Відео

Love Ben Tran

A terrible loss , condolences to his family ❤🙏🦋

I watched Brian grow up on Stoney Lane in Rtathcoole. He was a wonderful young man, born to wonderful parents, and he did wonderful work down here on Earth. My heart goes out to Margaret and his extended family. May his soul continue in eternal love. Dara.

Rest in Peace Brian.You sure have won your wings in Heaven for all the wonderful work you have done.I can see he was loved by many People.❤ Condolence to his Family.

A beautiful tribute to a beautiful man.i am crying writing this as i think of our beautiful son who also was a surgeon who lost his .life in new zealand in 2008.paul woods 29 years old.the pain of a childs loss never leaves you.paul like Brian was an amazing human inside and out.sounded very similar to our boy paul.paul loved newzealand but Liverpool england was his forever home.sending love to Brians mum brothers and sister.we know how heartbroken you are feeling.R.i.p Brian

😥

Future investigations needed

What was he investigating?

So sorry to hear this news.

Thank you for a very moving tribute to Brian. Heartfelt condolences to family, friends and kind colleagues. May Brian`s memory be your blessing. Love from Éire

Such a loss. Peace every stop Brian ... and care to his family, friends and colleagues.

Thank you for such a beautiful tribute to your colleague and friend. May he rest in peace.

What a beautiful tribute to a beautiful man ,he was obviously loved by all who's life's he touched around the world. I'd imagine wherever he is right now his face is beaming with that huge big smile of his. As a cancer survivor going on 16yrs i am eternally grateful for Dr's & Surgeons for the work they do, may God bless you all. To Brian's mother, sister, brother's & son i offer my heartfelt condolences, may his gentle soul rest in eternal peace . Hilary, Wicklow, Ireland.

We are very sad to hear about Brian's death. Our sincere condolences to his family, friends, colleagues and patients.

Very sad 😢

A sad loss of such a talented man who used his gifts to heal and give hope to so many people.. God bless all medical staff who serve to heal and give hope to all !

Here is an idea for prostate cancer researchers. I am an 85 yr old specialist physician with metastatic prostate cancer . There needs to be an analysis of what the life extension is for patients in age cohorts - e.g. Aged 50+, 60, 70, 80 and 85. When a patient decides what treatment he is going to be subjected to he wants to know the answer to two questions a) quality of life - side effects of treatment and b) how long am I projected to live based on the many studies that have been done on many ADT and Chemotherapeutic agents? The research into life extension in the various age cohorts would help inform patients and their clinicians.

Sending LOVE & prayers to Brian’s family, loved ones & all of you ❤

I enjoyed this Olympics episode. As an 85 yr old (retired specialist physician) with metastatic prostate cancer I would like to hear commentary on the decisions based on age group (suggest 5 year cohorts to analyze studies).

I’m listening with interest in the hope there is some new treatments being considered. My husband had his prostate removed in October last year. He had a Gleason score of 4+5 and post surgery it was upgraded to 5+4. It was borderline breaking out he was told after the pathology, however they were content with how things had gone. He has had 2 PSA tests since surgery, both negligible score but the most recent has showed a PSA level of 0.89. He is pretty devastated and we are waiting for a PET scan. Until this is done we have no idea where it’s popped up again and so I’d appreciate any advice you can give us.

No harm in active monitoring.

More good than harm, unless you're a patient they misdiagnose.

If the random biopsy didn't miss a Gleason 3/4 or 4/3.

Bravo, Howard.

I love how you invite prostate cancer patients to tell their stories. Howard is a gift to the AS community.

