Understanding medicine is essential to finding the best medical care. Unfortunately, access to medical literature is almost impossible because of the complexity and cost. Our goal is to provide medical information about cancer care that can lead to meaningful improvements in your care. There are better options out there if you just know what to look for. When it comes to cancer we want everyone to know what is out there so they can get the best care possible.
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Is there any more data on IRE/nanoknife. You seemed focused on erectile dysfunction. If you are concerned about side effects of incontinence and colorectal issues and have 4+3 in one small segment why would nanoknife be a concern. I’m interested if you can do a talk more about IRE more such as nano knife.
The problem with surgery and radiation therapy is that there are side effects. As a result, the small additional risk of active monitoring might be worth it if you can live for many years without the side effects that you can have from treatment.
Lucky me … I am having 35 rounds of radiation after having been through the surgery
Cancer is misunderstood and overemphasized.
Thank you for a very factual and informative video..
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?
Is there anyone in colorado that would do this test
Sure yes. Many. Try a major university?
I live in Las Vegas, they don’t have that capability here.
They should. If they done come to Los Angeles. We definitely have it here
@@cancerbetter I’ve been scheduled for a biopsy, should I have gotten the MRI first. I have never had a problem with PSA before, it was brought to my attention this time When my PSA came in at 5.07 I was referred to a urologist. I asked for my past records to take with me. In 21 my PSA was 2.3 in 22 it was 3.2 there was nothing for 23 and in 24 it was 5.07. I’m 69 and in great shape, I workout 5 days a week and my training was going great. This is why I was taken totally by surprise. I have another blood test scheduled for Monday just to make sure my last blood test was accurate. I’m very hesitant to go through with this biopsy. It seems to me that when you start down this road there’s many risks.
Dr i have a digital and MRI confirmation of prostate cancer, i want to use fasting,diet and alternative therapy, i fear a biopsy it will spread? , im 65 ,and plan maybe to skip byopsie, your thoughts?. PSA last test 5 Please some common sense advice, if i can live another 5 or 10 and monitor id be happy,
Speak with your doctor about the merits of a biopsy. Your mri will give information about your risk of cancer
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.
Many options for you. Consider learning about focal therapy vs surgery vs radiation
Hello doctor great information. I am 61 had psa score 6.6 had mti irad 5 had biopsy getting results tmrw. Only had light symptoms no aches stinging or night trips no symptoms at all last 6 weeks very nervous abt tmrw however.
Wish you good luck!
Thank you for this great information. I’m 75 years old diagnosed with prostate cancer on March 2024. My psa is 4.3, Gleason 3+4 m=7, favorable intermediate risk, DRE negative with family history. My Psma Petscan is negative. However my Decipher is .64 and it puts me on high risk group. My choice is radiation or surgery. My radiologist thinks that I will need 6 months of ADT. However my hormone therapist left it up to me if I want ADT or not. He said in a bubble as far as needing ADT and my urologist agreed. If I do radiation I have to have a second TURP due to my bad urinary symptoms and I have to wait 2-6 months for prostate to heal before radiation. My first TURP was done 30 years ago. My surgeon favors radiation due to my age and side effects. If I do TURP on July 2024 and start radiation on December 2024, am I waiting too long to start treatment? Am I making the right decision for not wanting ADT due to my joint pains? Is surgery still a good option for me? Thanks.
I really can’t answer these questions without seeing your scans.
almost surprised they screened you for PCa at age 75.... with that low a PSA
Important!!! My first urologist made the conclusion that because my PSA was 23 he wanted to take 12-14 biopsies without a physical exam via the TRUSS approach. Second urologist with the knowledge of my PSA of 23 did do a physical exam then stated “you have cancer” then ordered a T3MRI with a T3 magnet and concluded the necessity of 12-20 biopsies via the TRUSS procedure. My third urologist reviewed the T3MRI that did identify cancer and ordered a TPP biopsy. (Not the TRUSS procedure) The 25 biopsies revealed cancer. He has ordered a PSMA PET scan to confirm if the cancer has spread through my body. Conclusion: do diligent and forensic research.
