ended up having that procedure in November. My six-month PSA was 0.23. I think many guys get pressured into surgery without exploring other options. It's all a business and Surgeons are going to "surgeon". A good book to read is The Invasion of the Prostate Snatchers. I am 72
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
Turning 58 in less than a month. I have 4+3 localized to prostate and a PSA of 4. I'm doing 6 months of Lupron (started May 17th) and 28 radiation sessions which should start July 15th. The Lupron fatigue side effects (which is my worst side effect) have mysteriously started to recede it seems. I still have hot flashes but they don't bother me as I'm hot natured and feel that way all the time anyway. The severe fatigue was more of a sleepy feeling than a tired feeling like I had hauled firewood all day. I started popping a 5 hour energy about noon everyday at work just so I could stay awake on the drive home. Now, I haven't used one in over a week. I was thinking about saying 'no' to the second 3 month dose of Lupron but since the fatigue is subsiding and I saw a presentation which stated ADT after radiation was actually more effective than ADT before or during radiation, I think I'll give it a go.
I had one injection so far along with radiation. Will not do another injection. Severe fatigue, mood swings, stomach issues, pee frequently. Also has possible long term effects with kidney and muscle damage.
Update: Radiation therapy ended August 19th and was a breeze. No issues peeing and no issues with the back door either. However, severe fatigue and night sweats have now set in. I am spending 100% of my energy at work and even with 9hrs/night of sleep, I still have to sleep around 13hrs/night on the weekends just to recharge. I also found out that my urologist gave me a 4th month Lupron shot instead of a 3 month dose. I am supposed to go back to him in 3 days for another shot. If he insists on another 4 month dose (which I believe he will), I'll get up and walk out. When I first started treatment, we discussed doing ADT for only 6 months. I am not going to increase that especially after my oncologist told me that he would have no objections to me only doing 6 months of ADT.
@@thomasflynt1764 I had a six month dose and will not continue with the Lupron. Major mood swings, fuzzy head, extremely tired , up 4/5 times at night to pee. Not again. Hopefully the radiation treatment I recently completed will buy me several more good years. But no more hormones therapy.
The verdict on ADT seems to swing wildly from the absolutely intolerable horrendous suicide-inducing to "it's terrible, but I am handling it." The length, the duration--how long --of ADT therapy also seems to vary without rhyme or reason, but it seems the higher the Gleason, the longer the stint. Query: Do ALL men regain their "sexual drive" (read: INTEREST IN and desire for--sex), no matter what length of ADT treatment? And once obliterated, can the testosterone levels ever be jacked back up to "pre-ADT"? (Through TRT, for instance?) All these "treatments" for this supposedly "treatable"--if not curable**--cancer seem gruesome and definitely alter the man: mentally, physically, spiritually, and emotionally. **I have read thousands of comments on hundreds of vids, and NOT ONE "fully cured" AND RESTORED to "close to pre-treatment," not one. Not. One.
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.
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.
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?
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.
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.
First, THANK YOU for your work in this field. It's invaluable My gleason score is 4+3 with a PSA of 8 and no metastasis. I'm 71 years old. This makes me an unfavorable-intermediate risk. Then my Decipher score came back as 0.96. I would think this moves me to high-risk but my radiation-oncologist says that the NCCN guidelines don't take Decipher scores into account and so I'm still intermediate and we'll use that to steer my treatment. Should I let the Decipher score determine my treatment or the (possibly dated) NCCN guidelines? Thanks.
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
"Quality of Life." And there it is. No matter what, there will be changes--changes mentally, physically, spiritually, emotionally. The "Former You" will have been turned into a. . . Lesser You. No matter what anyone tells you,--THIS is the truth. And as the author of the Comment above mine states, to paraphrase him, "And you will have to live with [the changes, the loss (of Quality of Life)]."