Thank you for your channel. It is really helpful! I live in the US. My RP and e PLND is scheduled for next week. I'm really concerned about PLND due to its possible life-long complications. My circumstances are as follows: Firm yet no nodular DRE. MP MRI showed 1cm lesion in the peripheral zone with no ECE. PSA 19.4 yet at the time I had CP/CPPS. Systematic biopsy showing (1) 4+4, (4) 4+3 and (1) 3+3. Gleason 8. PSMA Pet showed avidity in only the prostate. No other avidity at distant sites including the nodes and seminal vesicles. BRCA 1 and 2 negative. I'm also asymptomatic in the pelvic region. I'm wondering that, in my setting, can I forego the ePLND? My thinking is to go ahead with the RP only, test PSA every 3 months for two years and if it starts to rise, repeat the PSMA to find it then deal with it. Thanks so much!

Loved it, thank you

I did not understand why I had to suffer a biopsy. PSA 2000, bone scan showed extensive mets to upper skeleton, I mean everywhere. PSMA PET Scan after biopsy simply confirmed the bone scan and showed-up a met in a pelvic lymph node. The biopsy was done after the bone scan for what? All it did was raise my PSA to 3500 and I was put on ADT immediately anyway. Result of the biopsy - I couldn't sit down for a week and needed a catheter for six weeks afterwards. It's eventual removal was horrendous for two days after, pissing pure blood, then pushing clots until it cleared up. I sometimes wonder if you doctors and the guidelines you follow understand anything. From what I can make out all it did was give me a Gleason 9 diagnosis, SoC sucks.

Had a RP in April, 4 lymph nodes removed as well. Path Report GG4, Gleason score 8, pT3aN1. Three month PSA coming up soon. I realize the risk is pretty high for metastasis, if I need radiation can i do it without ADT? Thank you, Joe

Thank you Doctors. This was very interesting. My husband was just diagnosed so we are trying to learn all we can.

Regarding Dr. Flesher's lutetium PSMA-Germany story, I find it interesting that Dr. Hofman did a sabbatical with Dr. Richard Baum at Zentralkinik Bad Berka in 2016. Seems like we have Germany and doctors like Richard Baum to thank for the spread of PSMA RLT throughout the world.

If systematic biopsy is still recommended for focal treatment planning, what happens if the initial focused biopsy turns up PCa that requires treatment? Does the patient then have to undergo a systemic biopsy for focal treatment planning?

Good to see Alice👍

I greatly appreciate the best academic minds giving their opinions. Being an 85 yr old retired specialist physician with metastatic prostate cancer I am glad to hear increasing discussion on how to assist patients decide with their oncologist or urologist what is the best treatment approach. Developing a regularly performed quality of life assessment would help. Patients need to know what side effects they may suffer and for how long. Also what is the expected life extension with various treatments based on the data from studies.

Loved it, well done

Sequencing ARPIs in a control arm isn't debatable. It's unethical, based on Phase 2 data showing that the response rate for sequencing abiraterone followed by enzalutamide is only 30%, and for enzalutamide followed by abiraterone, a dismal 5-7%. Sequencing abiraterone and enzalutamide has shown it does not improve overall survival in several clinical trials. Using ARPI sequencing as a control arm because its suboptimal overestimates the benefits of whatever is being studied in comparison. Ensuring that control arms consistently represent the best current standard of care is essential to protecting patients and maintaining the integrity of the clinical trial process.

Amazing new research and great to see Declan keeping us up to date with current clinical research over seas. Ongoing refinement and as always a man has to meet the criteria to access these treatments.

An interesting study and as always research keeps improving. Urologists need to stay abreast of new initiatives.

Always nice and fun listening to GU cast. Love you guys

Beautiful work & cast

I appreciate the open minded discussion rather than blind fixation on a standard of care mantra. We are all different so there is no one size fits all.

Thank you! Outstanding episode. Super relevant to me. Diagnosed at 52 with Gleason 9, oligometastatic (lymph nodes plus one bone met) disease. Did triplet therapy plus radiation to prostate, pelvic LNs and bone met. I’m about 2 years into it and fighting the quality of life issues with long term ADT.

