What Happens if You Don't Treat Prostate Cancer? with Dr. Michael Ahdoot
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- Опубліковано 29 чер 2024
- Dr. Michael Ahdoot, Urologic Oncologist at Cedars Sinai in Los Angeles discusses which prostate cancers are dangerous and which ones are not. He discusses scientific papers which provide data to support that some prostate cancers should not be treated while others should.
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I was diagnosed with Stage 1 Gleason 6 Prostate Cancer in 2006 through a needle biopsy. I researched all of my options, Robotic, Radiation, Proton, etc. I then brought my file to an Oncologist for a 2nd opinion. She reviewed my file and history and then recommended active surveillance. She adamently advised against any invasive treatment. I have been on active surveillance for nearly 20 years with my PSA dropping from 18 to nearly normal over the years. The only medical procedures that I have gone through are a couple of MRI and CAT scans both showing no indication of the cancer advancing nor even present. I am now 83 and relatively healthy due to a healthy diet and regular exercise. I now have a different Urologist as my original Urologist had insisted upon Radical Prostatectomy immediately.
This is a good examples of Gleason 6 prostate cancer not progressing. About 1/2 of Gleason 6 prostate cancers do not progress and these people (like yourself) are great candidates for surveillance. The other half can have their disease change over time so we recommend MRI and repeat biopsy over time.
Great! My PSA is persistently elevated for almost 1 year. I am quite nervous. Could you please give me tips on how to lower PSA level?
Sounds to me like you did the right thing by not allowing yourself to "fear mongered" into having immediate Radical Prostatectomy. I myself was diagnosed with very aggressive PC (Gleason 7) way back in June of 2012. I took absolutely NO conventional treatments. I drastically changed my diet, got more sunshine and exercise (you can do that in Southern Arizona), took quality vitamin D3/K2 supplements, as well as other quality supplements that put a major kibosh on the cancer, putting it into remission. The diagnoses came when I was just shy of my 56th birthday; I am now 67 years of age. I have been able to enjoy my retirement of 5 years (and counting) from Fed Ex. My quality of like has NOT diminished over the last 10, almost eleven years. Now could this thing ramp up again? Yes, it could! But if and when it does, I think I have a pretty good idea of how to address it. However, I want you to know that in NO WAY am I suggesting that someone else do what I DID. However, what I did do worked for me up to this point, so far.
@@chicago-l9125
When diagnosed I did all of the rounds, getting other opinions from various discplines. I researched everything, had consultations with medical people in each discipline, and took all of my research to a well respected female Oncologist here in town. She reviewed by paperwork and reviewed my medical history. She then told me why I should put all of my research either in the round file or in a file located in my basement (which I don't have in Florida) and then recommended I go on Active Surveillance and remain there until there was something that showed the Cancer was progressing. Diagnosed in 2006 and my PSA is now 4.4 with no indication, through a couple of MRI's and Cat scans, that the Cancer has progressed one iota. To tell you the truth I think that, in many cases, the cure is worse than the disease.
@chicago-l9125 so the data shows that this strategy of non treatment for Gleason 7 prostate cancer is fairly unlikely to result in cancer death. However over longer periods of time of 15 years or longer the risk increases and for this reason we often do recommend treatment. It might be worth consulting with your doctor to check in on the cancer to see if things have evolved over time or are stable.
I just wanted to add one clarification, Gleason 7 prostate cancer is considerate intermediate risk prostate cancer, not high risk by typical conventions
A really interesting video but from my experience AS is a similar risk to having treatment - I'm 57 and after PSA rising to 6.9 I was sent for MRI (2 Pi-Rad 4 lesions detected), then biopsy (7 of 18 cores positive) and finally PET scan (no other cancer picked up). I was initially diagnosed as Grade Group 1, G6, but my Urologist strongly advised a Prostatectomy due to my age and high volume of cancer, and this was supported by a Radiation Oncologist. I considered AS but in the end the though of cancer being present in my body was too much, and I had a radical prostatectomy in Nov 23. Upon pathology my cancer was upgraded to Group 2, G7, and staged as pT3b! Thankfully negative margins and first PSA post op is undetectable. Had I gone with AS I fear my cancer would have spread quickly and the outcome not nearly as good. Only the person diagnosed can truly know what is best for them, its a very hard decision to make and all men going through this should be supported in whatever decision they end up making.
I was diagnosed with prostate cancer April 15 (my father has PC Stage 4 metastasized in his bones. He's 92yrs old, having only been diagnosed 3 yrs ago. Dr. said he would pass of old age so to speak, before the cancer could get him). I had a Total PSA of 2.9 and percent free PSA below 10% (the red flag that alerted me). My in-bore MRI targeted biopsy confirmed Gleason score 3+4=7. After exhaustive research I elected for in-bore MRI focal laser ablation. Surgery was outpatient and it went excellent. Surgery was 8 days ago and I feel great, with no negative conditions following the surgery. The only inconvenience was having a catheter in for 8 days. There were no issues with the catheter other than "it was in there". My best to all that have been diagnosed with PC.
I'm so glad I stumbled across this video! As I'm heading towards dealing with a high PSA test result this is great information to take forward. I'm going to get informed and not just let the medical system run roughshod over me. Thank you for the video!
I hope you are well! I just witnessed a 72-year-old friend go through chemo & radiation and he's not the same. All kinds of problems incl constant pain. I've decided that I'll avoid that even if it meant a couple of yrs shorter life.
FYI: check out what Dr. Thomas Seyfried's team has found about cancer, and how this can be used to manage cancers. He's got plenty of interviews on this platform and more than 150 peer reviewed papers.
This is a very helpful video. However, what is missing is a discussion of the terrible side effects of prostate cancer treatment and their effect on a patient’s quality of life. Virtually all treatments are difficult, hormone therapy, radiation, or surgery. Many people, including me, would prefer a better quality of life, even if shorter. Also, there are effective treatments for metastatic prostate cancer that were not available to the patients in these studies. Many people seem to be living extended periods with metastatic disease. For me, I would not seek treatment for intermediate prostate cancer at my age (62) or older. I observed treatment ruin the last years of my father’s life, and I will not allow that to happen to me.
So I do have a video about the risks of treatment and side effects. As a surgeon who does prostatectomies several times a week I have to say that my patients do not reflect this sentiment. I routinely hear the comment “Doc, the surgery wasn’t that bad”. Remember most people do well from these treatments but a minority have complications. I think it’s important to be knowledgeable about those complications so you can choose a treatment that feels right for you. Or in some cases people may choose non treatment. It’s just important we know the consequences on each side of these choices. For most people with high risk cancer for example the benefits of treatment greatly outweigh the risks so people choose treatment.
I suggest that the distinction between most people and a minority be explored more in depth because there is a substantial literature and voice that insists on the negativity of radical prostatectomy that includes salvage radiation, metastasis, ED, and several other side effects, not to mention its necessity.
I totally agree, people are rushing into rp and radiation without exploring other alternatives, but i live in southern ireland and there are no alternatives to rp or radiation so we have to go to England wher it can cost €20k to get nanoknife. So you are caught between a rock and a hard place, i have 3+7 20% 4, it is so tough weighing up what to do, but i like u will take 10 more years of quality life with erections and ejaculations than 20 years without. This is the delema at my age iam 61
@@hyway62 At age 53, Living as a fully functional man is more important then living longer. If I was young, maybe I would feel differently. Even if I only got 5 years vs 20,l. I found that my best experiences involved being able to function in bed as well.
@@Greg-yu4ij your still a young man at 53 i wish i was 53 iam nearly 62 but i would want more than 5 years good quality of life. It all depends on your diagnosis if your low intermediate u can look at your options and u have time to do that, but u need to know exactly what u have and weigh up your options
I wish more doctors were more clear about it like he is. First thing is biopsy. When I had my prostate removed they told me that my prostate looked like a piece of Hamburg from the biopsy. Make sure they use all the modern technology when they do biopsy. Ultrasound is not a modern way of doing biopsy. They did 13 biopsies on me . I could go on but I recommend to find a support group talk to other men that are going through the same thing. Had no symptoms of prostate cancer. Until they did the biopsy.
@richardbennington323
My understanding is that many Urologists have gone away from biopsies, which only give results from the areas of the Prostate where the needle takes samples from (maximum 12), and have gone to the 3-Tesla MRI to discover Cancer. I had a Urologist that did a Biopsy and found the Possibility of stage 1 cancer in 1 sample core. Wanted to do Robotic Prostatectomy right away. I requested 3-Tesla MRI to insure there was Cancer present. He refused. I changed Urologist. New Urologist Sent me for a 3-Tesla MRI. Results came back indeterminate. Have been on active surveillance ever since, 18 years.