Thanks for sharing your story
Appreciate the correspondence and sincerity you have with your commenters... Subscribed! (And yes, just got my MRI results showing a PIRADS 4 and 5 discovery after a PSA blood draw level of 4.74... age 61)
Thank you for subscribing and I’m happy this information is helping. Lots left for me to share with you all!
Am in the UK, my husband is just going through this. PI-RAD of 3, PSA of 10.1. He's had the MRI, 2 x DREs and now they are talking about a biopsy and will take 12 bites so my thoughts are why did they bother doing the MRI because they will revert to the grid system and just go with that anyway. Yet the MRI was sold as a tool to reduce biopsies - now it seems as though they are causing an increase in the number of bites during biopsy. Surely, if the MRIs are all they cracked up to be the biospy bites should just be in that area.
MRIs are not perfect at finding cancer. A PIRADS 3 for example means the radiologist sees something they think might be cancer but they aren’t sure. A pirads 5 however is very likely to be cancer. It’s just where we are. With time things will improve as technology evolves
I was diagnosed with prostate cancer April 15 (my father has PC Stage 4 metastasized in his bones. He's 92yrs old, having only been diagnosed 3 yrs ago. Dr. said he would pass of old age so to speak, before the cancer could get him). I had a Total PSA of 2.9 and percent free PSA below 10% (the red flag that alerted me). My in-bore MRI targeted biopsy confirmed Gleason score 3+4=7. After exhaustive research I elected for in-bore MRI focal laser ablation. Surgery was outpatient and it went excellent. Surgery was 8 days ago and I feel great, with no negative conditions following the surgery. The only inconvenience was having a catheter in for 8 days. There were no issues with the catheter other than "it was in there". My best to all that have been diagnosed with PC.
Focal therapies like FLA can be great in well selected patients. Issues with swelling of the prostate after burning a segment of the prostate is common and needing a catheter after for a while it totally expected
Hi doc,No blood in the urine,abdomen twice are fine,ct are normal ,cystoscopy bladder are red. Burning in penis after toilet.doctor are no clue.should i go for biopsy
I did half my prostate 3 years ago with hifu but unfortunately it has come back. I was happy with the lack of side effects, however, sad that it didnt last long. I was psa 13 and had a 4+3, and a 3+4..
Sorry to hear that. High PSA (>10) can be suggestive of a lower likelihood of focal therapy success. Your options to discuss with your doctor may be relay HIFU, radiation or prostatectomy. Talk to your doctor to see what options work for you
@cancerbetter ty and ty for your channel, very informative, honest and direct.
@@dmcarden So glad I can help!
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.
My pleasure and I’m happy my knowledge can help people
I don't know what to do. I have early T2a cancer, growing through the prostate capsule, possibly. My gleason is 3+7..psa 7.6. My cancer hasn't gone into any other areas, definitely not lymph nodes or reproductive ducts. I don't want surgery and can't have radiotherapy as also have median lobe enlargement. So am stuck. Terrified of the treatment not so much the cancer. I cannot make a sensible decision. My surgery would definitely cut out erectile nerves
You could ask your doctors if you could have a TURP to address the median lobe and urinary issues prior to radiation. This might allow you have the radiation you desire.
@@cancerbetter thank you so much for your reply, yes they have just offered TURP. Am just worried it might me more traumatic than the RALP they suggested. Its so strange to be at ease with having the cancer but fearful and all with any treatments
A great summary of the stats. Your counterpart did a great job of pulling the data all together. I'm Gleason 8 and have been researching options for treatment. Your video was very helpful in understanding the risks of my Gleason group. Thank you.
I’m happy I could help and I wish you good luck with your treatment.
Thanks ☮️ very useful information given me a clear understanding of my condition. ