Great wrap up at the end Alex. I can personally vouch for an approach to prostate ca which uses the many sources of sound scientific clinical information available on the internet. Your channel is certainly one of the best and I am eternally grateful for the knowledge you and Mark provide.
I will have a biopsy done on the 26th. of this month because of an 8mm lesion in the left anterior portion of my prostate seen on MRI. Should I ask my doctor if I can have a PSMA PET scan before the biopsy to see if the lesion lights up and possibly avoid the biopsy ? I was diagnosed with prostate calcifications 15 years ago, and this may have been what was seen on recent MRI. Just a thought.
What a brilliant advocate Dr Scholz is of a balanced approach to prostate problems. Listening to other commentators - the merchants of doom - frightens men into premature decisions about their prostate.
Many Thanks Alex and Dr. Scholz. Great Program 👌. Understanding the MRI is very helpful esp. avoiding the biopsy and no radiation needed but what about the contrast medium?? They found a very high Gadolinium score in my blood work! afterwards. Diagnosed with a leaky gut so the blood brain barriere might be open to the gadolinium as well! What about a MRI without a contrast medium and or a liquid biopsy, f.e. an EDIM Test available in Germany via TKTL1 Enzym and Apo10, in lieu?? Any Experience? And what does the pirads score, lets say 5 and/or 4, really tell ??
My prostate measured 74cc and my PSA is 5.4. PSAD = .073. Random biopsy was negative but MRI showed a 7mm lesion and was scored at PI-RADS 3. Now I’m on the fence as to next steps. Leaning towards an MRI-guided biopsy.
I'm not a doctor, but I've been doing active surveillance for 10 years. I wouldn't worry if I were in your place with those numbers, but I'd probably do another MRI in a year or 2 to see if that lesion is growing.
I have BPH but PSA density is .007 Finasteride adjusted and considered normal. My PSA is 2.2 for Yeats with Finasteride. Has 2 precious MRIs with PIRAD 4. Urologist wanted biopsy but i said do another MRI. The latest MRI showed PIRAD 2, no lesion but just inflammation. Don't rush into biopsy if other indicators are good.
Yes my doctor is a fan he said the trus test is cost effective he said it's great to know my size so as much as it is necessary accurate test useful and avoid biopsie 4:474:484:484:494:494:514:524:524:534:534:554:56
Wow. This is where I am at. What a relevant topic for me. Also, her comments at the end should put on a poster, the comments about the more you know the better off you will be. The only problem is with knowledge is I am exposing doctors lack of state-of-the-art practices, confinement to fast medicine reather than good medicine and insurance companies controlling treatments instead of shape medical reasoning. - in fact I would like see a video on how to navigate the almost non-functional medical system. -- But thanks so much for this video.
My 3T MRI shows "no suspicious lesions" and signs of past prostatitis and BPH nodules. Both of the aforementioned are rated as PIRAD 2. My uro is insisting that I have a biopsy. The tipping point to do one is that my grandfather on my dad's side and my uncle on my dad's side both had prostate cancer. Also I scored 29.87 on the Exo test, with 15 being the cut point; anything above more likely to contract prostate cancer. Your thoughts? One question: what the heck are we targeting for biopsy? There are no tumors or lesions. And at what point do I say, let's stop digging and shooting in the dark - can I just not have an MRI in a year or six months? Re-test the PSA, maybe quarterly?
What have you decided, I am almost in the same situation. 3T MRI did not even rate the PIRAD score but says no suspicious lesions found and suggestive of prostatitis. My PSA is around 8+.I understand that sometimes if PIRAD 1 and 2, it is considered negative and sometimes not even rated. My urologist did not even contact me to discuss until one week later I called them. Then he asked his assistant to schedule a blind biopsy on the phone. I said what about the treatment for the chronic prostatitis first, then only he prescribed antibiotics BACTRIM for 3 weeks and retest PSA to rule out prostatitis but still insists on blind biopsy. All these without seeing or talking to him but via his assistant after the MRI results. Should I get a 2nd opinion? Anyone knows a good urologist in Charlotte,NC that will listen and make decisions with you instead of spending 5 minutes every time I visit him.
A saturation biopsy would logically increase the risk of spread of prostate cancer outside the prostate, unfortunately the situation in the U.S. is that no treatment center (to my knowledge) will even consider treating you if you don't have a histological diagnosis from a biopsy.
