You guys have been a Godsend in my short journey so far. I cant say enough about how you helped me understand this disease. Thank you from the bottom of my heart. ❤
Both of you are great. I am a doctor and was diagnosed with Prostate cancer in 2019(Dec) -- with breach of capsule and involvement of both seminal vesicles. PETCT showed no metastasis. Gleason (4+3) PSA 75 at diagnosis... treated with ADT (Zoladex) and radiotherapy and my PSA dropped to .05. It is about five years now since I was diagnosed --- and all the while Dr. Scholz and you have been such a support. Keep doing the good work -- God Bless
2015 Gleason 4+5=9 Tp3a, surgery, Radiation Proton. Xtandi lypron. Currently 0.14 . I've been off Xtandi. Lypron for 160 days. Still 0.14 psa. Yes weight training three days a week. Good luck. I'm 70.
I am a hormone sensitive olio metastatic PC patient who has been on Eligard for 5 months and Xtandi for 4 months whose PSA went from 99 in 5 months ago to 3.9 at my 4 month mark. . I have Radiation scheduled for gland lymph nodes, seminal vesicles iliac bones and a rib starting next week at UCLA. I’m concerned that PSA while consistently dropping has not come down yet to below .1. I look forward to post SBRT PSA test levels going down further and not plateauing or reversing
I've been following this channel now for quite a while. It's Fantastic. I'll be seeing my Dr. next week to see how or If my PSA has risen from 2.1 to something different. It usually goes up every year which Really CONCERNS ME!!
Thanks Alex and Dr.Sholtz for getting me through some difficult challenges...Gleason 9 ,pyriads 5 , 2.9 cm ( yikes) ...😮. God Bless and keep doling out hope and knowledge to us all.
I have been diagnosed with Prostrate Cancer, I have been on ADT for 3 months. I go the gym 4 times a week, I bench press 75Kg (165lb), leg press 150kg (330lbs). I practice Intermittent Fasting 1 or 2 weeks a month and avoid processed and most sugary food. I do 15 minutes Static Stretching every day. I have zero sex drive and experience hot flushes but my muscle tone has not changed. I am 72 years old. I have been doing this stuff most of my life so not everyone will be able to but I highly recommend that anyone on ADT do regular exercise with some use of weights. The owner of my gym and has been diagnosed with prostrate cancer himself and has designed a program that we believe is beneficial for bone mass and muscle tone. Maybe it is early days, I hope not.
Another excellent and informative discussion on something many of us are dealing with. Another nice tie too! There’s realistic reason to be optimistic and this probably also helps with the battle and also how we enjoy life. I didn’t realize how powerful hormone therapy is. I’ve opted for Nano Knife. 🍀
Thank you both so much for such an informative and helpful video My husband and I are so appreciative of your knowledge and experience. We started watching your videos last May. My husband opted for radiation and 6 months of Orgovyx hormone therapy at Rochester Mayo.
Just curious, am soon to be in similar place, have begun Orgo Therapy, do you know approx. how many Gray units (Grays) they prescribed for your radiation ?
@@jamesrhoades1524 It will be Intensity Modulated Photon Radiotherapy (IMRT) to 60 Gy in 20 treatments daily Monday through Friday to prostate and pelvic lymph nodes. Do you know what your Gys will be?
For me (and I respect others choices) the question of whether or not to use ADT is whether I want to exist or to live. The changes that ADT bring to a person's daily life and quality of life should not be minimized. It is not a matter of not understanding how effective ADT may or may not be in extending life but what kind of life that would be.
I was diagnosed at 50 and went on ADT because my oncologist encouraged it and I was uneducated with the side effects. It is easy for people who have never been on ADT to minimize the side effects and give you the “well it will keep you alive” story. I would never have gotten on ADT if I knew the toll it takes on you mentally and physically. After 11 months, I decided to take my chances.
Please let me say that I have been receiving ADT for about a year now and of course it does have some effect on me and my body. But it is essentially minimal. Certainly everybody is different and ADT really does affect people differently. Just thought I would throw in my observation.
Dr. Scholz says PSMA Pet/CT Scan is practically revolutionary. He can kindly expand on that a little more. For a layman, that is a big deal on two levels. It so clearly defines the cancer if there is any that it enables the doctors to more prescribe the type of treatment well as the length of that treatment. Second it helps to remove a lot of unnecessary anxiety on the part of the patient.
G 4+3 psa 34 oligo one metastasis on tep choline. Xtandi lupron and radiothérapie prostate pelvic and met. Psa indétectable since 4 years but doctors want me to stay on ADT. My decision is to stop everything and monitor my Psa . We have now the game changer : Psma Pet.
Dear doctor, I am diagnosed with prostate ca last year. My Gleason score is 3+4 I have BPH condition too. 1. Do I have to under go proste biopsy again soon? 2. What is my prognosis? 3. My PSMA done lately. Cancer has not spread to lymph nodes 4. My father died of prostate cancer when he was 72. My PSA is 5.9 I Kindly request you to answer my above questions 🙏
I just found out about 2 months ago that I have Prostate cancer my Gleason score was 7 with 40 PSA and given only 2 choices surgery (Total removal along with nerves) Or Radiation with seeds, it's crazy hearing that there is treatment because I told him I would go with the surgery because of limited choices. I'm a 51 Year old so-called African American
@@lbaker9625Totally agree. A 2nd opinion is my thoughts. If you go the route of brachytherapy, find out how many of these procedures your oncologist has performed in a year, in a month.. It's a very skilled procedure, not all radiation oncologist are trained, and perform this procedure on a monthly basis. The higher the volume, the more skilled. Why only given two choices? That should be concerning to you. Why surgery that removes the nerves? I hope you fully understand what that can mean, since you are only 51 years old. Is the location and the extend of your cancer warrant the removal of the nerves? Typically doctors and patients wants to save the nerves. Will the surgery be a robotic-assisted radical prostatectomy? Do you have an unfavorable Gleason score of 7? meaning a 4+3 Did you get a PSMA Pet scan? Knowing early after diagnosis whether the cancer has already spread is key to better optimizing the treatment. Risk level is all about matching the right treatment to the right patient, so it’s very important.