I'm 68 have always been in great health. Just diagnosed this month with PC after a continuing PSA rise to 16.5 within one year. I had no symptoms but some ED issues with no fluid upon ejaculation. First had an MRI showed a 1.6, lesion and scattered areas associated with prostatitis. Biopsy showed 7 of 13 cores positive, Gleason 9. Then had a PMSA pet scan showing it has not spread but I am classified as high risk. My urologist suggests immediate prostatectomy, but I know I have options of radiation and hormone therapy as well. I have heard horror stories involving both the surgery and also the radiation along with the hormone drugs. I have seen basically that the mortality rates between surgery and radiation are about the same. I have an appointment with a radiologist in three days. This is a nightmare that just does not seem to go away and I have reluctantly joined the undesirable club of thousands of other men. I realize that no matter which option I choose at this point, I may indeed regret as it will undoubtedly influence the quality of the remainder of my life.
Ask your doctor to go over your MRI with you. It will help you get an idea if the cancer is growing out of the prostate capsule or not. If it’s not growing out of the prostate capsule surgery would have a decent chance of curing you. If it’s growing substantially out of the prostate capsule, you should ask how this would likely affect surgical outcomes.
Thank you Doctor. Great service to community.
This video is excellent for deciding whether to have active surveillance or radical treatment for prostate cancer . I have Gleason 3+4 low volume and was told by Urologist that best is to have prostatectomy because of my age 61 but never explained me why . After watching this video now I understand the reason.Thank you very much for this excellent video and for giving us all this information in plain english that everybody can understand.
Please check with Loma Linda Medical Center.Proton bean therapy .Great testimonial from Bob Marckini.Hope you do well
Thank you so much. So clear, so well presented!
As I am a diabetic person My physician asked me to do a PSA checkup test with Hemoglobin A1C .The result was a little bit high 5.54 ng/ml , and he referred me to a specialist. An MRI and a biopsy later, I discovered I was a 65 year old living with a Gleason 6 prostate cancer. I'm so grateful that my Doctor took action, knew that there was a history of prostate cancer in my family and encouraged me to do the test. I now can do active surveillance and get on with my life. Now I changed all my life style and start ketogenic diet In addition to I stop eating dairy foods and sugar and rice and and all products that feeds cancer since 3 months also I practice prolonged DRY fasting about 17 hrs for one month and i do two Psa tests one after 2 months and it was 3.54ng/ml and the other one after dry fasting and it was 2.7ng/ml . I lost about 12 KGS since 3 months That encourage me to complete fasting hoping that tumor marker will give me more good results.
Good for you! See the film FORKS OVER KNIVES (You Tube) that proves what you are doing WILL work to destroy prostate cancer!
Congratulations on your weight loss. I have seen the best reductions in PSA levels and potentially slowest rate of prostate cancer growth with a vegan diet. This data however is rather weak so I can't strongly recommend it.
Yes I look at people like Bill Walton. A vegan always life. Healthy basketball player. Died of prostate cancer.
Excellent exposition. Thanks Dr. Ahdoot
Hello Dr. I’ll be 52 years old in July, i had my 1st PSA scan 6months after I turned 50, it was 3.4, so i changed my diet lost 25-30 lbs starting eating healthier. I’ve always went to Dr appointments every 3-6 months for many years. I do have hypertension and take 1 pill a day of low dosage medication.
Well, to my surprise I went to my 6 month appointment my bloodwork showed my PSA was at now 9.45. I went to a urologist, my bloodwork showed that PSA was at 10.45 in 2 week period. Prostate Biopsy was done and of 16 samples 11 test for PC, mri showed PC, PET scan showed it has spread to lymph nodes, femur bone, hip bones, spine, PSA now at 22. I have no symptoms, no pain, no signs of anything other than what I’ve shared. I actually feel great, except mentally it’s very disturbing. My Gleason score is 9 and I’m high risk.
I just don’t understand this…
Thanks for your input advice and videos 🙏🏿
I’m terribly sorry to hear about this. It’s very unfortunate but I’m happy you feel well. It makes sense to be shocked as most prostate cancers do not progress this quickly. The good news is treatments for prostate cancer even after it has spread can be very effective. Talk to your doctor about your medication options. Second generation antiandrogen like enzalutamide and abiraterone are often added to older testosterone lowering medications to control the cancer and maybe something to consider.
Thank you for sharing your story so others know the importance of psa screening.
Great video with lots of relevant information. Nice job.
Dr Ahdoot has a very easy accessible manner of presenting the information...thanks good series
Stanford Med School!!
I'm forwarding this to my Primary Care MD from THE Buckeye U
Recent elevated PSA hence my visit and new member
this was great i just had surgery for a gleason 7. i am wondering if i should have just let it ride and lived my life. I guess if i make it to 80 or longer ill say it was best i did it! PS your a great dr. I remember you emailed me back a few months ago when I was first diagnosed, I wanted to come to you but we are just to far from each other so I stayed home for the surgery 1 week today. May you continue you helping people and be well!
Make a speedy recovery! Hope you do great
@mrjt3451 how are you doing after your surgery? Where did you go? I was diagnosed 2 months ago. Still researching my options.
Go to Loma Linda Medical center.Proton beam therapy
Appreciate the correspondence and sincerity you have with your commenters... Subscribed! (And yes, just got my MRI results showing a PIRADS 4 and 5 discovery after a PSA blood draw level of 4.74... age 61)
Thank you Doctor. Very helpful and informative!
Very informative videos, review of the literature very helpful. Technology is constantly improving diagnoses and treatment. Good that you bring all that into perspective.
Always appreciate your videos!
My pleasure. What would you want to hear about next?
Great informative video thanks for posting.
Great summary. Thank you
I’ve said this before but in November 1995 my doctor told me to get ready for death because of my psa test. The next April I ran the 100th running of the Boston marathon. It’s now 2023. I’m back to long distance training. I think scientists would be better for testing psa rather than a doctor. They would probably ask questions.
Glad you are doing so well! That’s awesome!!!
A great summary of the stats. Your counterpart did a great job of pulling the data all together. I'm Gleason 8 and have been researching options for treatment. Your video was very helpful in understanding the risks of my Gleason group. Thank you.
I’m happy I could help and I wish you good luck with your treatment.
I’m currently going through the prostate process at age 64.
Have a Gleason score of 6. Have seen 2 urologist and a radiologist.
Have very low psa.
Urologist suggested robotic surgery and am scheduled for surgery in March.
The radiologist sent my pathology to John’s Hopkins and a Prolaris* genetic test.
The test came back at 1.5% chance of spreading in 10 years vs .5% with surgery.
I’m going to cancel surgery and opt for active surveillance.
Good use of data to make a decision. Make sure your urologist has you on surveillance just to make sure the cancer doesn’t evolve over time.
@@cancerbetter yes 👍
WISE DECISION. ADT AND HORMONE TREATMENT ARE HORRIFIC AND BARBARIC
Thank you for great information.
...The one aspect that you overlooked is the importance of weighing quality of life vs. quantity of life. When ADT CASTRATION is added to the treatment, it has horrific side effects that many men find insufferable, yet doctors and drug companies obfuscate or minimize this cruel and barbaric treatment.
Without full disclosure, there can be no FREE AND FULLY INFORMED CONSENT.
I’m currently working on my second video to follow up this video about what happens when you do not treat prostate cancer. The second video will talk about the risk of metastasis not particularly death. During that video we will talk about how androgen deprivation therapy is a main state for controlling, prostate cancer, the head spread, and how that might not be desirable for any patient. The intent, of course is to help people know when treatment would be appropriate for them, and when it would, and also to help them, understand that short of death is metastatic, disease and metastatic disease has its own set of effects on quality of life, particularly if you start treatment or as the cancer gets advanced enough to cause symptoms
@@cancerbetterhere is my concern. What it seems like to me is that the “treatment” kills the patients. There are so many men being diagnosed with aggressive cancers with PSA’s in the 100’s and sometimes 1000’s. Now granted it had metastasized, BUT they lived full lives (mid 60’s). I’m 42, PSA of 17 (hovering between 15-18 the past six months), one small 6mm PIRAD lesion 4, no seminal involvement, no swelling of the lymph nodes OR no evidence of bone osseous.
I’m really considering doing nothing & living my life. At 42, I’d much rather live a normal life until I can’t live a normal life AND then seek treatment. Obviously changing my lifestyle because my issue is this… My PSA test was snuck in on me. I had no symptoms…. i was 40! So why?
ADT IS ABSOLUTELY BARBARIC.
BIG PHARMA. BIG BRIBES. CORRUPT DOCTORS
It should be noted that high psa is caused by enlarged prostrate too. not necessarily cancer
Correct!
This guy is really very good at this data analysis.
Thank you kindly
One year post op. Last four PSAs were 0. Gleason 7 pathology revealed no capsule excursion. Thanks for the thorough but clear explanation......and relief/encourgement
Life with no prostate must really suck.