I had brachytherapy and 16 external beam radiation sessions as well as 4 mos of ADT in Oct. 2022. I was so miserable after six months that I begged my urologist to let me start TRT. It's been a year and my testosterone has gone from 32 to 720 and my QOL is night and day. I did have a single tumor in a single lymph node found with a PSMA Pet scan after my PSA rose from 1.5 to 3.9. I had 17 lymph nodes removed on April 17, 2024 and in addition to the tumor, they found four with microscopic Pca. I will get another PSA test in four weeks to see if the residual PSA has washed away, and then I assume start active surveillance to see if the PSA once again rises. I've told my cancer team that I would prefer 8-10 great years (I am a world class master's athlete) than 15-20 so-so years, where I am constantly fighting various side effects. I am 70. Love your podcasts here in the states. Seems you guys are ahead of the curve in some ways.

Thank you..

Excellent show Declan as usual. No doubt you took the lead in establishing good rapport with nuclear medicine and uro oncology in Australia and now propagating this concept all over the globe.

Great episode - inspirational in the second half discussing surgical entrepreneurship. Now to go bother co-conspirators with my ideas!

As a patient undergoing the treatment discussed (first line for locally advanced MIBC) I found this discussion extremely helpful in answering questions I had regarding its clinical application and even heard some provocative questions posed that I would very much enjoy seeing addressed in a future podcast. I am documenting my journey on the blog on my website.

What can i sayy.Speechless.. Great Insight! On my way for treatment tomorrow...

Audio is MORE IMPORTANT than image quality in a video. Your guest's audio has consistently been lackluster. It's due to excessively low volume (gain). To fix, consider: 1. Route the audio from your guest through the Rodecaster Pro. 2. Adjust the guest's audio level using one of the **sliders** on your Rodecaster Pro to match the hosts' levels. Rode Microphones is in Australia. Have them help you.

Respectfully, this can be a slippery slope. In 2020 I had a rapidly rising PSA. I had a PSA - 4K test, which showed high likelihood of significant cancer. I then had a 3 Tesla MRI, which showed a single lesion by the anterior apex. Knowing. Understanding that this location is hard to reach with a TRUS biopsy, even an MRI guided one, I elected to have a stereotactic perineal mapping biopsy. The results showed only a single core affected core Gleason, 3+3. I elected to have focal brachytherapy on one side of the prostate. My nadir PSA was 2.2. 33 months later in March 2023, my PSA rose to 3.41. My radiologist/oncologist thought it was a “bounce” and told me to have my PSA rechecked in 90 days. He was mistaken. He also quit practicing due to health problems. My PSA continue to rise. Fast-forward to December 2023 when I finally found another healthcare provider to take over where he left off. My PSA had risen to seven. I had a PSMA- PET scan and 3T MRI with contrast. The cancer returned with a vengeance on the right side that was treated with brachytherapy 2020 and also a new lesion on the left side. Gleason 9 and Gleason 8 respectively. Lymph node involvement on the right side. Stage 3 N1. I was devastated. A standard course of treatment was originally planned with radiation and ADT. However, the MRI revealed that the cancer was bordering the internal urethra and radiation would probably result in the need for a diversion. It’s 68 years old I had a high level of fitness for my age, low, BMI, no other underlying health issues and arguably athletic. I underwent a salvage radical prostatectomy in January 2024. Radiation to the lymph node bed will be next along with up to two years of first and second generation ADT. The prognosis for MFS for 5 to 10 years is 70% likelihood and I’ll take those odds. The surgeons, radiologist, and oncologist that reviewed my MRI and biopsy from 2020 all feel that the biopsy missed significant high-risk cancer and erroneously gave me a 3+3 Gleason score. To add insult to injury, the MRI from 2023 indicated a high likelihood that the brachytherapy seeds weren’t located in the location consistent with the lesion shown in the MRI of 2020. The reason I’m writing all of this is because while I agree that there is a reasonable argument for calling Gleason six something other than cancer, the reality is that biopsies aren’t perfect and one can never be 100% certain that a Gleason six diagnosis later won’t have to be revisited as more significant and high risk cancer.