On my third transrectal biopsy I developed an infection and sepsis. I spent a week in the hospital on IV antibiotics, so cancer is not the only thing you have to worry about. In a week I will have a prostate MRI which will be a determining factor on any future biopsy.

@cancerbetter

4 ай бұрын

I would recommend you consider trans perineal prostate biopsy to reduce your risk of future infection. While not as common United States, as it is in Europe, many providers, such as myself started to perform transperineal prostate biopsy routinely. In my practice, almost all my biopsies are done transperineal now to avoid infection, such as what you experience

Dr. Ahdoot, FYI: the subtitle throughout the video is code. Oh, and excellent presentation. It gave me more information for my second opinion appointment. I had the old ultrasound biopsy.

It is very clear and understable. Thanks for your short but precisley info keep doing many thanks

Excellent presentation and articulate

Thank you, going through this/decisions right now. 22.5 PSA by two different labs and went to a third lab today as a final check.

Thank you for a very factual and informative video..

Excellent information and advice, clear and concise - thank you very much. Your videos are invaluable and thank you for taking the time to make them. Much appreciated!

@cancerbetter

3 жыл бұрын

My pleasure! I would love to hear from the viewers to know what topics you'd like to hear more about. More videos to come. I have been recently working on my clinical trials research that will advance the field of prostate cancer diagnosis and am excited to share it with you once it has completed peer review!

I got 20 samples pulled out my prostate. All were benign. My mri came out of a grade 2. My psa was a 7 also. Hope all this backs up no cancer. I going to have a holep procedure done in the next month also. The material pulled during the holep procedure. Will also go to the lab looking for cancer.

I had a steadily increasing PSA for almost fifteen years. (1999-2014) Given my age in '99, (44) I began regularly having my DRE and PSA level checked. The DRE never indicated any unusual characteristics during this time. (44 yrs- 59yrs) At 44, my PSA was 1.6, then after years (13 ) of incremental increases, in proportion to my age, I experienced in one year's time, in one's year's time (2012-13) at the age of 57-58, my PSA went from 5.1 to 8.1. At this time, I decided to see a different urologist, so as to get a second opinion as to what might be behind this increase. Neither urologist, at any time , mentioned anything in regards to preventative measure I might take (diet, over the counter testosterone supplementation etc.) I mentioned over the counter testosterone supplementation, because like many males my age, I was experiencing the natural decline of testosterone. The research I did, and by the way, I NEVER explicitly searched on the subject of over the counter supplementation of testosterone on the prostate, but instead would read up on the basic topic of 'decreasing testosterone in middle aged men, and it NEVER mentioned the possibility of the affect of testosterone supplementation on the prostate of middle aged men. So, with this increase in my PSA, my urologists, said not to worry, and to check back for my yearly DRE and PSA check. Well, in another year, (2012-13) at the age from 57 to 58, my PSA increased from 5.1 to 8.1. It was at this point that I engaged the opinion of a urologist at UCLA, who also said to wait, and possibly get an MRI. After relaying this MRI suggestion to my urologist back home, he ordered one done, which according to my urologist, indicated nothing abnormal. So, after going another year, (2013-2014) from age 58 to 59, my PSA increased from 8.1 to 10.0. Despite this high number, the advice was 'watchful' waiting'. During this period ('99- 2014) my urge to urinate increased, but never to a point to where it was concerning, especially given my age. Given the actions taken so far (DRE's, PSA testing and one MRI) and my urologist seemingly unconcerned, I got out of my confort zone and pushed to get an biopsy done. Okay, this took place- 12 plugs, no cancer. Three months later my PSA decreased from 10.0 to 8.0. I still was concerned and asked for another biopsy, as my urologisty said with 12 plugs taken, there's always a chance that a cancer could be missed. Again, 12 plugs, no cancer. Three months later, a PSA test shows a jump from 8.0 to 9.1. Again, I demand another biopsy, and this time 'Eureka'! 12 plugs and one plug was showing 'pre-cancer'. After waiting for the required three month recovery period (biopsy), we did our fourth biopsy, which of course no was re-biopsying the pre-cancer area from the biopsy before. "Eureka, Eureka"! The area had now turned into cancer. Watchfull waiting? For two months, then after getting the first person accounts of successful biopsies of three co-workers, from the same surgeon, I decided to undergo a prostatectomy. Successful- no lingering effects. For the next six years at six month intervals, my PSA was registering ay less than zer0. which is supposedly no active cancer cells. Then in Sept. '21, at my six month interval for my full blood labs, that SHOULD have included my PSA, it was omitted erroneously by the doctors office, and as such when reviewing my results a week later, I discovered that they didn't do my PSA. I asked why, and the doctor said that my insurance (Medicare Advantage) only covers it once a year. I was a bit miffed, because he knows from my file, and maybe more importantly, the previous six months blood labs, that per my urologist, I need to be tested every six months. He glossed over it, saying out of his hands was the reason for the omission, and went onto say that "besides, you've tested less than zero now for six years, I'm sure it's the same". At that point, I should of again gotten out of comfort zone and demanded that I be tested pronto,.....but I didn't. Sure enough, when the next lab work rolls around, (six months) my PSA has now registered 1.6. Whaaaat? What was it six months ago, when I SHOULD have been tested? Still zero? .03, 1.0, .1.6? Needless to say, I was hot, and told my primary as much. Longer story longer, (lol) I see my urologist (surgeon), and he says to go get radiation. I go consult with the radiologist and he gives me these testosterone suppressors to start taking, and to set up my initial appointment to get 'measured', and begin my radiation treatments. Five days a week, 15 min per day for eight weeks, all while staying on these testosterone suppressors for a year. WhaaaaT? I then tell the radilogist that obviously testosteron isn'y good for the prostate, and he says there's evidence of such. (study's) I said there has to be ample evidence, for anyone undergoing radiation treatment for the recurrence of prostate cancer, that ANYTHING testosterone, whether it's the bodies natural generation of such, or a persons ingesting over the counter supplementation, that TESTOSTERONE is a no-no. I look back, and think of the on and off again, (semi-regular) ingestion of testosterone supplementation by me, from probably the age 45, to literally after I became aware of my PSA measurement of 1.6. I was unknowingly feeding cancer! Wow! naturally in 2020, there's no shortage of online videos that tell you such. Obviously not enough damning evidence, to make it a priority for the urologists to pass along this simple preventive measure, to their middle aged patients. By the way, after weighing everything, I've decided to forego ingesting the testosterone suppressors, ($2500 per month) and of course ceasing the ingestion of any testosterone supplementation. On top of that, I'm atleast initially NOT taking any radiation, after my PET scan showed no cancer in the obvious areas. I'll be getting a PSA done next month, and I'll go from there. I understand that I might be wrong in not taking the testosterone suppressors, and radiation, but given the now realized proof of the culpability of testosterone's harmful effect on the prostate, I'm going to see if my ceasing of ingesting (albeit irregular) a testosterone supplement, has a positive effect on my situation.