@user-bq6ek7lz7h I know you are probably joking around but I feel like this is a good thing to address. Once people recover from surgery most people feel mostly normal. Assuming a person retains continence and erections the only true loss would be a loss of ejaculate during orgasm. Urinary flow is usually greatly improved.
@@user-bq6ek7lz7hLife with no prostate beats the hell out of a prostate with no life!
I'm really happy for you, your results are what you want to hear.
Very interesting. I’d like to learn more.
Thank you for this helpful video. So much has changed in prostate cancer treatment since this data set was started that I honestly do not put much stock in it except in a general way. One of the things that has changed is that surgical techniques have improved dramatically and so my guess, as you point out, is that survival rates with surgery are much better than this data shows. Also, the psma pet scan is HUGE. Also, however, a very large percentage of people who decide to treat their cancer in the present time are treating with radiation and hormone therapy which I believe are equal to surgical outcomes as far as survival with lower risk. Not sure the choice between surgery and radiation impact mortality so much, as it does quality of life after treatment.
Thanks Doc.
Quality of life is everything... one of my friends who was treated with Brachytherapy told me he'd rather be dead than never have another boner... a bit extreme but his point is well made.
Thanks ☮️ very useful information given me a clear understanding of my condition. ❤
Thank you very much. I’m glad I could be helpful.
Dr. A, you shed a great deal of more light on a varied and much talked about subject. Thank you. I have a Gleason 7 (3+4) and am having surgery tomorrow morning. Your data supports my decision with facts and is objective versus subjective. Thanks again, your information is a valuable tool for anyone with Prostate cancer.
My pleasure! I’m happy I could be of service. I wish you a speedy recovery!
My biopsy was 3+4 also. Dr recommended treatment (surgery) scheduled in December.
Hope yours goes extremely well.
@@robertjayroe9900 I have had 3+4 for 3 years. Doing Mri, PSI and Biophys. I am under survialence. It's subjective but there is no rush to remove prostate if 3+3 or 3+4. I don't have anxiety. I know I have cancer and can seek additional treatment if the numbers go up.
@@robertjayroe9900Did the Dr. inform you of the percentage of cancer found in the biopsy. John Hopkins will allow you to do Active Surveillance if under 5%. Each institution is slightly different. Also, the type of prostate cancer can determine how aggressive the cancer will behave. Also, a low genomic test may influence the decision. Just wonder if you were advised of these considerations with 3+4 and if you were advice if you were Favorable Intermediate or Unfavorable Intermediate.
@@MM-sf3rl : I was under active surveillance for a few years. My psa continued to climb. Last test was 20 before recent biopsy. Large lesion was the 3+4 gleson. Dr felt that there could be more higher grade that were possibly missed?
Hi Dr Ahdoot, your video is well presented and clear. Thank you. I am 61 and my PSA has gone from 4.56 in May 2023 to 7.6 in November to 11.2 on December 29. Had prostate biopsy on June 6 with GS of 6 with only one area (left apex) detected with small tumor (Adenocarcinoma) (length
Thank you
After the biopsy they said I was Gleason 7, 4+3. After the prostetomy they said I was a 9, 5+4. This was three months ago, I'm waiting on the results from the PSA test I had last week. Fingers crossed.
The exact same thing happened to me 2 years ago.
PSA was 15.4 3 months after surgery. And tripled one month later to 45 and to 152 a month after that. Did your surgeon do PSA test just prior to surgery ?
My pathology report came in higher than the biopsy. My cancer was ready to spread at the time of surgery. One month after radical surgery the PSA was now 0.1. If it get much higher, that means the cancer did spread, and chemo and or radiology may be required.
@@robertheinkel6225
Seriously, look into melatonin before you get on the treatment train.
I was diagnosed with PC on 11-27-2023 with a 3+4 =7 Gleason score PSA 6.5. I am scheduled for surgery 03-07-2024. After much research I decided surgery was my best option. I am 63 years old and have worked in the medical field for many years.
Wish you a speed recovery!
Anecdotal ...my father was diagnosed with PC at age 70. He did NOTHING....as the doctors wanted to operate, he declined. I took him to live with me in CR. He passed a few months shy of his 89th bd.
My take away do nothing at age 70 and live another 19 years. My mother had endometrial and was operated on at Cedars Sinai....the most expensive spot in the area. She lived another 12 years.
You make the call
It all depends on what kind of prostate cancer he had. The story you describe for your father is very possible especially with Gleason 6 prostate cancer.
I'm 6 months away from 70 years old. I'm scheduled for a prostate biopsy in 2 weeks. But the more I read and listen to people that have experienced this, the more I'm leaning in doing what your father did. If I was 45-50 with kids still at home, maybe I would go ahead with a biopsy, but I feel the way your father did. I just want to go ahead and live out my life without the complications of a biopsy and possible surgery. I'll take what ever the Lord gives me and be happy with it. I'm going to cancel the biopsy since I have discussed this with my wife.
@@RetiredFE I'm with you on that. We're all experiencing the same problem. Leave it with the Lord.
Prayers for us all.
Joe Tippens Protocol.
@RetiredFE talk with your doctor too. They should be able to give you numbers to help better inform your decision. At 70 and above sometimes it actually doesn’t make sense to do PSA screening but it depends on individual situations.
@@cancerbetter I just asked my doctor for a Prostate MRI. He said go ahead but regardless of what it said he wants to do a biopsy. I'm going to do the MRI but I'm pretty sure I will not be doing the biopsy.
Thank you. No specialist seems willing to describe how you die from prostate cancer. Slowly, quickly, extreme pain, managed pain, long drawn out in hospital etc. I did have the 20 visits of radiation, but 18 months later it has returned (a PSA of 5) and spread to 4 lymph nodes (whatever that means). For me to make a decision on hormone treatment and a the second lot of 20 days radiation that is being offered, I need to know how I would die. I am a very active 71 year old. Eat good, active and mentally great.
It’s all depends on the locations the cancer spreads too. If it spreads to bone, bone pain is possible. If it spreads to the the liver, liver failure or ascetics are possible. If to the lung it can cause coughing and shortness of breath. As cancer volume increases these issues can be numerous and become severe enough to cause someone to pass away.
@cancerbetter Thank you. That is way more than my specialist team informed me. Basically, if I do nothing, 50/50 I could still be ok and around till 80. If I had hormone treatment and more radiation, 50/50 I could end up in diapers or using a bag, no libido, and no erection. I think I will give the hormone treatment a big miss and just do the 20 days of radiation. Along with a much improved diet. Like a lazy keto, minimum carbs, and no sugar. Great youtube, BTW.
@12superoo you are making some large miscalculations and I very strongly recommend you look at my other videos. If you choose radiation for example your risk of incontinence is 2%. This is a much lower risk than you quoted. In addition, this video talks about your risk of death from non treatment of prostate cancer but please consider that before death occurs from cancer there is metastatic cancer which can dramatically reduce a person’s quality of life.
I was wondering if there is a genetic link or life style to prostate cancer ? Very informative video, Thank you.
Yes there are numerous know genetic changes that increase a person’s risk of prostate cancer. Some of the more common ones are BRCA, ATM, and CHEK. In terms of lifestyle, it’s seems non smokers and plant based vegans have lower prostate cancer risks
Hello doctor great information. I am 61 had psa score 6.6 had mti irad 5 had biopsy getting results tmrw. Only had light symptoms no aches stinging or night trips no symptoms at all last 6 weeks very nervous abt tmrw however.
Thank you for the info it is another piece in my decision to treat or not to treat my prostate cancer. I am Gleason 7 (3+4) with 4 being 5%. I have chosen "active surveillance". I am 68 years old with a life expectancy of at least 10 years. Do I fall more to the group of Gleason 6 and remain choosing active surveillance?
You would still fall into a the Gleason 7 group but would be among one of the lower risk people in that cohort. Your decision seems reasonable and so long as you are monitoring your PSA and occasionally performing biopsies you are at low risk of the ca ver evolving before you miss an opportunity to intervene should things get worse. Laurence Klotz published a good series on patients with few cores of Gleason 7 prostate cancer that he put in active surveillance. This may be something to discuss with your doctor.
Just discovered you; very impressed. I wish you would address Orgovyx 'only' without surgery or radiation might be an option. For instance, for a guy near 80, fairly active and Gleasure 8, grade 2T presumed localized, but with heart condition, stent, pacemaker, valve (the works).. why do anything other than this newer ADT, especially if it drops PSA to .03 from 17 and a bounce in PSA to 3 was taken back down to .5 after 2 weeks of treatment. Again without radiation or surgery... anyway terrific channel I appreciate it.. and I'd see you if in LA (lived there but now East Coast..fly out for a visit now and then though).
