Active Surveillance for Prostate Cancer
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- Опубликовано: 2 окт 2024
- As part of the 2024 Prostate Cancer Patient Conference, Dr. Kevin Shee presents a comprehensive overview of active surveillance in managing localized prostate cancer. Drawing from the extensive institutional database with over 9,000 participants at UCSF, Dr. Shee highlights groundbreaking insights into the field. From exploring the safety of active surveillance in younger men to investigating the potential of prostate MRI as a biopsy alternative, you'll gain valuable insights into treatment decisions and patient outcomes. Dr. Shee's session offers a profound understanding of how data-driven approaches are shaping the future of prostate cancer management. Recorded on 03/09/2024. [5/2024] [Show ID: 39757] Recorded on 03/09/2024. [5/2024] [Show ID: 39757]
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PSA is like BP. High numbers mean stress! Once your 'pipes' are stressed its not 'if' but 'when' there is a failure, you need emergency intervention else death, so you either prevent and treat early or roll the dice. Blessings for what YOU select. Doctor's opinions are self-serving$
Most informative discussion I have seen. I'm low intermediate risk, 3 + 4 at age 61. I've had many different discussions with 2nd, 3rd, opinions. For now, I'm on a/s but very uncertain as to which option is best. This presentation leads me to continue on a/s although I do fear metastasis.
A big issue is "percent of 4" in your 3+4. Getting a 2nd opinion on your pathology is very important before you decide next steps. Have it sent to Johns Hopkins for a 2nd read and, if your percent 4 is very low, the standard of treatment on that nowadays is active surveillance because it basically behaves like 3+3.
@@goyo2897 what is "very low'?
@@health6140 First off, it matters greatly who did the pathology. They need to be top tier. Your doctor doesn't know what you really have; only the pathologist who viewed the slides does. My understanding is that less than 10% is believed to be very low and AS may be possible. Protocols vary by doctors and institutions with input from the patient. Other factors matter too like the size. 8 o/o 12 cores positive is a high number but what percent of the core is positive? That matters too. The doctor will look at that. Age is also a factor. You're still pretty young. A much older guy might be a better AS candidate than a very young guy. But it boils down to this one thing: Look for 2-3 doctors that specialize in prostate oncology, get multiple opinions, decide what is best for you, do not be rushed into a decision, keep one eye on it periodically while you live a long life because this ain't going to take you out, and don't 2nd guess yourself. You get those opinions and think it through and you'll do the right thing for you, no doubt! And, that might be AS or something else. (I think by "PNI" you might mean "PIN"?)
@@health6140 10% 4 in one core is low and AS will probably be a point of discussion with your doctor. Make sure the pathologist is top-notch and get multiple opinions from doctors who specialize in prostate oncology.
@@health6140 10% four on 1 core is low and AS will most likely be a point of discussion with your doctor. Get multiple opinions from doctors who specialize in "prostate oncology" and go from there. Most men our age have some cancer in their prostate and most of the time it won't hurt us. You're smart to follow up on it all though because prostate cancer is curable and sometimes doesn't even need to be treated! But, to cure it, you need to be on top of things
My husband is 73 years old. He has a perfect health except a little bit frequent in urination.
Total psa shows 16.57*
After a month tested shows 10.700 ng/ml.
Free psa shows 1.900
Percentage 18%
MRI reveals pirads-3 lesion in the lower mid gland.
There are pirads-2 nodules in the transitional zone bilaterally as described.
Is here, he needs to go biopsy?
As to the Pirads 2 nodules, you should know that many Radiologists don't even report those because they reflect BPH. His free PSA is somewhat favorable. A very important question is how big is his prostate. If it's large, then the PSA might not be a big deal. The MRI report will state the prostate size so look at that. PSA divided by gland size in grams or cc's give you PSA density. If it is above .15, that raises suspicion of prostate problems like prostatitis or cancer. He should do his homework, talk to his doctor, and then decide next steps.
MRI shows- prostate is enlarged in size and measures 46x45x43 mm ib diameter (volume 44g.) Nodule measure 12x9 and left side gland measure 20x18 and transitional zone (ADC value measures approx. 0.6 to 0.7 x 10-3 mm2/s).
Another lab in Radiology & Ultrasounography in prostate gland shows 43x41x34 mm in size and weighs about 31 gms.
Impression shows:
1. Grade I hepatic STEATOSIS.
2. Grade I enlarged prostate.
My husband is physically not having trouble except a little bit in frequent urination and a bit of gastric stomach
problems.
Kindly advice and suggest your comments. Thank you🌹
@@JB-be8co Here is what I'm comfortable saying: His PSA went from 16 to 10 in a month. That is almost suggestive of an infection like bacterial prostatitis (I went from 18 to 10 in month because of that). That's a big drop if all other things were equal prior to the test. If he did have prostatitis, it is important to know that it mimics cancer on prostate MRIs, it will drive his PSA up, and it will drive his PSA density up. His prostate is not large; especially for a man his age. If a man wants to know whether he has prostate cancer, he just needs to put a percent by his age. We will all get it if we live long enough but, in most cases, it'll do no harm and we'll die of something else. It is literally everywhere in the aging male population. His PSA density is .22 which is on the higher side and more suggestive that there may be a problem like an infection or cancer. When cancer is discovered in men his age, it is more likely to be less aggressive. Prostate cancer is not only treatable, it's curable. The best advice for him is to read, research, and review and to not be pushed into unnecessary treatments or procedures. He needs a great doctor(s) he can talk to because his next decision point is whether to get a biopsy or not and he is kind of on the fence as far as I can tell. But that decision should not take into account the opinion of anyone like me that is not a doctor. He has to read and talk to real doctors!
@@goyo2897 Thank you for that, sensible and logical information.
Excellent presentation - complex issue made understandable to the lay person!
This is a highly-informative and well-organized presentation. Many thanks.
Can a patient who has received brachytherapy for single core Gleason 6 transfer to active surveillance if Gleason 6 is still the score in a new biopsy? Can't find this answer anywhere.
If gleason 6 was your original score you should have been on active surveillance all along.
This would be a good question to present in the facebook ...group non surgical prostate cancer.
@@dalefriar6389 That is correct. The year was 2016. My first local doctor told me I had MEDIUM aggression prostate cancer - which was incorrect - and recommended prostatectomy. He said nothing of active surveillance or any other alternatives. Total 'heroic' old school and even manipulative.
I asked for a second opinion and went to a leading cancer centre in Toronto. The doctor there recommended Brachytherapy which was successful with minimal side effects. Early 2017. But even THAT doctor said NOTHING of active surveillance.
MEANWHILE . . . arrgh . . . I learn later my Brachy doctor is a 25 year colleague of one Dr. Klotz who also works out of the same cancer centre in Toronto. Dr. Klotz, of course, is a pre-emminent pioneer and champion of active surveillance. So my Brachy doctor KNEW ALL ALONG about active surveillance and STILL said nothing!
I still do follow up with the Brachy doctor and when I mention Dr. Klotz in consults he has very little to say. I sense a rivalry. It was even my Brachy doctor who told my I would no longer qualify for AS since I had already received the Brachy. But it doesn't sound like a research-based opinion.
Now I no longer trust the doctors to give me full advice. I scour RUclips for high cred info on prostate cancer and AS. Lot's of posts by Dr. Klotz, Dr. Stolz and others.
Recently, I returned to Torotno for a follow-up PSMA scan. The scan was part of a Canadian trial study for the new procedure. The scan study is lead by, wait for it . . . Dr. Klotz.