Thanks a lot for the great videos. It has been very helpful for me to understand about the disease. My father aged 72 is recently diagnosed with PC which is metastatic and spread to 5 lymph nodes in pelvic area (as seen from PSMA PET Scan) with large gland of size ~125 cc. The biopsy report shows Gleason of 10 (5+5) with Cribriform pattern and 50-80% involvement in all the 28 cores. His PSA is about 21 (which was ~14, 4 months back). I am trying to educate myself with the terminologies and it seems to me that PSMA PET Scan provides a better representation of spread of the cancer vs the Gleason score. I am trying to understand, if the hormone therapy and radiation will be the form of treatment or some other form of treatment will be more appropriate here in your opinion. My confusion is usually it seems like with high risk cases, both ADT and Radiation are done simultaneously but with large gland there can be more side effect so waiting for radiation therapy is generally considered or it is still advised to do together. Also is surgical removal of prostate a viable option in this case ? Based on my read (at American cancer society articles) that seems to be more risky as it has spread in lymph nodes. Thanks in advance!
For what it's worth, my husband was diagnosed with stage 4 PC, 3 1/2 years ago, Gleason 9, PSA 23, with mets to the abdominal lymph nodes and suspicious, but tiny lung nodules. As a Mayo Clinic patient, he was intitially treated with 26 rounds of radiation (no surgery) and began ADT therapy (Lupron injection every three months + abiraterone) right after his diagnosis. Within a few months, his PSA dropped to
@@ga6589interested in reading your comment, thanks, but wondering why if the cancer returns it will be treated with chemotherapy instead of radiation again? I have a close family member with a Gleason score of 4+4=8 and a PSA or 12.5 and it’s 7 months since the suspicion of prostrate cancer, he’s had the Dre examination, two months after that the MRI, and one month after that, the needle biopsy. The DRE examination revealed a hardness and suspicious area on the right side. The MRI confirmed a small tumour, but showed it contained in the prostrate with no evidence that it has spread into the pelvis. A bladder camera work shows the bladder clear. Then he had a bone scan recently, we await results of it. All those procedures yet no treatment. Months ago he could have been put on hormone treatment to block its growth and spread. Very slow to actually start dealing with it, just delays waiting on more procedures. We think they will give him more weeks to await and have a PET scan. I know the procedures are important but why not arrange them quicker or near the same time giving a few days apart? Don’t know, don’t understand! But we are hopeful if your spouse has got a good outcome, perhaps the same for my relative.
@@BlueFlame-q6s If the cancer returns, radiation isn't necessarily off the table to treat specific spots. Chemo treats the stuff you cannot see on scans. I am sorry to hear that your relative's treatment and testing are delayed. My husband was started on ADT (hormone) therapy immediately after he was diagnosed, followed by radiation. Along with CT and bone scans, he was also given a PSMA PET scan right away, which is the gold-standard for determining if and where the cancer has spread. The Mayo Clinic schedules all the scans on one or two days and the results come back very quickly. The efficiency of the place is phenomenal. If I were your relative, I'd get a second and third opinion. Best wishes !
@@ga6589 thank you for your help. We are in the UK. I have heard of the Mayo Clinic, and certainly when they can do all the scans in one day or two then the British NHS should be able to do the same. Hopefully it won’t make much difference if any caused by delays between scans and procedures but it’s been torture awaiting each procedure and awaiting results and knowing that it would not have been wrong to be jumping into hormone therapy for it to have been started months ago after the MRI scan. Thank you!
Hi Doctor, I am 66 10/12th years old and have BPH. I have had elevated PSA for over 8 years, but it is not rising at a fast pace. I am at 7.25 now and was 8.75 last year. 6 years ago I was at less than 5. I have had 2 prostate MRIs in the past 2 years that showed NO lesions and had a Pirad score of 2 both times. I actually have another MRI later this month. I have also had a gene mutation test at Northshore Medicine that showed I am at a low risk of developing prostate cancer by the age of 80. I have 2 older brothers that had/have prostate cancer and have been treated. 1 with a prostatectomy the other with seeds implanted. I am considering having the HOLEP procedure at Northwestern Medicine in Lake Forest, IL to help with BPH. Should I get a biopsy before the HOLEP? The doctor that would do the procedure says I can go ahead with it because of my MRIs and gene mutation test. She said itt is the ultimate biopsy and all the flesh removed will be sent to the lab, Please advise. Thomas I.
Having the BRCA genetic variant is already a poor prognosis predictor. My father was checking PSA every year. It went from 3.9 to 5000 in less than a year. Bone metastasis. Two years later the cancer is in his liver and lungs and we’re now down to months.
I've been on Orgovyx and Abiraterone almost 6 months now and doing pretty good. I've kept up my regular cardio, walking, biking, hiking, and push-ups, stretching, etc. to mitigate muscle mass loss, and to boost my energy level. I get the hot flashes throughout the day/ night but have gotten used to them. PSA has been undetectable since beginning hormone treatment. I'm 16 months post prostatectomy, and 2.5 months post radiation for micro metastatic spread outside of the prostate and pelvic lymph nodes discovered from prostatectomy. They want me on two years of hormone treatment. Doc says it will starve and kill remaining cells over that time frame. I hope so.
Thank u for this video in fact thank u for all the videos in which you have helped me to make my decision in fighting my prostate cancer. My PSA isn’t undectable but it has gone all the way down to 0.07 from 3.65 last year. I am on ADT since December of 2023 and had my second injection in June with my next being this coming December. Outside of hot flashes I feel great and continuing on with life thank God. I’ll have my next visit with my oncologist in December and PSA test. I’m praying my number goes down even lower. Last November I had the the PSMA CT SCAN which showed no cancer spread thanking God again. I’m on this journey and keeping positive, working, and enjoying life to the fullest.
What went wrong?.... It was 7 sessions of R/T over two + weeks… However after the second day of treatment, I experienced pain whilst urinating and the flow was extremely small. This continued for months after R/T ....but in addition soon after my "poo" had been almost non existent with mucus mostly and very occassionally a smallish lump of poo. I had been taking water and with very little pee, but with determination and concentrating beyond the pain, I had managed to urinate very small amounts. In effect I could not poo or pee effectively. I had been eating well and drinking well as advised. I was afraid of going to bed at night because of the fear of pain and not being able to empty my bowels nor pee enough....I set my alarm every 30 minutes so that I could get up and at least get some pee (very little) and occasional poo (only mucus and wind and very little poo). It appeared that if I could get a decent poo, I could urinate much better. On the 6th R/T session, I had a panic attack due to pain and called it to stop at the very end of the session and then rushed to the toilet to ease the pain a bit. I asked one of the nurses if it was possible for me to get a catheter in case of emergency because of my extreme fear of not being able to pee. The radiographer decided to do my review that day which was the final review and she told me that this was to be expected and she gave me one large pad and three urine bottles for use if necessary in a plastic bag to take away. It was also mentioned that the effects of R/T are likely to get worse over the next few weeks due to "flare ups". A week after my R/T I had to call out the doctor because of excruciating pain and unable to pee and then emergency nurses appeared and fitted a catheter and a very large of urine removed. Later I had to have a permament catheter fitted for a month because I could not pee. Later still I was prescribed Tamsolusin and eventualy talked to a surgeon who informed me that he could not operate to clear the blockage because I had had R/T to the prostate and I would be either on a permament catheter of self catheterisation....Very depressed. Not long after having been instructed on the use of self catheterisation and supplied with lots of catheters by the NHS, I somehow managed to force myself into peeing with great pain and from then on it improved gradually, (suggested it was Proctotitis), until at least a year later I am still managing to pee with effort and frequency and with the pills (Tamsolusin one per day). My poo cleared up about a month after the R/T and is now normal. 18 months after the R/T my only problem other than tiredness is weak flow and frequency of peeing...But at least it works in a fashion without the use of catheters. Relief! But the question still on my mind is, what went wrong if anything?
Can anyone direct me to where I might find stats for men who do not opt for any PaC treatments and what their life expectancy might be? I closest I have found is from Sloan Kettering nomograph based on each patients specific health status and prostate numbers. I would appreciate the help. Thanks....
I had a prostatectomy in 2015 and started with 0 PSA.Fast forward the PSA was 0.270 in 2023 to 0.520 in 2024.Took a Pet scan which showed no cancer but Doc still thinks I have cancer and recommends Radiation.I am at a standstill of what to do.Any recommendations for this soon to be 74 year old?
I have been down this road had prostate out went on to have radiation six months of adt i would wait and get a pet scan again in 6months time to see if they can find the cancer . I would like to point out my psa is going up again and have been told they will do a pet scan again when i get to 0.40 and if no cancer is found they will wait and pet scan ever 3months till they find it. you have time on your side no rush at all.
@@andrewgynn4502 Thanx for your input.I went to see them today about taking lupron at the same time as Radiation.Probably will not take it and they too offered another PET as soon as I do another PSA in November.Their reasoning is that they have seen many cases such as mine and say that a fast rising PSA indicates cancer.It has gone up and down before.If it goes down this time I will not worry about it for awhile.Good luck to you on this.I know for me it is a nagging thing to have this on my mind.
Curious, why is PSA considered but seldom the PSA DENSITY??? Why is there not more attention paid to PSA doubling time before diagnosis to gauge the aggressiveness of a man's cancer??? Can you clarify these important questions in a future video, PLEASE????
I think people can have a 0.15 PSAD but sill need immediate treatment or would be on AS. PSAD is recognized as an important indicator of cancer progression and a predictor of upgrade. This comes from Peter Carroll at UCSF.
What if MRI results Pi-rads is 4 and 6 months later your PSA drops from 6.4 to 3 should still considere for biopsy? I’m trying to avoid biopsy as much as possible.
You can see the definition of PIRADS4 below. PI-RADS 4: high (clinically significant cancer is likely to be present). Only the pathology can tell you if it’s cancer and give you the pattern, type, and Gleason score. Knowing your BRAC 1/2 genetics and getting a Decipher test will also help you manage risk. PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2: low (clinically significant cancer is unlikely to be present) PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal) PI-RADS 4: high (clinically significant cancer is likely to be present) PI-RADS 5: very high (clinically significant cancer is highly likely to be present) PI-RADS X: component of exam technically inadequate or not performed
Hi, I was diagnosed with PC 6 months ago. I initially refused a biopsy because I’d heard stories about the actual biopsy causing the cancer to spread because the prostate capsule was breached with the biopsy needle. After a lot of research I found out that this was almost unheard of so I agreed. Got to be honest, it’s not the most pleasant of procedures but if there’s a chance you have PC, find out for sure, if, like me, it’s caught early before it spreads the treatment is curative. 👍
There is no reason to avoid a biopsy if your urologist thinks it is indicated. If you have the transperineal procedure under anesthesia, there is no discomfort, no anxiety, and extremely low risk. That’s how I did it and looking back, I’d rather have another prostate biopsy than a tooth filling. It was a quick and trivial procedure from the viewpoint of the patient because you’re out. And no, there is little to no pain. During the procedure they numb that area well and deeply so for the first few hours there is no discomfort. Then when that wears off, it only feels a bit sore in the general area. Nothing to it if you have general anesthesia. 🙂
@@bartram33 3+4 and 4+3 is almost always curative. Also, 3+4 very rarely spreads outside the prostate. Some men will live 10 years before they have to have radical treatment.
@@MM-sf3rl I’m 4+3, PSA 10.7. T2. I was a bit worried when I went to have my ADT jab and asked the urology practitioner nurse who gave me shot does this help, she looked at me surprised and said ‘your treatment is curative, see you on the other side of your treatment’.
in Australia 1 shot of Eligard 22.5mg lasts 3 months $713 australian dollars, I had 1 shot 2 months before radiation and another shot after radiation had finished. my initial PSA was around 7 after 65 1/2 months eligard PSA dropped to 0.05 ng/ml. feel very tired
I am sure that I have heard Dr. Scholz say that the median time to castrate resistance on modern combination ADT is 17 years…can someone help me find that video? Is that statement true for most Gleason scores and most situations…I have positive pelvic lymph nodes, of course hoping for a cure but would like to know that I had a safety net if I don’t get that cure???
These folks have posted hundreds of videos, Paul. I have found it useful (and comforting) to watch each video and take notes, carefully timestamping the points of interest in each video. Sometimes the Doc says things that sound like they conflict with other things he’s said, but it’s usually a matter of specifics, e.g. what’s true for one Gleason score or cancer load may not be true for another. As to your question, I’m sorry to say that I don’t think you can count on it taking 17 years to castration resistance. There are studies out there where it’s much sooner than that, but again it’s a matter of specifics: these studies usually target men with high loads of prostate cancer. If you can take anything away from my long response, it’s this: 1) Watch all the videos and take notes. Knowledge is power. 2) Take some comfort in the fact that there are tons of effective treatments out there, and more on the way. Odds are you can and will benefit from them. 3) Godspeed to you and the rest of us fighting this disease.
@@edg531thank you for your quick response! Dr Scholz’s videos are indeed very informative and encouraging! I have encountered the studies you mentioned, and I have been trying to make sense of the disparity…
@@davidjamespeterson Apparently it slows or even stops the growth of the cancer cell. It doesn’t kill them it just weakens them and stops them multiplying.
My husband has been in remission on ADT for 3 1/2 years. (He also had 26 rounds of radiation.) Iniital diagnosis was stage 4, mets to the abdominal lymph nodes, and suspicious, but tiny lung nodules. His recent PSMA PET scan shows no sign of cancer. From what I understand, the hormone therapy blocks the production of testosterone, which the PC depends on in order to grow.
I’m going to be honest, it’s past time to put hormone therapy in the dark ages where it belongs and come up with something new. My guess is that most of these doctors that prescribe hormone therapy have zero first hand experience with it and simply can’t relate to what it feels like to actually be on what I refer to as the devil’s cocktail. I understand that hormone therapy works, it’s working on me now, but overall medical science needs to get off their ass and develop something that is not so life altering both physically and mentally.
This is an evolutionary process and medical research has come a long way. Let's not forget that Dr. Charles Brenton Huggins won a Nobel prize for medicine in 1966 for his work related to prostate cancer. Back then, the miracle procedure was surgical castration.
I did 6 months of hormone therapy with Orgovyx while I underwent radiation. I had every side effect possible and it was severe. At one point I was suicidal. I told my urologist if I get a recurrence hormone therapy is not an option.
@@brockjennings I’m not talking about the overall prostate cancer discoveries, just that hormone deprivation therapy is certainly archaic by modern medicine standards. Btw, as important as Huggins discovery was he used one test patient in his research? You have to admit that medical science needs to come up with an alternative to ADT but for me, it’s too late.
Absolutely agree!! I so much wish there was a less debilitating treatment that was just as effective. I'm at 18 months and hope to get my life back soon!
Not 100% of doctors are in the top 10% of experience and qualifications and practicing current state of the art medicine in 2024 at a center of excellence. Many patients do not have adequate insurance and adequate self education.
What I’d like to see is a 3D model, computer aided and three D printed. Just show me. And not some Rorschach Test of the MRI. I don’t think patients can really visualized just where the cancer is, how close to the urethra, or transitions zone that then in the anterior and abuts the base. The only time is when you have the consult, the day before treatment, and there and then you need to make a decision. Very time-share, high pressure, deal.
: ADENOCARCINOMA, Gleason 3+4=7 (Grade Group 2). 1. Left Base: Adenocarcinoma, Gleason 3+4=7 (10% pattern 4) involving 1 core. Core involvement: 25% (1mm). 2. Left Mid: Adenocarcinoma, Gleason 3+3=6 involving 1 core. Core involvement: 27% (3mm). 3. Left Apex: Benign Prostatic Tissue. 4. Right Base: Benign Prostatic Tissue. 5. Right Mid: Benign Prostatic Tissue. 6. Right Apex: Benign Prostatic Tissue. 7. Lesion #1: Adenocarcinoma, Gleason 3+4=7 (10% pattern 4) involving 1 core. Core involvement: 25% (3mm) discontinuous. Adenocarcinoma, Gleason 3+3=6 involving 1 core. Core involvement: 90% (9mm). Gleason Grade Group: 2 (1-5) Prostate size (on MRI): 44 cc Component Ref Range & Units 3 mo ago (8/5/24) 6 mo ago (5/7/24) 1 yr ago (8/18/23) 1 yr ago (2/20/23) 2 yr ago (6/6/22) 2 yr ago (5/16/22) 4 yr ago (8/17/20) Prostate Specific Ag, Serum 0.000 - 4.000 ng/mL 5.757 I am a 59 y.o.male PSA 5.757 and biopsy proven adenocarcinoma of prostate looking at radical prostatectomy and have talked with Dr about possible external beam radiation, brachytherapy ,hormone therapy, cryotherapy, and possible active surveillance what would you suggest to do with the above thanks
You guys have been a Godsend in my short journey so far. I cant say enough about how you helped me understand this disease. Thank you from the bottom of my heart. ❤
🇺🇦ditto
Two lovely people making the world a better place.
Both of you are great.
I am a doctor and was diagnosed with Prostate cancer in 2019(Dec) -- with breach of capsule and involvement of both seminal vesicles. PETCT showed no metastasis. Gleason (4+3) PSA 75 at diagnosis... treated with ADT (Zoladex) and radiotherapy and my PSA dropped to .05.
It is about five years now since I was diagnosed --- and all the while Dr. Scholz and you have been such a support.
Keep doing the good work --
God Bless
Did you have any major side effects from your radiation treatment?..and what kind of radiation application. If you don't mind me asking sir.
I'm also happy you're doing fine
Great reassuring video. Many thanks 👍
You both are a beautiful gift to the prostate cancer community. Blessings over you.
Thank you for your kind words, Mark! We are happy you're here
DR. Scholz is the best.
2015 Gleason 4+5=9 Tp3a, surgery, Radiation Proton. Xtandi lypron. Currently 0.14 . I've been off Xtandi. Lypron for 160 days. Still 0.14 psa. Yes weight training three days a week. Good luck. I'm 70.
I am a hormone sensitive olio metastatic PC patient who has been on Eligard for 5 months and Xtandi for 4 months whose PSA went from 99 in 5 months ago to 3.9 at my 4 month mark. . I have Radiation scheduled for gland lymph nodes, seminal vesicles iliac bones and a rib starting next week at UCLA. I’m concerned that PSA while consistently dropping has not come down yet to below .1. I look forward to post SBRT PSA test levels going down further and not plateauing or reversing
What a great show and so much needed. Thank you. These conversations are the best❤
I love you Alex you are so genuine
Thank you for being such a good source of information. Much appreciated!
I've been following this channel now for quite a while. It's Fantastic. I'll be seeing my Dr. next week to see how or If my PSA has risen from 2.1 to something different. It usually goes up every year which Really CONCERNS ME!!
The work your team is doing and the information you are providing is incredibly powerful, essential and confidence building. Thank you so much.
Thanks Alex and Dr.Sholtz for getting me through some difficult challenges...Gleason 9 ,pyriads 5 , 2.9 cm ( yikes) ...😮. God Bless and keep doling out hope and knowledge to us all.
This is yet another oustanding and encouraging video from you both. I'm proud to know you and so appreciate the blessing you are in my life!
I have been diagnosed with Prostrate Cancer, I have been on ADT for 3 months. I go the gym 4 times a week, I bench press 75Kg (165lb), leg press 150kg (330lbs). I practice Intermittent Fasting 1 or 2 weeks a month and avoid processed and most sugary food. I do 15 minutes Static Stretching every day. I have zero sex drive and experience hot flushes but my muscle tone has not changed. I am 72 years old. I have been doing this stuff most of my life so not everyone will be able to but I highly recommend that anyone on ADT do regular exercise with some use of weights. The owner of my gym and has been diagnosed with prostrate cancer himself and has designed a program that we believe is beneficial for bone mass and muscle tone. Maybe it is early days, I hope not.
Thanks for the video..
Great information on prognosis, very reassuring, thank you.
Great video Alex! (And Doc)
Thank you a lot. You both are great
Thank you for this and all other videos. Most useful source of information!!
Great video thanks for sharing your knowledge 🙏
Another excellent and informative discussion on something many of us are dealing with. Another nice tie too! There’s realistic reason to be optimistic and this probably also helps with the battle and also how we enjoy life. I didn’t realize how powerful hormone therapy is. I’ve opted for Nano Knife. 🍀
THANK YOU
Thank you both so much for such an informative and helpful video My husband and I are so appreciative of your knowledge and experience. We started watching your videos last May. My husband opted for radiation and 6 months of Orgovyx hormone therapy at Rochester Mayo.
Just curious, am soon to be in similar place, have begun Orgo Therapy, do you know approx. how many Gray units (Grays) they prescribed for your radiation ?
@@jamesrhoades1524 It will be Intensity Modulated Photon Radiotherapy (IMRT) to 60 Gy in 20 treatments daily Monday through
Friday to prostate and pelvic lymph nodes. Do you know what your Gys will be?
@@jamesrhoades1524 He will have 60 gray units
@@jamesrhoades1524 60 gray units
Y’all are the best
For me (and I respect others choices) the question of whether or not to use ADT is whether I want to exist or to live. The changes that ADT bring to a person's daily life and quality of life should not be minimized. It is not a matter of not understanding how effective ADT may or may not be in extending life but what kind of life that would be.
It must be horrible to be on ADT. Muscles wasting, extreme fatigue, anxiety, sweating profusely, no sex drive. What a way to exist.
I was diagnosed at 50 and went on ADT because my oncologist encouraged it and I was uneducated with the side effects. It is easy for people who have never been on ADT to minimize the side effects and give you the “well it will keep you alive” story. I would never have gotten on ADT if I knew the toll it takes on you mentally and physically. After 11 months, I decided to take my chances.
I very much appreciate these videos and would recommend them to anyone that is going through this journey as well as their spouses.
Please let me say that I have been receiving ADT for about a year now and of course it does have some effect on me and my body. But it is essentially minimal. Certainly everybody is different and ADT really does affect people differently. Just thought I would throw in my observation.
@@PrescottJackson-ih9owwell said Sir
Dr. Scholz says PSMA Pet/CT Scan is practically revolutionary. He can kindly expand on that a little more. For a layman, that is a big deal on two levels.
It so clearly defines the cancer if there is any that it enables the doctors to more prescribe the type of treatment well as the length of that treatment.
Second it helps to remove a lot of unnecessary anxiety on the part of the patient.
G 4+3 psa 34 oligo one metastasis on tep choline. Xtandi lupron and radiothérapie prostate pelvic and met. Psa indétectable since 4 years but doctors want me to stay on ADT. My decision is to stop everything and monitor my Psa . We have now the game changer : Psma Pet.
Really like both of you two, very good interview s.
Ty I feel educated keep up the good work.
Dear doctor,
I am diagnosed with prostate ca last year.
My Gleason score is 3+4
I have BPH condition too.
1. Do I have to under go proste biopsy again soon?
2. What is my prognosis?
3. My PSMA done lately. Cancer has not spread to lymph nodes
4. My father died of prostate cancer when he was 72.
My PSA is 5.9
I Kindly request you to answer my above questions 🙏
I just found out about 2 months ago that I have Prostate cancer my Gleason score was 7 with 40 PSA and given only 2 choices surgery (Total removal along with nerves) Or Radiation with seeds, it's crazy hearing that there is treatment because I told him I would go with the surgery because of limited choices. I'm a 51 Year old so-called African American
Don’t make a hasty decision my friend. Call the PCRI folks who host this video and chat with them first.
@@lbaker9625Totally agree. A 2nd opinion is my thoughts.
If you go the route of brachytherapy, find out how many of these procedures your oncologist has performed in a year, in a month.. It's a very skilled procedure, not all radiation oncologist are trained, and perform this procedure on a monthly basis. The higher the volume, the more skilled.
Why only given two choices? That should be concerning to you.
Why surgery that removes the nerves? I hope you fully understand what that can mean, since you are only 51 years old. Is the location and the extend of your cancer warrant the removal of the nerves? Typically doctors and patients wants to save the nerves. Will the surgery be a robotic-assisted radical prostatectomy?
Do you have an unfavorable Gleason score of 7? meaning a 4+3
Did you get a PSMA Pet scan? Knowing early after diagnosis whether the cancer has already spread is key to better optimizing the treatment. Risk level is all about matching the right treatment to the right patient, so it’s very important.
Thanks a lot for the great videos. It has been very helpful for me to understand about the disease. My father aged 72 is recently diagnosed with PC which is metastatic and spread to 5 lymph nodes in pelvic area (as seen from PSMA PET Scan) with large gland of size ~125 cc. The biopsy report shows Gleason of 10 (5+5) with Cribriform pattern and 50-80% involvement in all the 28 cores. His PSA is about 21 (which was ~14, 4 months back). I am trying to educate myself with the terminologies and it seems to me that PSMA PET Scan provides a better representation of spread of the cancer vs the Gleason score. I am trying to understand, if the hormone therapy and radiation will be the form of treatment or some other form of treatment will be more appropriate here in your opinion. My confusion is usually it seems like with high risk cases, both ADT and Radiation are done simultaneously but with large gland there can be more side effect so waiting for radiation therapy is generally considered or it is still advised to do together. Also is surgical removal of prostate a viable option in this case ? Based on my read (at American cancer society articles) that seems to be more risky as it has spread in lymph nodes. Thanks in advance!
For what it's worth, my husband was diagnosed with stage 4 PC, 3 1/2 years ago, Gleason 9, PSA 23, with mets to the abdominal lymph nodes and suspicious, but tiny lung nodules. As a Mayo Clinic patient, he was intitially treated with 26 rounds of radiation (no surgery) and began ADT therapy (Lupron injection every three months + abiraterone) right after his diagnosis. Within a few months, his PSA dropped to
@@ga6589Thanks for sharing your experience. I really appreciate it.
@@ga6589interested in reading your comment, thanks, but wondering why if the cancer returns it will be treated with chemotherapy instead of radiation again? I have a close family member with a Gleason score of 4+4=8 and a PSA or 12.5 and it’s 7 months since the suspicion of prostrate cancer, he’s had the Dre examination, two months after that the MRI, and one month after that, the needle biopsy. The DRE examination revealed a hardness and suspicious area on the right side. The MRI confirmed a small tumour, but showed it contained in the prostrate with no evidence that it has spread into the pelvis. A bladder camera work shows the bladder clear. Then he had a bone scan recently, we await results of it. All those procedures yet no treatment. Months ago he could have been put on hormone treatment to block its growth and spread. Very slow to actually start dealing with it, just delays waiting on more procedures. We think they will give him more weeks to await and have a PET scan. I know the procedures are important but why not arrange them quicker or near the same time giving a few days apart? Don’t know, don’t understand! But we are hopeful if your spouse has got a good outcome, perhaps the same for my relative.
@@BlueFlame-q6s If the cancer returns, radiation isn't necessarily off the table to treat specific spots. Chemo treats the stuff you cannot see on scans.
I am sorry to hear that your relative's treatment and testing are delayed. My husband was started on ADT (hormone) therapy immediately after he was diagnosed, followed by radiation. Along with CT and bone scans, he was also given a PSMA PET scan right away, which is the gold-standard for determining if and where the cancer has spread. The Mayo Clinic schedules all the scans on one or two days and the results come back very quickly. The efficiency of the place is phenomenal.
If I were your relative, I'd get a second and third opinion.
Best wishes !
@@ga6589 thank you for your help. We are in the UK. I have heard of the Mayo Clinic, and certainly when they can do all the scans in one day or two then the British NHS should be able to do the same. Hopefully it won’t make much difference if any caused by delays between scans and procedures but it’s been torture awaiting each procedure and awaiting results and knowing that it would not have been wrong to be jumping into hormone therapy for it to have been started months ago after the MRI scan. Thank you!
Hi Doctor, I am 66 10/12th years old and have BPH. I have had elevated PSA for over 8 years, but it is not rising at a fast pace. I am at 7.25 now and was 8.75 last year. 6 years ago I was at less than 5. I have had 2 prostate MRIs in the past 2 years that showed NO lesions and had a Pirad score of 2 both times. I actually have another MRI later this month. I have also had a gene mutation test at Northshore Medicine that showed I am at a low risk of developing prostate cancer by the age of 80. I have 2 older brothers that had/have prostate cancer and have been treated. 1 with a prostatectomy the other with seeds implanted. I am considering having the HOLEP procedure at Northwestern Medicine in Lake Forest, IL to help with BPH. Should I get a biopsy before the HOLEP? The doctor that would do the procedure says I can go ahead with it because of my MRIs and gene mutation test. She said itt is the ultimate biopsy and all the flesh removed will be sent to the lab, Please advise. Thomas I.
This may help you
Enlarged Prostate (BPH) Vs. Prostate Cancer | Mark Scholz, MD | PCRI
ruclips.net/video/eCeJPLJ0PdM/видео.html
Having the BRCA genetic variant is already a poor prognosis predictor.
My father was checking PSA every year. It went from 3.9 to 5000 in less than a year. Bone metastasis. Two years later the cancer is in his liver and lungs and we’re now down to months.
Are you going to post videos from the Sep 11 conference? Thanks
I attended the conference in person and it was mentioned that it will posted in October.
I've been on Orgovyx and Abiraterone almost 6 months now and doing pretty good. I've kept up my regular cardio, walking, biking, hiking, and push-ups, stretching, etc. to mitigate muscle mass loss, and to boost my energy level. I get the hot flashes throughout the day/ night but have gotten used to them. PSA has been undetectable since beginning hormone treatment. I'm 16 months post prostatectomy, and 2.5 months post radiation for micro metastatic spread outside of the prostate and pelvic lymph nodes discovered from prostatectomy. They want me on two years of hormone treatment. Doc says it will starve and kill remaining cells over that time frame. I hope so.
Oxybutnin works great for me for hot flashes.
Thank u for this video in fact thank u for all the videos in which you have helped me to make my decision in fighting my prostate cancer. My PSA isn’t undectable but it has gone all the way down to 0.07 from 3.65 last year. I am on ADT since December of 2023 and had my second injection in June with my next being this coming December. Outside of hot flashes I feel great and continuing on with life thank God. I’ll have my next visit with my oncologist in December and PSA test. I’m praying my number goes down even lower. Last November I had the the PSMA CT SCAN which showed no cancer spread thanking God again. I’m on this journey and keeping positive, working, and enjoying life to the fullest.
Makes perfect sense. Best wishes, Steve!
What went wrong?....
