Treating Micro-Metastatic
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- Опубликовано: 6 окт 2024
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0:28 What is micrometastatic disease, and how is it relevant in prostate cancer treatment?
3:53 How has the advent of the PSMA PET scan affected treatment of micrometastatic disease?
7:17 Should every new prostate cancer patient be getting a PSMA PET scan?
9:58 What options are there for those who've already received treatment and are now monitoring?
12:18 How might a prostate cancer patient be monitored after treatment?
12:53 What "cured" mean in the context of prostate cancer?
13:45 What hormone therapy options are there for treating micrometastatic disease?
17:39 How should a patient go about communicating their treatment preferences to their doctor?
18:57 Have PSMA PET scans changed the definition of micrometastatic disease?
20:05 Alex's conclusions
21:00 If you need help
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My deep gratitude to Dr. Scholz and Ms. Alex Scholz for this video.This video is absolutely stellar. It gave me a clear insight into the PSMA PET SCAN technology. I was diagnosed with an advanced, donovo metastatic adenocarcinoma of Prostate, Seminal Vesicles and Pelvic Lymph Nodes. I have undergone 2 months of radiation, 1 year of Orgovyx, 1 year of Orgovyx, Abiraterone and Prednisone. My last treatment will end on June 29, 2024. I am in complete remission for at least 18 months. My PSA has been non detectable for 18 months.
I have a question for PCRI. Can someone at PCRI please tell me what should be my treatment strategy after I stop all my Meds at the end of June 2024. Thank you PCRI in advance for your kind info.
Just had my Pet Scan yesterday. After 45 radiation sessions last year and 15 months of testosterone treatment. PSA test next Tuesday with my follow up next Thursday. Psa has been 0.01 or less since radiation ended.
Thank You So Much for such a helpful and informative video. I've just had a relapse after 9 years post RP; just had my first PSMA-PET scan ever and am awaiting an appointment with my specialist in two weeks time. Whereas I was quite fearful before watching this video, I am much more informed and relaxed about my meeting now. Again, Thank You and God Bless.
RP in 2013. PSA undetectable for 8 years, then slow rise. First nudge up coincided with first Covid vaccination? 2 MRI scans showed nothing in prostate bed. 1st PSMA PET scan showed 2 possible bone lesions. 2nd PSMA PET scan showed a single lesion in pubic bone. PSA kept rising to 0.6. 4 months of ADT brought it back down to undetectable. 4 months later PSA started rising again rapidly, now at 1.2. Just had my 3rd PSMA PET scan and waiting for results. Previously had requested spot radiation of pubic lesion. This was denied and i was coherced into ADT. This is now turning into a barenuckle fight as i am totally set on being cured. Never mind my age, I'm now 80.
So good for you. We should be living to 100 and even 120 plus years. So wonderful to see you are not allowing it. Take those boxing mits off and hit them HARD. My huband is 70 and doing the same. Bless you.
🤠🥰♥️🌹🙏
@@teresa9760 Thank you for your kind thoughts and very best wishes to your husband. What I have learnt is that the medical profession does the best it can within its down limitations,, though it's up to us, the patients, to take responsibility for ourselves and to hold the medical profession accountable.
In 2019 I had a PSMA PET scan that lit up only in the prostate and shortly after, radiation and ADT, Three years later, I have multiple bone mets. So much for Dr. Scholz's theory.
Just curious - what was your Gleason and PSA at the time?
Update please?
Thanks for this update. Eleven years ago I had my prostatectomy for Gleason 7 cancer. After surgery my PSA was undetectable until a year ago, ten years after surgery. Over a year or so it rose from 0.18 to 0.21 then to 0.41 I got a PSMA Pet scan at .18 that showed nothing, and a second PSMA pet a year later when the PSA was about 0.41 which was also negative. I got several opinions but all of them concluded I should go on hormone treatment and get radiation to the prostate bed area. So I have done that. My oncologist prescribed 18 months of ADT with lupron but I have elected to stop after nine months, which are now up and my radiation treament was completed two months ago. I am 78 years old and the ADT has been very difficult and damaging to my overall health, with sleeplessness, weight gain, muscle loss, more aches and pains and somehow a reduction in energy level. So my intention now is to have my now undetectable PSA monitored every 6 months or so and if it starts rising again to get another PSMA pet scan then take appropriate action. Of course my hope is that the combination of 9 months of ADT therapy and the 7 weeks of radiation will have taken care of whatever cancer I had. Time will tell. I will get another PSA in 2 months and if that comes back undetectable I may ask the oncologist if I can go on testosterone supplements. I feel like this hormone therapy has aged me ten years in 6 months. The radiation was not bad at all, a few minimal and short term side effects only. So I am optimistic, and more worried about the effects of this ADT than I am about the prostate cancer. Any thoughts or comments are welcome.
