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GU Cast
Australia
Приєднався 3 бер 2008
The home of GU Cast, top Urology Podcast hosted by Professor Declan Murphy and Dr Renu Eapen. Plus other mostly urology and surgical content.
www.declanmurphy.com.au
www.gucast.org
www.declanmurphy.com.au
www.gucast.org
Three Big Waves in Testis Cancer | With Rob Hamilton and Ben Tran
Testis cancer! We don't talk enough about this on GU Cast. But we are making up for it today with a cracking overview of three hot topics in testis cancer a couple of world-leading testis cancer experts. We are joined by Rob Hamilton (Urologist, Princess Margaret Cancer Centre, Toronto), and Ben Tran (Medical Oncologist, Peter Mac, Melbourne) to discuss changes in surveillance for stage 1 seminoma, changes in the management of stage 2 seminoma (including robotic RPLND), and miRNA as a really useful biomarker. A really lively discussion on three really topical areas in testis cancers.
We recorded this one at the ANUP Annual Scientific Meeting in July 2024. You can find a full GU Cast covering the rest of the ANZUP24 highlights here ua-cam.com/video/XJOEV3gQEgo/v-deo.htmlsi=RlTdYy3k-DeKF1bw
We recorded this one at the ANUP Annual Scientific Meeting in July 2024. You can find a full GU Cast covering the rest of the ANZUP24 highlights here ua-cam.com/video/XJOEV3gQEgo/v-deo.htmlsi=RlTdYy3k-DeKF1bw
Переглядів: 185
Відео
Why you should go to Bali!! #UAA24
Переглядів 63День тому
As if any of us need an excuse to go to beautiful Bali! Well the Urological Association of Asia (UAA) Annual Meeting takes place there from 5-8th September 2024. Renu caught up with Dr Agus Rizal Hamid recently to hear what the UAA have in store for us! www.uaa2024.com
PSA and Testosterone | Why low numbers matter
Переглядів 234День тому
How often do you check PSA and testosterone in your patients on androgen deprivation therapy? Probably not often enough!! Declan caught up with friend of the podcast Professor Axel Merseburger at a conference recently to chat about this under-appreciated topic. Don't get too distracted by fancy scans and genomic testing; but do make sure you know a bit about why it matters to get testosterone (...
Remembering Dr Brian Kelly
Переглядів 10 тис.21 день тому
Today we dedicate our podcast to the memory of our colleague, Dr Brian Kelly (40), who passed away unexpectedly this week. We are devastated to lose Brian, who was a Consultant Urologist at Peter Mac and Eastern Health here in Melbourne, and one of our closest friends in the world. Here we replay the Memorial Session which we conducted at Peter Mac this week. It features some great memories of ...
Three big things in advanced/high risk kidney cancer | With Rana McKay and Lewis Au
Переглядів 15728 днів тому
We were very happy to have world-famous kidney cancer guru Dr Rana McKay in Australia this week to do some educational events and to visit us at Peter Mac. So of course we also invited her to the GU Cast studio to pick her brains on all things kidney cancer, along with Dr Lewis Au, GU Medical Oncologist at Peter Mac. We asked them to cover three hot topics: 1. Adjuvant immunotherapy following s...
Sunshine and Science from #ANZUP24 on the Gold Coast
Переглядів 196Місяць тому
Renu and Declan escape winter in Melbourne to enjoy a few days of sunshine and science at the #ANZUP24 Annual Scientific Meeting on the Gold Coast. ANZUP is our fantastic GU Oncology co-operative trials group here in Australia and New Zealand and have an outstanding record in running clinical trials and supporting research and education in GU Oncology. Plus this is their 14th Annual Scientific ...
The Prostate Cancer Olympics 2024! With Elena Castro and Arun Azad
Переглядів 304Місяць тому
To celebrate the Paris 2024 Olympics, we bring you this special Olympics-themed episode of GU Cast - our very own Prostate Cancer Olympics! Yes we We are joined in the GU Cast studio by Dr Elena Castro, GU Medical Oncologist at Hospital 12 de Octubre in Madrid, who happened to be passing through Melbourne. And by our own A/Professor Arun Azad, GU Medical Oncologist at Peter MacCallum Cancer Cen...