It was 7 sessions of R/T over two + weeks…
However after the second day of treatment, I experienced pain whilst urinating and the flow was extremely small.
This continued for months after R/T ....but in addition soon after my "poo" had been almost non existent with mucus mostly and very occassionally a smallish lump of poo.
I had been taking water and with very little pee, but with determination and concentrating beyond the pain, I had managed to urinate very small amounts.
In effect I could not poo or pee effectively.
I had been eating well and drinking well as advised.
I was afraid of going to bed at night because of the fear of pain and not being able to empty my bowels nor pee enough....I set my alarm every 30 minutes so that I could get up and at least get some pee (very little) and occasional poo (only mucus and wind and very little poo).
It appeared that if I could get a decent poo, I could urinate much better.
On the 6th R/T session, I had a panic attack due to pain and called it to stop at the very end of the session and then rushed to the toilet to ease the pain a bit. I asked one of the nurses if it was possible for me to get a catheter in case of emergency because of my extreme fear of not being able to pee.
The radiographer decided to do my review that day which was the final review and she told me that this was to be expected and she gave me one large pad and three urine bottles for use if necessary in a plastic bag to take away.
It was also mentioned that the effects of R/T are likely to get worse over the next few weeks due to "flare ups".
A week after my R/T I had to call out the doctor because of excruciating pain and unable to pee and then emergency nurses appeared and fitted a catheter and a very large of urine removed.
Later I had to have a permament catheter fitted for a month because I could not pee.
Later still I was prescribed Tamsolusin and eventualy talked to a surgeon who informed me that he could not operate to clear the blockage because I had had R/T to the prostate and I would be either on a permament catheter of self catheterisation....Very depressed.
Not long after having been instructed on the use of self catheterisation and supplied with lots of catheters by the NHS, I somehow managed to force myself into peeing with great pain and from then on it improved gradually, (suggested it was Proctotitis), until at least a year later I am still managing to pee with effort and frequency and with the pills (Tamsolusin one per day).
My poo cleared up about a month after the R/T and is now normal.
18 months after the R/T my only problem other than tiredness is weak flow and frequency of peeing...But at least it works in a fashion without the use of catheters.
Relief!
But the question still on my mind is, what went wrong if anything?
MY PSA WENT FROM 1200 TO 264. I WAIT 2 YEARS BEFORE ANY HORMONE SHIT. ADT IS BARBARIC. 1 AM 75
Hi guys, after my prostate removal in my first 3 months psa test I show .11 can someone tells me if that’s cancer left over?
Can anyone direct me to where I might find stats for men who do not opt for any PaC treatments and what their life expectancy might be? I closest I have found is from Sloan Kettering nomograph based on each patients specific health status and prostate numbers. I would appreciate the help. Thanks....
I had a prostatectomy in 2015 and started with 0 PSA.Fast forward the PSA was 0.270 in 2023 to 0.520 in 2024.Took a Pet scan which showed no cancer but Doc still thinks I have cancer and recommends Radiation.I am at a standstill of what to do.Any recommendations for this soon to be 74 year old?
@@T.Z.M4N , if the Petscam showed no cancer, why take radiation? Radiation will kill you.
I have been down this road had prostate out went on to have radiation six months of adt i would wait and get a pet scan again in 6months time to see if they can find the cancer . I would like to point out my psa is going up again and have been told they will do a pet scan again when i get to 0.40 and if no cancer is found they will wait and pet scan ever 3months till they find it. you have time on your side no rush at all.
@@andrewgynn4502 Thanx for your input.I went to see them today about taking lupron at the same time as Radiation.Probably will not take it and they too offered another PET as soon as I do another PSA in November.Their reasoning is that they have seen many cases such as mine and say that a fast rising PSA indicates cancer.It has gone up and down before.If it goes down this time I will not worry about it for awhile.Good luck to you on this.I know for me it is a nagging thing to have this on my mind.
Is Alex a doctor? She is really astute and quite alluring.
@@iainblack2975 lovely lady!
Curious, why is PSA considered but seldom the PSA DENSITY???
Why is there not more attention paid to PSA doubling time before diagnosis to gauge the aggressiveness of a man's cancer???
Can you clarify these important questions in a future video, PLEASE????
I think people can have a 0.15 PSAD but sill need immediate treatment or would be on AS. PSAD is recognized as an important indicator of cancer progression and a predictor of upgrade. This comes from Peter Carroll at UCSF.
What if MRI results Pi-rads is 4 and 6 months later your PSA drops from 6.4 to 3 should still considere for biopsy? I’m trying to avoid biopsy as much as possible.
You can see the definition of PIRADS4 below. PI-RADS 4: high (clinically significant cancer is likely to be present). Only the pathology can tell you if it’s cancer and give you the pattern, type, and Gleason score. Knowing your BRAC 1/2 genetics and getting a Decipher test will also help you manage risk.
PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present)
PI-RADS 2: low (clinically significant cancer is unlikely to be present)
PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)
PI-RADS 4: high (clinically significant cancer is likely to be present)
PI-RADS 5: very high (clinically significant cancer is highly likely to be present)
PI-RADS X: component of exam technically inadequate or not performed
Hi, I was diagnosed with PC 6 months ago. I initially refused a biopsy because I’d heard stories about the actual biopsy causing the cancer to spread because the prostate capsule was breached with the biopsy needle. After a lot of research I found out that this was almost unheard of so I agreed. Got to be honest, it’s not the most pleasant of procedures but if there’s a chance you have PC, find out for sure, if, like me, it’s caught early before it spreads the treatment is curative. 👍
There is no reason to avoid a biopsy if your urologist thinks it is indicated.
If you have the transperineal procedure under anesthesia, there is no discomfort, no anxiety, and extremely low risk. That’s how I did it and looking back, I’d rather have another prostate biopsy than a tooth filling. It was a quick and trivial procedure from the viewpoint of the patient because you’re out.
And no, there is little to no pain. During the procedure they numb that area well and deeply so for the first few hours there is no discomfort. Then when that wears off, it only feels a bit sore in the general area.
Nothing to it if you have general anesthesia. 🙂
@@bartram33 3+4 and 4+3 is almost always curative. Also, 3+4 very rarely spreads outside the prostate. Some men will live 10 years before they have to have radical treatment.
