2020 PSA was 15.4 Within weeks had MIR at Plymouth UK. Also then within weeks had biopsy. Out of 15 snipes found two areas. Gleason scale 3+3. The decision was just to do PSA tests every 3 months. 3 months later PSA down to 12 Once back cycling jumped to PSA 19 then back down to 15. For the last two years having PSA test every 6 months. After second year had second biopsy they could only find one area. I drink plenty of tomato juice, and glass of water in mornings with bicarbonate of soda in.
This makes so much sense. Aside from the awkwardness and discomfort of having to go through a prostate biopsy, it never seemed like a good idea to me to be poking holes in ones prostate. Does anyone know for sure that poking holes in the prostate doesn't potentially allow cancer cells to escape the prostate capsule? It seems reasonable to think that if there were cancer cells in the prostate, a biopsy might cause some to be released and travel through the body.
Can't say with certainty (been doing a lot of research on Prostate cancer in the past 5 yrs since my husband was diagnosed with Gleason 6 3+3, Group Grade 1) but that issue has been brought up in a FB group I am in and the term for what you are referring to is "seeding" which would also apply to breast cancer biopsies.
Like Dr. Emberton said, it's a frequent patient question, and his answer was that he didn't know, and then cited a mouse study where "seeding" took place. There's two components of risk. One is the chance that the event will happen, and two, the severity of the event. For me personally, the potential for a metastasizing cancer outside of the prostate is too great a risk.
Nothing is perfect, this is about the balance of risks and adverse effects from diagnostic tools. It was an excellent discussion. There are too many over enthusiastic urologists over-sampling in biopsies: I have heard of 40 plus samples being taken where MRI indicated only one small localized lesion. There’s a case for that being medically negligent if adverse consequences like bleeding or infection develop; and that omits the whole rather alarming possibility of seeding from withdrawn needles. Moreover histology is itself a by no means perfect tool. The sooner we can get rid of biopsies the better. Dr Emberton’s carefully detailed approach is very cogent.
A friend of mine is an MD/PhD Neurosurgeon, recently retired from everyday practice. Not long ago he nearly lost his life due to an infection from a transrectal biopsy. A future with just no transrectal biopsies sounds pretty good to me.
Fantastic... One of the few experts that had me nodding my head in agreement , instead of saying BS. at every turn. I would not hesitate to have Dr. Emberton as my oncologist as I feel I could trust him to give full, accurate, and up to date information upon which we would share decision making. Thank you Dr. Geo for this interview.
@@hikerJohn Exactly which is why patients need to be given written material to read before meeting with the doctor so the doctor doesn't need to waste his time on the basics.
Just to say that Mark Emberton is Professor Emberton, not Dr. As one of his patients - and a prostate cancer survivor - I can attest to the excellence of his knowledge, skill, judgement and care.
Thank you for this information. I’m 63 with an enlarged prostate(BPH symptoms) for many years. I just had all blood screening done for first time in many years and my PSA came back 4.6. Repeated a month later 4.6 with free PSA ratio of 18%. My primary doc recommended the 3t MRI. Results were all RDS 1 and one area of RDS 2, with PSA density of .08. My doc referred me to a Uroligist and he did an ISO PSA test which came back 10.7. Because of this, he scheduled a random 12 plug biopsy. Because of great information as this and Dr Ted Schaefer, I have decide to cancel biopsy and go with monitoring at list til MRI shows bad data.
No biopsies would be fantastic news. I have had three biopsies, and the last one led to an extended stay in the hospital with sepsis directly related to the biopsy procedure. I am currently scheduled for a prostate MRI and those results will determine the need for biopsy. I have BPH and for years my PSA has been elevated due to the BPH. With medication there has been a significant drop in my PSA over the last 10 years, but over the last year my PSA went from 4.22 to 6.1 which warrants further investigation.
Dr. Emberton has brought to us years of experience with highly detailed information. I'm just about to get a prostate MRI here in Tallahassee, FL, and I have taken one page of notes for my urologist. The biopsy he insists upon is trans rectal (with antibiotics), and PSMA scans do not seem to be on his radar. Too bad there isn't a Dr. Emberton clone here in Florida.
I’m disillusioned with MRI’s also. My MRI showed Pirads 4-5 (two different interpretations). A targeted biopsy of the “lesion” showed no cancer, however other cores showed a repeat Gleason 3+3….. So now I’m labeled with cancer. Did the two different transrectal biopsies I’ve gone through spread the Gleason 6 cells?? Who knows. My prostate is large so my PSA seems to be 4-5; however one reading was up closer to 9. So did I have inflammation which showed up on the MRI as a lesion?? (Also would cause the higher PSA reading.) Sooooo now I’m headed in for another MRI this coming Monday. I will definitely be resistant to having a 3rd trans-rectal biopsy. Would it be possible to have Dr. Mark Emberton review all of my test results and pathology? It seems that both the Gleason system and the MRI Pirads system are all subject to interpretive error….. Thanks Tom - stuck in “Active Surveillance Cancer”
You do not have to worry about G3+3. To call it cancer is debatable, and maybe we should stop doing that. Nobody dies from G3+3. Problem is, that if you got 3+3, there is an increased risk of G4 or G5, and on those you do not do active surveillance. The Protect-study now has 17 years follow-up, and nobody dies, not even those presenting metastatic lesions!.
I see you commented a couple months ago.I too recieved a Pirad 4 on a recent MRI and immediately my urologist puched the biopsy.Told him I needed to think about this.Been reading lots of info on biopsies and prostate cancer as well..Seems there's plenty of time to decide a plan of attack.Been reading lots of successful cancer patients )Prostate & others) using fenbendazole .Especialy a Joe Tippens Protocol. Have you looked into this? I showed my urologist my plan of attack and he said just do the biopsy and we'll go from there.How did you most recent MRI go?