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 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
As a Medicare patient, what I'm experiencing is that, even at centers of excellence, it appears that I am "prioritized" and assigned to junior-level physicians and assistant attending physicians who don't discuss or offer what I know this center of excellence can offer. What can a patient do to obtain the best care when he's been assigned to a junior-level physician? Example, at one of the best in the country, the assistant attending told me he'd need to do a biopsy to map out the location of my localized tumor when I know this center has a mult-parametric MRI machine.
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
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.
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?
I was diagnosed with Prostate cancer at 54 years of age in 2019. PSA of 10 (fast rising) Gleason 7 (4+3) Grade 3 with 90% cancer in biopsy core sample, PERINEURAL INVASIVE ADENOCARCINOMA and with family history on father's side. I had external beam radiation for 9 weeks. I chose not to do hormone therapy. My PSA reached its nadir of 0.7 two years in. Now, I am 5 years since treatment and the last 3 PSA tests have been rising. Up to 1.38 now. Anybody had this experience? Was it a reoccurrence or just the PSA "Bounce"? I am scheduled with my former oncologist in a week but wondering what others have experienced.
@@rickj9615 I’m on hormone therapy 8 weeks in. Same scores as you. Why did you not have hormone therapy? I’ve decided on HDR Brachy and 15 sessions of EBRT 27.5 GY then hormone lasting 1 year. I’m no doctor but hormone therapy is there to starve any loose cancer cells that may have been missed. You may have missed a trick avoiding hormone therapy
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!
@@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!
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.
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
@@edwardkirby7679 Yes. And it’s nobodies fault. I read a book called “Noise”, which talked about how reading biopsies is very subjective. Often the same pathologist will get a different result depending if he reads it in the morning or just before getting off work at night. Btw. I still have major regret about the surgery 9 months in. It’s destroyed my sexual life, and I have extremely bad incontinence. Without the surgery maybe the cancer would have mestatacized in 3 years, maybe 5: maybe 10. Who knows. For me quality of life over quantity. My choice, might be different fur someone else.
@gbfowler Thank You for your candor and openness. This all begs the question, "Should I get a second opinion on the biopsy"? Gleason 8 (4/4). Best shape of my 63 years. Look late 40s. 28 year old girlfriend. Blah blah blah. PSA 15. Two weeks (!) later, 17.17. MRA showed "suspicious areas." Awaiting PMSA PET on the 26th. Not thrilled about ANY of the "treatments" that will "save my Life." Radiation doesn't sound much better than the Big Slice. And ADT--based on the hundreds of comments made by men who have experienced it--is nothing short of torture, "on a whole new level." Thanks for getting back so quickly. . . Friend of mine had surgery in 2018 and uses the injections, but has told me he has had a few "bad episodes" with them (didn't elaborate). May God have Mercy on Us All!! -EK
@@edwardkirby7679 I think it’s an individual choice what to do. Second opinion would be good, but not sure how you’d go about it. The reason I chose surgery is not to do ADT. But really whether or not to ADT is up to you. I had been on testosterone for thirty years. Stopped it four months before my surgery, and my testosterone level fell to about fifty, so i was close to chemical castration levels anyways. I restarted T in August against my doctors wishes, I might have not but so frustrated about the major incontinence. I’m 66, but very active, hiking, biking, backpacking. Travel a lot, in Asia for 3 months now, with a younger bf for the past 5 years. We were very sexually active, but now I feel more asexual. But he’s been understanding. The incontinence has made everything I love to do very difficult. Looking into sphincter surgery in a few months. Also I’ve been hiv positive for 40 years, so use to having something in my body I don’t want. My tumor was a pea sized tumor in the prostate. My PSA was never over 5, My last PSA was undetectable, so there’s that. Maybe if I had to do it again I’d just do a short course of radiation, and stay off T for a year or so. Like I said, for me quality of life first. Some men would want the cancer out period. And they have their own reason, like being there for kids, grandkids or walking their daughter down the aisle for the wedding is more of a priority for them, so their goal is just to stay alive no matter what. As I told my doctor, I’m 66, men in my family tend to live to about 80, with the last few years being frail and sick. I realistically only has 10 healthy years left, now I’m giving away those few years just to live longer? I’d been happy with 5 more healthy years, which I probably would have had anyways without the surgery. but I’ve lost much of that because of the surgery.
