Meet Dr. Scholz, Dr. Moyad, the PCRI Team, and world renowned prostate cancer experts at our 2024 Prostate Cancer Patients & Caregivers Conference: pcri.org/2024-conference

My cancer is no more after three years now, but I still appreciate and enjoy watching your videos. Thank you so much.

Diagnosed with Gleason 6 in May. My urologist sent the biopsy slides out for a Genomic Decipher evaluation. Came back with a .59 score. Upper end of Intermediate Risk. My radiologist believes that takes me out of Active Surveillance and into the Brachytherapy arena?????

Thank you! both of you provide outstanding information! its very calming to have straight forward informative information 😊🙏 Just wish the VA had the funds to treat me. I have been waiting for a year to see a Urologist because of funding! It always comes down to Money!

I found a study showing that doing yoga attenuates side effects of radiation. Have been doing yoga for a couple years and have continued it during my radiation. I think it is helping. I consider yoga as part of my treatment.

Thank you both for answering questions that I needed answers for. Best wishes from Australia.

This was a great recap. Thanks for all you do.

Over the last 5 years I started out with 44 radiation treatments since then I have had 2 targeted treatments and chemo and Pluvicto now I am going to have 4 more targeted radiation treatments. I would much rather have the 4 targeted than more chemo. I admit I am tired of treatments but life goes on. Good luck to all going through this journey.

@edg531

20 күн бұрын

Best wishes, Tom. Sounds like your attitude is serving you well. I hope that PSMA scans are being used to guiding target your radiation, as it seems like these are the most accurate technology available!

Another timely session thanks a million

Thanks for this. I just went through surgery typical open surgery by a very good surgeon who has very good outcomes over Robotic. The issue was I had a previous Hernia surgery with Mesh and the surgeon could not get through the Mesh or around it. It was attached to my Bladder and other structures. He did unattached it from my bladder but the surgery was going to be to dangerous to continue therefore he aborted my surgery. He stated that Robotic Surgery is out of the question and didn’t feel like they could safely accomplish the procedure. Now I’m on my way down the Radiation route with slow radiation therapy and have an appointment for SpaceOR jell and Hormone treatment for 6 months over the next two weeks. I am a 55 yo, I did get Testosterone replacement therapy which most likely hasten the process. I’m a Gleason 3+4 with 11.6 PSA which rose over one year from a 4.8 and was closely watched by my Dr. We could not find it through the typical test in the Rectum and found it with an MRI way out of reach from previous test and used a more Targeted test which could be tested. One positive out five core samples. Been watching your videos and thank you.

@scottdavis5749

21 күн бұрын

You should have a good outcome with your dx. I finished 28 IMRT treatments in May. I have one 3+4=7 and also 55 yr old. I didn’t want t go surgery route because outcomes are nearly identical

@scootermason2746

20 күн бұрын

Thanks for your positive response. As you can imagine it’s been a little much with the ups and downs

@NobodyNobody-hx6wh

20 күн бұрын

I can understand your situation. I also underwent an open retropubic prostatectomy with an experienced high volume surgeon that was aborted as my blood vessels above the prostate made it too dangerous to operate due to increased risk of death or need to amputate the right leg if things went wrong. It was a shock once I awoke from anesthesia thinking well the prostate is out then told it's still in. But I felt very fortunate that I had an experienced surgeon wise enough to make the call. Like you, I am going down the radiation therapy route now. My radiation oncologists have recommended SBRT for me and would come with fiducial placement and SpaceOar in preparation. My provider also ordered an ArteraAI test for me which returned negative and supports what I wanted anyway in terms of not taking ADT. I paid for PROSTOX out of pocket, which returned low risk which is reassuring for the SBRT route. The final piece for me now is checking into MRI Lineac as my treatment vs SBRT. The tighter targeting / higher precision of targeting the prostate with smaller margins makes sense to me and it would still likely be just 5 treatments. Best of luck to you and all of us on our prostate cancer treatment journey.

Excellent discussion and detailed answers!

Thanks for the info. Can you do a video for those that got a side effect of low platelets under 50,000 or lower, due to pluvicto. What can these patients do if their platelets go back up after platelet transfusion, but by the next day it continues to drop? Is this the end for these patients, or is there hope? Can you go in depth of why this happens, does platelets ever stabilize with transfusions, what are the best treatments for this, etc?

Gleason 8, went thru 28 rounds of beam radiation that went well. Psa is

@texasrider5621

17 күн бұрын

I’m doing 26 myself exact same thing you are I got one week left. I’m hoping I can get off my pills as well.