Hi, undetectable for 10 years,you mean PSA
I am so glad that I found this episode. I was just diagnosed with OligoMetastatic disease after having surgery and radiation in 2019 and having Gleason 8. 5 years later my psa has risen to .4 and I had the PSMA Pet that revealed a lymph node in my left lung. Med Onco suggested SBRT and 18 months of ADT. My thoughts are SBRT and active surveillance. If it returns we scan, locate and shoot again. So that is the approach that I am going to take.
Dr. Scholz, thanks so much for this update. I’m one of those patients who had 8 biopsies taken with my surgery. The results from 7 of the 8 were clear; however, one had a Gleason of 3+4. The options presented to me seemed overwhelming: 39 radiation treatments and 24 months of Lupron shots. Being an active person, I decided to go on active surveillance, with PSA tests every three months. I also, switch to a Mediterranean Diet. It’s been 2-years now, and my PSA has remained undetectable. I know I’m not out of the woods. I’m so grateful for all your videos, especially this one! 😊
So you did not have your prostate removed or surgery?
@@schmingusss
Yes, I had it removed by Laparoscopic surgery.
@@JerryEgge Oh man, ouch. Any sexual side effects?
@@schmingusss My sexual drive is bad - I have absolutely none. Ugh.
@@JerryEgge Aw crap! :(
I was diagnosed with prostate cancer, via multi core biopsy, in 2016 with one core Gleason 3+4. The core was sent to genetic testing and came back with only a 3% probability it would kill me in 10 years. My doctor and I decided on active surveillance and I've been doing that since. Three years ago I had another biopsy with no growth. This past October I had another MRI and the prostate had grown by 50% in 2 years. The following month I had my 3rd biopsy and no cancer was found. The urologist told me that doesn't mean I'm cancer free, it just means it's difficult to find. He did note that I had acute and chronic inflammation. In 2016 my PSA WAS 4. It has gone up as high as 9, but was 5.4 at the time of my last biopsy. Three questions:
1. How common is this in your practice? That is, the disease not "progressing"?
2. What prevents the cancer from spreading from a needle biopsy?
3. What would you recommend for a patient like me? I know this question is difficult for you to address with the limited info provided.
Thank you for your videos, they're very informative.
I was diagnosed in 2017 with a Gleason 3+4 and was offered the option of active surveillance and I chose that. So in that case they insisted I get a mri to make sure there was no cancer in the upper prostate. They found 4 irregular spots in the upper prostate which could not be detected in the normal biopsy. So then they did an mri biopsy and found 4 tumors in the upper prostate that were 4+3 Gleason. I then had to make a choice between surgery and radiation. I had the prostate removed 6 years ago March 2024. They found cancer in the cavity Gleason 3+4 and suggested a PSA test every 6 months for 5 years. My PSA is still 0 but I know I am still not cancer free and more then likely will have to face the battle again if I live long enough. But I consider myself blessed! I wish you well in your journey!
Sounds like a good time for a psma scan.
Thanks Dr Scholz and Alex for very informative micro metastatic prostate cancer video.
Wow such an amazing video, for me. Because I fall into that category. And if my PSA starts to rise again, will demand a PSMA PET scan only. Thanks a million, because like y’all conveyed in the video. The PCRI is not giving advice. But, information and knowledge so we can know how to move in an (excuse the English), “ A more better way.” lol I love it and it has given me hope and inspiration. Please keeping up the good work. R Chef A a Ron
No hormone therapy. Live a better life. I'm already in my 70's. Then PSMA PET scan when the PSA reaches a level that can be detected by the PSMA PET scan. Destroy tumors with radiation, and possibly come close to a cure. It really is a paradigm shift in treatment and possible outcome.
Thank you I feel so much better your videos are great I've had surgery and had my prostate removed my PSA only went down to 0. 3 did all the scans all clear on hormone right now PSA was 5.6 before surgery it's undetectable now put on hormone for 3 months starting radiation in about 2 weeks your videos made me feel better that I possibly could be cured even though my cancer is so small they can't see it microscopic left over from the surgery
Wow, I'm in your boat, lookin at surgery. Afraid removeg prostrate won't be a cure
Hi if i was you would not do surgery i have been down this road and two years later my psa had gone back up to 0.52 had four weeks of rad and six months of adt this was last summer the surgery has left problems that are life long . my psa was 21 at the start and now it is down to 0.03 the start was 53 and now 57 work full time and enjoy life just do radiation. @@boblongmore907
@boblongmore907 Doctor said 50-50 chance of having reoccurrence I took the chance..doing radiation therapy it's microscopic and doesn't show up on scans this should do it..fingers crossed
Wow, excellent video! Thank you very much. My most recent PSA was 0.128. Getting my PSMA-PET scan in 2 days (on 4/8/24). Radical prostatectomy was in August 2014.
Hi , how many years your PSA was undetectable, meaning PSA
@@alk8933 A few years from 2014 to 2019 when it reached 0.02 to answer your question. My recent PSMA-PET and MRI scan was negative, no (visible) evidence of disease, and therefore, no treatment for now. Maybe the exercise, diet changes, and supplements are making a difference?
I had a negative PSMA in Dec 23 with a PSA of 1.8, my second psma in April 24 at a PSA of 5.86 finally showed two metastases 5mm, still waiting for therapy and possibly another psma to confirm oliogo metastases.
This was such refreshing information from a patient with Gleason 9 and positive margins on the pathology. My first PSA was undetectable. This information takes the guess work out of just Radiating an area without knowledge of where if any is lingering. Thank you for such and informative video!!! Knowledge is Power and this is great information going forward!
Great topic! It seems that the profession are only now starting to see the possibilities of PSMA PET scans.
Thank you so much for this video. Incredibly valuable to a have such a modern viewpoint of todays treatments.
Thank you Dr. Scholz and Alex! You are doing amazing work!! To: Anyone who may be able to help, I am a 65 y/o, (active and otherwise very healthy male) who had a radical prostatectomy 12 years ago- and after being undetectable for years I had a PSA of 1.44 in 2022 and then measuring 8.53 on 1/4/24 and6.97 on 01/12/24.
With recent Pet/CT and MRI, 2 small lesions were found.(the larger of the 2 is a 0.8 cm restricting and enhancing lesion within the right side of the prostatectomy bed adjacent to the anterolateral aspect of the rectum)
I believe proton therapy would be appropriate treatment as opposed to photon radiation and intermittent hormone therapy (following an initial long period) if the PSA becomes and continues to be undetectable instead of 2 years of continuous hormone therapy.
Is there anything in my situation (All Chart data Below) that would require me to have photon radiation instead of proton or preclude me from intermittent hormone therapy?
-------------------------------------------------------------------------------------------------------------------
Date: Feb 13, 2024
Dx: Prostate CA-Gleason score of 4+3=7 (GG 3) iPSA 4.21 involving 15%of the specimen, negative margins, positive extraprostatic extension.
His final pathologic stage was T3aN0. Current Tx: bi/Pred, Eligard, XRT Prior Tx: Radical prostatectomy May 2012
Oncology History: This is a 65 y.o. caucasian male referred re: rising PSA remote from his radical prostatectomy in 5/2012 at U of C. He underwent a robotic assisted laparoscopic radical prostatectomy in May of 2012. His final pathology revealed prostate adenocarcinoma with a Gleason score of 4+3=7 involving 15%of the specimen, negative margins, positive extraprostatic
extension. His final pathologic stage was T3aN0. No adj XRT or hormone therapy was administered. His PSA since the time of surgery had been undetectable.
Date Value
3/10/2012 4.21
11/29/2012
Hi Sean,
Our helpline would be able to help greatly. You can find them at pcri.org/helpline
Fantastic information as always, thank you. Your channel in many ways is the light at the end of the tunnel. ❤
Great information
Excellent video.
Thank you so much for this information !
Thank you for this video. You answered a few questions for me in this video.
Great insight! This info is very timely to me on this journey. I recently discovered my prostate cancer and that I'm in the intermediate risk category.
Amazing video! I’m reading your book now; The Key to Prostate Cancer🙏🏽
Dr Scholz , can you address the Decipher testing in this micro spread enviroment? You never did talk about the usefulness of Decipher.
Thx for all your discussions, great learning always.
Best of all your videos. Thank you so much.
Timely video! I saw this about 2 hours after leaving my doctor's office talking about this very situation.
I had an RP in 2011 that failed with a very slowly increasing PSA that allowed me to wait until July 2022 to have salvage radiation therapy. It, too, appears to have failed with my post-SRT PSA now higher than before starting SRT (0.37 ng/mL),
I've had two PSMA PET scans, one with my PSA at 0.22 ng/mL in November 2021 and the other earlier this month with my PSA at 0.37 ng/mL. Both had "no signs of recurrent prostate cancer or metastases." On the one hand, that's a good thing, but we know those little bugger cancer cells are somewhere.