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 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.
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.
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?
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.
Is a 4+ 3 in 2 areas of a biopsy (multiply pieces) in a 66 yr old normally a good candidate for Brachytherapy ? other areas are 3+4 and 3+3 Pet scan shows it's just in the prostate at this point but who knows if that's accurate. (Sure hoping it is). I've heard if radiation is done and cancer comes back surgery isn't an option. Does that include Brachytherapy
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?
Does anyone know about how to reduce/stop dysuria as a result of prostate radiation? Everytime i try to pee, dysuria surfaces and feels like I'm trying to pee lava, yikes!
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.
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?
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!
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 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 !!!
Love your videos! A question: A short video on Agent Orange related PCa would be helpful to many. The Prostate Cancer Foundation states: "Men who were exposed to Agent Orange and other battlefield chemicals often present with more aggressive prostate 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?
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.
Just found out I’m 4+3… PSA 4.2… my doctor at USC Keck Medicine is recommending surgery, says it’s the gold standard and radiation has a lower cure rate and more bad side effects… totally opposite of this video… man it is so confusing what to believe and do… ugh…
Look into focal therapy. I had to find another center, but it was worth it to get the NanoKnife (and then TulsaPro to finish) treatment. Initial provider only offered surgical removal or radiation (both choices from the same group practice). I spent 25 years selling energy-based surgical devices in operating rooms…dealing with surgical technology. Dang if I’m only going to take a “Column A, or Column B” proposition. 74 yrs old and no life style side effects.
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.
Oct 2023, Was diagnosed with 4+3 in 1/12 cores using ultrasound guidance alone. Feb 2024 Repeat biopsy using ultrasound plus MRI Nav tech found have 4+3 in 4/12 cores. Deciper results came back at 0.3 so went with SBRT w/o ADT. Finished last radiation session on 17 May 2024. Had severe urinary problems for first two weeks and now completely off Tamosuloin after 4 weeks Will have PSA and PSMA Pet scan in a months time to see if I am out of the woods or not
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?
I am 86yrs+ 2yrs back I was diagnosed prostate cancer4+3 after biopsy I was put on hormonal therapy Lupron 240mg 1st dose and subsequently ,80 mg monthly for 24 months and external radiation five days in a week for 4 weeks PSA has came down from 7 to .01 ,02 .03 in the last three 3 monthly survey results three monthlyl surveys the side effects of hormonal therapy are dreadful Inspite of muscular wastings severe fatigue they advise physical activity excercise with weights etc They don'ot realise they are trying to whip a tired pony what is next for me lhow long the side effects of hormall side effects will be there
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.
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.?
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.
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.
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 hope you are OK. What was your treatment and was it successful. I was just diagnosed 4+3 and urologist wants to do surgery. I am in shock now and trying to sort my options that are possible. Thank you and I hope you are well.
How are you doing a year later? I was in a situation like you and that was twenty years ago. I had a radical prostatectomy.
@@williamwaters4506 And , your results of surgery ?
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!
Thank you so much for this video. My father has two 4+3s on the Gleason score. (That's from 26 samples they collected) He has been waiting months to find out. He has two or three spots with other numbers, too, but not 4+3. Doc said the 4+3 need RX. Dad chose radiation. He has done much research. He's waiting for the call for the placement of radiation type pieces (?) put into the prostate for when he gets the radiation. The call can't get here fast enough. This information you've shared is invaluable and has put me a bit at ease. Every bit helps. Moment by moment. Understanding. Love. Support. And just being there not saying a word is needed for the patient. Build them up. Some beliefs may make you wonder and even get in the way of healing. I understand being angry and beyond. I was angry and its not my illness. But that will make it all so much worse. And again, slow the healing process. Even MY anger can effect HIS healing. So I keep the vibe up and try to lift his Spirit and make him laugh. Hearing him laugh makes us forget about the illness for a second, but that second os a second with higher quality of life. He deserves such. Blessings, love, healing, strength, light, and hope, to all who have encountered this dis-ease in one way or another. As it is not an easy road to travel. Please don't travel alone. Though you may want to at times. Support and love are what we need to give our family, friends, and ourselves, in such a situation. And, a stellar team of Doctors! 💞👩⚕️👨⚕️🫂🙏
thank you both. So much.
