Meet Dr. Scholz, Alex, and world renowned prostate cancer experts at our 2024 Prostate Cancer Patients & Caregivers Conference: pcri.org/2024-conference
I am very relieved by the information that was provided in this video regarding the genomic test. I had the Decipher genomic test and my score was Low (0.17). The 5-year risk of metastasis was 0.7%; the 10-year risk was 1.7% and the 15-year risk of mortality was 3.2%. The doctor ordered the test to see if I should be treated "more aggressively" despite my intermediate risk PSA at 12.7 ; Gleason 4+3=7 and clean PSMA/PET, MRI, Bone Scan, PET Scan results. Thanks!
So what have you decided to so? I have 3+4 for 2.5 years now on the left side and a small lesion of the right side - yet to have it biopsied. The Decipher survival rate is based of radical treatment (RP/RT). I think I’ve decided on TULSA-PRO but…jump back on the fence every other day.
3+4. Took my prostate out and did 17 biopsies and found all clear. No PSA for a year then started going up then Radiation therapy. Put me on Elligard 3 month injections. Good for 3 years. PSA going up. Started me on Casodex. Lasted 3 years and gave me afib. PSA around 5 started me on Nubuqa 2pills a day with continued Elligard. Stopped my pills for 3 months to get my sugar back to normal PSA went up to 13. Started Nubeqa again and PSA went to 6 Next bloodwork 3 months later PSA 11. I would like to send my surgical reports to you Doctor to review. Something is strange
55 yr old with one 3+4=7. Did 28 IMRT treatments that finished in May. Back to normal after 3 weeks and now can’t tell any difference pre treatment and post
I wish they would do a video like this for someone who is diagnosed with Gleason score 7(4+3) & also with an EPE (extraprostatic extension), and with ADT hormone therapy (6 months), brachytherapy, and 5 sessions of SBRT (cyber knife) as recommended treatment.
Diagnosed at 45, 61 today. At diagnosis: 4/2008, PSA 9, Gleason 4+3, RP performed. PSA never hit undetectable so in 7/2008 I did salvage RT to the prostate and local lymph nodes, followed by 2 years of lupron, which I tolerated pretty well. PSA undetectable until 2014. Then began a slow, steady rise until now, 10 years later, it’s at 2.5. PSMA/PET revealed “a few” spots in pelvic lymph nodes in two different areas (low volume disease). Oncologist and original radiation oncologist recommend against radiation due to difficulty of hitting affected lymph nodes. Instead, a recommendation of ADT for 6 months has been made. I have an appointment to speak to another radiation oncologist. I was wondering about the efficacy of adding an ARPI, and even a chemo agent to the ADT at this stage. I’m in excellent physical and cardiovascular health with a BMI of 21. Thanks so much for doing what you do. I've leaned heavily on PCRI for timely and detailed information over the years.
Regarding the patient with apical lesion I had one 3+4 apical lesion which had progressed from 3+3 (seems I am an exception to 3+3 not progressing) and was concerned about quality of life so had nanoknife. Just over a year later MRI shows cancer free though this reduced the volume of my prostate. Some urgency but does not affect my social life. You need to have sufficient margin round the lesion to do it. The first week difficult with urethral inflammation, catheter for 3 days, continued urgency afterwards but no incontinence, good recovery thereafter but don’t believe the claims you will be able to do manual work or return to work in a week just like before! Can get erections, though better durability with cialis. So I would recommend this as a less invasive treatment with good prospects of outcome. Other forms of focal therapy are not suitable for the apex and may have more complications. I hope this is helpful.
Just had a PSMA/MRI combo scan and all looked same as 6 months ago MRI but as part of the study will have another Biopsy BUT my PSA taken after few days later and went up about 1.5 in 2 months to mid 7 so I am very concerned. I am 3+4 and with only one lesion but prostate is large and lesion is next to urethra. Hoping I can have TULSA treatment or if not MRI guided HDR Brachytherapy at one of the leading university research and treatment hospitals. All depends on my Oncologist/Urologist say this coming Friday. Full body scans did not detect anything other than the one lesion confined to my prostate. 🤞🍀 I decided to do active surveillance when we first discovered my condition 6 months ago and hoped to continue but feel now is the time to do something before it changes which seems to be the case sooner or later for most …I did have something show up on a rib in my back as Dr. Sholz used as an example but the Doctor reading the scans dismissed it as most likely an old injury. I feel that I am at the right hospital. New edit results from biopsy. Biopsy said same size same location but for some reason change to grade 3 from a grade 2. So it seems that at least for me the PMSA Pet/ MRI is not as revealing as a biopsy.