The conversation with the urologist today was about timing of ADT and whether it's worth letting the PSA continue to increase to the point where a PSMA PET scan can actually locate the lesion(s). A conversation with the radiation oncologist revealed that he's more inclined to find the lesions and zap them if they are few and well-defined. I've asked for a medical oncologist to weigh in on the case, too. (I'm getting my care through the VA.)
My PSA doubling time according to the Memorial Sloan-Kettering PSADT calculator is just over 6 months, which is concerning.
For now, we decided to retest my PSA in 3 months and see where we're at then.
Excellent, define it first. And something thats important, keeping the 3+3 defined as cancer. Then the insurance will cover.
My husband was recently diagnosed with intraductal carcinoma of prostate with perineural invasion...4 + 3.
He had a myocardial infraction, (3 years ago) coded 4 times... So doctor said best to do removal of prostate but due to his health they are hesitant to do surgery. We are now waiting on an oncologist for radiation appt.
Q: can you tell me what treatment is used for this type of cancer?
Thank y'all for your videos, I am so knowledgeable about what the doctor was talking about and able to ask questions and understand it as he was speaking.
Do not let IDC change your course of treatment. It's an adverse finding but it should NOT alter your choice of treatment. Concentrate on the amount of 4+3 and get some consults going with R/O's as well as URO's. I had G8 with IDC and I've been NED for over 2 years now. I had RP but only because of urinary issues. All systems are functional. I'd look at SBRT, Brachy, etc etc. Get some consults going and don't worry about the IDC. Good luck to ya's!!
@@dcveem3 thank you.... We actually live close to MD Anderson and he has an appt. with an oncologist tomorrow, he's so nervous.
The holy grail is a scan that detects/locates all ECE/EPE and micrometastatic spread. For staging purposes.
As far as reoccurrence goes, an agent that consistently locates PSMA at .1 PSA is a worthy goal for researchers. Closing the gap between detectable and locatable /targetable.
Been fascinated watching the series of videos but I have a question… I was diagnosed with prostate cancer in 2019… Gleason 7(4+3) PSA was 10 with some Perineural invasion - I opted for nine weeks of external beam radiation no hormone therapy… My PSA reached a nadir of 0.7 two years ago… The last three PSA's (every 6 months) have been rising slowly to where I am at 1.38 now… Going back to the oncologist on Monday… Should I be worried? Would I be a candidate for my insurance company… Which is good insurance… To cover a PSMA pet scan?
I’ve been on Lupron for 3 1/2 years
This is great information
I understand that focused radiation to metastasized sites identified by PSMA PET can be very beneficial. I am curious to know how focused radiation compares to Lutecium 177 and other such radionuclide treatments.
Thanks again for the valuable information in PCRI videos.
Thoughts on combination therapy with Abiraterone, lupron, prednisone with metastatic (bone) disease and intact prostate? Now at two years. Starting PSA over 1,000. Now undetectable. 75 years old. Previously healthy and active.
Did you ever do chemo as well. ? I am new on this journey. Abiraterone, Firmagone, and Prednisone. Now Docetaxyl Chemo.
@@infinityrecordsusa1482 No, have not been chemo. Have you been on ADT continuously? How long? Why chemo now?
I would like to know what is Micro Metastatic Cancer. A .6 mm cancerous area has been identified in one of my lymph nodes following Radical Prostatectomy in June of 2023. Is this considered as micro metastatic? I am presently under ADT, but have not taken radiation treatments. What are the Pros and Cons of adding radiation to my treatment regime?
Why is that biopsies are never mentioned as a possible or likely source of metastatic PC?
Good question...they really don't know but you make a good point!
Dr. Scholz mentioned that a PSMA-PET scan can be used to diagnose whether prostate cancer is present; but if there is no biopsy prior to the PET scan, most insurance companies won’t pay for it. But what about Medicare? Will Medicare pay if there is no prior biopsy? And if they won’t, would they pay if the patient has had an MRI that strongly suggests the patient has prostate cancer?
Thankyou for this very informative discussion. My husband had a radical prostatectomy in 2020 and after the pathology was done, there was an indication of EPE (PIRADS 5). He was not given salvage radiation or any form of treatment or medication.
Re: Patients who have EPE, are they more likely to have micro metastasis down the track ?
What is EPE?