I now this is not relevant this video, but can you have Dr. Scholz address MRI Linac. I've been told that this could be better than IBRT or SBRT because of the use of MRI to target the lesion
To Target the Lesion or Lesions, i have 2 one in the front and one in the back but seed radiation is blasting them into the stratosphere 😊 at the moment, hopefully
This is good, but Scholz misspoke a couple times. He got the PSA density upside down. Said ""If you divide the PSA into the prostate volume, Vol/PSA, it should give a value of < 1.5". This is non-standard. The standard is PSA/Vol < 0.15 . In the U.S.A. PSA =ng/ml and Prostate vol is measured in cc. So the ratio of PSA to volume has units of ng/(mlxcc). Both PSA and prostate volume increase with age so using Prostate density also adjusts, approximately, for age. All physicians should routinely use PSA density rather than PSA. Most don't because they don't have an MRI (Which can give volume). Therefore, and for many other reasons, a prostate MRI of all men when they turn 50 should be routine, just like colonoscopies have become routine. Those urologists who having done many digital prostate exams can get quite good at estimating prostate volume just from the feel of the prostate. Nowadays they sometimes have an MRI to check their digitally obtained estimates against.
Can you discuss PSA results after salvage radiation treatment for biochemical recurrence after radical prostatectomy. There are many of us not finding reliable information concerning how long it takes to determine cure vs failure.
Thanks for this informative video! Last year my MRI showed 1.6 cm lesion with PI-RAD 5, then I had 12 core biopsy and it gave me a gleason score 6. I just had MRI again and now it shows no lesion at the same area with PI-RAD 2. Can the 2nd MRI miss it that much? I am so confuse. Wonder if I should do MRI or biopsy again. My PSA went down from 4.06 to 3.5. Appreciate any comment or someone have similar case like me!
On my first and second MRI in 2022 I had two lesion, 1.3 x 0.6 x 1.2 cm and 0.8 x 0.4 x 0.6. The MRI on 12/4/23 did not see the smaller lesion; the doctor said, I’m paraphrasing, “it must have resolved itself”. ???? What. Due to my PSA rising 7.12 - 9.07 in four months I got another MRI. Again, only the larger lesion showed on the left side - so I will take, “it resolved itself”. But, now there is a lesion on the right side measuring 1.1x0.6cm. Previously the right side was benign. So, without a biopsy I will not know it is cancerous. It is likely cancerous as they scored PIRADS 4. However, if the second MRI in 2022 showed a lesion, which resolved itself by 12/4/23, and they scored it PIRADS 4, but it resolved itself, was it true that “clinically significant cancer is likely to be present”. What was also very confusing was the doctor said that the “cancer was outside of the lesion”. So is the lesion I found out about today, on the right side really PIRADS 5, and “clinically significant cancer is highly likely to be present”? Could it resolve itself? Maybe it’s not cancerous within the “lesion”, but upon doing a targeted and random biopsy per quadrant, they would find 3+3 or 3+4 (as that’s been my pattern) on the right side of the prostate. If you had a PI-RADS 5, but just Gleason 6, then why was it not PI-RADS 3? In my opinion, having Gleason 6 means you can observe, not do a biopsy, but do Active Surveillance. I would get test for BRCA1&2 and have a Decipher test done. These two tests will just add to the rational to remain on AS or treat. I may have confused you even more but it’s interesting that a lesion can “resolve themselves”, not have cancer, but, maybe, are the indication of cancer in that area. Best of luck!!! FYI: my care was at top institutions. I’ve found of that there are different camp and approaches at these institutions so we must do what’s right for us.
Thank you for these PCRI videos; they are a great resource. Can you tell me, are there different types of MRI's and if so, what is the recommended type of MRI one should be using when screening for PC? Thank you.
Thanks, Dr Scholz and Alex for this very useful information about PSA density.
Great wrap up at the end Alex. I can personally vouch for an approach to prostate ca which uses the many sources of sound scientific clinical information available on the internet. Your channel is certainly one of the best and I am eternally grateful for the knowledge you and Mark provide.
Thank you for your kind words!! We so appreciate you!
I will have a biopsy done on the 26th. of this month because of an 8mm lesion in the left anterior portion of my prostate seen on MRI. Should I ask my doctor if I can have a PSMA PET scan before the biopsy to see if the lesion lights up and possibly avoid the biopsy ? I was diagnosed with prostate calcifications 15 years ago, and this may have been what was seen on recent MRI. Just a thought.