@daisuke6072

Жыл бұрын

I don't understand if you get radiation and testosterone suppressors like lupin at the same time how they can tell if the radiation worked since the the ADT will suppress the cancer cells anyway - and ADT has awful side effects.

@edgar2907

Жыл бұрын

Thanks Remmy for a full description. Can you say a bit more about your prostatectomy? Was it with Laparoscpy or Robot? You really had zero erectile disfunction or incontinence side-efffects?

@dappa311

Жыл бұрын

@@edgar2907 Yeah very good question I would like to know

@delinquense

Жыл бұрын

TL;DR

@alanlewis4573

Жыл бұрын

😊

Excellent analysis

I've had two MRI targeted and fusion biopsies. In both cases the MRI found a 5/5 PIRADS but in both cases it was negative.The second involved 42 samples/cores and caused bleeding in the semen and ED for over 2 months. In one other MRI was PIRADS 2/5. You will forgive my scepticism about MRIs. It caused tremendous anxiety.

@cancerbetter

Жыл бұрын

Sorry to hear about that experience. It's an unlikely occurrence but the data shows that in about 5% of cases a person will have a PIRADS 5 and cancer will not be found in the most expert hands. Less experienced centers with MRI may have lower success rates. Glad to hear you do not have cancer.

@thechosenonedotinfo

Жыл бұрын

@@cancerbetter Sorry to say. It is not about data or anything. The whole healthcare about making money from us (CUSTOMERS). Remember one day we all have to answer to our Big Boss. Be Prepare!

@millermcmillan5532

6 ай бұрын

If an MRI and modern, ultrasound-guided biopsy are professionally done, what percentage will miss significsnt cancers?

@cancerbetter

6 ай бұрын

@millermcmillan5532 about 7.5% risk of understaging, meaning the biopsy finds low risk cancer but a higher grade of cancer is present.

Thank you Dr Ahdoot for the knowledge & insight to diagnostic options available for men. I'm 71 have BPH & my most recent was PSA 6.5 up from 4.5 from my last exam 5 yrs ago. At that time underwent MRI & Aphiny test/analysis not sure which kind. Radiologist did not find anything to raise concerns. I'm thinking of a follow up with a urologist. My understanding is that men with BPH will see a rise in PSA as they age. I want to be proactive with my health but don't want invasive exams unless completely necessary. My experience with urologists over last 20 yrs has been we need do biopsy etc. Your research & videos provide a wealth of up to date information for men with decisions to make. Thank you again.

@cancerbetter

Жыл бұрын

Glad I can help!

@jerrymunroe5593

Жыл бұрын

What is a BPH?

@cancerbetter

Жыл бұрын

Growth of the prostate that is related to age, rather than cancer.

- Thank you!

Sir I'm 58, had an exam 2 years ago was told PSA was elevated to see a Urologist. The urologist recommended a biopsy, it came back negative, PSA was 6 at the time. Had annual checkup again this year and PSA was 9, went back to the urologist and he ordered an MRI, I was told this is needed to determine / pinpoint location to do another biopsy. The MRI came back with no findings, should I have the 2nd biopsy even though the MRI came back with no recommended target areas? I appreciate the advice.

I wonder if pet-scan could be reliable considering the presence of prostate cancer. I appreciate a lot your time to let me me know, how you evaluate this decision making process.

I was asked if I want a MRI guided biobsy. I agreed. So doc found 3 targets. It was difficult to hit the targets with ultrasound help. Also he did 12 samples even though nothing was found on MRI on left side. Very good information for planning treatment!

@tonysmith2082

Жыл бұрын

So what were your final results and actions. Good luck to you sir.

@LeinonenHannu

Жыл бұрын

@@tonysmith2082 My psi was about 10 and gleason 7. (25% was 4). I had radiotion for 20 treatments. 4weeks daily excluding weekends. After one control psi was 2.7. Next control is in 3 months. Radiation had fairly few side-effects. Maybe urgency to pee comes faster, but its not a new issue. Waiting to see how things develope, but all is looking good.

@tonysmith2082

Жыл бұрын

@@LeinonenHannu man your doing good. I'm scared as hell. My psa was 7, all 12 samples,gleson group was 6 of the 12 3 was benign and I have to discuss my results on the 30th of this month. Your doing good for radiation with little side effects.

Excellent video. Thanks a lot. Do you have video which compares MRI target biopsy with MRI fusion biopsy?

@cancerbetter

Жыл бұрын

Those are two terms that describe the same thing.

MRI found type 2 prostate cancer 3+4 Glyson 7.. after reboot prostate surgery pathology found type 3 not type 2 and 4+3 glyson 7 !! Not 3+4!! Any comments or concerns regarding my case please??

What can you say about the new prostate scan called PSMA? I believed it is fairly new came out in 2021. From what I understand is that this test or scan is so precise , the patient can have this scan and can tell if the patient has cancer, if the cancer is contained in the prostate, if the cancer moved out of the prostate and had it metastasized to the bone, lungs or other parts of the body. I am 78 years old, I had prostate MRI and was given a Gleason 8 score and was sent to for a PSMA scan and the result shows that the cancer is contained in the prostate. I was given hormone shots to contain the cancer in the prostate and I chose radiation therapy over surgery because I believed that radiation therapy today is much better than in the 1990’s and probably less complications than surgery for my age. At present I suffer some complications because of the hormone pills and radiation but I was told that after treatment, everything will be back to normal.

@dappa311

Жыл бұрын

Does the hormone therapy effect erectile dysfunction , is that a side effect?

Can you explain this to me please, our urologist never did. The 3T MRI, no contrast, was done in May. Not seen a doctor since begining of May just before this MRI. Thank-you Prostate gland measures 6.6, 5.5, 4.4 centimeters on CC, TR and AP dimensions respectively with estimated volume of 84 cc and PSA density of 0.063 ng/ml/cm3. 9.5 mm ill-defined nodule with obscured margins are noted within posterior medial aspect of left peripheral zone at mid gland which show mild hypointense signal on ADC and mild hyperintense signal on high B value DWI sequences likely representing PI-RADS 2/3 lesion. No other peripheral zone lesion is noted. PSA is 4.86.