What is the diference between a psma scan and a spect ct scan?
My concern is the time it takes for you to get the radiation started, and for that reason I think a short course of hormone therapy is beneficial to halt the growth until radiation occurs ( speaking as a patient, not a professional)
That's my plan right now on hormone just did blood work yesterday PSA is undetectable I see the oncologist next week the get radiation started had to wait 3 months
What are the limits to PSMA PET scan? I've read that the tumor has to have the width at least 4-5 mm to show on PSMA PET scan. There has to be a limit because PSMA PET scan doesn't show anything for PSA lower 0.2 (some say 0.4).
I've found that:
They say that PET scans cannot detect anything smaller than about 5 mm
1.) Look up on Google: "PSMA PET/CT is not very good; it's just the best that is widely available"
2.) For PSA lower than 0.5 the detection is lower than 50 % and the sensitivity of PSMA PET scan depends highly on the PET indicator.
Look up on Google: "Percent of patients in whom prostate cancer was detected by the PET indicator, broken down by the PSA of the patients"
What about if no metestic through psma and when off elligard rises faster than the 10 month calculation It has been 14 years since my surgery and psa never went to 0.
When speaking of 18 months of hormones, does it mean the same if on the newer ones that don't take as long for recovery?
i was diagnose with PC last aug 2021 gleason 4 + 4 PSA 7.0 had robotic prostectomy oct 2021 after 2yrs all PSA were undetectable until last Nov 6 ,2023 PSA was 0.110 Nov 28/23 0.117 had a PSMA Pet scan last Dec 2, 2023 turnout to be negative of Mets last Jan 12, 2024 PSA is 0.125 my doctor wants to do a Salvage Radiation on my Prostate bed n pelvic area for preventive measure need advise do i monitor my PSA and wait or do the salvage radition ? thanks
Not recommending this to anyone for any reason, however, liposomal curcumin is starting to generate papers on the NIH, not specifically for PC but others, (for now).
I had brachytherapy followed by 6 weeks radiation and have been on luperon for 3 shots. My psa is 0.08 Would it be wise to stop luperon? My body is aching everywhere
Good Doctor are you related to Charles?
I think I have this problem I had a Gleason score of 7 and it showed up 8 months later in my lymph nodes after cyberknife
💪🙏
I was diagnosed with stage 2 high risk PC on April/22 and my biopsy revealed a Gleason 4+4 and PSA of 7.3. Two months after my RP on June 16/22, my PSA 0.014, 0.037, 0.043, 0.064, 0.064 and up to Jan. 10/2024 is 0.070. from this data, could this be a micro metastatic disease?
Based on the rise in PSA levels after your radical prostatectomy, it's important to discuss with your healthcare provider whether further evaluation is needed to determine if there are any signs of micro metastatic disease. Early detection and proactive management are key in addressing any potential concerns.
I’ve been recently diagnosed with metastatic prostate cancer. I have 2 lesions on my spine, one on a rib, and 2 in the lymph nodes in my pelvis. I started ADT 2 weeks ago. How would the doctor attach this disease?
Add fenbendazole ASAP and get glucose level down to ketosis levels~
What happens when the cancer is in lymph nodes that can not be surgical removed or radiated?
My Husband had 2 lymph nodes (in front of spine, behind kidneys). IV Chemo eradicated them, but if it didn't work then zapping with Proton Radiation was next on the agenda.
Where exactly is the lymph node that it can't be radiated?
I am on orgovix for 4 months now. My psma scan was clean. It's hard to say whether it's the facts or the chemistry but I do not want to live anymore.
My hubbie has been on active surveillance for a year now he will be getting radiation. I have aggressive endometrial cancer.
We are on a journey.
I am sad that you don't want to live anymore. I know all this can be overwhelming. Pl. keep in touch.
Lost my wife almost 23 years ago to breast cancer. Felt at the time that the medical industry failed her and decieved us with undeserved optimism. Aaand now here I am. Listening to and reading similar words to what I heard back then. I feel I'm a waste of the governments money
It is impossible for a urologist nor oncologist to explain what PCRI informs us.Dr. Mark Moyad , an associate of Dr. Scholz, publishes a Book," PROMOTING WELLNESS for prostate cancer patients "; my urologist suggested such to me and I follow such with vigor. I am 70 and have a personal trainer 32 x a week with HIIT training 5 x a week.
I AM PSMA NEGATIVE PROSTATE CANCER GLENSON 8
I recently read there are various PSMA agents, some of which will pick up different types of prostate cancer with rare mutations.
Needle biopsies i bet