I had a 4+3. I did radiation in 2020. I did a PSMA Pet-scan. I still have active cancer in the same location. I'm told that I can't do radiation or removal now that I already had radiation.
Oh..! If I am right, this was my comment.Thank you for the answer about the brachytherapy/cyberknife risk in the case of an Apex location in a located Gleason score 3+4 tumor. ( I am in France). Finally I didn't listen to this Surgeon who was predicting a terrible burn of the uretral sphincter. I did my brachytherapy a month ago. I am waiting to see if light urinary problems do increase or not. It would be normal. At the moment they are manageable with some medications. There remains strangely a retrograde ejaculation, and orgasm is either very weak- or painful, at the level of the urethra( as it exits the perineum, perhaps the after-effects of the urinary probe, or the muscle relaxant medications. I am given low dose tadalafil for 6 months. We'll see.
I was recently diagnosed with 3+4 in MRI/Ultrasound fusion biopsy (in 12 standard cores, 1 core 3+3, 1 core 3+4 with 5% of 4; in 6 targeted cores, 1 core 3+3, 2 cores 3+4 with 5% of 4). My PSA was 8.01, with PSA density of 0.16. I checked some of the Active Surveillance eligibilities, and I find I should be in the AS. But my doctor suggests focal therapy treatment because my MRI showed growth of the tumor of 21x5 mm this year, comparing to 9x6 mm last year, and 6x5 mm the year before. My question for Dr. Scholz and others, am I still a good candidate for Active Surveillance? I remember watching a video from UCSF, department of urology and their study showed the Gleason Score and the amount of 4 matters most in deciding the AS candidate, and size of the tumor didn't make big role down the road. A doctor from Uni of Maryland, department of urology also uses if the tumor size is less than 1/5 of the total prostate size to determine if the tumor is too large for Active Surveillance.
Each institution can use a different percentage of 4 found in the sample. John Hopkins, I believe, use 10% involvement to be eligible for AS. But I think others may use higher, how many cores and other criteria.
Update. Had my biopsy and got the results. Although a lesion was seen on MRI earlier and PSA was 5.56 at one time, no evidence of malignancy was found after 14 samples were taken. My understanding was that 2 samples were taken from the lesion. However my prostate is much degraded. Diffuse acinar atrophy. Diffuse acinar hyperplasia. Acute inflammatory infiltration. I'm of the opinion that untreated prostatitis in years past could have been part of the cause. I've done some research but have found nothing definitive. Still, I'm very thankful that I don't have a cancerous prostate.
I am 68 years old. Had radical prostectomy for 4+3 Gleason score CA prostate. No mets at that time (PET scan) Present PSA is 0.07 . Post surgery level was 0.001 Any cause of worry
I'm no doctor, but no worry. If you had nerve sparing surgery. Believe it or not,NSS produces a small amount of psa from benign microscopic prostate tissue left on the nerve endings after surgery. If it holds steady under .2 you should be in the clear, also doubling time is a good indicator. Always ask a physician brother.
@@RH-xd3nx If the post-prostatectomy PSA steadily climbs (say three consecutive increases) I believe that rules out benign prostatic tissue. Some docs, in the age of ultrasensitive PSA tests, look to begin salvage radiation at the .1 mark. while others still hold off until .2
My dad is 79, recently diagnosed 3+4=7. PSA of 5.92. Based on your previous video, I urged him to pursue Oncatype testing which came back 13%, low risk. Lives in an area without great options for medical care and feels a bit forced into having surgery, radiation or proton beam therapy as his doctors are not presenting additional options. Is he a candidate for active surveillance?
Maybe make sure it’s real 3+3. Random biopsies can miss aggressive cancer. Transperineal in bore MRI-guided targeted biopsy is the safest and most precise. If it’s true Gleason 3+3 you’ll most likely just go on active surveillance and continue with you life. Check with experts however, as I’m not a doctor 🙂
I can’t find much info on this type of situation, but my husband was a 3+4 with 9 of 12 cores, up to 80% in one core of 6+6 and up to 50% 3+4. 5 cores 3+4 and 4 cores 3+3…other two cores atypical and suspicious. He had 28 treatments of EBRT without hormone therapy, ending on September 28, 2023, very close to 2 years ago. His PSA has been up and down, but no lower than about 2.5. No multiple increases in a row, but I get concerned about whether to check with an oncologist to make sure it’s completely eradicated. Am I overthinking this?