You and I, have almost an exact scenario. Had an MRI done , it showed a RAD5 lesion 1.62cm , The Dr took 3 extra cores directly from that area ( it was a MRI Fusion biopsy) those cores came back all negative for cancer. However on the left side, the routine 6 cores there showed a 3-3 , a 3-3-, and a 3-4. So now I am also in Active Surveillance mode. By PSA was 4.96 a year ago and 5.1 a year later. Where do we go from here, I have 3 urologists and they all think " I'm theirs", none of them agree on a "one treatment", and yeah this gets complicated. BTW, next time you have a biopsy have a PERINEAL one, I had that, and no pain at all, only peeing for the first 2 days after, but the % of infection with perineal is 0.1. Where are you located? I went to Mt Sinai in NYC , though I live a bit more than a hour north of the City, Mt Sinai was excellent. Best of luck to you in this journey. If you have any questions feel free to ask. also I should have added I'm 73.
This has answered many questions I didn't even know I wanted to ask. I am a 60 year old who, apart from going to pee more often at night, had no symptoms but due to high prevalence in the media of the 'importance' of PSA testing, decided to get a PSA test. (wish I hadn't now) After DRE and MRI I discovered I have a PSA of 6.4 with a large prostate of 76ml (PSAD of 0.084) and a very small (7mm) PI-RADS 3 lesion. I went for a guided trans perennial biopsy but when the 1st needle went in I screamed like a bitch so the consultant very kindly suggested I come back for one under a general anaesthetic. He immediately followed that up with the rather disconcerting news that because I'd be under, they would take many more samples from my prostate! whoopee! So I learned about a blood test which tells you if you have or don't have prostate cancer (of any grade) and took it. That came back today positive for prostate cancer (its called the Episwitch PSE test) So this positive test would include 3+3 results. I have subsequently learned of a more specific blood test which I wish I'd known about first called Proclarix, which when combined with "prostate volume" of men with PI-RADS 3 produces quite reliable results in detecting/predicting gleason 7 or higher csPC. It resulted in potentially avoiding 66% of needless biopsies. I was all ready to get this test then I see this video and Mark says that for someone with a PI-RADS 3 lesion and a PSAD of under 0.15 (thats me on 0.084) he would advocate "come back in a year for another MRI" So I'm delighted to hear this as it suggests I'm not as in peril as I thought I was this morning! What do you think? I have no family history of PC or early breast cancer
I had a PSA done a year ago, 3.5 PSA decided to do an MRI. 2 Rad 4 lesions and my prostate 100cc. I had a biopsy, 14 samples, benign. Great! 2 months ago, PSA 5.25 bummer! I decided to change doctors because I did not feel like I was getting the best care (staff and equiptment). Ok new Doctor, MRI at a different place using their brand new high tech MRI machine. Results NO lesions at all!! Yes, no lesions detected and no signs of prostate cancer. I asked my former doctor why? Well, our equipment is old, and the magnets are not that powerful. Are you kidding me?!? Bottom line PSA in 6 months and praying it's just BPH. Good luck.
@@dondgc2298 Because 3.5 was elevated from my previous PSA test. Read my comment after a benign biopsy my PSA was elevated to 5.25 second MRI completely clear. Doctor says BPH, 2 months until my next PSA.
@@funhumanusa I understand the significant increase from 3.5 to 5.25 triggering an MRI; if you discussed the 3.5 being a jump from an earlier test it must be in another discussion thread here.
It is so rarely spoke of that the tool used for ablation needs to align with the specific area of the cancer in the prostate. It makes me think of all the different types of levels used by tradesmen to find level. Even the Egyptians used a unique method to level the pyramids.
The PSMA PET/CT scan combined with a 3T MRI scan is envisioned as the future method for diagnosing prostate cancer, boasting both a positive predictive value and a negative predictive value exceeding 90%. I recently underwent these tests in Canada (self-paid for the PSMA PET/CT scan) last month. Despite exhibiting an elevated PSA level (22 ng/ml), high PSA density (0.28 ng/mL/mL), rapid PSA velocity (12 ng/ml/year), short PSA doubling time (9 months), along with an acceptable free-to-total PSA ratio of 17% and a negative digital rectal exam, the results returned negative. Subsequently, these findings were confirmed (more accurately, enhanced) through a systematic transperineal biopsy.
@@Jack-2day I paid 3,200 CAD for it. There are: INITIO medical in Burnaby, BC VM-Med in Montreal ResoScan in Greenfield Park, Quebec There should be some in Ontario as well. What kind of tests and their results have you done so far? I may be able to offer some insight if you share your info.
I had IRE(nanoknife) for PCA, no recurrence after 5 years. I was alerted to the possibility by one of the professor's videos. Before the procedure, I had PSMA PET scan. I live in Australia which, like most countries , has a vastly better health system than the US.
I love how prostate cancer doctors speak on how advanced imagery is on a daily basis, but is real quick to pull out that biopsy gun. When the pc returns and then they do a psma. Sometimes they find the cancer in the prostate bed....Hello..most likely the biopsy site..biopsies are medieval and outdated unless they are targeted one's. Why do radiologist have a higher success rate, maybe because the bed gets a proper dosage...especially guys who do seed implants.