Good information! Thanks for sharing. Are your prostate biopsies done by the transperineal approach?

@cancerbetter

Жыл бұрын

The studies referenced in my videos were done using transrectal prostate biopsies. In my current clinical practice I have transitioned to doing the vast majority of my biopsies transperineally for the lower infection and bleeding rates. Transperineal prostate biopsies do require a learning curve so they are not very commonly used in practice yet but I am always teaching others how to do these biopsies.

Yep , I wound up having two biopsies , the first was clear but the PSA increased ( doubled) over the next 6 months , the second biopsy found the cancer , it was a gleason 9

@cancerbetter

10 ай бұрын

It’s great it was found. Wish you successful treatment and a quick recovery from whatever you select for treatment.

Hello and thank you for this very useful information. It seems that I am in a bit of a difficult situation. My last several PSA tests indicate an elevated score and my urologist has suggested having an MRI guided analysis to test for prostate cancer, however I am a Parkinson’s Disease patient (diagnosed 8 years ago and received a DBS device one year ago) and have been informed that the battery in my unit is not compatible with MRI. My options seem to be to request a change in battery design (apparently a relatively minor procedure) to allow an MRI, or simply go with a standard biopsy which can be quite inaccurate. Some say that I could just wait until the battery is due to be changed anyway but this could be several years (between 2 and 5 years more), during which time, potentially aggressive prostate cancer could be advancing uncontrolled . I am interested n your thoughts. Thank you.

@cancerbetter

Жыл бұрын

There is also a very high frequency ultrasound that is good at cancer detection. You might want to consider that.

All of your comments are so thoughtful and respectful and considerate✅👌🏾 Your comments gives me humility on your part and that’s what I am looking for in a doctor. Your answer here says it all about your personality and how you approach healthcare and you are diligently replying to so many people. Thank you so much.

@cancerbetter

27 күн бұрын

My pleasure and I’m happy my knowledge can help people

52 year old male, have been on finesteride for the past 26 years for male pattern baldness, came off finesteride (5mg 1/4 daily) in March, psa went from 2.6 to 4.5 in 14 weeks, free psa % was 12.6%. Had an MRI 1 week ago, a 5mm lesion was identified with a PI RAD = 4 score. Urologist recommending a biopsy. Could this lesion have been in my prostate for a number of years whilst on finesteride and it has now become more aggressive from ceasing the 5 alpha blocker?

Hi MRI results came back and it's PRADAS 2. And my psa went upto 14 then came down to 9.4 in January but has now risen to 11. At times it plays on my mind as my Father passed away with prostrate. My Radiologist and Urologist say I have prostatitis and a enlarged prostrate too which results in a high psa. So every year I intend taking an MRI on prostrate to keep in check.. I'm 65yrs old.

@cancerbetter

2 ай бұрын

No harm in having information to make good decisions with.

I had a PSA of .69 nine months ago and retested two weeks ago my PSA was 7.9 and CRP was 51. I retested yesterday and my PSA dropped to 2.1 and my CRP is 1.0

When having an MRI to detect prostate cancer is the dye, composite necessary? Thank you for your excellent video.

@cancerbetter

2 ай бұрын

Not always necessary. A scan without contrast can still find cancer but is not as good as a scan with contrast.

My doctor did a MRI and two Biopsies on the second one they change it from 3+3 to 3+4 ??

Thanks for this very useful information. I had a question - is there any evidence or risk of a prostate biopsy causing cancer that is localised within the prostate to contaminate and spread the cancer to the surrounding tissue outside of the prostate ?

@cancerbetter

2 жыл бұрын

That's a common and interesting question. It's actually 2 questions. First does biopsying a tumor lead to cancer spreading throughout the body? In other words does biopsying a mask cause metastasis. The data is pretty strong and it shows that is not the case. The second question is whether you can get seating from the biopsy track. This can actually happen though is it extremely uncommon. The risk of seeding (or cancer spreading) along the path of the needle at the time of a biopsy is a fraction of 1 percent. So yes, while there is a risk, the benefits of confirming a cancer diagnosis is likely worth the risk of seeding.

@bassbytes

2 жыл бұрын

@@cancerbetter thank you for your comprehensive answer.

Is a PET scan the same as an MRI?

My surgeon told me my PSA is 3.9 non smoker and drink iam fluid restrictions the test they done me iam 59 years old are ct thorax mri the scan my enlarge prospate is 31 ins and going with biopsy and keep a eye on my bladder then the operation .iam concerned if discover the C.

I have BPH symptoms plus prostate cancer. What treatments out there would take care of both. Besides surgery.

@cancerbetter

2 ай бұрын

Surgery would be the go to for that. An alternative would be a TURP(or other BPH surgery) followed by radiation. Hifu can help with prostate enlargement but is reserved for people with small volume intermediate risk disease

Hello Dr. Ahdoot: I am PIRAD-2 with a big prostate (166 cc) and a PSA of 15 for a Prostate density less than 0.1. I will have a PAE (prostate arteries embolization), but first i will have a biopsy. I have the following questions: a. Probability of cancer? b. Probability of a significant cancer c. Is it necessary to have a biopsy before PAE? d. Is PAE a good option for me? According to this excellent video the best biopsy for me is the systematic... Is it right? Thank you in advance to your answer, I appreciate a lot you recommendations. Best regards

@cancerbetter

2 жыл бұрын

Lots of questions. I can give general information but not specific medical advice for your situations. Generally PIRADS 2 have pretty low risk of cancer (

Just had my PSA done for the 1st time ever after years of doctors telling me to wait until I was 45. It cam back at a 7.5. My doctor did the digital and said everything felt normal. He then suggested a biopsy. I had the biopsy and had to do some studying on prostate cancer. My primary care physician didn't ask if I had sex recently. I had a lot of sex and drinking up to 12 ours before my psa test, which I didn't know they were doing. I also had sex about 12 hours before my biopsy. Noone said not to. After researching, I am very afraid. I am 45 years old and wondering if I am missing something by what my doctors aren't saying. Waiting 2 weeks for my results.

@cancerbetter

2 жыл бұрын

The biggest predictors of finding cancer on a prostate biopsy are #1 your PIRADS Score. This is the score the radiologists gives on the MRI. This ranges from 1 to 5 with 5 being the highest risk. #2 PSA Density. This is the PSA level corrected for the size of a persons prostate. If you have a PIRADS 5 and a PSA density greater than 0.15 cancer is very likely. If you had a PIRADS 2 and a PSA density of

@daisuke6072

Жыл бұрын

you should not have sex or exercise for 48 hours before a PSA blood test as it can increase the PSA level

@dappa311

Жыл бұрын

How did everything work out, did you come up with prostate cancer diagnosis if you don't mind me asking?

@Jabotank1

Жыл бұрын

@dappa311 yes. It was cancer. Had it removed and doing good

@robertcuba5947

6 ай бұрын

Did you repeat the elevated psa test before biopsy?

Here is a question, Doctor. Does the expression "MRI targeted biopsies" mean that the doctor performing biopsy looks only at the image obtained via MRI (not having the ultrasound image) when he shoots for the tissue samples?

@cancerbetter

Жыл бұрын

Most MRI targeted biopsies are not done in the actual MRI machine. Instead what we do us use an ultrasound to identify the outline of the prostate then create a virtual overlay of the MRI on the real time ultrasound imaging to perform and MRI targeted biopsy. As a result both MRI and ultrasound imaging are used for MRI targeted prostate biopsies.

@alexandergofen1771

Жыл бұрын

@@cancerbetter Thank you very much!

Hi , for the past couple years I've been having problems with a enlarged prostate. My psa has been steady around 5.7 , now it jumped to 6.5 , my family doctor sent to a urologist. He had a mri done on me which came back showing a suspicious area on the right lobe . He now has a biopsy scheduled for me . When he done a rectal exam he felt nothing. Do you have any advice for me ? I'm 61 years old with no family history of prostate cancer.

@cancerbetter

Жыл бұрын

I’d recommend that you collect information. Watching these videos is an excellent start.

Please comment, I'm 60 with a psa of .97 do I need a traditional biopsy? Had trouble urinating that's what prompted my visit to urologist. Since then worked on diet and it's been better. Biopsy coming up and don't know what to do... Please reply. Is it still needed?

@cancerbetter

3 жыл бұрын

Usually people with a PSA below 4 do not get a prostate biopsy unless there is an abnormally felt on a rectal exam. There are exceptions. For example a PSA of 3 in a young person can be highly concerning or a PSA that is rising quickly. I can't make comments on your particular situation though as I have not seen you. If you are in doubt get a second opinion.

Im a Gleason 6,, wondering if I should undergo surgery to take out prostate

@cancerbetter

2 жыл бұрын

In very rare cases do I recommend surgery for Gleason 6. As long as your were diagnosed by an accurate biopsy method the risk of upgrading to more dangerous cancer is actually quite low(about 7%). The exception is for people with high volume gleason 6. For those people with more than 4 biopsy cores with gleason 6 cancer their risk of having higher grade cancer is much higher and in that situation you can consider surgery. But in general, gleason 6 prostate cancer does not spread and is not a life threatening disease.

I had two lesions rad 4 show up on an MRI, PSA 3.12, prostate 100cc. 14 sample MRI targeted biopsy, all benign. 9 months later, a new Urologist and hospital, PSA 5.25, second MRI with what they described as a brand-new state of the art MRI machine. Results, no lesions present and no signs of prostate cancer at all! Prostate again 100cc. My new Urologist said you are good to go, high PSA is probably from BPH but obviously we will monitor everything. The former urologist said sorry, but our MRI machines are old and it could be the lack of magnet strength. I still worry.

@cancerbetter

4 ай бұрын

This post brings up several good points. First, the MRI machine matters. Ideally, you want to try and find a strong MRI magnet that rated at 3 Tesla. Second, as a persons prostate volume increases we expect the PSA to also proportionally increase. This is why we calculate something called a PSA density to stratify someone’s risk. Based on the numbers presented in this post, this person’s PSA density was likely very low. Meaning, their risk of us to cancer is also OK correspondingly low. The completely normal appearing MRI is more consistent with the low PSA density finding. This is why individual pieces of medical information cannot be used in isolation and you need to contextualize them within the context of other findings to help create a more global picture of a persons risk of prostate cancer and needed for prostate biopsy.

I had a psa 0f 4.6 a 2nd one of 3.6 I had a mri which gave me a score of 4 I have now got to have a biopsie. Dose this mean the mri found something ?

@cancerbetter

Жыл бұрын

There is about a 50-60% chance of prostate cancer that we would recommend treatment for when a PIRADS 4 score is assigned.

Hello Dr. Ahdoot - Thank you for this information. I'm 64 years old. Because of an elevated PSA I underwent the systematic biopsy in November 2021 where my doctor took I believe 13 patterned biopsies. The results were all negative except for one section where he found atypical cells that he said he couldn't say I had cancer, but also couldn't say I didn't have cancer. I'm schedule for more biopsies of just that specific section in February 2022. I'm concerned about the damage to my prostate and my rectum wall from taking all the new biopsies in one small targeted grouping. Would an MRI at this stage be a better idea? My doctor says MRIs can't show cancer of the prostate. Thank you in advance for answering my question.

@cancerbetter

2 жыл бұрын

I cannot give medical advice on here but I can tell you the science and the science shows that MRI prior to prostate biopsy leads to WAY better cancer detection than systematic biopsy alone. Here is the paper I wrote on the topic if you want to get an idea of the numbers. www.nejm.org/doi/full/10.1056/NEJMoa1910038

@robertcuba5947

6 ай бұрын

Did you retest after your initial elevated test?

@cancerbetter

6 ай бұрын

@robertcuba5947 indeed, initial elevations in PSA should be confirmed with a repeat test

I am a 78 year old male with a PSA score of 11.5 and have had an MRI indicating a tumour that is suspected of being 90% cancer. My urologist has proposed a prostate biopsy to verify the findings. My concern is that I am Factor V Leiden homozygous and taking blood thinners. In your opinion would this condition make a biopsy very risky and should I proceed with treatment without the biopsy.

@cancerbetter

Жыл бұрын

You should look into transperineal prostate biopsy for the lower bleeding risk.

My husband is having a biopsy and I wondered if he could ask for MRI first before cut a little piece of his skin.

@cancerbetter

11 ай бұрын

You absolutely should. Also, you will need to go to a provider who knows how to do an MRI targeted biopsy. It’s possible that the person who he has been seeing does not have experience with MRI Target biopsied and even if you got an MRI would not know how to target the biopsy to the area of concern. In addition, the MRI would be helpful and surgical planning in the event that prostate cancer was found and he elected for surgery or focal therapy.

Scared spitless.... PSA of 52, 53, & now 63. (not 6.3) Biopsy shows some 7 to 8 gleason scores BUT was not an MRI guided biopsy. Referred for Radiology now.... 64 yr old with no family history.

@cancerbetter

2 жыл бұрын

Sorry to hear news but treatment options have improved substantially in recent years. Here is some information that might help. In the event of high PSA levels doctors will historically order a bone scan and CT scan to look for evidence that the cancer has spread, however these scans can miss many early cancers that have spread beyond the prostate. In the last year a new PET scan called PSMA PET has become available and actually does a better job of finding cancer than the traditional bone scan and CT. The newest studies show that if cancer has spread to fewer than 5 spots radiating those spot in addition to testosterone lowering drugs can lead to improved survival. In terms of testosterone lower drugs, for many years we were putting people on lupron then waiting for it to stop working over several years then adding on the second generation of testosterone blockers like enzalutamide. We now know that starting the second generation of testosterone blockers at the time of first diagnosis leads to improved outcomes over waiting. This data is all new so it has not spread to the medical community yet. I hope this information is helpful and is able to get you closer to the best treatment possible. As always, this is general information and without knowing someone's complete medical history I can not make medical advice. I am just trying to share the most up to date medical information to help people get the best care possible when they have a cancer diagnosis. - Michael Ahdoot MD

@WarriorRemnantBride

2 жыл бұрын

@@cancerbetter Way COOL THANKS very much for the info....... Going to my 1st Oncologist appt. tomorrow

I had a PSA done after a 4 year lapse and it came back 5.7. One year later it was repeated and came back 7.7. At that time the urologist asked if I wanted a biopsy. I replied yes, but after I have a 3T MRI to show if and where any lesions are located. The MRI came back PIRADS 4 with a 1.1cm lesion noted. I was never contacted by the ordering physician so I started looking for another urologist. The new urologist performed the biopsy sampling 20 cores of which 5 were positive for cancer and two of the cores were Gleason 4+4. I was started on Lupron and two and a half months later I began Proton Therapy with 39 therapy sessions. No side effects of the Proton Therapy noted, it was completed only 4 days ago. I will continue with the Lupron probably with two more six month injections. As an aside my initial diagnosis was high risk/aggresive cancer but a genome test on the cancerous cells put me in the low risk category. From what I have read, the high risk category is a heterogenous class with varying patient outcomes. As an aside, anyone going through this should read Robert Marckini's book, "You Can Beat Prostate Cancer and You Don't Need Surgery to Do It". I learned a lot from it and it was the time it took to read. BTW, it has been 7 months since I had the MRI and the ordering physician still has not called me back with the results. That should be a lesson to everyone, no news from your doctor does not necessarily mean "good news".

@dappa311

Жыл бұрын

What were the side effects of the Lupron and is that hormone therapy?

@georgewashington687

Жыл бұрын

@@dappa311 Yes, it is hormone therapy and it lowers the PSA in my case to less than 1.0 and also lowers the testosterone to very low levels. The most annoying side effect in my case are the "hot flashes".

Great videos! I'm 75 yrs old, PSA had been gradually rising from 4.0 (PSA-Free % 29.0) 12 years ago to the current 5.4 (PSA-Free 35.9%). MRI recently shows that my 53ml prostate has a 1.5cm peripheral lesion. Radiologist scored it PIRADS3 with no evidence of spread beyond prostate. Urologist ordered ExoDx antigen test which came back at 44.3 risk score out of scale of 100. He recommends fusion biopsy now but I want to take time to choose the best institution for biopsy and possible subsequent treatment. Urologists are booked out 6-8 weeks so my question is: What level of urgency (to get a biopsy) is advisable? If I indeed have a "clinically significant, high grade" cancer that hasn't yet metastasized? Should I risk waiting two months to get the biopsy or just find a place that can do it right away even if it involves added cost and perhaps travel?

@cancerbetter

Жыл бұрын

2 months is unlikely to result in any meaningful progression of prostate cancer in almost all cases. Take your time to find someone you are comfortable with. In general the complication rates of transperineal prostate biopsy are lower than transrectal. You might want to consider a transperineal biopsy.

@melberry3978

Жыл бұрын

@@cancerbetter Wow, thank you so much for your almost instant response, Dr Ahdoot! I just breathed a huge sigh of relief and yes, I will certainly explore the transperineal biopsy. You have earned one very loyal subscriber.

@dappa311

Жыл бұрын

@@cancerbetter Hi Doc, have a very frightening question but I am going to ask anyways, I am 44 going to be 45 in January , I just got my routine physical done about a month ago. My PSA was 3.3 and my free PSA was at 9% , my doctor sent me to a Urologist and I am scheduled to see one this coming week. My PSA was also the same back in 2017 , 3.3 , so it never rose from then to now. She put in her notes that I have a prostate malignancy . 1. From what I have been reading , even if your psa is with in range and you have a low free PSA it almost always means a diagnosis of prostate cancer, is that True? 2. I am terrified of this because I consider my self still young, sexualy active and past that I feel great ,no body pains except for when I exercise , I take no medications except finasteride to keep my hair and I am wondering if that may play a part in getting prostate cancer if that's what it actually is? 3. Lastly being that I am middle aged, how likely is it for me to actually have this and how aggressive would it likely be where I would need to remove my prostate and their being a high probability that it has already spread, from your experience? These are my fears. As far as I know , no one close to me thus far has had prostate cancer , my dad died from liver cancer , my grandfather died from lung or throat cancer, he smoked his whole life , none of my uncles as far as I know thus far have this issues and they are all in their early 60's to early 70's. lastly what would be the recovery for someone like me , if I had to remove my prostate, I have no erectile issues now , none what so ever in fact, I think about sex all the time and masturbate probably way more than I should ; and I have been doing that for years.

@cancerbetter

Жыл бұрын

1. Free PSA is not a perfect test. Sometimes it is suggestive of cancer but nothing is found. It's more of a test to determine your risk but not something you can make absolute predictions on. 2. When on finasteride for over a year it should cut your PSA in half so to get your corrected PSA you should double your PSA to get the actual level you would have if you were off finasteride. Finasteride reduces the rates of low grade prostate cancer but in historic studies, before we used MRI, it also lead to higher rates of high grade cancer diagnosis. I personally believe this was because finasteride shrinks the prostate increasing the odds of cancer detection by the systematic biopsies, however this is a point of contention among my colleagues who are also experts in this field. 3. Being young reduces the likelihood of prostate cancer significantly. That being said if cancer is found younger men, in their 50s and below, have much better rates of erection preservation than those reported in the studies I quoted, which included predominantly men in their 60-70s.

