Gleason 3+4 Active Surveillance, PSMA Alternatives, and More | Answering YouTube Comments #46 | PCRI
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- Опубликовано: 16 июл 2024
- Medical oncologist Mark Scholz, MD answers questions from RUclips comments focusing on active surveillance for Gleason 3+4 and advanced prostate cancer.
0:05 "Can you get a prostate cancer recurrence without any change in PSA?"
0:41 "I have a Gleason 3+4 and I am considering active surveillance. Can you please tell me which tests I need to take to confirm that my cancer is low-grade? Where can I find these tests?"
2:39 What is the active surveillance protocol for a Gleason 3+4 patient?
4:01 How often would a Gleason 3+4 patient need to have their PSA checked?
4:57 How do you deal with a 3+4 active surveillance patient whose PSA is above the normal range?
5:45 "I am 56 and diagnosed with advanced metastatic prostate cancer. My PSA dropped immediately when starting Lupron and Xtandi and now my doctor wants to administer radiation to the prostate itself. Is there any benefit to local radiation?"
7:24 "If a PSMA PET scan fails to find a lesion at a PSA level at which the scan would be expected to find one, should the patient consider having an Axumin or choline PET scan as well?"
8:22 "How long should a patient wait to see if a second-generation anti-androgen (e.g. Xtandi, Zytiga, Nubeqa, Erleada) is working before starting a different treatment?"
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My last PSA was 4.65, biopsy results showed 2 needle cores with 3+3 and 15% total tissue, and 1 needle core with 3+4 at 15% total tissue. All 3 cores from the left side. The urologist said I could do active surveillance, radiation or surgery. Essentially just your standard 3 options. He didn’t pin down a recommendation. I got a CT scan and a bone scan which all indicated no spread. I saw a radiation oncologist who said I would be a good candidate for SBRT. I would really appreciate Dr Sholz input on this. But I am heavily leaning towards the SBRT.
Size of prostate and PSA was so informative. This answers my families big question about no detectable cancer with PSA above 4.
Brilliant! This 3+4 question is on my mind a lot as i am 3+3 and wondering what happens if it goes up. Thank you for such precise questions and answers.
This one is so relavent to me (3+4 5%) Thank you!🙏
Great questions Alex!
Very informative information from Dr Scholz as well!
Doctor Scholz has great taste in ties.
Thank you and bless you both.
Thanks for your great knowledge 🇨🇮
I am confused about the PSMA. If it detects cancers so accurately , in the prostate as well as beyond, why are biopsies still necessary?
This is an excellent question, but one that few will address. Nobody wants to take pathologists "out of the loop", in my opinion. The "system" is set up to do things a certain way, and there is a lot of resistance to change.
Your point is an excellent one, and I've brought it up often, with no response....crickets.
@@Freedom24560 because you will still need to do a biopsy if it lights up to score the grade of cancer. PSMA is used to detect spread.
Very useful..thanks 👍
Prostatectomy done a month back. Removed prostate gland is Gleason 3+4. Hormone therapy started ten days back. What is your view on the line of treatment, Sir?
These videos are very helpful
You mentioned Doppler as a method of diagnosis. I've already had an mpMRI so would it still be useful to have the Doppler?
Age 66, for 5 years the PSA was between 3-4, prostate volume 60-80cc, beginning of 2021 the PSA rose to 7, MRI showed cancer, 15th of October the prostate gland was removed, Gleason score 3 (70%)+4(30%), 10 weeks after surgery the PSA is now 0.02.
If you have a large prostate and a resonably high PSA, you can't exclude cancer!
Independent of the prostate size, if cancer can't be detected with the finger of the doctor, take an MRI ! Can save you a lot of trouble.
I am 71 years old , diabetic, recently diagnosed with Ca prostate , gleason 3+4=7. PSMA pet scan , suggestive of extracapsular extension . Always my PSA 2-3 ng/ ml . Stage T3a . What is my best option for treatment?.