Great question. Medication to manage prostate cancer has become incredibly effective. With these medications we can control cancer that has even spread for on average 5-10 years. In some situations longer. The reason these are not done for most cases is that once these medications stop working we have few additional options. Rather we attempt to cure cancer while it is localized and reserve those medications where initial treatments fair. In men with shorter life expectancy sometimes the risks of surgery or radiation are greater than the medications that lower testosterone but that is often the exception rather than the rule.
At age 60 my PSA was 328. I felt the cancer when the doctor did the rectal exam I had cancer to 3 lymph nodes and one spot in the spine as the cancer almost penetrated my rectum when they did my biopsy 12 of 12 cores were positive 3 were Gleason 4 + 3, 3 were Gleason 4 + 4, and 6 were Gleason 4 +5. I had radiation and am currently on ADT I have had 3 turps and a peri-cath and three surgeries just to get a foley in place sometimes I don’t get the signal to have a bowel movement until it is too late my quality of life has greatly decreased since the journey began thank god for opioids I have to keep telling myself and finding meaning to life but I always manage to I have no doubt without treatment I would have died and still might and I did not have symptoms until I had a hairline fracture to my spine I have great doctors and nurses and support I wish I would had had to worry about if I needed watchful waiting in all life is still good
I’m so sorry to hear about your story and sorry to hear you were not getting PSA testing. Your story is a good example of the importance of regular PSA screening which for most people should begin at the age of 45.
What is turps?
@joemaxwell1044 TURP is a surgery to shave down the prostate to allow for stronger urinating.
I had Gleason 6 after two biopsies. Great presentation.
Happy I could help!
Hello my favorite internet Urologist. Quick question, not too many Urologist on UA-cam talk about psa levels under .1 but above .05 .This is a gray zone because you don't know if you should be gearing up for imaging or are you still considered undetectable after a RP . Would love to hear your expertise on this matter...thank you.
At these ultra low PSA levels it’s hard to know what to make of it so we usually wait several months and recheck the PSA. PSA that is on trajectory to double every 9 months is a concerning finding and would warrant additional treatment.
I am new to this channel and I was wondering if you have ever done a video on the 4Kscore test which is a noninvasive blood test and is very accurate predicting fast or slow growing prostate cancer.
I haven’t. Short version… it’s a good test for people with an elevated PSA but an MRI is better and similiar cost at least in the US
Great summary! I think I would add that the risk of dying from prostate cancer in 10 years when the patient has a true Gleason 6, and no other higher grade disease, is about zero.
This is a very good point. The people characterized as Gleason 6 who went on to die in these studies were all likely misdiagnosed as Gleason 6 and actually had worse disease.
Finally a more cogent explanation..Gleason 7 treated with radiation 11 years ago. PSA never went to zero and two years after radiation it began to rise again. PSA now 48 at 84 years old.
You can speak with your doctor about treatment options to see if it’s the right thing or not for you. Sometimes as we get older treatment is not the right move and in others it’s worth it.
One of the best videos I’ve seen, I like that you present actual data as I’m a numbers guy. One question I have not found an answer to: if you have a PSA>20 but all other measures are consistent with intermediate or low risk, the PSA overrides everything else and you are lumped in the high risk group. What is the evidence to support this decision? And is it really justified to group those w high PSA with those that have high Gleason scores? Thanks!!
The high psa resulting in high risk is a bit of a factor influenced by the past. There most important things in a persons cancer risk are cancer stage (ie metastatic or not) and Gleason score. Historically imaging to assess for metastatic disease was poor so PSA level was used as a surrogate because as psa rises the risk of metastatic disease also rises.
@@cancerbetter thank you for the quick response I really appreciate it. Yes this is the situation I'm in. Super high PSA- 45, Gleason 3+4, PSMA Pet negative. Yet my risk category is high due to the PSA. Am told it's possible for some tumors to produce a lot of PSA OR that perhaps micrometasteses could cause it. But I was just wondering if any literature exists disaggregating these risk strata a bit more
@@cancerbetter was just reviewing the NCCN guidelines. It's fascinating to me that the classifications they refer to are at least 7 years old.. I do wonder what would happen if PSMA Pet scan data was also used in risk prediction, I guess it will be ten years before we know...
@jazandriz exactly we need time to see how PSMA PET will affect long term outcomes. Presumably we will have improved staging resulting in higher cure rates per stage.
The data in this video is from clinical trials data. The studies are referenced in the video prior to the data
@jazandriz I don’t know studies on high PSA producers but I can confirm I have seen people with PSA as high as 50 with localized disease. It’s not common but it can happen. Once you get treatment you can see what your psa does
I am 68 y/o, PSA 6.6, volume of prostate 32 cc. Under active surveillance. Diagnosed with T1c, Gleason 3+3 cancer in Sept. last year. My urologist said it was a T1c stage cancer based on DRE. However, I am worried that it might be T2b or T2c because the lesion shown in the MRI is 2.5 cm diameter. Volume of lesion 8 cc at the apex.
NCCN Guidelines for patients states
“T1 tumors can’t be felt during DRE and aren’t found on imaging tests ….....….”
Therefore, it might not be T1c based on DRE that is subjective, only part of the prostate is in contact with the rectal, not the whole prostate can be felt. I consider MRI imaging to be more reliable because ' seeing is better than guessing'. I think my case is in the gray area. My urologist says he does not interpret MRI. It is a matter of life and death to me. I might miss the opportunity to cure the cancer and suffer from great pain if it becomes advance stage cancer.
After watching your video, I think there might be an opportunity for me to make sure of my Tumor Stage. I think it is no harm asking for help to confirm it so that I can at ease continue active surveillance.
July 2023, MRI findings:
Lesion 1, ROI 2, 2.5 cm diameter within the left anterior peripheral zone at the apex. Bulges the capsule. T2: circumscribed homogeneous moderate hypointense focus/mass; ??1.5 cm greatest dimension; PI-RADS 5;
Lesion 2 - RA lateral peripheral zone PI-RADS 4.
Aug 2023, random biopsy findings:
1/14 cores (1 mm in 11 mm core); Stage 1 Gleason 6 Prostate Cancer; non palpable T1c
Then, I got an MRI guided biopsy after I queries about the two large lesions shown in MRI that there is a possibility that these areas were not sampled during the random biopsy.
Sep 2023, MRI guided biopsy findings:
Gleason 6 involving 2 of 3 cores (6mm of 13mm core; 3mm of 10mm core) and small focus of atypical glands on another core, suspicious for carcinoma.
Gleason 6 involving 2 of 3 cores (6mm of 17mm core; 4mm of 15mm core; 1 mm of 15mm core)
Your help in offering second opinion on my Tumor Stage would be very significant to me to decide the way forward. I would ask for radiation treatment if it is not T1c. Your prompt response is greatly appreciated.
I can’t give medical advice on this platform as I haven’t been able to see you for a consultation however I can give you general information to help you understand the medial literature.
Let’s start with this: prostate cancer clinical staging is outdated and in need of updating. It was designed before MRI was routinely used and therefore is antiquated and in my opinion is not very helpful. Rather the MRI in my opinion tells you a lot more about what is going on. What you want to look for is the presence of extracapsular extension. If the cancer is growing out of the prostate it is usually a more dangerous cancer and is more advanced. The more the cancer grows out of the edge of the prostate the less likely it is that surgery will be curative. Your cancer (according to your post) touches the capsule causing a bulge. This means there is a possibility of microscopic cancer extension beyond the capsule and is something you can discuss with your surgeon.
One issue that is missing is the transition to metastasis which may not be related to Gleason Score or Stage. As PSA increases, these is the inference that the probability of metastasis increases. This should discount the absolute value of AS and present other factors via imaging that might indicate necessary treatment. I wonder whether the only treatment following the detection of metastasis is ADT or Hormone Therapy, notwithstanding the presence of lesions.
This well be the topic of my next video
With Favorable Intermediate PC (15 year life expectancy), with less than 10% cancer in the biopsy specimen, and a very low genomic test score, would you still (in this hypothetical) recommend some form of treatment or could this person be on Active Surveillance?
It’s an option. Find a urologist with expertise with this and speak with them. Or consider focal therapy.
I totally agree that treatment gives just about all PC patients a better chance of survival, whether 5 years, 10 years or longer. The reason is that no biopsy is able to cover 100 % of the prostate.
Fair point but with modern techniques the risk of a biopsy missing an area of dangerous prostate cancer is pretty low. That being said everyone has an individual risk tolerance and what is an acceptable risk to one won’t be an acceptable risk to others. For this reason it’s extremely important that people have access to the data like I present here so they can help decide with their doctor what exactly they want for themselves and what level of medical intervention they desire. Thanks for the great comment and I love seeing how different people react to the data.
@@cancerbetter2:01
Diagnosed in September. Gleason 3+3. Decipher .86 High Risk. MRI PI-RADS 4 High. Looking at treatment options now.