One additional comment, - I’m reluctant to keep getting gadolinium contrast with my MRI’s. To much gadolinium!!!! My doctor told me that the gadolinium contrast was not necessary. Unfortunately I’ve never been asked if I wanted the gadolinium…they just went ahead and used it
100%...excellent. Maybe one could put together a criteria list of types of lesions and locations that would be cross reference to energy types for treatment.
This is a very informative discussion. I'm only two months into my PCa situation, currently researching as much as I can. The fog is slowly lifting....
@@DrGeoProstatePodcast If a cancer and non cancer patient complaining of the same enlarged symptoms why go to all the risky procedures associated with finding a positive cancer in a suspect case when to just introduce the many interventional type procedures ie in embolization shrinkage would cure the cancer patient thereof because as we know most of these people die of something else anyway! Surely there needs to be other methods of outwardly assessing the general ongoing heath of these patients that maybe only complaining of unary inconveniences no more than the non cancer patient saving a lot of unnecessary suffering and cost to the national heath care system. I'm eluding to people thought to have what might be a mild form of the disease........?
Superb interview. Every man deciding on an approach to diagnosis or treatment should play this full interview. You (the patient) might want to first learn some of the basic terms such as Gleason, PiRad, MRI, PSMA Pet scan and a few others. This video provides state of the art info that can be life changing. I had prostate removal in Feb 2021. PSA 17, PiRad 4, Gleason 4+3 confirmed post op. So far the cancer is totally gone. I did suffer severe incontinence though from the surgery and that diminished my life quality severely. 2 years of great difficulty. Walking = leaking. It was cured with a sling surgery in March 2023, but the emotional impact lingers.
I’ve had two transrectal biopsies in the West Midlands last one in 2018! Now been offered a transperineal biopsy based on a pirate 3 lesion on an an MRI the quality of which I have not yet been told
Hello Dr. Geo, I had a PSA go from 5 5 - 7 in about 7 months. MRI Showed a T2 PRad 5 lesion in the 2PM location. The next step is Biopsy via needle. The Dr. Tells me there still a possibility of no cancer as there were signs of scars that must have healed from prostatitis they suspect. Seeding is of concern to me. Is there some other blood test like PCE or Circulating DNA you would recommend? If so who my do it? Im in Philadelphia PA, USA My urologist firm told to refrain from googling anything....
I have problems urinating. Weak urine stream and an urge to urinate a lot. So blood in urine. What does this sound like? I got a pirads 3 on the prostate mri. Radiologist noted lesion and bph on report
The City of Hope is adding Ivermectin to TNBC treatment, University at Glasgow is adding Mebendazole to Docetaxel for PC, Dr. Marc-Eric Halatsch is using Itraconazole in a 9 repurposed drug protocol for Glioma and Glioblastoma. Dr Tim Rogers YT video on Artemisisin and Fenbendazole has some comments you may be interested in.
Not only was Australia ahead on PSMA, but on radioligand therapies as well. >>Undetectable levels of Prostate Specific Antigen (PSA) have been reported from the first patient with metastatic castrate-resistant prostate cancer (mCRPC) to ever receive two cycles of Clarity’s 67Cu-SAR-bisPSMA at the 8GBq dose level. PSA is a marker of tumour burden, clinical response to treatment and an indicator of the recurrence of disease for prostate cancer.
68 yo. PSA bouncing from 2-10 over the last 8 years. Currently at 3.0. Two biopsies ( 2017 and 2020 ) came out negative. The second biopsy was performed after an MRI showed two spots on my prostate ( PIRADS score of 4 ). Then 4Kscore and ExoDx (44%) tests that showed a high probability of getting prostate cancer. My Dad had prostate cancer at age 78. I just had my third MRI and biopsy ( MRI showed two PIRADS score of 4 ) and waiting on a meeting with my Doctor. I viewed my report and samples 1-5 showed benign prostate tissue with chronic inflamation. Samples 6-15 showed benign tissue. Let's see what my Doc says.
No cancer was found in all biopsy samples. Great news but confused as to why two MRI's showed lesions and two MRI fusion biopsies came back negative. Anyone else experience this ?
I had a MRI which came out negative but than my psa level went little higher than I did a biopsy than the Dr said I have cancer in my prostate. Tomorrow I going for the pet scan to see If the cancer spreads. I got a lot of questions any one got answers. Lmk Thank You for This Video
The only incentive a doctor should have is the health of the patient and " First do no harm" as stated in the Hippocratic oath! To big pharma, money comes first as amply illustrated by the last 4 years! Money is always an issue with the NHS, but is never a concern for the rich, who benefit from trials on the plebs! I have an enlarged prostate with a highish, but stable PSA. All i want from my specialist is the RIGHT treatment for my condition, which is what ive paid for the last fifty years!
Recurrence after surgery or radiation occurs because the initial biopsy procededure liberates micro cancer cells that then migrate and can show up as tumors years later.
@@DrGeoProstatePodcast I took another PSA test and it’s down to 2.7. Two weeks prior to my first test, I was sick with Covid. So I wonder if that raised my initial PSA. How’s 2.7 for my age?
IMO, you have a high chance of having PCa due to the low free PSA ratio of 8%. See your urologist and if he suggested a biopsy, do not hesitate to go for it. If he doesn't suggest a biopsy then you may need to get a 2nd opinion bc to my eyes, the free PSA of 8% looks quite bad, together with the PSA of 4.8 the whole picture looks even worse. FYI: For most men, free PSA ratio should be 18+%.