My psa after radiation years ago of prostate cancer is now .05 the latest revealed count .09 I have no problem urination at age 88 this year.
God bless you. I hope you have many years left.
How old were you when you were initially diagnosed?
What a brilliant advocate Dr Scholz is of a balanced approach to prostate problems. Listening to other commentators - the merchants of doom - frightens men into premature decisions about their prostate.
Can you do a show about upcoming vaccines that are showing such promise in other cancers...vaccines that use the patient's own tumor antigens.
Thank you. This was a very helpful video!!!
Many Thanks Alex and Dr. Scholz. Great Program 👌. Understanding the MRI is very helpful esp. avoiding the biopsy and no radiation needed but what about the contrast medium?? They found a very high Gadolinium score in my blood work! afterwards.
Diagnosed with a leaky gut so the blood brain barriere might be open to the gadolinium as well! What about a MRI without a contrast medium and or a liquid biopsy, f.e. an EDIM Test available in Germany via TKTL1 Enzym and Apo10, in lieu?? Any Experience?
And what does the pirads score, lets say 5 and/or 4, really tell ??
Thanks again. You both excel!
My prostate measured 74cc and my PSA is 5.4. PSAD = .073. Random biopsy was negative but MRI showed a 7mm lesion and was scored at PI-RADS 3. Now I’m on the fence as to next steps. Leaning towards an MRI-guided biopsy.
I'm not a doctor, but I've been doing active surveillance for 10 years. I wouldn't worry if I were in your place with those numbers, but I'd probably do another MRI in a year or 2 to see if that lesion is growing.
@@ernesthanks6125- thanks for the note. I neglected to mention there is prostate cancer on both my maternal and fraternal sides of the family.
U shud get a mri guided MRI why not, get it done and catch it early and u cud get focal therapy on it and get no side effects
@@hyway62- thanks. That is the direction I’m leaning now.
I have BPH but PSA density is .007 Finasteride adjusted and considered normal. My PSA is 2.2 for Yeats with Finasteride. Has 2 precious MRIs with PIRAD 4. Urologist wanted biopsy but i said do another MRI. The latest MRI showed PIRAD 2, no lesion but just inflammation. Don't rush into biopsy if other indicators are good.
Yes my doctor is a fan he said the trus test is cost effective he said it's great to know my size so as much as it is necessary accurate test useful and avoid biopsie 4:47 4:48 4:48 4:49 4:49 4:51 4:52 4:52 4:53 4:53 4:55 4:56
Wow. This is where I am at. What a relevant topic for me. Also, her comments at the end should put on a poster, the comments about the more you know the better off you will be. The only problem is with knowledge is I am exposing doctors lack of state-of-the-art practices, confinement to fast medicine reather than good medicine and insurance companies controlling treatments instead of shape medical reasoning. - in fact I would like see a video on how to navigate the almost non-functional medical system. -- But thanks so much for this video.
My 3T MRI shows "no suspicious lesions" and signs of past prostatitis and BPH nodules. Both of the aforementioned are rated as PIRAD 2. My uro is insisting that I have a biopsy. The tipping point to do one is that my grandfather on my dad's side and my uncle on my dad's side both had prostate cancer. Also I scored 29.87 on the Exo test, with 15 being the cut point; anything above more likely to contract prostate cancer. Your thoughts? One question: what the heck are we targeting for biopsy? There are no tumors or lesions. And at what point do I say, let's stop digging and shooting in the dark - can I just not have an MRI in a year or six months? Re-test the PSA, maybe quarterly?
What have you decided, I am almost in the same situation. 3T MRI did not even rate the PIRAD score but says no suspicious lesions found and suggestive of prostatitis. My PSA is around 8+.I understand that sometimes if PIRAD 1 and 2, it is considered negative and sometimes not even rated. My urologist did not even contact me to discuss until one week later I called them. Then he asked his assistant to schedule a blind biopsy on the phone. I said what about the treatment for the chronic prostatitis first, then only he prescribed antibiotics BACTRIM for 3 weeks and retest PSA to rule out prostatitis but still insists on blind biopsy. All these without seeing or talking to him but via his assistant after the MRI results. Should I get a 2nd opinion? Anyone knows a good urologist in Charlotte,NC that will listen and make decisions with you instead of spending 5 minutes every time I visit him.
A saturation biopsy would logically increase the risk of spread of prostate cancer outside the prostate, unfortunately the situation in the U.S. is that no treatment center (to my knowledge) will even consider treating you if you don't have a histological diagnosis from a biopsy.
practical useful advice ,tks
I now this is not relevant this video, but can you have Dr. Scholz address MRI Linac. I've been told that this could be better than IBRT or SBRT because of the use of MRI to target the lesion
To Target the Lesion or Lesions, i have 2 one in the front and one in the back but seed radiation is blasting them into the stratosphere 😊 at the moment, hopefully
@@hyway62 Blast away!
Finally got order for ultrasound it's only a short test it's for free psa 3:52 3:53 3:54 3:54
I agree it's a ratio getting a ultrasound while unpopular mite be necessary Psa level accurate and cost effective and easy to get 4:52
This is good, but Scholz misspoke a couple times. He got the PSA density upside down. Said ""If you divide the PSA into the prostate volume, Vol/PSA, it should give a value of < 1.5". This is non-standard. The standard is PSA/Vol < 0.15 . In the U.S.A. PSA =ng/ml and Prostate vol is measured in cc. So the ratio of PSA to volume has units of ng/(mlxcc). Both PSA and prostate volume increase with age so using Prostate density also adjusts, approximately, for age. All physicians should routinely use PSA density rather than PSA. Most don't because they don't have an MRI (Which can give volume). Therefore, and for many other reasons, a prostate MRI of all men when they turn 50 should be routine, just like colonoscopies have become routine. Those urologists who having done many digital prostate exams can get quite good at estimating prostate volume just from the feel of the prostate. Nowadays they sometimes have an MRI to check their digitally obtained estimates against.
Can you discuss PSA results after salvage radiation treatment for biochemical recurrence after radical prostatectomy. There are many of us not finding reliable information concerning how long it takes to determine cure vs failure.
Does PCRI have a video on TURP for an enlarged prostate
Thanks for this informative video! Last year my MRI showed 1.6 cm lesion with PI-RAD 5, then I had 12 core biopsy and it gave me a gleason score 6. I just had MRI again and now it shows no lesion at the same area with PI-RAD 2. Can the 2nd MRI miss it that much? I am so confuse. Wonder if I should do MRI or biopsy again. My PSA went down from 4.06 to 3.5. Appreciate any comment or someone have similar case like me!
On my first and second MRI in 2022 I had two lesion, 1.3 x 0.6 x 1.2 cm and 0.8 x 0.4 x 0.6. The MRI on 12/4/23 did not see the smaller lesion; the doctor said, I’m paraphrasing, “it must have resolved itself”. ???? What. Due to my PSA rising 7.12 - 9.07 in four months I got another MRI. Again, only the larger lesion showed on the left side - so I will take, “it resolved itself”. But, now there is a lesion on the right side measuring 1.1x0.6cm. Previously the right side was benign. So, without a biopsy I will not know it is cancerous. It is likely cancerous as they scored PIRADS 4. However, if the second MRI in 2022 showed a lesion, which resolved itself by 12/4/23, and they scored it PIRADS 4, but it resolved itself, was it true that “clinically significant cancer is likely to be present”. What was also very confusing was the doctor said that the “cancer was outside of the lesion”. So is the lesion I found out about today, on the right side really PIRADS 5, and “clinically significant cancer is highly likely to be present”? Could it resolve itself? Maybe it’s not cancerous within the “lesion”, but upon doing a targeted and random biopsy per quadrant, they would find 3+3 or 3+4 (as that’s been my pattern) on the right side of the prostate. If you had a PI-RADS 5, but just Gleason 6, then why was it not PI-RADS 3? In my opinion, having Gleason 6 means you can observe, not do a biopsy, but do Active Surveillance. I would get test for BRCA1&2 and have a Decipher test done. These two tests will just add to the rational to remain on AS or treat. I may have confused you even more but it’s interesting that a lesion can “resolve themselves”, not have cancer, but, maybe, are the indication of cancer in that area. Best of luck!!! FYI: my care was at top institutions. I’ve found of that there are different camp and approaches at these institutions so we must do what’s right for us.
Thank you for these PCRI videos; they are a great resource. Can you tell me, are there different types of MRI's and if so, what is the recommended type of MRI one should be using when screening for PC? Thank you.
Great question! We have a team happy to answer you on our helpline. You can find out more at pcri.org/helpline
My doctor agrees a density test is only a simple way a ultrasound is nessessary