I can’t find much info on this type of situation, but my husband was a 3+4 with 9 of 12 cores, up to 80% in one core of 6+6 and up to 50% 3+4. 5 cores 3+4 and 4 cores 3+3…other two cores atypical and suspicious. He had 28 treatments of EBRT without hormone therapy, ending on September 28, 2023, very close to 2 years ago. His PSA has been up and down, but no lower than about 2.5. No multiple increases in a row, but I get concerned about whether he should check with an oncologist to make sure it’s completely eradicated. Am I overthinking this?
All the prominent hospitals: Mayo, Duke, UCSF, Stanford, UCLA, John Hopkins, etc. But, they all have protocols, or standard or care. Mayo Clinic in MN may not do focal therapy whereas Mayo Clinic in Florida or AZ will do focal therapy. Looking at the same MRI one institution will say your candidate and the institution across the street will say you’re not a candidate for focal therapy. It’s quite crazy making.
I have 4+3..recently finished SABR Radiation Treatment..My PSA was at 7.7 Now after 1st test after Radiation it is now 3.2? is this OK/.. Thankyou fromAustralia.Also my Oncologist said see you in 3 months.. I'm just woried about did the Therapy work completely in eradicating my enclosed cancer? I'm 65...
Sorry to disagree with Alex, but some times, run like hell from your doctor. My doctor would raise his finger and exclaim how often he had found cancer. My 3+4 was all on the left side. Per his notes it was on the right side. The pathology report showed the right side cores were benign.
Meet Dr. Scholz, Alex, and world renowned prostate cancer experts at our 2024 Prostate Cancer Patients & Caregivers Conference: pcri.org/2024-conference
This is so helpful - thank you both for the content.
Been following PCRI videos as I will be making decisions this summer. Remarkable resource helping me with my decisions!!!!!!!
Very informative video. Dr. Scholz seems to be a voice of reason amidst a world of confusion.
Thanks for sharing your expertise! We appreciate your videos so much.
Great job Dr. Scholz, Alex and PCRI.
I am very relieved by the information that was provided in this video regarding the genomic test. I had the Decipher genomic test and my score was Low (0.17). The 5-year risk of metastasis was 0.7%; the 10-year risk was 1.7% and the 15-year risk of mortality was 3.2%. The doctor ordered the test to see if I should be treated "more aggressively" despite my intermediate risk PSA at 12.7 ; Gleason 4+3=7 and clean PSMA/PET, MRI, Bone Scan, PET Scan results. Thanks!
I'm thinking I may go this route, 77 Yr. old. 1 Gleason 4+3=7 and 2 Gleason 3+3=6 waiting to get PSMA / PET and get the Decipher test.
So what have you decided to so? I have 3+4 for 2.5 years now on the left side and a small lesion of the right side - yet to have it biopsied. The Decipher survival rate is based of radical treatment (RP/RT). I think I’ve decided on TULSA-PRO but…jump back on the fence every other day.
3+4. Took my prostate out and did 17 biopsies and found all clear. No PSA for a year then started going up then Radiation therapy. Put me on Elligard 3 month injections. Good for 3 years. PSA going up. Started me on Casodex. Lasted 3 years and gave me afib. PSA around 5 started me on Nubuqa 2pills a day with continued Elligard. Stopped my pills for 3 months to get my sugar back to normal PSA went up to 13. Started Nubeqa again and PSA went to 6 Next bloodwork 3 months later PSA 11. I would like to send my surgical reports to you Doctor to review. Something is strange
55 yr old with one 3+4=7. Did 28 IMRT treatments that finished in May. Back to normal after 3 weeks and now can’t tell any difference pre treatment and post
I wish they would do a video like this for someone who is diagnosed with Gleason score 7(4+3) & also with an EPE (extraprostatic extension), and with ADT hormone therapy (6 months), brachytherapy, and 5 sessions of SBRT (cyber knife) as recommended treatment.
Diagnosed at 45, 61 today. At diagnosis: 4/2008, PSA 9, Gleason 4+3, RP performed. PSA never hit undetectable so in 7/2008 I did salvage RT to the prostate and local lymph nodes, followed by 2 years of lupron, which I tolerated pretty well. PSA undetectable until 2014. Then began a slow, steady rise until now, 10 years later, it’s at 2.5. PSMA/PET revealed “a few” spots in pelvic lymph nodes in two different areas (low volume disease). Oncologist and original radiation oncologist recommend against radiation due to difficulty of hitting affected lymph nodes. Instead, a recommendation of ADT for 6 months has been made. I have an appointment to speak to another radiation oncologist.