@@eric5285 I've just wrote a comment before seeing your updated PSA level. It's very good sign that your PSA level go down to 2.7. It is not alarming anymore. It looks like COVID made it jumped as you guessed. But males in their 40s have a median level of PSA at around 1 only. So your second PSA number is still high compared to your peers. Get the free PSA checked again, it needs to be at least 18% to feel at ease. If it is below that, the possibility of PCa is still high, but given the downtrend of PSA level, all you need for now probably an MRI and monitoring. Note: prostatitis will lower the free PSA ratio too, but the level typically doesn't go that low (8%). Typically it is 15+%.
The MRI is not perfect. My 64 YR OLD friend had a PSA of 6.2. Four months later his PSA WAS 8.2 which prompted an MRI with PIRAD score of 3. His prostate is small, with no palpable irregularities, and he s completely asmymptomatic. He underwent a biopsy which sampled 12 places. Gleason score was 8. He is scheduled for a PMSA, to be followed with cyber knife treatment.
Excellent way to attack the disease. My father goes for a PSMA in a couple of weeks, and I'm fairly certain about recommending the cyber knife treatment as well.
I guess 64 is a good age to loose 2" of penis length,nonejacqlatory orgasms,probable incontinence, and severe ED(there's always a penis pump). No thank you
@todd4952 if one has a biopsy and ANY of the sample cores test positive for cancer would the psa number be irrelevant at this point? I mean cancer is cancer at this point right? Please help me with what I don't understand
I am allergic to MRI contrast (Gadolinium), but my doctor told me that MRI without contrast is useless in diagnosing prostate cancer. Is that true? And what can I do?
Dr. Geo, husband of 66, has a 9.5 lesion with BPH, a PIRADS score of 2-3 with a PSA density of 0.016. No issues except slow urination and mild ED. We are looking at getting a nanoknife IRE. Your take on this procedure? And to shrink his prostate possible getting a PAE procedure. He can't tke Flomax, faints and gets high anxiety attacks, sensitive to drugs. Your thoughts please. His PSA was 5.24 in May, today it’s 5.6, any reason for alarm? This was his MRI back in May: Prostate gland measures 6.6, 5.5, 4.4 centimeters on CC, TR and AP dimensions respectively with estimated volume of 84 cc and PSA density of 0.063 ng/ml/cm3. 9.5 mm ill-defined nodule with obscured margins are noted within posterior medial aspect of left peripheral zone at mid gland which show mild hypointense signal on ADC and mild hyperintense signal on high B value DWI sequences likely representing PI-RADS 2/3 lesion. No other peripheral zone lesion is noted.
Obviously, I cannot diagnose, treat, or suggest specific treatment approaches over the internet. Not only would it be irresponsible for me to do so, but not be helpful. That said, nanoknife is a treatment for prostate cancer, and your comment does not indicate that he has prostate cancer evident from a biopsy which is the only method to currently diagnose this disease. He clearly has BPH from your description and PAE is a potential option as many other forms of treatments are as well. Good luck to your husband.
The psa as a marker for prostate cancer is not the best test . U can hi psa and no cancer and low psa and have cancet. Avoid anybtrestment for cancer till itvhas been confirmed by other tests. Watchful waitingbis best .
![CHILE vs. BRASIL [1-2] | RESUMEN | ELIMINATORIAS SUDAMERICANAS | FECHA 9](http://i.ytimg.com/vi/5ObJt_71AYc/mqdefault.jpg)
2020 PSA was 15.4 Within weeks had MIR at Plymouth UK. Also then within weeks had biopsy. Out of 15 snipes found two areas. Gleason scale 3+3. The decision was just to do PSA tests every 3 months. 3 months later PSA down to 12 Once back cycling jumped to PSA 19 then back down to 15. For the last two years having PSA test every 6 months. After second year had second biopsy they could only find one area. I drink plenty of tomato juice, and glass of water in mornings with bicarbonate of soda in.
3+3 has very low chance of metastasis. Glad you’re doing well.
This makes so much sense. Aside from the awkwardness and discomfort of having to go through a prostate biopsy, it never seemed like a good idea to me to be poking holes in ones prostate. Does anyone know for sure that poking holes in the prostate doesn't potentially allow cancer cells to escape the prostate capsule? It seems reasonable to think that if there were cancer cells in the prostate, a biopsy might cause some to be released and travel through the body.
I have been wondering the possibility of that happening myself.
Can't say with certainty (been doing a lot of research on Prostate cancer in the past 5 yrs since my husband was diagnosed with Gleason 6 3+3, Group Grade 1) but that issue has been brought up in a FB group I am in and the term for what you are referring to is "seeding" which would also apply to breast cancer biopsies.
Like Dr. Emberton said, it's a frequent patient question, and his answer was that he didn't know, and then cited a mouse study where "seeding" took place. There's two components of risk. One is the chance that the event will happen, and two, the severity of the event. For me personally, the potential for a metastasizing cancer outside of the prostate is too great a risk.
Nothing is perfect, this is about the balance of risks and adverse effects from diagnostic tools. It was an excellent discussion. There are too many over enthusiastic urologists over-sampling in biopsies: I have heard of 40 plus samples being taken where MRI indicated only one small localized lesion. There’s a case for that being medically negligent if adverse consequences like bleeding or infection develop; and that omits the whole rather alarming possibility of seeding from withdrawn needles. Moreover histology is itself a by no means perfect tool. The sooner we can get rid of biopsies the better. Dr Emberton’s carefully detailed approach is very cogent.
A friend of mine is an MD/PhD Neurosurgeon, recently retired from everyday practice. Not long ago he nearly lost his life due to an infection from a transrectal biopsy. A future with just no transrectal biopsies sounds pretty good to me.
Absolutely agree.
same. i got ecoli sepsis and was in icu for a week - it was horrendous
It’s amazing that doctors at major medical institutions are still doing trans rectal biopsies. The potential for infection is so great.
@@dondgc2298 It seems to me that perhaps Urology has the widest range of "standard of care" of any specialty,
@@wsteele5864 I agree.
Fantastic...
One of the few experts that had me nodding my head in agreement , instead of saying BS. at every turn.
I would not hesitate to have Dr. Emberton as my oncologist as I feel I could trust him to give full, accurate, and up to date information upon which we would share decision making.
Thank you Dr. Geo for this interview.
But he wont have the amount of time available to explain it to every patient as he is taking here.
@@hikerJohn
Exactly which is why patients need to be given written material to read before meeting with the doctor so the doctor doesn't need to waste his time on the basics.
Just to say that Mark Emberton is Professor Emberton, not Dr. As one of his patients - and a prostate cancer survivor - I can attest to the excellence of his knowledge, skill, judgement and care.
I ended up in the hospital for 4 days with sepsis after a prostate biopsy because the antibiotics were not sufficient. I followed all instructions.
I feel for you brother. Ive had 2 of those stinking things. They have to come with a better way!!
@@petegodfrey5735there is a better way. Transperineal. If your doctor is doing trans rectal - find another doctor.
Thank you for this information. I’m 63 with an enlarged prostate(BPH symptoms) for many years. I just had all blood screening done for first time in many years and my PSA came back 4.6. Repeated a month later 4.6 with free PSA ratio of 18%. My primary doc recommended the 3t MRI. Results were all RDS 1 and one area of RDS 2, with PSA density of .08. My doc referred me to a Uroligist and he did an ISO PSA test which came back 10.7. Because of this, he scheduled a random 12 plug biopsy. Because of great information as this and Dr Ted Schaefer, I have decide to cancel biopsy and go with monitoring at list til MRI shows bad data.
No biopsies would be fantastic news. I have had three biopsies, and the last one led to an extended stay in the hospital with sepsis directly related to the biopsy procedure. I am currently scheduled for a prostate MRI and those results will determine the need for biopsy. I have BPH and for years my PSA has been elevated due to the BPH. With medication there has been a significant drop in my PSA over the last 10 years, but over the last year my PSA went from 4.22 to 6.1 which warrants further investigation.
Dr. Emberton has brought to us years of experience with highly detailed information. I'm just about to get a prostate MRI here in Tallahassee, FL, and I have taken one page of notes for my urologist. The biopsy he insists upon is trans rectal (with antibiotics), and PSMA scans do not seem to be on his radar. Too bad there isn't a Dr. Emberton clone here in Florida.
I’m disillusioned with MRI’s also. My MRI showed Pirads 4-5 (two different interpretations). A targeted biopsy of the “lesion” showed no cancer, however other cores showed a repeat Gleason 3+3….. So now I’m labeled with cancer. Did the two different transrectal biopsies I’ve gone through spread the Gleason 6 cells?? Who knows. My prostate is large so my PSA seems to be 4-5; however one reading was up closer to 9. So did I have inflammation which showed up on the MRI as a lesion?? (Also would cause the higher PSA reading.) Sooooo now I’m headed in for another MRI this coming Monday. I will definitely be resistant to having a 3rd trans-rectal biopsy. Would it be possible to have Dr. Mark Emberton review all of my test results and pathology? It seems that both the Gleason system and the MRI Pirads system are all subject to interpretive error…..
Thanks
Tom - stuck in “Active Surveillance Cancer”
You do not have to worry about G3+3. To call it cancer is debatable, and maybe we should stop doing that. Nobody dies from G3+3. Problem is, that if you got 3+3, there is an increased risk of G4 or G5, and on those you do not do active surveillance. The Protect-study now has 17 years follow-up, and nobody dies, not even those presenting metastatic lesions!.
PSMA PET Scan will light up the carcer cells in your prostate.
I see you commented a couple months ago.I too recieved a Pirad 4 on a recent MRI and immediately my urologist puched the biopsy.Told him I needed to think about this.Been reading lots of info on biopsies and prostate cancer as well..Seems there's plenty of time to decide a plan of attack.Been reading lots of successful cancer patients )Prostate & others) using fenbendazole .Especialy a Joe Tippens Protocol. Have you looked into this? I showed my urologist my plan of attack and he said just do the biopsy and we'll go from there.How did you most recent MRI go?
You and I, have almost an exact scenario. Had an MRI done , it showed a RAD5 lesion 1.62cm , The Dr took 3 extra cores directly from that area ( it was a MRI Fusion biopsy) those cores came back all negative for cancer. However on the left side, the routine 6 cores there showed a 3-3 , a 3-3-, and a 3-4. So now I am also in Active Surveillance mode. By PSA was 4.96 a year ago and 5.1 a year later. Where do we go from here, I have 3 urologists and they all think " I'm theirs", none of them agree on a "one treatment", and yeah this gets complicated. BTW, next time you have a biopsy have a PERINEAL one, I had that, and no pain at all, only peeing for the first 2 days after, but the % of infection with perineal is 0.1. Where are you located? I went to Mt Sinai in NYC , though I live a bit more than a hour north of the City, Mt Sinai was excellent. Best of luck to you in this journey.
If you have any questions feel free to ask. also I should have added I'm 73.