What excellent timing. I just received a message from my Urologist Oncologist. I am 72 and have 3 plus 4 one lesion but close to Urethra. I will be having a Psma PET MRI. PSA has been 5.6 +/- .2 for past two years or so. Things seem to be stable according to my urologist but will go ahead with the imaging mentioned as I will also be in a study and well watched but want to be ready just in case so this and all your videos are extremely helpful. I am somewhat interested in IRE but seems to be short term effective. If you are able to suggest where IRE is used more so I may look there as another hospital offers it within an hour of home. mine doesn’t, but doctor at the other hospital doesn’t have much experience doing it but says he does many other focal so this one is just another focal and all are similar…I am also on TRT and last test this week is at 250 because I’m doing low dose or .4 cc cypionate per week. I also have BPH and take cíalis and Flo Max for that. Thanks for another the great video!

@ricknowak4582

20 күн бұрын

One core at 3 + 4 = 7? Only one! And your PSA isn't really crazy number. Don't you think active surveillance is the way to go? I know I would. Thoughts. Just don't panic you don't need to.

@stillaliveandwell5291

15 күн бұрын

Hah my one core became more after multi parametric fusion mri. Viewray Mridian sbrt 5 treatments 35 gray total all good so far psa dropping steadily from 7.6 to .6 over 18 months. My psa was also fairly steady going from 3.6 to 6.2 over 3 years before diagnosis. No ed and still no dry orgasms and bph is same as gentleman above. Prostate is shrinking so hopefully this resolves on its own though flo max works fine except for nasal congestion which l have a problem with already. No hormone therapy.

@antoniodelrey164

15 күн бұрын

@@stillaliveandwell5291 great! Hope it keeps going your way.

@stillaliveandwell5291

15 күн бұрын

@@antoniodelrey164 Thank you and good luck to you as well!! you seem to have all the bases covered at the moment. The only regret I have as mentioned in this video is not taking care of the BPH before radiation. It is a long story that I'll forgo but options are very limited afterward. My urologist said Urolift is one, although my enlargement is also in the transitional area near the urethra and it is a more challenging procedure. New treatments that definitely are available before radiation are iTind and Optilume and may be available after as well but I have not met with my urologist to discuss. These procedures cause no bleeding in the prostate tissue itself although they do use the urethra which is weakened after radiation, so best to take care of the BPH beforehand if it is a big issue. Mine became a big issue as I got very close to the RT so it was too late to do anything about it. I turned down a TURP much earlier, when the BPH was discovered, but it wasn't bothering much and I was focused on finding the right cancer treatment for me.

@ricknowak4582

15 күн бұрын

@@stillaliveandwell5291 no hormone treatment?! Wow! Was that your decision or theirs? Thank you.

I had both ADT and raditst

Dr, I am 61 years old, PSA : 10, PSA ratio 13% and in a biopsy I got sample points 8, 9 and 10 with a Gleison 3+4 = 7, with 20%, 50% and 20% incidence... ... What do you recommend as a treatment Surgery or Radiotherapy (in its different forms)? Are there other alternatives? Thank you

Thank you for these videos, I've learned so much! I'd be curious to hear Dr. Scholz 's thoughts on the UK study of 1600 men that didn't seem to show much survival benefit to any PC treatment....what does he feel should be the takeaways from a patient perspective?

Many thanks for the insights I have had SBRT w/o ADT two months ago. How often should I get my PSA done I understand it takes a long time for PSA to come down w/o ADT but how else can I have some sense of confidence if I have been treated

Does ADT kill cancer cells in the same or similar way that radiation does? It would seem that taking ADT would just deprive the cancer of fuel and that as soon as ADT is discontinued the cancer would start growing again. Am I misinterpreting this?

@ga6589

20 күн бұрын

ADT deprives the cancer of testosterone, which is required for the cancer to grow. In essence, it puts the cancer to sleep. Sometimes, the cancer can become hormone-resistant and it will start growing again on its own. My husband was diagnosed 3 years ago with stage 4, gleason 9, with mets to the abdominal lymph nodes. He inititally received 26 rounds of radiation and has been on ADT since then. His latest PSMA pet scan shows no sign of cancer and his PSA has remained

@gary4451

20 күн бұрын

@@ga6589 I wish you and your husband the most favorable outcome. This confirms my thought that ADT could temporarily suppress the symptoms of prostate cancer and make it more difficult to tell if the radiation or surgery treatment actually worked. Thanks for sharing your experience.

