Видео

I come from 30 years of medical device development - including PET/Ct and proton therapy. My first line treatment for locally advanced MIBC was EV/pembro. I began treatment in December 2023 and currently have no evidence of disease by imaging or circulating tumor DNA. We need to spread the word about bladder sparing options!

Great fun being part of GU Cast and sharing the story of ANZUP Cancer Trials Group and the ENZAMET trial - thanks Declan and Renu!

This is why pathology (& imaging) reports should come with results with error bars; preferably all numerical results should be intervals to say the 95% confidence limit. Now I know that my PSA serum level changes over the last 6 months from 6.1 to 7.7 is probably significant, but the fluctuations from 7.3 to 7.7 is just noise. I had a similar issue with an ultrasound prostate volume measurement claimed to be 9.0ml. Being scientist I inferred this meant PV was between 8.5 & 9.5ml. However on looking at the normal distribution of prostate volume for men over 60yo, fewer than 1% have such a small prostate. I asked the sonographers about the precision and accuracy and did they check there was not a mistake and was given a total rubbish response. My subsequent inquiries of the research literature suggested PV measured by ultrasound was +/-30% to the 95% confidence limit and still clinically useful for calculating PSA-D. Really patients should not have to do this. Sure most patients aren’t trained in science (many of us are though). But more importantly the medical professions failure to provide numerical results as one would expect from 1st year university students , ie. with the correct number of significant figures, just erodes trust. I could also go on about the three seperate contradictory pathology reports from the one prostate biopsy procedure that my brother received. Which one does he rely on for his decision?

Where can I find the results of the randomized trial?

I had the robotic surgery, lost functionality , they should provide pumps to every guy that goes through surgery . The reason men get erections in the morning is to maintain penis tissue . If you no longer get them you will want to artificially cause the erection so that the tissue doesn't atrophy and waste away.

Just diagnosed Gleason 6 couple of months ago. PSA 5.3, MRI suggested high likelyhood of cancerous lesion. Half of the biopsies were positive, a couple at 90% of the core.

Great

Gold Knowledge !!! Thanks

does this mean most (70%+) of men with high volume castrate sensitive prostate cancer who go onto ADT+chemo (common to both arms) failed to suppress PSA by the end of the year? implying that most of the arm that did not include LuPSMA went castrate resistant by the end of the year? or was psa in both arms dropping, just not as fast on average in the control arm?

Awesome work - congratulations

Awesome keep up

Congratulations on a huge result!

Corona Vaccinated???

Loved it 👌

Love Ben Tran

A terrible loss , condolences to his family ❤🙏🦋

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

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

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

😥

Future investigations needed

What was he investigating?

So sorry to hear this news.

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

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

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

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

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

Very sad 😢

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

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

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

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

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

No harm in active monitoring.

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

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

Bravo, Howard.

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

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

Loved it, thank you

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

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

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

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

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

Good to see Alice👍

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

Loved it, well done

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