@@RogwinMusicHopefully we will never have to do more than monitor. Please see my latest comment on the gadolinium contrast used with the MRI. Thanks
This has answered many questions I didn't even know I wanted to ask. I am a 60 year old who, apart from going to pee more often at night, had no symptoms but due to high prevalence in the media of the 'importance' of PSA testing, decided to get a PSA test. (wish I hadn't now) After DRE and MRI I discovered I have a PSA of 6.4 with a large prostate of 76ml (PSAD of 0.084) and a very small (7mm) PI-RADS 3 lesion. I went for a guided trans perennial biopsy but when the 1st needle went in I screamed like a bitch so the consultant very kindly suggested I come back for one under a general anaesthetic. He immediately followed that up with the rather disconcerting news that because I'd be under, they would take many more samples from my prostate! whoopee! So I learned about a blood test which tells you if you have or don't have prostate cancer (of any grade) and took it. That came back today positive for prostate cancer (its called the Episwitch PSE test) So this positive test would include 3+3 results. I have subsequently learned of a more specific blood test which I wish I'd known about first called Proclarix, which when combined with "prostate volume" of men with PI-RADS 3 produces quite reliable results in detecting/predicting gleason 7 or higher csPC. It resulted in potentially avoiding 66% of needless biopsies. I was all ready to get this test then I see this video and Mark says that for someone with a PI-RADS 3 lesion and a PSAD of under 0.15 (thats me on 0.084) he would advocate "come back in a year for another MRI" So I'm delighted to hear this as it suggests I'm not as in peril as I thought I was this morning! What do you think? I have no family history of PC or early breast cancer
Thanks for the comment.
Allways such informative conversation thanks Doctors
Brilliant! This is an Honest Man.
I had a PSA done a year ago, 3.5 PSA decided to do an MRI. 2 Rad 4 lesions and my prostate 100cc. I had a biopsy, 14 samples, benign. Great! 2 months ago, PSA 5.25 bummer! I decided to change doctors because I did not feel like I was getting the best care (staff and equiptment). Ok new Doctor, MRI at a different place using their brand new high tech MRI machine. Results NO lesions at all!! Yes, no lesions detected and no signs of prostate cancer. I asked my former doctor why? Well, our equipment is old, and the magnets are not that powerful. Are you kidding me?!? Bottom line PSA in 6 months and praying it's just BPH. Good luck.
Urologists are worse than used car dealers.
Hoping for the best. Kindly update on your condition.
Why did you have an MRI with a PSA of 3.5? Was there some other factor?
@@dondgc2298 Because 3.5 was elevated from my previous PSA test. Read my comment after a benign biopsy my PSA was elevated to 5.25 second MRI completely clear. Doctor says BPH, 2 months until my next PSA.
@@funhumanusa I understand the significant increase from 3.5 to 5.25 triggering an MRI; if you discussed the 3.5 being a jump from an earlier test it must be in another discussion thread here.
It is so rarely spoke of that the tool used for ablation needs to align with the specific area of the cancer in the prostate. It makes me think of all the different types of levels used by tradesmen to find level. Even the Egyptians used a unique method to level the pyramids.
The PSMA PET/CT scan combined with a 3T MRI scan is envisioned as the future method for diagnosing prostate cancer, boasting both a positive predictive value and a negative predictive value exceeding 90%.
I recently underwent these tests in Canada (self-paid for the PSMA PET/CT scan) last month. Despite exhibiting an elevated PSA level (22 ng/ml), high PSA density (0.28 ng/mL/mL), rapid PSA velocity (12 ng/ml/year), short PSA doubling time (9 months), along with an acceptable free-to-total PSA ratio of 17% and a negative digital rectal exam, the results returned negative. Subsequently, these findings were confirmed (more accurately, enhanced) through a systematic transperineal biopsy.
Thanks for sharing. And what was the MRI PIRAD score?
@@suggarface1 The MRI PI-RADS score was ZERO.
Wait, and how did they recommend a biopsy then? Good luck and please let us know about the new results! @@hn5460
Also Canadian, so could u please tell me how much $ we have to pay out of pocket for the PSMA pet/ct scan? Much appreciated Cheers
@@Jack-2day I paid 3,200 CAD for it.
There are:
INITIO medical in Burnaby, BC
VM-Med in Montreal
ResoScan in Greenfield Park, Quebec
There should be some in Ontario as well.
What kind of tests and their results have you done so far? I may be able to offer some insight if you share your info.
The doctor also seemed to allude to liquid biopsies. How close are we to that?
I had IRE(nanoknife) for PCA, no recurrence after 5 years. I was alerted to the possibility by one of the professor's videos.
Before the procedure, I had PSMA PET scan. I live in Australia which, like most countries , has a vastly better health system than the US.
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Fabulous discussion with Dr. Emberton.
I love how prostate cancer doctors speak on how advanced imagery is on a daily basis, but is real quick to pull out that biopsy gun. When the pc returns and then they do a psma. Sometimes they find the cancer in the prostate bed....Hello..most likely the biopsy site..biopsies are medieval and outdated unless they are targeted one's. Why do radiologist have a higher success rate, maybe because the bed gets a proper dosage...especially guys who do seed implants.
One additional comment, - I’m reluctant to keep getting gadolinium contrast with my MRI’s. To much gadolinium!!!! My doctor told me that the gadolinium contrast was not necessary. Unfortunately I’ve never been asked if I wanted the gadolinium…they just went ahead and used it
100%...excellent. Maybe one could put together a criteria list of types of lesions and locations that would be cross reference to energy types for treatment.
That is a good idea and one that is being worked on. A lot will improve through AI technology on this front.
This is a very informative discussion. I'm only two months into my PCa situation, currently researching as much as I can. The fog is slowly lifting....
Great to hear.