@ga6589

20 күн бұрын

@@gary4451 From my understanding, the ADT suppresses the cancer and allows for the other treatments to be more effective in killing it off. Also, PSMA pet scans are the standard now for determining whether or not the cancer is in remission. It is more sensitive than traditional scans.

Thank you both. Your talks are so informative and helpful

I am 54 years old & live in the U.K. Had no symptoms, but had a rising PSA to last reading of 4.4. Recently diagnosed through MRI. 1x 13mm lesion left lower near to the wall of the prostate. 17 core targeted Biopsy 6 out of 6 cores of lesion were 50% & Gleason 7 (3/4). 1 random core on the right showed 3/3 (5%). Seen 2 Urologists, both recommend surgery as I am so young. I had a left inguinal hernia laparoscopy 6 months ago, with mesh repair. Will this affect robotic surgery? Does the lesion near the wall of prostate make surgery a better choice or is a form of radio better?

@koof1776

20 күн бұрын

54, wow! Do you have any other issues like diabetes or overweight?

@markkendall6854

20 күн бұрын

I’m overweight with a BMI of around 28. But I go to the gym 3 times a week 20% cardio/80% weights. Work shifts, so diet not the best!

@akashsuryavanshi8257

15 күн бұрын

What is your prostate volume

@akashsuryavanshi8257

15 күн бұрын

What is your prostate volume

@markkendall6854

15 күн бұрын

37cc, density 0.12

What are your thoughts on treatment for recurrence after surgery? Was undetectable for 3 yrs then showed .03 PSA. Went back to every 3 months testing. Next showed .06.

@stevehotchkiss3403

3 күн бұрын

Gleason from biopsy was 3+4=7. Pathology after surgery was 4+4=8

Regarding Prostox testing. Please explain why this test might indicate that SBRT which is higher doses over a shorter period would be less toxic that IGRT/VMAT, which is inherently safer because it is lower doses over a longer period. Biologically speaking what makes non prostate tissue more susceptible to one delivery dosing schedule over another? I could see if a patient elected SBRT and Prostox indicated that to be a bad choice that it might sway treatment to IMRT/VMAT.

@NobodyNobody-hx6wh

19 күн бұрын

I think you are asking something that PROSTOX is not able to answer. I recently ordered and have received my result from the test. There are now two PROSTOX tests available. PROSTOX ultra for SBRT and PROSTOX CFRT for conventionally fractionated radiation therapy. The tests seek to answer the question are you low or are you high risk for developing Late grade, greater than or equal to 2, genitourinary toxicity after radiation treatment by SBRT or CFRT depending on which test / tests you choose to have done. You do a swab that is analyzed to see if you have DNA signatures that place you at genetically higher risk of developing late grade genitourinary toxicity. SBRT/IGRT/VMAT and Gy delivery dosing schedules are a separate question set. What I have learned from listening to Dr Scholz here and my own team of Urology - Med Onc and Rad Onc providers is the need for each of us a patients regardless of External Beam radiation therapy treatment chosen is to ensure that we have the best, high volume comprehensive cancer center and most experienced team availalbe to us providing the treatment. The Rad Onc team providing your treatments determine relative safety and toxicity. IGRT/VMAT is not inhernetly safer because it is lower doses over a longer period of time as you posit above. If the center you go to for treatment isn't on it, you may have worse long term outcomes in terms of treatment side effects. The PROSTOX tests are not designed to make a statement regarding SBRT which as you have it is higher doses over a shorter period would be less toxic than IGRT/VMAT.

@aknittel1

19 күн бұрын

My question was confusing because it attempted to posit a theory and weave it into the test theory. My reading of the test and their web site whuch might also be confusing is this: order each test and the results will tell you which dosing method you're tissues are most sensitive to the toxic side effects of radiation. By dosing method I meant fast high doses over a short period of time, or slow low doses over a longer period.