Radical prostatectomy and the wave of new robots in China today
Переглядів 199Місяць тому
In the second of our special episodes focussing on GU Oncology in China, we are delighted to welcome back our GU Cast China Editor. Professor Yao Zhu, who has put together this cracking epsiode focussing on radical prostatectomy in China. We are joined by Professor Ming Liu (Beijing Hospital, Beijing) and Professor Jiahua Pan (Ren Ji Hospital, Shanghai) to discuss everything from current practi...
We meet the Active Surveillor | Howard Wolinsky
Переглядів 204Місяць тому
There are patient advocates and there are patient advocates, and then there is Howard Wolinsky! We chat with the inimitable Howard, medical journalist and very long-time active surveillance patient, about his varied interests in low-risk prostate cancer and prostate cancer diagnostics. He runs a great substack called The Active Surveillor with a regular newsletter which we devour every week! l ...
#APCCC24 Conference Highlights | Part 2
Переглядів 162Місяць тому
Part 2 of our Conference Highlight specials from the Advanced Prostate Cancer Consensus Conference, held in April 2024 in Lugano. This is our very favourite prostate cancer meeting and we are thrilled to bring you these highlight podcasts. In this episode we chat with Elena Castro, Nick James, Anthony Joshua, Bertrand Tombal, Silke Gillessen, Aurelius Tomlin, Yüksel Ürün, Gill Morgan, and a gan...
2024 EAU Prostate Cancer Guidelines - some big changes!!
Переглядів 3,8 тис.2 місяці тому
Pelvic lymph node dissection down-graded. Systematic prostate biopsies no longer recommended. More clarity around PSMA PET/CT for staging. Surgery no longer recommended for cN1 prostate cancer. Yep the recent updates to the EAU Prostate Cancer Guidelines had a lot of important changes for the global urology community to digest. So we invited EAU Prostate Cancer Guideline Vice-Chair Derya Tilki,...
#APCCC24 Conference Highlights | Part 1
Переглядів 2772 місяці тому
The first of two Conference Highlight specials from the Advanced Prostate Cancer Consensus Conference, held in April 2024 in Lugano. This is our very favourite prostate cancer meeting and we are thrilled to bring you these highlight podcasts. In this episode we chat with Silke Gillessen, Derya Tilki, Jochen Walz, Neha Vapiwala, Dingwei Ye, and the lucky trainees who won a GU Cast Travel Award t...
GU Highlights at #ASCO24 | with Marty Schoen
Переглядів 1882 місяці тому
Didn't get to ASCO this year?? Us neither!! But not to worry, we checked in with Dr Marty Schoen who did, and brings us all the key highlights! Marty is a GU Medical Oncologist at the St Louis Veterans Affairs Medical Centre and the University of St Louis, Missouri. He runs through a smattering of stuff that caught his eye at ASCO this year. Thanks Marty! Also available as an audio podcast - ju...
Pembro improves survival after nephrectomy | Huge news for Urologists!
Переглядів 2273 місяці тому
For Urologists, there are not that many papers that come along where we can say - "this will almost immediately change my practice". But KEYNOTE-564 looks like one of those! A large phase III randomised trial of adjuvant pembro following nephrectomy for renal cell carcinoma in patients deemed at higher risk for recurrence. Regular listeners/viewers might remember we discussed this on GU Cast ba...
En-bloc party! RCT of TURBT with Jeremy Teoh
Переглядів 4453 місяці тому
Should we remove bladder cancers piece-meal by chopping them into little pieces, or should we try and remove en bloc with a margin around the base?? This very nice randomised controlled trial from our friends in Hong Kong demonstrates that the recurrence rate is significantly lower if we use the all-too-rarely used en bloc technique. Dr Jeremy Teoh from the Chinese University Hong Kong joins us...