I was wondering about the efficacy of adding an ARPI, and even a chemo agent to the ADT at this stage. I’m in excellent physical and cardiovascular health with a BMI of 21.
Thanks so much for doing what you do. I've leaned heavily on PCRI for timely and detailed information over the years.
Regarding the patient with apical lesion I had one 3+4 apical lesion which had progressed from 3+3 (seems I am an exception to 3+3 not progressing) and was concerned about quality of life so had nanoknife. Just over a year later MRI shows cancer free though this reduced the volume of my prostate. Some urgency but does not affect my social life. You need to have sufficient margin round the lesion to do it. The first week difficult with urethral inflammation, catheter for 3 days, continued urgency afterwards but no incontinence, good recovery thereafter but don’t believe the claims you will be able to do manual work or return to work in a week just like before! Can get erections, though better durability with cialis. So I would recommend this as a less invasive treatment with good prospects of outcome. Other forms of focal therapy are not suitable for the apex and may have more complications. I hope this is helpful.
Alex and Dr scholz I'm 63 3,+4 tumor 16mm is that considered a large tumor ???
Just had a PSMA/MRI combo scan and all looked same as 6 months ago MRI but as part of the study will have another Biopsy BUT my PSA taken after few days later and went up about 1.5 in 2 months to mid 7 so I am very concerned. I am 3+4 and with only one lesion but prostate is large and lesion is next to urethra. Hoping I can have TULSA treatment or if not MRI guided HDR Brachytherapy at one of the leading university research and treatment hospitals. All depends on my Oncologist/Urologist say this coming Friday. Full body scans did not detect anything other than the one lesion confined to my prostate. 🤞🍀 I decided to do active surveillance when we first discovered my condition 6 months ago and hoped to continue but feel now is the time to do something before it changes which seems to be the case sooner or later for most …I did have something show up on a rib in my back as Dr. Sholz used as an example but the Doctor reading the scans dismissed it as most likely an old injury. I feel that I am at the right hospital. New edit results from biopsy. Biopsy said same size same location but for some reason change to grade 3 from a grade 2. So it seems that at least for me the PMSA Pet/ MRI is not as revealing as a biopsy.
I had a 4+3. I did radiation in 2020. I did a PSMA Pet-scan. I still have active cancer in the same location. I'm told that I can't do radiation or removal now that I already had radiation.
43 year old diagnosed 3+7 a month ago.
Oh..! If I am right, this was my comment.Thank you for the answer about the brachytherapy/cyberknife risk in the case of an Apex location in a located Gleason score 3+4 tumor. ( I am in France). Finally I didn't listen to this Surgeon who was predicting a terrible burn of the uretral sphincter. I did my brachytherapy a month ago. I am waiting to see if light urinary problems do increase or not. It would be normal.
At the moment they are manageable with some medications. There remains strangely a retrograde ejaculation, and orgasm is either very weak- or painful, at the level of the urethra( as it exits the perineum, perhaps the after-effects of the urinary probe, or the muscle relaxant medications. I am given low dose tadalafil for 6 months. We'll see.
I was recently diagnosed with 3+4 in MRI/Ultrasound fusion biopsy (in 12 standard cores, 1 core 3+3, 1 core 3+4 with 5% of 4; in 6 targeted cores, 1 core 3+3, 2 cores 3+4 with 5% of 4). My PSA was 8.01, with PSA density of 0.16. I checked some of the Active Surveillance eligibilities, and I find I should be in the AS. But my doctor suggests focal therapy treatment because my MRI showed growth of the tumor of 21x5 mm this year, comparing to 9x6 mm last year, and 6x5 mm the year before. My question for Dr. Scholz and others, am I still a good candidate for Active Surveillance? I remember watching a video from UCSF, department of urology and their study showed the Gleason Score and the amount of 4 matters most in deciding the AS candidate, and size of the tumor didn't make big role down the road. A doctor from Uni of Maryland, department of urology also uses if the tumor size is less than 1/5 of the total prostate size to determine if the tumor is too large for Active Surveillance.
Each institution can use a different percentage of 4 found in the sample. John Hopkins, I believe, use 10% involvement to be eligible for AS. But I think others may use higher, how many cores and other criteria.
You can manage what you don’t measure. “Active” Surveillance.