@NobodyNobody-hx6wh

18 күн бұрын

@@aknittel1 From your reply, I can better see what you are asking. It's a good question but PROSTEX is not designed / validated to give you an answer. Before ordering the test, I had a question for them and they replied promply. I recommend just going to the website to get their email and asking the PROSTEX folks your question. For me, I want to minimize toxic genitourinary, rectal and sexual side effects. So as Dr. Scholtz speaks about, I'm travelling a few hundred miles from home to get to a comprehensive cancer center with excellent outcomes and my radiation oncologist is first rate. CT guided SBRT is the treatment modality recommended by them for me. They use fiducials and SpaceOAR and use a 5mm margin around the prostate except for the rectal side where they go down to 3mm. Fortunately my PROSTEX SBRT test came back low risk. Had it come back high risk then that would have changed the type of treatment I would have pursued. I would want to have MRI guided SBRT but would have to travel much farther to one of the two top of the line facilities that I identified. MRI guided SBRT uses near real time monitoring of the prostate. It has greater accuracy and they shoot 2mm margins and if the prostate moves outside of set tolerances, the beam stops until the prostate is back in tolerance. Thus it is expected to decrease adverse effects like genitourinay, rectal and sexual. I say all the above, to say I think I feel where you are going with your question and in a way, my ordering PROSTOX was done to give me some insight into if my genes placed me at higher risk for toxic side effects from radiation therapy. And if that answer was yes, then I needed to get someplace that provided the smallest treatment margins around the prostate to minimize toxic urinary and rectal effects. Then even if I ended up having an issue down the road, at least I knew that I had done my best, based on the technology/therapy available at the time to minimize my risk and would have no regrets rather than thinking wouda, coulda, shoulda. Hope that helps. All the best to you and all of us.

@NobodyNobody-hx6wh

17 күн бұрын

@@aknittel1 I see where you are trying to go with this, it's just that PROSTEX is not designed / validated to answer that question as far as I can tell. I recommend that you contact MiraDX through the email that they post on their website and ask them the question. I asked them a question prior to purchasing the test and they responded promply to me.

For the past five years my psa has read 0.018 and imches up a little.now it is reading 0.057.last three m0nths it had read 0.042.i had done a psma two years ago with good results.what is causing pda to inch up little by little

@ricknowak4582

20 күн бұрын

Why even worry? I don't get it.

@koof1776

13 күн бұрын

Life, nobody lives forever~

I am going through prostate radiation. I used to get up at night to urinate about once a night. Now it's about 5 times a night. Flowmax has not helped. Is this a permanent condition, or will it get better with time?

@richardbennington323

9 күн бұрын

I had reoccurring prostate cancer I went to 33 radiation treatments I did have that problem at night time it's been over 4 months seems like it's getting better hang in there I might just take a little more time

Most men over 50 have BPH and their prostate is enlarged affecting their flow. I'm no different. Deciding on whether to take surgery or radiation a few months ago I told the doctors that I saw about my reduced flow of urine and was offered flomax or tamsulosin but never even heard of the term turp, nor was it ever discussed. Now halfway through my radiation treatments the flow of my urine is reduced even further. My radiation oncologist tells me to just continue the tamsulosin. Am I looking at a turp operation after my radiation?. There has got to be others in my nightmare situation.

@vandenro

20 күн бұрын

This is exactly me as well. I've just finished my treatment and it went extremely well. Only thing is, my already reduced flow is even worse. My oncologist said this is normal and that my flow should improve over time. He's put me on Duodart ( tamsulosin). There was never any mention about HOLEP or TURP beforehand. I probably should have asked more about it. Now I'm a bit worried what will happen if my flow blocks up completely. Not a permanent catherter I hope. 😢

@ricknowak4582

20 күн бұрын

​@@vandenroI am the same way! I am 70 years old and really always have trouble peeing at night. I usually pee at least five times but lately have been peeing seven and even eight! Which worries me because when I do take proton radiation therapy I am terrified of having urine retention!

@beegood

20 күн бұрын

I’m a bit over a month past my radiation treatments, and at about the 2nd week, my blockage increased severely to the point of completely stopping the flow. Plus it hurt so bad to urinate. Really bad, glass shards in my urethra wouldn’t have hurt much worse. Also, diarrhea really blew up at that time. What a nightmare! Doc put me on 2x Tamsulosin. But those side effects started to very slowly subside. I can pee again! (Since 2 or 3 days ago). Well, not as good as a healthy male, but pretty close to what I had before being treated. I’ve had BPH for 20 years. I’ll have a visit to oncology next week to find out how things are going. But I about quit the radiation, I was in so much pain and misery. Glad I didn’t. I’m about 6 months out on Lupron and probably will get another injection. 4+5; Gleason 9, stage 3C.

@vandenro

18 күн бұрын

​@ricknowak4582 Yes, before my radiation I would peeing 3 to 4 times a night. Just post my SBRT I'm now up 8 or more times. Not much comes out.

@akashsuryavanshi8257

13 күн бұрын

@@beegood what was your psa levels and prostate volume 😮

How do you find a competent doctor and verify their skill level? I am not sure how much you can trust google reviews.