My concern is that the Gleason score alone may not indicate the severity of your disease. @cancerbetter can you address the question? Would I still be a candidate to wait?
A high risk decipher score means your risk of your cancer spreading is 3x higher than the average Gleason 6. In other words 3x a very low risk of ~3% at most. The state I would suggest that you likely can still consider surveillance. I highly recommend discuss this with your urologist and also recommend that if you continue with surveillance that you do a repeat, biopsy with MRI targeting to get the most accurate diagnosis possible. You should also be considering your age and life expectancy to determine if there is value and treatment or not. These are all things you should have a detailed discussion with your urologist about. He’ll be best off looking for a urologist who specializes in oncology, also known as a urologist oncologist who has done a fellowship in this specialization. I wish you the best of luck.
Great job "Dr.-A". I do highly recommend a 2nd reading on the Biopsy slides from John Hopkins or an institute of similar stature. Most local labs just don't have the expertise to read Prostrate slides as accurately as the experts at a John Hopkins type facility. My own biopsy went from a 3+4=7 Gleason (local lab) to a 3+3=6. (John Hopkins). AND (I know that you will agree)----only have a biopsy AFTER you get a 3TMRI. (Must be a 3T machine....That is the "latest-n-greatest"). Since all 3 procedures (Surgery, standard Radiation and Proton Beam) all have the same life expectancy, I am personally leaning towards the Proton Beam procedure when that time comes. The side effects of Proton Beam (especially concerning incontinence) seem to offer the best results from all the data that I've seen.
Thank you for the comment! I agree your MRI should be 3T and an MRI prior to a biopsy is a good idea. Re-reads of pathology slides is often a good idea especially if you are not at a major medial center or if you have a type of cancer that might be watched with surveillance (i.e. Grade group 1 or 2).
As for the merits of proton beam vs more traditional radiation, based my last review of the literature side effect profiles were very similar between the two treatments.
I’m 54 and from what I’ve been told is that any kind of radiation treatment causes scar tissue(becomes more sticky to the surrounding nerves)If the cancer should return down the road treatment options become more limited from radiation vs surgery. Being that removal of the prostate at that point is not a good option
@Trailjunkie62 one detail that is no discussed in my videos is that for men in there 50% the risks of erection loss and incontinence after surgery are significantly lower than than the averages reported in this study. In other words the older men 70+ were far more likely to loose erection after surgery than the men in their 50s.
Peterb: Ine advice go to Loma Linda medical center.Also read a book of Robert Marckini.Proton beam therapy is a way to go.There is a testimonial from 20+ years and they doing great.Hope this helps.
Thanks, I did read that book! Fabulous!!.... I'm just finishing up Proton Beam here in JAX. Absolutely world class care here...AND definitely the right decision. @@user-zu4jz1hx2w
Could you discuss genomic prostate scores and what they mean and are they indicative of anything?
I could do a future video on this topic
Lots of anecdotal stories on here from people advocating one therapy strategy or another. As someone who was diagnosed with Prostate cancer in 2015 the only advice I’d give is;
There are many ways to treat Prostate problems, doing nothing isn’t one of them.
So praying to my imaginary friend doesn't work 😳, seriously?!
@@elijahfluw4347 Funny guy, yeah it’s a blindingly obvious statement I made wasn’t it but TBH it wasn’t directed at a sassy know it all like yourself but to worried men who know something is wrong but don’t have the confidence yet to get checked out by a qualified physician.
BTW I can’t claim to have come up with that slogan, it was on the wall of my Urologists waiting room and gave me the courage to go through the process of examinations and biopsies through to eventual diagnosis and surgery but if one guy reads my comment and gets checked out then it would be worth receiving a thousand sneering and snarky responses from someone like you.
@@sultanoftippoo3857
Shame, I really mean that. You totally had me until your last words where you accuse me of the things you just did, like sneering and judging me, except I tried to be funny not toxic. If I failed at being funny that's ok, I'm not a clown. I will still be happy making funny or stupid jokes. You can be toxic all you want if that's your way, IDC...
@@elijahfluw4347 Trying to twist the conversation around to make yourself out as a victim of toxicity when you are the one who mocks not just my original post but the 95% of people on this planet who believe in one faith or another is something you can’t hide from - Your own words are posted above for all to see.
By all means carry on making your negative and unnecessary comments about the need to help the thousands of men who need support and encouragement to combat this terrible disease, it doesn’t bother me in the slightest. I truly hope you are lucky enough never to be in that position.
@@sultanoftippoo3857
Damn dude! You got some serious issues. If you get all worked up about a silly comment on social media your life must be hard to say the least.
Stop doing drugs, drinking alcohol, find yourself a new partner or get yourself another job because something makes you a very nasty not to mention paranoid person. Trust me, when you solve that problem your life will be so much better. You can thank me later.
I'm a Christian by the way (raised as a child and by choice as an adult) so you couldn't be further from the truth. I have also no problem joking about it or accepting people with different believes or sexuality. In fact, my girlfriend is Jewish and no one around us make a problem of that. You can't compare my generation with previous ones, it's 2023 you know.
I have been reasonably respectful and nice (considering) but admit there's is room for improvement. To keep it that way I will not continue this conversation.
this channel is so helpful. Advised to have RP today for Gleason 7 in one core after two previous biopsies were 6 in all cores. The problem is that I had `15 minutes with my doc before he was off to see the next patient. The 15 minutes is supposed to represent "informed consent". Hours later, I barely remember what he told me and I have more questions.
It’s an unfortunate state of medicine that you experienced. I’m happy the information is helpful and happy I can be source for accurate and unbiased information for you. Thank you for your comment.
Also you might be a candidate for focal therapy if that interests you
Why is there such a big difference between the SPCG-4 and PIVOT numbers ?
e.g Intermediate Risk shows at 18 years SPCG-4 a difference of 24%(15% surgery to 39% waiting) while PIVOT shows a difference of only 6% ( 8% surgery to 14% waiting)
Did these studies differentiate between 3+4 and 4+3 in the 7 Gleason score? Or favorable vs. unfavorable intermediate level? These would seem to be important differentiations.
Great question! They did not. 4+3 is more dangerous than 3+4. We didn’t recognize this difference until the more modern times.
@@cancerbetter Thanks. Hopefully, newer studies will consider the two levels of Gleason 7 scores.
@@cancerbetter. When you say more dangerous you mean the danger of metastasis, I suppose. What causes that? Do you know?
@fredwelf8650 dangerous meaning higher risk of metastasis which can lead to death. Risk of metastasis is largely a partly a molecular process where cancer cells accumulate enough mutations that they are both able to evade the immune system and survive in a non native organ.
Thanks for the reply. In the 2023 Prostate Cancer Foundation Final Report, one study posits that it takes approximately 1500 mutations to cause cancer. I wonder about the direct causes of metastasis; perhaps it’s just the quantity of mutations.
Should differentiate between the two stage 4's as this can have a dramatic effect on treament options and prognosis. In the UK there is some move away from radical prostectomy surgery to Holep (laser enucleation of the prostate) which gives more tissue for biopsy. Standard treatment for Stage 4 is now 20 cycles of 35 Gray targeted radiotion, prior, during and affter Hormone ADT for 18 months. (e.g. Deca Peptyl). PSMA PET scans can be used to detect metastsis after treatment. Interesting statistics. Thank you.
Peter I feel obligated to say what you are describing does not make sense for the vast majority of people. People with stage 4 cancer have metastatic disease. In this cases removing the prostate is often not helpful in making someone live longer so not routinely done. That being said getting samples of the prostate cancer can be helpful for genetic testing and sometimes people have trouble urinating so they need an operation to remove prostate tissue so they can urinate. There are several method to get tissue out ranging from biopsy of the prostate or a metastatic site to TURP, HoLEP or rarely prostatectomy if they have blockage of their urinary flow by the cancer. That being said HoLEP and prostatectomy in these situations are used infrequently but in the right situation could be useful tools.
Thanks for your reply. I have to humbly apologise for my highly inaccurate post. I was confusing "Stage" with "Gleason Score" when referring to "Stage 4". I really meant Gleason score 7 which has two components either 3 and 4 (not so bad) or 4 plus 3 (worse). Please accept my apologies and grateful thanks for the time you have taken to reply so fully. I accept everything you say.@@cancerbetter
Hi. I was wondering about Brachytherapy. Do you have any videos regarding this subject?
I don’t but I should make some. Brachy has very good cancer control rates but also high rates of urethral strictures particularly when combined with external beam radiation. It’s a reasonable treatment option but like all options it has some short comings.
Thank you for the prompt reply!
10 of 15 positive cores, intraductal, Gleason 7(4+3), age 75. What is the best treatment? As for now started hormone therapy, then scheduled SBRT in 6 weeks.
Damn. That is a bitter pill my brother. I empathize. Best wishes for your treatment. I think at your age, you are making the right choice of radiotherpay + ADT. Hang in there.