@dappa311

Жыл бұрын

​@@cancerbetter Thanks for the response Doc, my last question is , worse case scenario , from what you have said if my PSA was 3.3 then doubling it would be 6.6 and that would be high for my age from what you have stated ? Lastly, worse case scenario , if cancer be the case , being that I am young would it more likely to be an aggressive form or age has little no bearing?

Doctor, thank you for your video. I am 68 years old and I have elevated PSA 5.3. My MRI fusion transperineal biopsy with 26 cores, all came out benign. I know I need a second biopsy done if my PSA keeps rising. What do you think of in-bore MRI biopsy, I believe UCLA offers that? This is the type of biopsy where patient lies inside MRI bore, and urologist looks at real time imaging from MRI machine performing biopsy. This sounds like an even more accurate method of doing biopsies. What is your opinion?

@cancerbetter

3 ай бұрын

There are pros and cons to biopsy inside the MRI machine. For the best majority of Pat it makes no difference in some situations. However, if someone has a very small lesion that’s very challenging to target with MRI fusion software. There is a small chance it’ll make things more accurate the downside is that doing a biopsy inside an MRI machine leads to a very small workspace, and there are a lot of limitations on the use of metals within the magnet of the MRI, which can make the process cumbersome. Issues such as limited space poor organics, and also make accessing certain areas of the prostate for a biopsy challenging. This is why the majority of biopsies are now done with a MRI fusion system to allow for targeting for the MRI abnormalities outside of the MRI machine itself.

@frankh8471

3 ай бұрын

Thank you very much, Doctor@@cancerbetter

@cancerbetter

3 ай бұрын

@frankh8471 Happy I could help!

can you talk about micro US, apparently close to MRI

@cancerbetter

11 ай бұрын

Not as good as MRI but still pretty good. Great option for people who can’t get an MRI for whatever reason.

I am 64 and have over a year and a half of a psa score in the 5-6.5 range. I am now going to do a 4k test. This profession has been over diagnosing/treating prostrates for a long time now due to lack of better testing. I am really hoping that this new test will forgo a painful completely unnecessary biopsy. We shall report back as to how this turns out. Btw I tried to do a MRI w/contrast but was unable to go into that tube! Why not do anesthesia? Just like a colonoscopy? 100% success rate of doing this MRI! Also why do urologists refuse to use anesthesia for prostrate biopsy? If you guys were dentists you'd all be out of work for allowing us to suffer such agonizing painful biopsies!!

@cancerbetter

3 жыл бұрын

Lots of good questions. 4k score, phi, PSA 3, and decipher scores can all help determine your risk of agreesive prostate cancer but the MRI is the most accurate (at least based on our most recent studies). In cases where people have an elevated PSA it's often wise to correct that PSA level for the size of a person's prostate by calculating a PSA density. (PSA density =PSA level/prostate volume in grams or ml.) Generally, a PSA density of >0.15 is very concerning for cancer and

@b8kersfield

2 жыл бұрын

Dave, I raised daughters and so am not afraid of anything! ... at least I thought. My biopsy was performed with laughing gas. I felt nothing but a little pressure from each of the twelve extractions. What you went through must have been horrifying! I could never knew such barbarism existed! There needs to be a t-shirt for guys like you!

@davenone7312

2 жыл бұрын

@@b8kersfield As a follow up my 4K score indicated that a biopsy was required. I did it and it was not as bad as I thought it would be. Saying that I can also understand how it could have been far worse. The results of the 14 samples of tissue found less than 3% of #6 Gleason in just one sample! So yes I am proof that a elevated PSA does not necessarily mean a biopsy is required from that test alone. The 4K test was far better and even that was misleading. I am on a watch with a psa taken every 6 months followed by a visit to my Urologist. BTW I raised 4 daughters myself lol

@TimConama

2 жыл бұрын

I've had two biopsies. One with anesthesia, and a year later, one without. I didn't find the anesthesia necessary. I did have local anestheisa (lidocane), however.

What are odds of the various Gleason scores with a PIRAD 4 lesion found on a mpMRI?

@cancerbetter

5 ай бұрын

Look up my paper in the European Urology Oncology. There is a table with exact numbers. Search “Ahdoot European Urology”. Will be the first or second hit.

@groove9tube

5 ай бұрын

@@cancerbetter Thank you. Will consider giving a donation to Cedars Sinai in your honor.

@cancerbetter

5 ай бұрын

@groove9tube if you would like to support my efforts on this channel you can donate at cancerbetter.com/donate

Can the patient demand general anesthesia for the procedure? I think it depends on whether insurance will pay or not.

@cancerbetter

Жыл бұрын

You can request it. If you want something more then local anesthesia, most times simple sedation without a breathing tube is adequate.

Wow. What about perennial biopsy. Would that be a good option with the study of the MRI FIRST. and than basically just using the ultrasound. I had that done Not the in bore. My doctor is confident he got the two lesions 7mm and 4mm. Im a little worried. I'm sure If psa goes up or lesions get bigger I should ask for the in bore. The scarry thing is the radiologist rated the lessions a 4. I dont konw how good they are. My urologist thought it was not cancer right off. Or I should say in fusion biopsy. One urologist said in early detection cure rates are the same for surgery or radiation. Focal lazer therapy looks very promising. Maybe 5 years from now the preferred treatment? Plus two biopsys at each leasion site probably should of been done. Side effects were nil. No blood in sperm either.

@cancerbetter

3 жыл бұрын

Hi Tom! You are right on! Perineal biopsy is superior to transrectal biopsy in both cancer detection rates and lower infection risk. I have switched my practice to nearly entirely transperineal prostate biopsy for these reasons. My recent New England Journal of Medicine publication (www.nejm.org/doi/full/10.1056/NEJMoa1910038) showed the benefit of MRI targeting over traditional methods but was done before we had good evidence on the value of transperineal biopsy. I am confident that in about 10 years the rest of the urologic community will make the change to using only transperineal biopsy but adoption is slow. This is yet another example of how we can do cancer care better...hence the name of the channel! Hope this helps. - Michael Ahdoot MD

@tomslick2058

3 жыл бұрын

@@cancerbetter thank you. Many top universities in Chicago dont have it. Loyola does. Was not bad at all. Of course in bore and in fusion whould be even better. Seeding is making a big comeback. But your right radiation can cause rectal problems even though it's much more pinpoint than before. Some are advocating high dose for 5 days on the beam. Also just radiation on only the lobe effectied if that's the case. Surgery may not be the gold standard that it once was. My problem is a catheter really hurts. The metus gets bad. I dont know if I can handle that for 10 days or more. 3 or 4 days yes. Plus no matter what I took I could not defecate. And that was just bladder cysto surgery.Theres definitely a controversy between surgeons and radiation oncologist. Let's hope I won't have to cross that path.