Three big challenges in metastatic prostate cancer | Dr Alicia Morgans
Переглядів 6793 місяці тому
Three big challenges in metastatic prostate cancer | Dr Alicia Morgans
Metastatic prostate cancer in China today
Переглядів 1933 місяці тому
Metastatic prostate cancer in China today
ProsTIC24 PSMA Theranostics Conference Highlights
Переглядів 2804 місяці тому
ProsTIC24 PSMA Theranostics Conference Highlights
Proton therapy no better than standard prostate radiotherapy
Переглядів 1925 місяців тому
Proton therapy no better than standard prostate radiotherapy
ADT and cardiac risks (and how I sold my company for $1.4bn)
Переглядів 4645 місяців тому
ADT and cardiac risks (and how I sold my company for $1.4bn)
Happy days for metastatic bladder cancer | Enrique Grande and Andrew Weickhardt
Переглядів 2635 місяців тому
Happy days for metastatic bladder cancer | Enrique Grande and Andrew Weickhardt
High risk prostate cancer and mHSPC | With Axel Merseburger
Переглядів 6085 місяців тому
High risk prostate cancer and mHSPC | With Axel Merseburger
What does a randomised trial tell us about prostate biopsy?
Переглядів 4606 місяців тому
What does a randomised trial tell us about prostate biopsy?
"Unethical trials", or so says Vinay!
Переглядів 5886 місяців тому
"Unethical trials", or so says Vinay!
Bringing LuPSMA earlier | ProsTIC/PCF/ICIS Global Webinar
Переглядів 2837 місяців тому
Bringing LuPSMA earlier | ProsTIC/PCF/ICIS Global Webinar
A Touchy Subject | With Victoria Cullen
Переглядів 1,3 тис.7 місяців тому
A Touchy Subject | With Victoria Cullen
APCCC Travel Award Winners Revealed!!
Переглядів 827 місяців тому
APCCC Travel Award Winners Revealed!!
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).
Thanks Shaun! And thanks very much for reaching out through our website also. We are very sorry to hear of your diagnosis and hope that you are going well. You make a great point about age groups. An issue with clinical trials is that they pretty much only recruit patients in quite good health, with not enough older patients. Real world data needed for this. You messaged us separately about how important quality of life is for you and many older patients. It's not always about prolonging life by a modest period, if the quality of life is not great. We must talk more about this. Declan and Renu
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.
So sorry to hear this Rhonda. We do hope that you are both going well. Not everyone around the world gets access to PSMA PET/CT so we are glad to hear that. We hope that he gets some good options after that and send you all our best wishes. Declan and Renu
@@gu_cast thanks for your good wishes.
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.
Did he say random?
Bravo, Howard.
I love how you invite prostate cancer patients to tell their stories. Howard is a gift to the AS community.
Wow, Thanks. And Nebula are a gift to the entire galaxy. Thanks for the support Br. N. Where on the planet are you?
@@HowardWolinsky Howard, it's me Keith😊
Thanks for the great feedback @doctornebula! We totally agree. Declan and Renu
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!
Hi Richard. First of all, so sorry to hear about your diagnosis. It certainly sounds like an important diagnosis as that is a proper cancer. We are very happy to hear that your PSMA PET/CT is all clear. The discussion about PLND remains contentious and advice is changing. We very much respect what individual surgeons recommend and we totally respect the fact that it is up to the individual patient at the end of the day. We encourage people to use the excellent nomogram published by Gandaglia et al in European Urology Oncology a few months ago which is aimed at patients who have had a PSMA PET/CT showing no disease outside the prostate (like you). We featured this on GU Cast a few months ago with Dr Gandaglia. On that nomogram thankfully, your risk of having positive lymph nodes is extremely low indeed which is good news. We wish you all the very best with your surgery. Declan and Renu
@@gu_cast Thanks so much for your reply and information.
@@gu_cast Hey y’all. Hope you’re doing great. I met with my surgeon today before tomorrow’s RP to express my concerns about the PLND planned. I laid out all I learned about it and he agreed there was no benefit in doing it other than for diagnostic staging. Thank y’all for that video posted about the subject so it’s not being performed . Just wanted to let you know.
Loved it, thank you
Glad you enjoyed it Baz! Declan and Renu
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.