I need help. I have a very large BPH, candidate for a turp,and have experienced urinary blockage. I also need knee surgery big time. The prostate issue is stopping me from having my knees worked on. I am having a high degree of mobility issues. I have been on medication for the prostate for several years and the overall quality of my life is not good, hard to walk or stand. I could use some advice.
I think you need to walk. Get your knee fixed first. Damn if it spreads at least you’d be mobile.
Hi. Me again. So I was listening to a discussion regarding Brachytherapy. Both Doctors agreed that a person should take Viagra before and after the procedure. If you are aware of this practice of taking Viagra, how long before and after? And how often?
Thanks again for the reply regarding the PSMA Pet Scan. Btw, in my post to you I didn't mention that I had several cores of 4+3 and so this is why I wanted a PSMA. Anyway, I requested it and got a confirmation that a request was sent a facility where I can get one.
Good for you!
I’m not familiar with the penile rehabilitation practices following radiation however after surgery we give patients regular viagra or Cialis to help speed up the recovery of erections. I expect the radiation oncologists are emulating this practice but I must admit I have not read studies on this particular topic in relation to radiation treatment
@cancerbetter Dr Ahdoot, can you give any insights or share your thoughts regarding how Ai will impact/improve prostate cancer therapy within the next 5 years. This would be only an educated guess as you may have already noticed changes elsewhere in the medical fields. Much appreciated Dr.
Cheers
I think ai will be used to help interpret imaging, assess data to find trends previously in noticed, and allow for more natural data collection from patient charts to facilitate research.
Thank u Dr. !
I am 62 years old with a recent G4+3 intermediate diagnosis with no other co-morbidities and good overall health with potential to live another 20-25 years. I'm trying to decide between radiation and surgery (leaning towards surgery with possible nerve sparing technique). I recently retired with the hope of extensive international travel in my future. The information I seem to come across really seems to be about what side effects to deal with after chosen treatment. I tend to lean towards surgery with the initial damage and then recovery from that point. Radiation has the potential of side effects far into the future which concern me, but not sure how much weight to put in that aspect of it. Being a very active person the incontinence aspect of surgery concerns me but if it can eventually be controlled I would be ok with it. Any perspective from you would be appreciated. Thank you for your videos.
Based on your concerns it sounds like surgery is the right choice for you. If that is the decision you choose and you are very concerned about continence you can look for someone who does retzius sparing prostatectomy as one possible way to have above average continence outcomes. If you can’t find someone locally you are welcome to come see me in Los Angeles.
I am in Seattle and will do my homework regarding retzius sparing prostatectomy practitioners in my area. Thank you for your perspective!
Hope you can give me some insight.56 white male,been dealing with chronic Lyme disease for a little over a decade.Haven’t been treating it the way I should because I’m also a full time caregiver to my 91yr old mom who has Alzheimer’s/dementia in this same time period.I get all over body inflammation,brain fog and my adrenal glands are shot from the stress of watching my mom deciine.Shortly after my diagnosis of Lyme my psa started rising.Had a biopsy 6-7 years ago when psa was 7.8,I think my Gleason was 6.Came back negative.It’s steadily risen over the years.Last April it was 11.3 this April it’s 13.1.Can my cortisol levels being high and the chronic bacterial infection of Lyme be causing this continual rise?I also consumed way too much sugar.I’m cutting back on my sugar and my physician wants me to go back to the urologist.They didn’t do an mri last time they just went straight to the biopsy.Unless they’ve figured out a lesser evasive way of biopsy I want no part of it and my urologist seems to have a very aggressive manner of treating things.I truly feel that the continuous stress I’m under and bacterial load from Lyme can be causing this,what are your thoughts?Thanks for any input.
I cannot speak to your medical condition here without having seen you. If you feel uncomfortable with your urologist, I recommend you get a second opinion.
I am 61 years old, and I was recently diagnosed with Gleason 9(4+5) prostate cancer. There seems to be relatively little information about this grade of cancer compared to the lower grades. I am in excellent health otherwise, and have no symptoms as yet. I am going to meet with a surgeon in a couple of days to try to get a prostatectomy scheduled.
So far, a bone scan and a CT scan have not indicated any metastasis.
BTW, my PSA has been a maximum of 4.6.
Edit: I looked again, and I was wrong. My PSA was 5.3 at it's highest.
With your PSA that low you are likely to have found it early. Wish you best of luck.
Consider a PSMA PET scan(see my video on the topic).
@@cancerbetter Thanks for the reply. And yeah, I am going to talk to my doctor about getting that test.
My first priority is to get that bonfire out of the forest, then we can try to ascertain whether there are any spot fires smoldering elsewhere.
I have a similar pattern. I was diagnosed a year ago at 58, Gleason 9 and a max PSA of 7. No obvious metastasis. I chose HDR brachytherapy with 23 external beam radiation treatments. I’m also on ADT for two years (one year completed so far). I’m also on a clinical trial and taking darolutamide (with a 50% chance of placebo) for 2 years. My PSA as been undetectable for several months (< 0.01). Beside hot flashes at night, I’m doing good. No complication or major issues so far. I’m very active at the gym 3 times/week and running 15 km a week. Crossing my fingers that I’ll be cured at the end of the 2 years.
I did the same treatment as you HDR brakey and 25 rounds of imrt I had an initial PSA of 110 and a Gleason of 8 finished treatment in November my first blood test was 0.01
@mikesachse445 Nice!!! 💪
Hi. Yesterday I had my biopsy. Prior, I had asked for an MRI and this showed a growth on one side of the prostate. So the biopsy went to this area, as well as the others in the prostate. If I get a score of Gleason 6, is it out of the question to ask for a PSMA Pet Scan? In other words, is it common for patients to do this?
Not out of the question but very unlikely to find anything. PSMA PET often does not detect low risk disease like Gleason 6
I didn't read all the comments, but where is there a discussion regarding radio surgery? Anyone heard of Dr. Gil Lederman who's a triple board-certified oncologist at Radio Surgery New York? His success rates are much higher than conventional surgery where the cancer typically returns, including robotic surgery. And from what I understand, most radio surgery is done on an outpatient basis. There are many success stories.
There are many successes with radiation and surgery. I’d recommend you check out the other videos on this channel comparing surgery and radiation. I tried to be as fair and unbiased as possible. If someone is telling you radiation is better than radiation that’s a misrepresentation of the literature. It’s far more nuanced.
I had prostrate cancer and was treated at the University of Washington in 2015 my PSA was 8 and my Gleason score I don't remember the exact number but was high. I was told it would be a good idea to treat the disease. I had Proton Radiation Treatment (44 treatments) with some slight side effects but not too bad all things taken into account. My biggest problem as I age is some hip issues and ED. At 73 I can live with better than being dead.
Indeed, this is a good example of how radiation can have affect many years later. You put it in a good context by saying it is better than being dead and I agree. Glad to hear you’re doing well in general and sharing your experiences with some of the side effects that can occur many years after radiation.
I was diagnosed in 2018. My PSA was 14 my Gleason score was 9. I had 9 weeks 5 days a week of radiation and 2 years of Hormone Lupron treatment. 5 years later my PSA is 0.4 and I have regained some erection and libido. My ejaculations are dry or very little semen. I notice some rectal pain which is a result of the radiation. No bone pain. I was stage 2 and told it was 80% curable.
Would love to see your opinion of proton radiation vs. prostatectomy. The side effects from surgery are brutal up front and every patient’s healing mileage varies greatly. The side effects of radiation are usually delayed. Is there any data that indicates which modality is “better “ 3 to 5 years after treatment?
Yes lots. Look at my video on side effects of surgery vs radiation
thank you.@@cancerbetter
54 years old with Gleason 7(3+4) and considering surgery. Wished there was some way to know if some of the newer treatment options would be as effective with less side effects. Such as, cryosurgery, HIFU, or something such as brachytherapy or proton. Unfortunately some these options are not even offered in my area and then there’s the insurance issues…what will it cover
All depends on your insurance. Cryotherpy followed by HIFU are the most likely to get insurance approval.
I’m in the same category and wish there was more information on the alternatives to surgery.
I was diagnosed at 59 and a half that I have prostate cancer. I have had 3+4 for 4 years. Doing Mri, PSI, and Biophys. I am under surveillance. It's subjective but there is no rush to remove prostate if 3+3 or 3+4. I don't have anxiety. I know I have cancer and can seek additional treatment if the numbers go up. Active surveillance is the current preferred method of treatment. So far all is going well. There are more complications in removing it if there is no immediate danger. This cancer my doctor told me and my category grows so slow I will probably die of something else.
@@edotero6331: thanks for the info. What psa history and numbers.