@@MM-sf3rl I’m 4+3, PSA 10.7. T2. I was a bit worried when I went to have my ADT jab and asked the urology practitioner nurse who gave me shot does this help, she looked at me surprised and said ‘your treatment is curative, see you on the other side of your treatment’.
what’s average cost of these hormone therapies?
in Australia 1 shot of Eligard 22.5mg lasts 3 months $713 australian dollars, I had 1 shot 2 months before radiation and another shot after radiation had finished. my initial PSA was around 7 after 65 1/2 months eligard PSA dropped to 0.05 ng/ml. feel very tired
I am sure that I have heard Dr. Scholz say that the median time to castrate resistance on modern combination ADT is 17 years…can someone help me find that video? Is that statement true for most Gleason scores and most situations…I have positive pelvic lymph nodes, of course hoping for a cure but would like to know that I had a safety net if I don’t get that cure???
These folks have posted hundreds of videos, Paul. I have found it useful (and comforting) to watch each video and take notes, carefully timestamping the points of interest in each video. Sometimes the Doc says things that sound like they conflict with other things he’s said, but it’s usually a matter of specifics, e.g. what’s true for one Gleason score or cancer load may not be true for another. As to your question, I’m sorry to say that I don’t think you can count on it taking 17 years to castration resistance. There are studies out there where it’s much sooner than that, but again it’s a matter of specifics: these studies usually target men with high loads of prostate cancer. If you can take anything away from my long response, it’s this: 1) Watch all the videos and take notes. Knowledge is power. 2) Take some comfort in the fact that there are tons of effective treatments out there, and more on the way. Odds are you can and will benefit from them. 3) Godspeed to you and the rest of us fighting this disease.
@@edg531thank you for your quick response! Dr Scholz’s videos are indeed very informative and encouraging! I have encountered the studies you mentioned, and I have been trying to make sense of the disparity…
@@edg531great advice sir well said👏
Question: If ADT doesn’t cure cancer, what is its role post radiation or post prostatectomy?
@@edg531 Yeah, that doesn’t answer my question. I’ll wait for Dr. Scholz to reply.
@@davidjamespeterson Apparently it slows or even stops the growth of the cancer cell. It doesn’t kill them it just weakens them and stops them multiplying.
My husband has been in remission on ADT for 3 1/2 years. (He also had 26 rounds of radiation.) Iniital diagnosis was stage 4, mets to the abdominal lymph nodes, and suspicious, but tiny lung nodules. His recent PSMA PET scan shows no sign of cancer. From what I understand, the hormone therapy blocks the production of testosterone, which the PC depends on in order to grow.
I’m going to be honest, it’s past time to put hormone therapy in the dark ages where it belongs and come up with something new. My guess is that most of these doctors that prescribe hormone therapy have zero first hand experience with it and simply can’t relate to what it feels like to actually be on what I refer to as the devil’s cocktail. I understand that hormone therapy works, it’s working on me now, but overall medical science needs to get off their ass and develop something that is not so life altering both physically and mentally.
This is an evolutionary process and medical research has come a long way. Let's not forget that Dr. Charles Brenton Huggins won a Nobel prize for medicine in 1966 for his work related to prostate cancer. Back then, the miracle procedure was surgical castration.
I did 6 months of hormone therapy with Orgovyx while I underwent radiation. I had every side effect possible and it was severe. At one point I was suicidal. I told my urologist if I get a recurrence hormone therapy is not an option.
@@brockjennings I’m not talking about the overall prostate cancer discoveries, just that hormone deprivation therapy is certainly archaic by modern medicine standards. Btw, as important as Huggins discovery was he used one test patient in his research? You have to admit that medical science needs to come up with an alternative to ADT but for me, it’s too late.
Yeah the ADT is a medical cop out, scientists and doctors too happy giving the $2,000 a pop in office injection to think outside the box.
Absolutely agree!! I so much wish there was a less debilitating treatment that was just as effective. I'm at 18 months and hope to get my life back soon!
Not 100% of doctors are in the top 10% of experience and qualifications and practicing current state of the art medicine in 2024 at a center of excellence. Many patients do not have adequate insurance and adequate self education.
No one talk about leftover prostate tissue after radical prostatectomy
What I’d like to see is a 3D model, computer aided and three D printed. Just show me. And not some Rorschach Test of the MRI. I don’t think patients can really visualized just where the cancer is, how close to the urethra, or transitions zone that then in the anterior and abuts the base. The only time is when you have the consult, the day before treatment, and there and then you need to make a decision. Very time-share, high pressure, deal.
1rst
Thanks 🙏
:
ADENOCARCINOMA, Gleason 3+4=7 (Grade Group 2).
1. Left Base:
Adenocarcinoma, Gleason 3+4=7 (10% pattern 4) involving 1 core.
Core involvement: 25% (1mm).
2. Left Mid:
Adenocarcinoma, Gleason 3+3=6 involving 1 core.
Core involvement: 27% (3mm).
3. Left Apex:
Benign Prostatic Tissue.
4. Right Base:
Benign Prostatic Tissue.
5. Right Mid:
Benign Prostatic Tissue.
6. Right Apex:
Benign Prostatic Tissue.
7. Lesion #1:
Adenocarcinoma, Gleason 3+4=7 (10% pattern 4) involving 1 core.
Core involvement: 25% (3mm) discontinuous.
Adenocarcinoma, Gleason 3+3=6 involving 1 core.
Core involvement: 90% (9mm).
Gleason Grade Group: 2 (1-5)
Prostate size (on MRI): 44 cc
Component
Ref Range & Units
3 mo ago
(8/5/24)
6 mo ago
(5/7/24)
1 yr ago
(8/18/23)
1 yr ago
(2/20/23)
2 yr ago
(6/6/22)
2 yr ago
(5/16/22)
4 yr ago
(8/17/20)
Prostate Specific Ag, Serum
0.000 - 4.000 ng/mL
5.757
I am a 59 y.o.male PSA 5.757 and biopsy proven adenocarcinoma of prostate looking at radical prostatectomy and have talked with Dr about possible external beam radiation, brachytherapy ,hormone therapy, cryotherapy, and possible active surveillance what would you suggest to do with the above thanks