Update. Had my biopsy and got the results. Although a lesion was seen on MRI earlier and PSA was 5.56 at one time, no evidence of malignancy was found after 14 samples were taken. My understanding was that 2 samples were taken from the lesion. However my prostate is much degraded. Diffuse acinar atrophy. Diffuse acinar hyperplasia. Acute inflammatory infiltration. I'm of the opinion that untreated prostatitis in years past could have been part of the cause. I've done some research but have found nothing definitive. Still, I'm very thankful that I don't have a cancerous prostate.
I am 68 years old. Had radical prostectomy for 4+3 Gleason score CA prostate. No mets at that time (PET scan)
Present PSA is 0.07 . Post surgery level was 0.001 Any cause of worry
I'm no doctor, but no worry. If you had nerve sparing surgery. Believe it or not,NSS produces a small amount of psa from benign microscopic prostate tissue left on the nerve endings after surgery. If it holds steady under .2 you should be in the clear, also doubling time is a good indicator. Always ask a physician brother.
@@RH-xd3nx If the post-prostatectomy PSA steadily climbs (say three consecutive increases) I believe that rules out benign prostatic tissue. Some docs, in the age of ultrasensitive PSA tests, look to begin salvage radiation at the .1 mark. while others still hold off until .2
My dad is 79, recently diagnosed 3+4=7. PSA of 5.92. Based on your previous video, I urged him to pursue Oncatype testing which came back 13%, low risk. Lives in an area without great options for medical care and feels a bit forced into having surgery, radiation or proton beam therapy as his doctors are not presenting additional options. Is he a candidate for active surveillance?
What's the meaning of PSA that fluctuates?
74 years old diagnosed wih gleason score 3+3=6 what should be done
Watch it with active surveillance.
Probably active surveillance, wirh frequent testing.
Maybe make sure it’s real 3+3. Random biopsies can miss aggressive cancer. Transperineal in bore MRI-guided targeted biopsy is the safest and most precise. If it’s true Gleason 3+3 you’ll most likely just go on active surveillance and continue with you life. Check with experts however, as I’m not a doctor 🙂
Second check the biopsy and if there is agreement, active surveillance. Especially in your 70s.
I can’t find much info on this type of situation, but my husband was a 3+4 with 9 of 12 cores, up to 80% in one core of 6+6 and up to 50% 3+4. 5 cores 3+4 and 4 cores 3+3…other two cores atypical and suspicious. He had 28 treatments of EBRT without hormone therapy, ending on September 28, 2023, very close to 2 years ago. His PSA has been up and down, but no lower than about 2.5. No multiple increases in a row, but I get concerned about whether to check with an oncologist to make sure it’s completely eradicated. Am I overthinking this?
I can’t find much info on this type of situation, but my husband was a 3+4 with 9 of 12 cores, up to 80% in one core of 6+6 and up to 50% 3+4. 5 cores 3+4 and 4 cores 3+3…other two cores atypical and suspicious. He had 28 treatments of EBRT without hormone therapy, ending on September 28, 2023, very close to 2 years ago. His PSA has been up and down, but no lower than about 2.5. No multiple increases in a row, but I get concerned about whether he should check with an oncologist to make sure it’s completely eradicated. Am I overthinking this?
How does one find a "center of excellence?"
All the prominent hospitals: Mayo, Duke, UCSF, Stanford, UCLA, John Hopkins, etc. But, they all have protocols, or standard or care. Mayo Clinic in MN may not do focal therapy whereas Mayo Clinic in Florida or AZ will do focal therapy. Looking at the same MRI one institution will say your candidate and the institution across the street will say you’re not a candidate for focal therapy. It’s quite crazy making.
I have 4+3..recently finished SABR Radiation Treatment..My PSA was at 7.7 Now after 1st test after Radiation it is now 3.2? is this OK/.. Thankyou fromAustralia.Also my Oncologist said see you in 3 months.. I'm just woried about did the Therapy work completely in eradicating my enclosed cancer? I'm 65...
The PSA can lower gradually over a year’s time after radiation. I had exactly your situation and after three years PSA is below 1.
@@ransomcoates546 Thanking you...
69 w/m gleason 4+3, is it same as 3+4, and what would you recommend
It’s not the same. 3+4 is “intermediate favorable.” 4+3 is “intermediate unfavorable.”
Look at his previous video regarding 3+4=7
What the hell is with all these commercials at the beginning YT?
Sorry to disagree with Alex, but some times, run like hell from your doctor. My doctor would raise his finger and exclaim how often he had found cancer. My 3+4 was all on the left side. Per his notes it was on the right side. The pathology report showed the right side cores were benign.
Wow! I am so sorry you went through that. In cases like this, I agree with you! - Alex