@@robertjayroe9900I have the same 3+4, less than 10% cancer in the biopsy and a 0.24 Decipher genomic test score. The entire left side of the prostate was negative. I’ve been on Active Surveillance for one year and will repeat the biopsy the first week of December. I had the biopsy done at Mayo Clinic. It’s a well oiled machine there but they do not offer (within there Stander of Care) Electroporation, HIFU, lazar, TULSA, etc. They do offer Cryo and Brachytherapy. They were doing a trial study with Electroporation, but a few others have been offering this for several years. So I’ve opted for UCSF for the followup biopsy because they “say” they can do many alternative treatments. Also, Prostate Cancer Research Institute has some good discussion on PC subjects. Hope this helps.
Frank Zappa died from this disease while being treated at this very same hospital. It was 30 years ago so lets assume they've learned much in the years.
Thank you so much for this information. I am curious how ´other´ and co - morbidities were calculated. What is the general chance 100 AS 100 RP and 100 RT patients being alive in general after 10,15, 20 years? Such a statistic would need to be age grouped. My urologist begrudgingly told me my Gleason score of 6 after already deciding RP was the next step. I am 54 and I should „get it out of the way“. I want to armed with data before I get a second opinion.
For low volume Gleason 6 prostate cancer we usually do not recommend prostatectomy as the initial treatment selection except in exceptional cases. Consider a second opinion.
Thank you. 2nd opinion, Head of the hospital that did the fusion biopsy said today “active surveillance.” What I love about your videos is that you present data….not anecdotes. Many doctors don’t trust patients with their own data.
@user-tx8vq2sz6x I’m truly happy I could help you in your journey.
I've been reading up on the properties of apigenin.... wondering if it has any role in prevention. Also wondering what and if the recent AOH1996 cancer med may play in all of this.
That’s in phase 1 trials. No idea if it will have the desired effect yet.
Very informative, but I believe having Gleason 6 is too simple of a statement to not have treatment. As a patient with Gleason 6, I am also looking at the volume - how many core samples from my biopsy showed cancer? I had 6 positive out of 12 cores. The six positive cores were in muktiple areas of my prostate, not in one section or one side. Also, the mri showed two lesions abutting the wall, one being quite evident during a dre. And also had to take into consideration my decipher score and family history. So I believe not all Gleason 6 patients are equal. I am considering my options now of AS, SBRT, or prostatectomy.
Thank you for this great video.
Excellent point. As the volume of Gleason 6 prostate cancer rises the odds the pathologist will find some Gleason 7 in there rises. Also, one should consider if the Gleason 6 prostate cancer may grow so large that treatment may become more challenging in the future. There are several other exceptions to this rule which is why I say these data should be used as general information to better inform discussions with your doctors.
Merhaba eşime 8 ay önce yapılan biyopsi sonucu 12 korun üçün de pozitif çıktı.Gleason3+3.radikal prostatektomi oldu.patoloji sonucu ameliyattan sonra pT3bNoMx çıktı.ameliyat sonrasi psa da yükselme oldu.0,25. İlaçlı emar ,ilaçlı tomografi ve kemik sintigrafisi çekildi bir şey görülmedi.onkolog kırk gün radyoterapiyi önerdi.
I have a question concerning prostate cancer, I have BPH and was recently looking at PAE as a potential treatment, I don’t have prostate cancer. The PAE treatment cut’s off the blood supply to the prostate, as cancer requires oxygen to survive or multiply which is delivered by the blood would the PAE have a potential to treat prostate cancer ?
It’s been tested and does not work well
Hello Doctor,On a January,12,24 I had a blood work done and PSA was 4.3.Then I had a MRI on February,21,24 came back as Pirad,3.On February,22,2024,I did another PSA test ,came back 1.23.Now My Urologist wanted me to do a biopsy before we got a new PSA test level.What’s your advice,please respond.Regards,Nick
In general, the lower person’s PSA to lower the risk of prostate cancer. Having a low, PSA, however, does not completely exclude the risk of prostate cancer, as there are some very rare situations in which prostate cancer will not produce PSA. This is an exception rather than the rule, and sometimes people will still recommend a prostate biopsy if they feel a hard spot on the prostate even if your PSA is below four. That being said, most people should be getting a prostate biopsy in the context of an elevated PSA at least above three and this is something good to talk to your doctor about and see if he still thinks the biopsy is indicated.
Hello Dr. Ahdoot . I'd like to get your opinion. At the end of August I was diagnose with PC left base Gleason grade 3+3 within 20% of 1 core and rightlateral base Gleason grade 3+4 within 35% of 1 core. After i went on second opinion. Another Dr. order first MR 3T scanner. After MR Dr. order fusion prostate biopsy and final result Gleason grade 3+4 (Score 7, Grade Group 2) within 5%, 15% and 30% of 3 out of 5 cores, tumor lengths 1mm, 4mm, and 4mm. Negative for perineural invasion. Approximately 20% of tumor is Gleason pattern 4. I had PSA 5.7 when they found Cancer then PSA was 5.4 . MR result Seminal vesicles: normal, Extracapsular spread: None, Lymph nodes: No lymphadenopathy. Urinary bladder: normal. Other incidental findings: None. Final recommendation - Surgery. I am 64 years old without any health problem. I would love to get your opinion. Thank you very much
I can’t give medical advice on this platform. If you wanted to come see me for a consultation I’d be happy to see you in my clinic at Cedar Sinai but this would require a trip to Los Angeles. I I have offered some weekend consultations via Skype call in the past in exchange for a donation to keep cancer better going.
If this interests you, you can email me.
The thing is, it’s very challenging to make a recommendation without seeing the context of someone’s entire medical history. For example, before I give an assessment, I usually want to see a history of peoples PSA their MRI, and review their MRI personally, the biopsy results and the biopsy results demonstrate cancer within the area. That’s MRI visible And to see if there’s any evidence of the cancer may have grown outside of the prostate capsule or is close to the neurovascular bundle. Without these details, simply can’t give advice, but I can’t say as you may want to speak with your urologist about whether or not you are a candidate for focal therapy, this may be something you want to consider. It does have a moderate rate of cancer recurrence requiring additional treatment. I recommend you watch the video on focal therapy and then discuss with your urologist. Second opinions from a high volume urologic oncologist is also a good idea.
What would the recommended treatment be for Gleason 7 (4+3), with a PSA of 22? PMSA Pet scan has been scheduled.
Depends on if your MRI shows the cancer is growing out of the prostate boundary or not. Also depends on your age. Look at the video about the side effects of prostate cancer surgery versus radiation and try to make a decision about which seems more desirable for you.
@@cancerbetter 57 yo, 1 in 16 biopsies were positive. It seems like a Vegas odds game. The outcomes of both radiation and surgery seem similar but I don’t like the side effects of the surgery. The PET scan is supposed to show if the cancer has spread to other areas in the body and is rated as 95% accurate so it will miss the cancer 1 in 20 times. If the PET scan comes back showing no spread I’m leaning to the Cyberknife radiation treatment. It has side effects I’m more willing to live with and comprises 5 treatments. It was recommended to do the hormonal treatments but I don’t know yet. Seems like a form of chemical castration for 2 years. Thoughts?
Depends at what stage it's diagnosed. Problem has been over-diagnosis and until recently especially over-treatment. What is not clear is what happens when you are first diagnosed with 6 [grade2] and defer treatment and then evolve say to 7 [grade 2]. Do these lower mortality figures apply based on grade at diagnosis even if there is progression? also is the lower mortality risk "preserved" so long as treatment is initiated as soon as the progression is detected. I assume the figures are based on position at diagnosis. As you suggest, diagnosis and treatments have advanced considerably since these studies were started.
Yes this data is based on initial diagnosis and patients did not routinely undergo rebiopsy. The question about cancer progression while on surveillance is a good one and we have several series showing the rates of progression to incurable cancer are extremely low.
I was diagnosed at 59 and a half that I have prostate cancer. I have had 3+4 for 4 years. Doing Mri, PSI, and Biophys. I am under surveillance. It's subjective but there is no rush to remove prostate if 3+3 or 3+4. I don't have anxiety. I know I have cancer and can seek additional treatment if the numbers go up. Active surveillance is the current preferred method of treatment. So far all is going well. There are more complications in removing it if there is no immediate danger. This cancer my doctor told me and my category grows so slow I will probably die of something else.
@@edotero6331Do you know if you are Favorable Intermediate or Unfavorable Intermediate 3+4? And do you know the percentage of cancer found in the biopsy. I have less than 10% found in the biopsy, and a very low Decipher genomic test score. So I am also doing active surveillance with a 1 year followup biopsy this coming December. I’m with you. If I can put it off and have treatment when the numbers go up, that’s want is ideal to me.