@@MrKitty-zv3dl this is why I chose NOT to have my prostate removed. My diagnosis was almost identical to your. My own extensive and painstaking research determined a much better recurrence with HT/HDR Brachy and Radiotherapy. I have my Brachy op on 15th Nov
@@jawnaraestokes5836 sounds like you father has what I have. Also sounds like he’s having HDR Brachy like me. I’m only 57
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
Can I ask. Why u choose this Clinik ?
@@yurydash1828 I don't know specifically about their Urology Dept, but I'm in health care, and the Cleveland Clinic has a world class reputation in the world of medicine
Same age and diagnosis here. Had prostate removed in December 2022. No spread, and PSA is still undetectable.
what is likely to happen with 4+3 with no treatment?
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.
Ab kese h ? Kya treatment liya ap ne ?stage?
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
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 a million for these videos...Alex & Dr.Scholz. Remember that office MDs don't have time to educate patients. Prior to my evaluations I reviewed PSA history, staged my cancer with PCRI, and reviewed the biopsy burden, then prepared specific questions for consultations. The EXPRESS LANE to surgery was always there.
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!
Hows your father doing now??
Which treatment you opted for
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
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.
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~
Everyone here has given great input about your experience with this cancer . Thanks again keep up the great work 👍
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.
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 advice. Get your advice from someone who has no conflict interest.
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
Thank you for a wonderful and informative presentation.
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?
I have prostate cancer get video Alex you ask great questions
Thank you again for the excellent assistance. It is appreciated.
65years, PSA9, biopsy 8/12 cores positive, Da Vinci surgery, prostata size 58g, PSA after 5 months 0,018. Im satisfied..
I was diagnosed with 4+3 a year ago. No family history and no symptoms. DRE was always normal and prostate was of average size. PSA 5.7 I first went to UH in Cleveland where I was (IMO) strongly pushed in RP. The only other option I was given was Radiation and hormone therapy. PSMA PET revealed no spread. The surgeon told me that "no one does Brachytherapy anymore. Which sent up red flags.
Through further search I found a Brachytherapy specialist at the Cleveland Clinic. I ended up having that procedure in November. My six-month PSA was 0.23.
I think many guys get pressured into surgery without exploring other options. It's all a business and Surgeons are going to "surgeon". A good book to read is The Invasion of the Prostate Snatchers. I am 72
Beautifully said. Thank you!!
Thanks for the tons of infos regarding 4+3 which I have.
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
Turning 58 in less than a month. I have 4+3 localized to prostate and a PSA of 4. I'm doing 6 months of Lupron (started May 17th) and 28 radiation sessions which should start July 15th. The Lupron fatigue side effects (which is my worst side effect) have mysteriously started to recede it seems. I still have hot flashes but they don't bother me as I'm hot natured and feel that way all the time anyway. The severe fatigue was more of a sleepy feeling than a tired feeling like I had hauled firewood all day. I started popping a 5 hour energy about noon everyday at work just so I could stay awake on the drive home. Now, I haven't used one in over a week. I was thinking about saying 'no' to the second 3 month dose of Lupron but since the fatigue is subsiding and I saw a presentation which stated ADT after radiation was actually more effective than ADT before or during radiation, I think I'll give it a go.