@@DrGeoProstatePodcast If a cancer and non cancer patient complaining of the same enlarged symptoms why go to all the risky procedures associated with finding a positive cancer in a suspect case when to just introduce the many interventional type procedures ie in embolization shrinkage would cure the cancer patient thereof because as we know most of these people die of something else anyway! Surely there needs to be other methods of outwardly assessing the general ongoing heath of these patients that maybe only complaining of unary inconveniences no more than the non cancer patient saving a lot of unnecessary suffering and cost to the national heath care system. I'm eluding to people thought to have what might be a mild form of the disease........?
Surprised no mention of the new PSE blood test, It's 94% accurate in detecting PC, PSA is only 55%
What about prostate resection for those of us that have real trouble peeing? Is there a video on that?
Superb interview. Every man deciding on an approach to diagnosis or treatment should play this full interview.
You (the patient) might want to first learn some of the basic terms such as Gleason, PiRad, MRI, PSMA Pet scan and a few others.
This video provides state of the art info that can be life changing.
I had prostate removal in Feb 2021. PSA 17, PiRad 4, Gleason 4+3 confirmed post op.
So far the cancer is totally gone. I did suffer severe incontinence though from the surgery and that diminished my life quality severely. 2 years of great difficulty. Walking = leaking. It was cured with a sling surgery in March 2023, but the emotional impact lingers.
I’ve had two transrectal biopsies in the West Midlands last one in 2018! Now been offered a transperineal biopsy based on a pirate 3 lesion on an an MRI the quality of which I have not yet been told
I had the MRI scan 4 years ago having had a biopsy 5 years prior to that.
Hello Dr. Geo, I had a PSA go from 5 5 - 7 in about 7 months. MRI Showed a T2 PRad 5 lesion in the 2PM location. The next step is Biopsy via needle. The Dr. Tells me there still a possibility of no cancer as there were signs of scars that must have healed from prostatitis they suspect. Seeding is of concern to me. Is there some other blood test like PCE or Circulating DNA you would recommend? If so who my do it? Im in Philadelphia PA, USA My urologist firm told to refrain from googling anything....
Very informative, and in addition to that, this conversation truly reveals how superior The English language is to American😂
Is there any room for aquablation in your treatment process!?
How do you get a gleason score if no biopsy where primary treatment of the gland is radiation.
Wondering what about a pirad 4 with low PSA
Does it get a biopsy ??
Brilliant, what a great presentation
Glad you liked it!
Like to know more details about without biopsy how to get cancer detection done. Thanks
I have problems urinating. Weak urine stream and an urge to urinate a lot. So blood in urine. What does this sound like? I got a pirads 3 on the prostate mri. Radiologist noted lesion and bph on report
I had a prostate MRI. Came back as pirads 3 lesion and bph. What should I do?
The City of Hope is adding Ivermectin to TNBC treatment, University at Glasgow is adding Mebendazole to Docetaxel for PC, Dr. Marc-Eric Halatsch is using Itraconazole in a 9 repurposed drug protocol for Glioma and Glioblastoma. Dr Tim Rogers YT video on Artemisisin and Fenbendazole has some comments you may be interested in.
Not only was Australia ahead on PSMA, but on radioligand therapies as well.
>>Undetectable levels of Prostate Specific Antigen (PSA) have been reported from the first patient with metastatic castrate-resistant prostate cancer (mCRPC) to ever receive two cycles of Clarity’s 67Cu-SAR-bisPSMA at the 8GBq dose level. PSA is a marker of tumour burden, clinical response to treatment and an indicator of the recurrence of disease for prostate cancer.
68 yo. PSA bouncing from 2-10 over the last 8 years. Currently at 3.0. Two biopsies ( 2017 and 2020 ) came out negative. The second biopsy was performed after an MRI showed two spots on my prostate ( PIRADS score of 4 ). Then 4Kscore and ExoDx (44%) tests that showed a high probability of getting prostate cancer. My Dad had prostate cancer at age 78. I just had my third MRI and biopsy ( MRI showed two PIRADS score of 4 ) and waiting on a meeting with my Doctor. I viewed my report and samples 1-5 showed benign prostate tissue with chronic inflamation. Samples 6-15 showed benign tissue. Let's see what my Doc says.
No cancer was found in all biopsy samples. Great news but confused as to why two MRI's showed lesions and two MRI fusion biopsies came back negative. Anyone else experience this ?
Very interesting & logical thinking. Thanks for this video.
I had a MRI which came out negative but than my psa level went little higher than I did a biopsy than the Dr said I have cancer in my prostate. Tomorrow I going for the pet scan to see If the cancer spreads. I got a lot of questions any one got answers. Lmk Thank You for This Video
Interested to know how you got on , been on active surveillance for 15 years , I'm 72 now .
I'm.a bit confused myself had biopsies mris etc
do I need to undergo biopsye to determineb I have cancer
The only incentive a doctor should have is the health of the patient and " First do no harm" as stated in the Hippocratic oath!
To big pharma, money comes first as amply illustrated by the last 4 years!
Money is always an issue with the NHS, but is never a concern for the rich, who benefit from trials on the plebs!
I have an enlarged prostate with a highish, but stable PSA. All i want from my specialist is the RIGHT treatment for my condition, which is what ive paid for the last fifty years!
Thank you
Recurrence after surgery or radiation occurs because the initial biopsy procededure liberates micro cancer cells that then migrate and can show up as tumors years later.
Is there any scientific research or data that supports this claim?
Best provide some evidence before making such claims.
And your evidence for this is??
I have pirads 3 lesion. Is there a way to find out if i have prostate cancer without biopsy?
No, but ExoDX may suggest you don't need a biopsy.
@@mperloe how do I get this test? Is it covered via insurance?