@cancerbetter

2 жыл бұрын

@@tomslick2058 For people who cannot tolerate a urinary catheter there is a way to do a prostatectomy without using a catheter. You need to find someone who does Retzius sparing prostatectomy and at the time of surgery they can put a drain directly into the bladder for one week while you heal from surgery. Retzius sparing is new and has excellent continence outcomes (i.e. most patients are continent on day 1 after surgery) but its challenging and few urologists do it. I have switched the Retzius sparing and I love it. Patients are doing amazingly from a continence perspective. Aside from myself I know the urologists at the University of Miami and Dr. Kowalcyzk at Georgetown in DC do Retzius sparing as well.

@tomslick2058

2 жыл бұрын

@@cancerbetter one more thing. Tell your patients they might want to sit and void the first couple times after a biopsy. They grease you up pretty good with that probe. Or maybe the enema is still at work. If you you get my drift. The only mishap. No burning or blood. 12 pinches. That's it. And I know two guys who got Sepsis from the transrectal.

@cancerbetter

2 жыл бұрын

@@tomslick2058 Risk of sepsis from transrectal biopsy is a real thing with 3-4% of people being hospitalized after transrectal biopsy. Transperineal prostate biopsy leads to the lowest rate of infection and has a 0% rate of sepsis. I am a fan of transperineal prostate biopsy and do the majority of my biopsies transperineally now.

So tell me, went you stick needles in a cancerous tumor, how can that needle be pulled out without spreading cancer cells out into other parts of the body? That is why I have not allowed my doctor to do a biopsy.

@cancerbetter

10 ай бұрын

While this is a common fear clinical studies have not show than biopsy results in metastasis.

I had a PSA of 9+, negative DRE, but a PIRAD-5 bilateral anterior tz lesion. I was given a fusion transperineal biopsy, which found a small amount of cancer (Gleason 3+3), but since this didn't match the MRI, I was given a second biopsy about 5 months later with samples taken a bit away from where the first one was aimed; this resulted in an upgrade to Gleason 3+4. I'm wondering how this approach of having multiple targeted biopsies compares to the idea of having a targeted biopsy plus a non-targeted one. (There was only one MRI.)

@cancerbetter

2 жыл бұрын

I've written a paper on this topic. Google European Urology Oncology and Ahdoot. It should be the first link. Summary of the paper is that in people with PIRADS 5 the addition of the non targeted biopsies leads to about 2% more clinically significant cancer diagnosis. For someone like you who has small volume disease and might be a candidate for focal therapy (i.e. burning one segment of the prostate instead of removing the whole thing) doing a systematic (i.e. non-targeted biopsies of the whole prostate) would be something to seriously discuss. If you confirm no cancer in other parts of the prostate then doing focal therapy might become a reasonable option. Hope this helps. Sounds like your work up thus far has been in line with modern practice.

@gshenaut

2 жыл бұрын

@@cancerbetter Thank you very much for your helpful reply. FWIW, in consultation with my doc, I've decided on RP.

@alliaj1

5 ай бұрын

@@gshenaut how are you today, after RP?

@gshenaut

5 ай бұрын

@@alliaj1 The procedure went well, no detectable PSA 18+ months after surgery, I am as continent as most healthy *women*, satisfactory lack of ED. I have no regrets about my decision to go the RP route. That said, every case is different.

@alliaj1

5 ай бұрын

@@gshenaut i have the maybe similar: PSA 8.8, PIRADS 5, Gleason in one core 4:3 (15%)...one core 3+4, six cores 3+3 (from all 12 cores), im waiting for a robot now 🙂

Would a CT scan be as good as a MRI ?

@cancerbetter

2 жыл бұрын

No CT does not provide resolution adaquate to detect most prostate tumors.

Always get a PSMA and then an MRI before you allow these doctors to poke your prostrate with their sharp needles. I am telling you, I have seen so many quacks in this field it is depressing as hell. Prostate cancer may not kill you, so they say, but some of these doctors definitely will. Talk about an ATM for doctors and hospitals and you need to include a prostate cancer diagnosis or just a suspicion.

In what city does Dr Adhoot have a clinic

@cancerbetter

6 ай бұрын

I work in Los Angeles at Cedars Sinai medical center. Google Michael Ahdoot MD and you can find me. Make sure you get the spelling off the last name correctly as many people transpose the d and h.

dr , if MRI guided trus biopsy can cause spread of cancer?

@cancerbetter

6 ай бұрын

There is no evidence of this, yet somehow a lot of people think it happens. I’m actually surprised how often people think this is a thing without evidence to support it in the scientific community.

My doctor sent me for a biopsy with psa at 5.6. Biopsy showed one of 12 positive for cancer what should I do now.

@cancerbetter

2 күн бұрын

Many options for you. Consider learning about focal therapy vs surgery vs radiation

Is multi focal HG Pin the same as Focal HG Pin

@cancerbetter

2 ай бұрын

Multi focal means they found pin in several biopsy cores instead of only more. More PIN means a higher risk of possible future cancer.

@dennisblack

2 ай бұрын

@@cancerbetter Thanks for your reply.

@dennisblack

2 ай бұрын

@@cancerbetter Since 2019 i have done 3 biopsy The last one a month ago showed one of the cores with an HG Pin. #Target. Should i do another target biopsy so soon. I’m leaning towards waiting another year before i do another biopsy

@cancerbetter

2 ай бұрын

@dennisblack High grade PIN was previously thought to be a cancer precursor with up to 40% of people later being found to have cancer. Now a days in the era of MRI it’s unclear if the rate of cancer detection would be nearly this high. Likely it is much lower. Definitely good to discuss with your doctor.

Hey doc, can cancer metastasize after a prostate biopsy?

@cancerbetter

2 жыл бұрын

I am not aware of data showing that biopsy leads to metastasis. Biopsy is generally a worth while trade off if you have a high PIRADS score >=3, high PSA density, or if you doctor feels a hard spot on your prostate.