I had one injection so far along with radiation. Will not do another injection. Severe fatigue, mood swings, stomach issues, pee frequently. Also has possible long term effects with kidney and muscle damage.
Try Orgovyx instead. Only hot flash side effects for me.
Update: Radiation therapy ended August 19th and was a breeze. No issues peeing and no issues with the back door either. However, severe fatigue and night sweats have now set in. I am spending 100% of my energy at work and even with 9hrs/night of sleep, I still have to sleep around 13hrs/night on the weekends just to recharge. I also found out that my urologist gave me a 4th month Lupron shot instead of a 3 month dose. I am supposed to go back to him in 3 days for another shot. If he insists on another 4 month dose (which I believe he will), I'll get up and walk out. When I first started treatment, we discussed doing ADT for only 6 months. I am not going to increase that especially after my oncologist told me that he would have no objections to me only doing 6 months of ADT.
@@thomasflynt1764 I had a six month dose and will not continue with the Lupron. Major mood swings, fuzzy head, extremely tired , up 4/5 times at night to pee. Not again. Hopefully the radiation treatment I recently completed will buy me several more good years. But no more hormones therapy.
The verdict on ADT seems to swing wildly from the absolutely intolerable horrendous suicide-inducing to "it's terrible, but I am handling it." The length, the duration--how long --of ADT therapy also seems to vary without rhyme or reason, but it seems the higher the Gleason, the longer the stint. Query: Do ALL men regain their "sexual drive" (read: INTEREST IN and desire for--sex), no matter what length of ADT treatment? And once obliterated, can the testosterone levels ever be jacked back up to "pre-ADT"? (Through TRT, for instance?) All these "treatments" for this supposedly "treatable"--if not curable**--cancer seem gruesome and definitely alter the man: mentally, physically, spiritually, and emotionally.
**I have read thousands of comments on hundreds of vids, and NOT ONE "fully cured" AND RESTORED to "close to pre-treatment," not one. Not. One.
Thank you soo much for this channel
The content is explained that a layman can easily understand
THANKS FOR THIS INFORMATION.
Another helpful video, thanks Alex and Doc
Thank you so much for your insight on treatments , I can make a decision now!
Thanks. Big help at a tough time. Well done .
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.
How old, I am wondering? And you're okay being impotent?
I appreciate this contents and it helps me a lot. I had a brachytherapy in Korea one year ago.
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.
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
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.
Thanks for another informative video.
Such good information. Thank you both!
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.
First, THANK YOU for your work in this field. It's invaluable
My gleason score is 4+3 with a PSA of 8 and no metastasis. I'm 71 years old. This makes me an unfavorable-intermediate risk. Then my Decipher score came back as 0.96. I would think this moves me to high-risk but my radiation-oncologist says that the NCCN guidelines don't take Decipher scores into account and so I'm still intermediate and we'll use that to steer my treatment. Should I let the Decipher score determine my treatment or the (possibly dated) NCCN guidelines? Thanks.
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
"Quality of Life." And there it is. No matter what, there will be changes--changes mentally, physically, spiritually, emotionally. The "Former You" will have been turned into a. . . Lesser You. No matter what anyone tells you,--THIS is the truth. And as the author of the Comment above mine states, to paraphrase him, "And you will have to live with [the changes, the loss (of Quality of Life)]."
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?
Yep stress incontinence described by two of my friends that had prostates removed
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...😢
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 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
As a Medicare patient, what I'm experiencing is that, even at centers of excellence, it appears that I am "prioritized" and assigned to junior-level physicians and assistant attending physicians who don't discuss or offer what I know this center of excellence can offer. What can a patient do to obtain the best care when he's been assigned to a junior-level physician? Example, at one of the best in the country, the assistant attending told me he'd need to do a biopsy to map out the location of my localized tumor when I know this center has a mult-parametric MRI machine.
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
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
@@cabacronulla potentially a bad idea. You should have researched harder. Prostatectomy is harsh and may not have been necessary
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.
I was diagnosed with Prostate cancer at 54 years of age in 2019. PSA of 10 (fast rising) Gleason 7 (4+3) Grade 3 with 90% cancer in biopsy core sample, PERINEURAL INVASIVE ADENOCARCINOMA and with family history on father's side. I had external beam radiation for 9 weeks. I chose not to do hormone therapy. My PSA reached its nadir of 0.7 two years in. Now, I am 5 years since treatment and the last 3 PSA tests have been rising. Up to 1.38 now. Anybody had this experience? Was it a reoccurrence or just the PSA "Bounce"? I am scheduled with my former oncologist in a week but wondering what others have experienced.
@@rickj9615 I’m on hormone therapy 8 weeks in. Same scores as you. Why did you not have hormone therapy? I’ve decided on HDR Brachy and 15 sessions of EBRT 27.5 GY then hormone lasting 1 year. I’m no doctor but hormone therapy is there to starve any loose cancer cells that may have been missed. You may have missed a trick avoiding hormone therapy
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!
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.
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.
Are you saying the biopsy was misread by the first lab tech who looked at the samples? . .
@@edwardkirby7679 Yes. And it’s nobodies fault. I read a book called “Noise”, which talked about how reading biopsies is very subjective. Often the same pathologist will get a different result depending if he reads it in the morning or just before getting off work at night.
Btw. I still have major regret about the surgery 9 months in. It’s destroyed my sexual life, and I have extremely bad incontinence. Without the surgery maybe the cancer would have mestatacized in 3 years, maybe 5: maybe 10. Who knows. For me quality of life over quantity. My choice, might be different fur someone else.
@gbfowler Thank You for your candor and openness. This all begs the question, "Should I get a second opinion on the biopsy"? Gleason 8 (4/4). Best shape of my 63 years. Look late 40s. 28 year old girlfriend. Blah blah blah. PSA 15. Two weeks (!) later, 17.17. MRA showed "suspicious areas." Awaiting PMSA PET on the 26th. Not thrilled about ANY of the "treatments" that will "save my Life." Radiation doesn't sound much better than the Big Slice. And ADT--based on the hundreds of comments made by men who have experienced it--is nothing short of torture, "on a whole new level." Thanks for getting back so quickly. . . Friend of mine had surgery in 2018 and uses the injections, but has told me he has had a few "bad episodes" with them (didn't elaborate). May God have Mercy on Us All!! -EK
@@edwardkirby7679 I think it’s an individual choice what to do. Second opinion would be good, but not sure how you’d go about it. The reason I chose surgery is not to do ADT. But really whether or not to ADT is up to you. I had been on testosterone for thirty years. Stopped it four months before my surgery, and my testosterone level fell to about fifty, so i was close to chemical castration levels anyways. I restarted T in August against my doctors wishes, I might have not but so frustrated about the major incontinence. I’m 66, but very active, hiking, biking, backpacking. Travel a lot, in Asia for 3 months now, with a younger bf for the past 5 years. We were very sexually active, but now I feel more asexual. But he’s been understanding. The incontinence has made everything I love to do very difficult. Looking into sphincter surgery in a few months. Also I’ve been hiv positive for 40 years, so use to having something in my body I don’t want.
My tumor was a pea sized tumor in the prostate. My PSA was never over 5, My last PSA was undetectable, so there’s that. Maybe if I had to do it again I’d just do a short course of radiation, and stay off T for a year or so.
Like I said, for me quality of life first. Some men would want the cancer out period. And they have their own reason, like being there for kids, grandkids or walking their daughter down the aisle for the wedding is more of a priority for them, so their goal is just to stay alive no matter what. As I told my doctor, I’m 66, men in my family tend to live to about 80, with the last few years being frail and sick. I realistically only has 10 healthy years left, now I’m giving away those few years just to live longer? I’d been happy with 5 more healthy years, which I probably would have had anyways without the surgery. but I’ve lost much of that because of the surgery.