Here Dr Scholz notes “5-10%” of Prostate Cancers don’t produce PSMA…and suggests if you don’t find cancer via the new and PSMA PET CT Scan in the face of a rising PSA (recurrence?) to try the somewhat older scans (Aximum, etc. ).
I’d like to hear particularities on which Prostate cancers don’t produce PMSA. It seems an increasingly important topic.
I am a youthful and healthy 74 and quite active sexually.
3 + 3 now but if I go 3 + 4 then i have to make some decisions.
I would like to hear dr. Scholz speak about men mid 70s continuing with surveillance on 3 + 4. . I'm kind of trying to educate myself now in the event my next biopsy
Is 3 + 4 .
Would love to get your view on CBD. I’m Gleason 7 with only one 4 core, diagnosed in June this year, I started Keto in March last year and removed dairy totally from my diet soon after my cancer diagnosis and started CBD more or less the same time. My aim was to shrink the prostate so I could get Bracchie more effectively without a TERP before hand, because I’m not keen on a Prostatectomy. I was told because of the shape of my Prostate their was a risk of not being able to pee at all if I just had the Bracchie. Bottom line is my PSA halved from just less than 2 to just less than 1 in 2 months to 3 months. At this stage I’m not going to be doing anything but Active Surveillance/ genetic tests/ other non invasive scans while the PSA is under 1. Thoughts?
Peter,
I will add the CBD question to our list for future videos. I am not sure if Dr. Scholz would speak on it since there have not been any phase III clinical trials on it yet, but they may be coming in the near future.
We have a free helpline with a patient advocate who is trained to answer patients' questions if you would like to contact us about your case. I think he would need more information. You can find out contact information here: www.pcri.org/helpline
Hi Peter did you do a treatment yet or still AS ?
@@kennytraylor6798 Hi Kenny, still thinking of the Active Surveillance route, in that regard I am doing a PSMA PET scan in January just to check again for spread and then if that’s clear am going to get my genes checked with Prolaris
@@Peter-qj6cx great move on the PSMA PET scan. Where are you getting that at ?
@@kennytraylor6798 I’m in South Africa so had it done on Thursday here, still have not had visibility of the report so hope to get Monday
I got a score Gleason 3+4 and PSA of 1.75. My Urologist recommended two options surgery to remove the prostate and External Beam Radiation. However he still sent me for PSMA PET/CT Scan. I’m 68 years old very healthy and no maintenance medications. No blood pressure issues and diabetes. Do you think surgery is the right path for me. That’s it what I’m heading my decision because I still need a gel pad inserted between the rectum and prostate.
However in 2 months time I still need to undergo a procedure for surveillance in my right ureter & kidney for low grade cancer. Hence I’m thinking of surgery because it will only be one procedure.
However if I go with EBRT the Gel pad will still be done but it can be done same time as my surveillance procedure. Heading in EBRT I need to undergo 5-6 weeks of this procedure and if it recurs again in several years it’s a harder process for surgery. Do you think in my case having surgery is the right option for me.
My Gleason score is 3+4 with 10% grade 4, yet my PSA 3 moths ago was 16.4 and this week was 14.6. I have had a PET scan , MRI and 12 point biopsy. I have no symptoms of prostetitis. Why is my PSA so high?
You say radiation is much safer now. Does that includ external beam, or is brachy still the safer option? Thank you.
David,
I will add this to our list of questions for the next round of videos.
@@ThePCRI Thank you.
Yes, I’d be interested too regarding EBRT (IMRT/IGRT).
@David Welburn - Did U get EBRT?
For those interested in EBRT/brachytherapy safety - ruclips.net/video/WDvk0_VjjFo/видео.html
After surgery in jan my husband s PSA is 138 now rising from 9 at the time of surgery now advised radiation need advise
Hello,
We have a free helpline staffed by patient advocates who may be able to provide you with information pertaining to your case. You can find our contact information at pcri.org/helpline.