So sorry to hear your story Mark. That is a really tough situation and I am really sorry to read your story. That is about as tough as it gets and I hope that you are going ok and that you have good people looking after you. We still often offer biopsy in these situations (even if the diagnosis and management is already clear), as it can help when trying to get access to clinical trials and certain treatments like PARP inhibitors. But really sorry to hear this and hope things are looking up for you. Sending you best wishes from Melbourne. Declan
@@gu_cast I'm doing OK thanks. Eight months into diagnosis. I live in Thailand so I'm not eligible for clinical trials here. What really makes a difference to me is to receive a reply from someone like yourself and to know someone is listening and understands. Thank you for taking the time to reply. Mark.
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
Sorry to hear about your diagnosis Joe and hope that you are on the mend. Let's hope that first PSA is good news. If radiotherapy were to be recommended, then there are definitely two schools of thought on adding ADT for a period. Conventional wisdom is that it helps, but most of that is based on men having radiotherapy to the prostate itself, not following surgery. We hope that you have a good team advising you. Good luck with the PSA! Declan and Renu
Thank you Doctors. This was very interesting. My husband was just diagnosed so we are trying to learn all we can.
Sorry to hear that Barbara. We hope that all goes very well for him. Declan and Renu
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.
That's for sure! Michael always gives Dr Baum a lot of credit, and indeed many other excellent doctors/nuc med technicians/physicians/nurses working in German centres who have done so much to advance the fields of PSMA imaging and theranostics. Declan and Renu
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?
Myself and Renu don't do focal therapy so we are hesitant to answer. Focal therapy still considered investigational in the EAU guidelines so only recommended in clinical trials or prospective registries. Best direct that question to a focal therapy specialist. However, updated EAU Guidelines no longer recommend systematic biopsy in men who have an MRI lesion - recommend just target teh lesion and area surrounding it. Good discussion in this podcast. But let's do a podcast on focal therapy soon. Declan and Renu
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.
Thanks so much for the comment, and we wish you all the best with your cancer management. We couldn't agree more, In our recent podcast with Dr Alicia Morgans (a top expert on Survivorship and QoL), we heard some really good views on this. Best of luck! Declan and Renu
Loved it, well done
Thank you! Cheers!
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.
Totally agree! We have an interesting few comments coming on this in our upcoming APCCC Highlights part 2
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.
Thanks Alan! Declan and Renu
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
Thanks so much! Declan and Renu
Beautiful work & cast
Thank you so much Baz 😀
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.
Thanks Francois! Declan and Renu
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.
Sorry to hear that Bob. So tough but hope you are doing great. You might enjoy listening to our two previous podcasts with Tim Baker. He was diagnosed with metastatic prostate cancer aged 49 and has some amazing insights into ADT and managing side-effects. Sending you our best wishes. Declan and Renu
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.
Wow Matthew that's quite the story! Hopefully your most recent surgery will help avoid the need for more ADT.Your words on the misery of ADT really chime with us. And going on testosterone replacement is something we should do more of as we talked about in this episode. Your story very compelling. You might enjoy listening to our podcasts with Tim Baker who has written a great book about his experience with ADT having been diagnosed with metastatic prostate cancer in his 40's. The book is called "Patting the Shark" and his most recent GU Cast is here ua-cam.com/video/cBL4iisksLk/v-deo.htmlsi=5vau1N-D2xpq7e2_
Thank you..
You're welcome Anwar!
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.
Thanks Makarand! Declan and Renu
Great episode - inspirational in the second half discussing surgical entrepreneurship. Now to go bother co-conspirators with my ideas!
Yep very inspirational listening to Neil! He is very modest
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.
Sorry to hear this Jon. Please send us a link to your blog. Sending you our best wishes. Declan and Renu
What can i sayy.Speechless.. Great Insight! On my way for treatment tomorrow...
Best of luck!! Hope treatment goes very well. Declan and Renu
@@gu_cast Was booked in for Surgery... But at the last minute cancelled and went with SABR Radiation treatment... I was back surfing after 1 week...Surfing every day NOW!..Just got to put up with the Wee n Poo changes... SurfForLife. Cheers Ross.
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.