How should the risk of developing a second tumor be assessed
I had 4+3 Gleason score. Had surgical removal of the gland in 2018. BCR in 2021 . Has completed 3 years of ADT + Apaltutamide . PSA0.01. What next?
great stuff people tks
Thank you for all you do
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 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.
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.
Im 4+3. 70 years old. Radiation plus lupron recommended. I think I'll take my chances with radiation only.
Possibility that tie would eliminate cancer.
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
Hot flashes after radiation treatment I would and guess others too need more info on this issue thanks
I had HIFU in 2016 and it failed miserably. Cancer came back in same area.
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.
How is your health now??
Is a 4+ 3 in 2 areas of a biopsy (multiply pieces) in a 66 yr old normally a good candidate for Brachytherapy ? other areas are 3+4 and 3+3 Pet scan shows it's just in the prostate at this point but who knows if that's accurate. (Sure hoping it is). I've heard if radiation is done and cancer comes back surgery isn't an option. Does that include Brachytherapy
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?
risks of spreading can happen also after surgery or radiation
My score is 4+3 with my PSA Level 3.9. Not sir what I want to do.
Does anyone know about how to reduce/stop dysuria as a result of prostate radiation?
Everytime i try to pee, dysuria surfaces and feels like I'm trying to pee lava, yikes!
Did the oncologist not discuss this with you?
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.
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
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!
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 !!!
What is 4 + 4 please
Love your videos! A question: A short video on Agent Orange related PCa would be helpful to many. The Prostate Cancer Foundation states: "Men who were exposed to Agent Orange and other battlefield chemicals often present with more aggressive prostate cancer."
What is a ‘maven’ ?
an expert!
an expert
I have a decision to make soon. You have me leaning towards radiation rather than removal.
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?
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?
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.
Just found out I’m 4+3… PSA 4.2… my doctor at USC Keck Medicine is recommending surgery, says it’s the gold standard and radiation has a lower cure rate and more bad side effects… totally opposite of this video… man it is so confusing what to believe and do… ugh…
Look into focal therapy. I had to find another center, but it was worth it to get the NanoKnife (and then TulsaPro to finish) treatment. Initial provider only offered surgical removal or radiation (both choices from the same group practice).
I spent 25 years selling energy-based surgical devices in operating rooms…dealing with surgical technology. Dang if I’m only going to take a “Column A, or Column B” proposition. 74 yrs old and no life style side effects.
Is your Dr. at USC a urology surgeon ? Maybe that's why.
Thanks
is l-arginine bad for prostate and cause cancer ?
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.
Oct 2023, Was diagnosed with 4+3 in 1/12 cores using ultrasound guidance alone.
Feb 2024 Repeat biopsy using ultrasound plus MRI Nav tech found have 4+3 in 4/12 cores.
Deciper results came back at 0.3 so went with SBRT w/o ADT. Finished last radiation session on 17 May 2024.
Had severe urinary problems for first two weeks and now completely off Tamosuloin after 4 weeks
Will have PSA and PSMA Pet scan in a months time to see if I am out of the woods or not
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?
I am 86yrs+ 2yrs back I was diagnosed prostate cancer4+3 after biopsy I was put on hormonal therapy Lupron 240mg 1st dose and subsequently ,80 mg monthly for 24 months and external radiation five days in a week for 4 weeks PSA has came down from 7 to .01 ,02 .03 in the last three 3 monthly survey results three monthlyl surveys the side effects of hormonal therapy are dreadful Inspite of muscular wastings severe fatigue they advise physical activity excercise with weights etc They don'ot realise they are trying to whip a tired pony what is next for me lhow long the side effects of hormall side effects will be there
Best wishes for a full recovery
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.
Good interview but the tie has to go.
Kanchnaar guggal from Planet Ayurveda is best for its treatment
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
👌
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.
Do you see patients doctor?
🙏🙏🙏😎💪🙏🙏🙏
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.