59 years old 3 cores 2 with 3+4 and 1 with 4+3 (with Intraductal) one lesion on one side all confirmed by 2 targeted biopsies with no spread shown on MRI, CT, and PSMA PET 12/22 had HIFU performed 2/23 reportedly hit the thing 3x plus the margins) A few months later 6/23 with PSA still rising had another PSMA PET 7/23 that revealed reduction in uptake at original site but two lymph nodes with uptake representing nodal metastasis. Now taking ADT (Orgyvyx & Abiraterone) plus Radiation 27 fractions (“with intent to cure”). Does this seem like there is a real chance of a good outcome and if so how good?
Current data supports the use of ADT plus radiation to the primary site (the prostate) and the of metastatic cancer. This treatment allows for a possibility of cancer control but success depends on catching the cancer before it has spread beyond the nodes. The more sites the cancer has spread to the less likely the radiation will provide a cure.
I would confirm you are getting radiation to the prostate if there is any residual cancer there and all the lymph nodes in the area including the PET avid ones.
@@cancerbetter thanks for the reply and the radiation plan includes the prostate, the PET avid nodes as well as those around it. Remaining hopeful that it is very early spread and the treatment works 🙏🤞. Being treated at MSKCC and these are supposed to be among the best doctors for this. Again thanks for taking the time.
@rayp7135 that’s a very reputable hospital and it sounds like you are getting a very modern treatment strategy supported by up to date evidence.
Was there any differentiation (maybe not at the time of these studies as guidelines may have changed) between Favorable Intermediate and Unfavorable Intermediate? Is it perceived that there is really no difference between FI and UI in a longitudinal perspective? And, maybe these are not the right questions, and you can elaborate.
At the time of these studies they did not differentiate 3+4 vs 4+3 like we do now. And yes they are absolutely different in their risk. Some people with small volume 3+4 are candidates for active surveillance but that is not the case for 4+3. I brought up the studies I discussed here because similar studies have not been repeated since.
@@cancerbetter Thank you.
My psa went up to 8.1 from 7.54 2 weeks ago. Im 61 years old in otherwise good health. I had a biopsy a couple years ago,got sepsis, and it came back negative. Some abnormalities. How worried should I be?
Some things to check would be to make sure that you had an MRI and that after your MRI was done. The biopsy was done in a way that was targeted the area of abnormality. In addition you can use the PSA divided by the volume of your prostate to get something called a PSA density. If the PSA density is greater than .1, then it may be wise to get a repeat biopsy, if you can’t find anyone who can do an MRI targeted biopsy in any area you’re welcome to come see me in Los Angeles but generally most academic centers will have someone who does MRI targeted biopsy.
Gleason 9 (4+5) . PSA -194. Extensive bone mets. Age 66, Very fit otherwise.
Whats the best treatment ?! and whats the prognosis?
Now a days there are actually many treatments for metastatic prostate cancer and the disease can be controlled often for many years. Generally people will get on 2 testosterone reducing medications. It’s often a good idea to get sequencing of your tumor to see if you are eligible to treatments targeted towards your individual cancer such as Olaparib. Hope this help. Go see an oncologist or urologist who specializes in treating metastatic prostate cancer. They will get you set up
With a PSA density of 0.016 is very low risk, so should they be on watchful waiting? Get MRIs and PSA checked?
I can’t tell you what to do as I’m not your doctor but that is a very low PSA density
Does any treatment actual reduce the peeing frequency problem?
Yes, there are numerous medications. You will need to figure out what the cause is. Usually it’s related to prostate enlargement. It can also occur after radiation as well as many other things. This should be relatively easy for a radiologist to sort out
We were told low grade {Gleason 6 and under} prostate cancer just needs watchful waiting
That is usually the treatment for Gleason 6 prostate cancer.
I read that active surveillance is for Gleason 6 and Lower grade Gleason 7, not watchful waiting, Do you agree?@@cancerbetter
I was diagnosed at 59 and a half that I have prostate cancer. I have had 3+4 for 4 years. Doing Mri, PSI, and Biophys. I am under surveillance. It's subjective but there is no rush to remove prostate if 3+3 or 3+4. I don't have anxiety. I know I have cancer and can seek additional treatment if the numbers go up. Active surveillance is the current preferred method of treatment. So far all is going well. There are more complications in removing it if there is no immediate danger. This cancer my doctor told me and my category grows so slow I will probably die of something else.
@@cancerbetter, how successful is a IRE focal procedure done on a single lesion in a T3 MRI?
@janetw9430 I wrote a review article which summarizes the data. You can find it here: pubmed.ncbi.nlm.nih.gov/30865133/
At age 75 with 0.6 psa, I suspect no problem with my prostate. But how would I know? I can hire a urologist but I have no idea what to say. Can you suggest a plan?
With a psa that low your risk of prostate cancer is likely very low. Talk to the doctor and tell them what is bothering you. I can’t give you direct advice on this platform.
I’m trying to determine what type of treatment treatment I should get for my prostate. If you get radiation treatments and it doesn’t work, can you at a later date have your prostate removed thank you.
Yes it’s possible but the risks of urinary incontinence and erection loss are higher in that order of events. Also healing time will be longer as well as radiated tissue heals slower.
I’m 64 and diagnosed with Gleeson 6, low risk prostate cancer cancer. But I cannot live with this in my mind if I follow the active surveillance program. What we do not know is the probability of the Gleeson score becomes higher in future,and therefore requires treatment. So I choose to have radical radiotherapy, involving just 5 fractions of SBRT. Fingers crossed
Over a 10 year period on average about 50% of men will have an evolution of their cancer from Gleason 6 to Gleason 7 or higher. Given that over half of these people will never need treatment choosing to go onto active surveillance allows an opportunity for a person’s cancer to declare itself. Alternatively genetic tests like decipher scores can be done to help further stratify a person’s risk. The decision to treat Gleason 6 for worry was a common one made for generations but from reviewing the data of the past we have found that this did not result in improvements in outcomes for patient and risks treatment related side effects.
thank you. 65, PSA 6.2. I see my Urologist in a few weeks. I've read that 97% of all PCa survive for 15 years with or without treatment. So, I might do radiation but that's it. still reading the studies.
Be cautious as your read these studies to see who the patient population is. Many surveillance studies such as PIVOT included mostly Gleason 6 and 7 patients. These are the lower risk cancers. People with higher risk cancers are at higher risk.
Thx Dr Ahdoot,
I'm 62 years I have been diagnosed recently Gleason 6(3+3), ISUP 1, Grade T1C,but multi focal and I have a family history of Prostate cancer , I'm very healthy du to exercise, healthy food, and intermittent and prolonged fasting, Do you think an active surveillance, is a good choose, surgical or radiotherapy. I ask you because may cancer is multi focal and I have a family history of prostate cancer, These factors can increase the risk ? thx a lot
I really can’t answer without seeing you in clinic for something like this.
Thx for you reply , I understand and I'm ready , but how the procedure to have an appointment with you, because I live in Quebec @@cancerbetter
@williamsemaan1017 you are welcome to set up an appointment in my clinic. I’m a member of the academic faculty at Cedars Sinai in Los Angeles. Google Michael Ahdoot MD and Cedars and you will find me
👌@@cancerbetter
I don't know what to do. I have early T2a cancer, growing through the prostate capsule, possibly. My gleason is 3+7..psa 7.6. My cancer hasn't gone into any other areas, definitely not lymph nodes or reproductive ducts. I don't want surgery and can't have radiotherapy as also have median lobe enlargement. So am stuck. Terrified of the treatment not so much the cancer. I cannot make a sensible decision. My surgery would definitely cut out erectile nerves
You could ask your doctors if you could have a TURP to address the median lobe and urinary issues prior to radiation. This might allow you have the radiation you desire.
@@cancerbetter thank you so much for your reply, yes they have just offered TURP. Am just worried it might me more traumatic than the RALP they suggested. Its so strange to be at ease with having the cancer but fearful and all with any treatments
Hi Im 65yrs young. For the last 14 months my psa has been 12.4. My Urologist sent me for an MRI scan and the results came back as inflammation and enlarged prostrate. My Urologist said i have prostatitis which would raise your psa levels. I suggested a biopsy but the Urologist was against the idea as no cancer was showing on mri scan plus the biopsy needle would have nothing to target.
Im a little nervous as both my Dad and Grandad both passed away with prostrate cancer.
I'm even contemplating paying to go private to have my prostrate removed as its giving me much anxiety.
Yesterday i had another blood psa the last one was 2 months ago, so I'm hoping a praying that the psa levels come down.
Results next week🙏🙏
Your plan to repeat a biopsy is a good one. I’d recommend you get a biopsy before you start even thinking about prostate removal.
,what do you think of cyber knife for Gleason 6?
For many people treating Gleason 6 prostate cancer does not result in any change in life expectancy. For this reason we often observe Gleason 6. Exceptions might include Gleason 6 with high risk genetic features or Gleason 6 with aggressive behavior such as extraprostatic extension.