@snozcocram

Жыл бұрын

The digital exams are useless. And, they have the negative effect of turning off men from regular exams. Turns out despite getting a clean bill of health since 48 years old (now 55) I have Gleason 8, t3 cancer. The main lesion is on the opposite side of the rectum and after years of grow time found its way to the seminal vesicles and left lymph node. I had no symptoms and ol’ numb fingers Dr. X felt nothing. I was only diagnosed when my PSA came back 30.2 and the psa pet mri lit up like a lightbulb. Moral of the story: get PSA blood work done and keep the fingers pit of the bum.

@cancerbetter

Жыл бұрын

You bring up a very important point. Rectal exams are actually a very poor way to detect prostate cancer. There was a large cancer screening trial called PLCO where we used PSA testing and digital rectal exams to screen for prostate cancer. Only 3% of the prostate cancers were found by digital rectal exams alone. What this means is that if you did only PSA testing you would find 97% of prostate cancers but if you wanted to be as confident as possible you would add a digital rectal exam. Digital rectal exams on their own without a PSA test is a poor screening tool for prostate cancer.

@snozcocram

Жыл бұрын

@@cancerbetter FYI - I have received 20 sessions of focused radiation therapy with the aid of the Kylipso markers (Boston scientific) and a Space OAR. Lupron and Abiraterone hormone therapy scheduled for 24 months. At this time my PSA is

@RH-xd3nx

Жыл бұрын

@@cancerbetter This Dre is also not good in the African American communities, because it's been documented that African American men prostate cancer tumors are at the bottom of the prostate being misdiagnosed, and when discovered that it may be too late. Black men have higher fatality rate than any other group. My question to you Doctor is, why protocols haven't changed with the advancement of technology. Maybe more imaging after psa goes over 3.5?

My dad had mpmri which showed multiple nodules in center prostate gland that appears to be benign so dr went for TURP surgery for bph prostate (vol 64cc and psa 18 free psa test gave 15%). But in biopsy after TURP he detected with gleason score 4+4 and grade 4 cancer. What should we do now?

One more thing Doctor. Is it true that High rated PIRADs are about 38 percent due to inflammation and not cancer? I guess another reason you do a biopsy and not automatically go to treatment. Plus the Gleason score needs to be found. I suppose prostate surgeons might interpret a Mri better than a radiologist since they actually take them out. Lol I had a cervical surgeon told me that before he performed a discectomy. Im not so sure there's alot of mri guided biopsies going on. University of Chicago does not even offer perineal biopsy. That's ridiculous. I know two people that got sepsis from Trans rectal. How can UOC tout themselves at the cutting edge of prostate cancer treatment without offering perineal biopsy. And don't get me wrong. They are doing trials with local Lazer. Of course no one will know the success for several years. North western has a great surgeon. Deniro and Stiller had it done there several years ago. Stiller was only 49. So get that psa done at 45. Deniro just had kid. If my condition goes sideways I'm starting to lean surgery. Hearing to many radiation burn stories. Ptoctitis does not sound pleasant. Although seeding is so attractive. There are actually doctors who say seeding is seldom taught because there's no money in it.

@cancerbetter

Жыл бұрын

On MRI it’s possible to differentiate cancer from inflammation if you are experienced in prostate MRI interpretation. Given that prostate MRI is relatively new many urologists and radiologists are not good at reading them. To get around that issue look for a high volume institution that does many prostate MRI studies. To see if your urologist is comfortable reading MRI you could ask them to go over your scan with you. Transperineal prostate biopsy is also fairly new in the US. Just look around and you will find someone doing them. Worst case you can come see me in Los Angeles but I’m sure there will be someone closer.

@tomslick2058

Жыл бұрын

@@cancerbetter I guess I got lucky my PIRADS 4 WERE NEGATIVE. But still leisons exists. So far 3 years out my urologist is just happy the psa stays in the low 5s. Will see in July if Psa montering is all he wants. Suspect if it spikes then another mri. Hes suppose to be good so I will go with his plan. . Did not know they could tell difference in inflammation vs cancer . Thank you. I would definitely see you for a second opinion. You seem up to snuff on the latest. Then again I'm not looking for trouble. Thanks for answering when so many doctors on here dont. Oh I go to the University of loyola. Volume is quite high. My urologist is the only one who does perineal out of maybe seven. He looks me in the eye and says he's the cancer doctor. So he must be there best. He don't mess around with to many other problems unless it's Cancer ,Amaloid etc. Had a rash he said not his expertise. Sent me to someone else. Excema.

@cancerbetter

Жыл бұрын

That’s who you want. The cancer guy who only does cancer.

@cancerbetter

Жыл бұрын

PSA density is an excellent variable to use to predict cancer risk as well. As soon as I get my current study published I’ll post a video here on our findings. Short version if your PSA Density is less than 0.05 prostate cancer is unlikely. If over 0.2 prostate cancer is very likely.

It involves pain, the biopsy.

@cancerbetter

8 ай бұрын

Average pain reported is a 3/10. Really depends on who does the biopsy. After almost every biopsy I do people say “doc, that wasn’t as bad as I expected! Thank you”.

I will NOT get a biopsy WITHOUT an MRI, and reluctantly with one, and likely will seek out a trans-perineal biopsy instead of a transrectal one. Pretty barbaric procedure when you get down to it. Do not want an RP either, focal therapy or SBRT for me.

@cancerbetter

Жыл бұрын

It’s great you have the knowledge to have a strong preference! That’s the whole point of this channel; to educate so people can guide their care around their own values.

@MrGuitar1458

Жыл бұрын

@cancerbetter it's thanks to the excellent content on your channel, and a couple of others, that I have the info I need to make informed decisions. Thank you! 😊

@menardtexsampson3745

27 күн бұрын

Your comment here gives me humility on your part and that’s what I am looking for in a doctor. Your answer here says it all about your personality and how you approach healthcare and you are diligently replying to so many people. Thank you so much.

The digital exams are useless. And, they have the negative effect of turning off men from regular exams. Turns out despite getting a clean bill of health since 48 years old (now 55) I have Gleason 8, t3 cancer. The main lesion is on the opposite side of the rectum and after years of grow time found its way to the seminal vesicles and left lymph node. I had no symptoms and ol’ numb fingers Dr. X felt nothing. I was only diagnosed when my PSA came back 30.2 and the psma scan lit up like a lightbulb. Moral of the story: get PSA blood work done and keep the fingers pit of the bum.