My total PSA is 4.8 and Free PSA is 8% or 0.4 NG/ mL. I’m 48 years old. How serious is this ?
There is no way that You van avoid a visit to a urologist. But serious or not, no way to judge online.
Your PSA is high for your age my friend. Get it checked by a urologist.
@@DrGeoProstatePodcast I took another PSA test and it’s down to 2.7. Two weeks prior to my first test, I was sick with Covid. So I wonder if that raised my initial PSA. How’s 2.7 for my age?
IMO, you have a high chance of having PCa due to the low free PSA ratio of 8%. See your urologist and if he suggested a biopsy, do not hesitate to go for it. If he doesn't suggest a biopsy then you may need to get a 2nd opinion bc to my eyes, the free PSA of 8% looks quite bad, together with the PSA of 4.8 the whole picture looks even worse.
FYI: For most men, free PSA ratio should be 18+%.
@@eric5285 I've just wrote a comment before seeing your updated PSA level. It's very good sign that your PSA level go down to 2.7. It is not alarming anymore. It looks like COVID made it jumped as you guessed.
But males in their 40s have a median level of PSA at around 1 only. So your second PSA number is still high compared to your peers. Get the free PSA checked again, it needs to be at least 18% to feel at ease. If it is below that, the possibility of PCa is still high, but given the downtrend of PSA level, all you need for now probably an MRI and monitoring.
Note: prostatitis will lower the free PSA ratio too, but the level typically doesn't go that low (8%). Typically it is 15+%.
rather have MRI and other non-invasive tests......PSA currently 14......monitoring
thank you very much Drs from oz xx
The MRI is not perfect. My 64 YR OLD friend had a PSA of 6.2. Four months later his PSA WAS 8.2 which prompted an MRI with PIRAD score of 3. His prostate is small, with no palpable irregularities, and he s completely asmymptomatic. He underwent a biopsy which sampled 12 places. Gleason score was 8. He is scheduled for a PMSA, to be followed with cyber knife treatment.
Excellent way to attack the disease. My father goes for a PSMA in a couple of weeks, and I'm fairly certain about recommending the cyber knife treatment as well.
I guess 64 is a good age to loose 2" of penis length,nonejacqlatory orgasms,probable incontinence, and severe ED(there's always a penis pump). No thank you
What is cyber knife treatment?
Need a targeted MRI because it showed up on mine. PSA tests not reliable maybe 30 -40% accurate
@todd4952 if one has a biopsy and ANY of the sample cores test positive for cancer would the psa number be irrelevant at this point? I mean cancer is cancer at this point right? Please help me with what I don't understand
Uk does transrectal now , I had 1 🇬🇧
I am allergic to MRI contrast (Gadolinium), but my doctor told me that MRI without contrast is useless in diagnosing prostate cancer. Is that true? And what can I do?
Why did you undergo a biopsy when your MRI showed no visible lesion in question ?
I had reading PSA 17 how serious is it.
They say over 4 you may have prostate cancer.. you better get to a doctor .. I was 5.6 had prostate cancer. Had it removed
My PSA is 1862. Still have to wait 3 weeks to get in to see the surgeon. Canadian Healthcare at its best.
Great job Dr. Geo !
First class seminar!
if my psa is high is it probablitues of bph or prostitis or cancer
Dr. Geo, husband of 66, has a 9.5 lesion with BPH, a PIRADS score of 2-3 with a PSA density of 0.016. No issues except slow urination and mild ED. We are looking at getting a nanoknife IRE. Your take on this procedure? And to shrink his prostate possible getting a PAE procedure. He can't tke Flomax, faints and gets high anxiety attacks, sensitive to drugs. Your thoughts please. His PSA was 5.24 in May, today it’s 5.6, any reason for alarm? This was his MRI back in May:
Prostate gland measures 6.6, 5.5, 4.4 centimeters on CC, TR and AP dimensions respectively with
estimated volume of 84 cc and PSA density of 0.063 ng/ml/cm3.
9.5 mm ill-defined nodule with obscured margins are noted within posterior medial aspect of left
peripheral zone at mid gland which show mild hypointense signal on ADC and mild hyperintense signal
on high B value DWI sequences likely representing PI-RADS 2/3 lesion. No other peripheral zone lesion
is noted.
Obviously, I cannot diagnose, treat, or suggest specific treatment approaches over the internet. Not only would it be irresponsible for me to do so, but not be helpful. That said, nanoknife is a treatment for prostate cancer, and your comment does not indicate that he has prostate cancer evident from a biopsy which is the only method to currently diagnose this disease. He clearly has BPH from your description and PAE is a potential option as many other forms of treatments are as well. Good luck to your husband.
@@DrGeoProstatePodcast is not an ill-defined nodule of the prostate a mass/tumor?
@@janetw9430 it may or may not be with a PIRAD 2-3 and has to be confirmed by a biopsy.
The breast cancer is needle biopsied will nilly. What about breast?
I was told the biopsy doesn't spread the cancer.
The biopsies are rather primitive indeed. It would be an improvement.
The psa as a marker for prostate cancer is not the best test . U can hi psa and no cancer and low psa and have cancet. Avoid anybtrestment for cancer till itvhas been confirmed by other tests. Watchful waitingbis best .
PSA is not a marker to diagnose prostate cancer. It’s an indicator that more examination is needed.
The NHS stopped doing transrectal prostate biopsies years ago? That isn't right. They're still doing them.
Yes I had 1 last year
If you’ve ever had a prostate biopsy 🙋🏻♂️ you will want to avoid it!🙄
HISTOTRIPSY !!!!!
So basically still mutilating men, very sad indeed.v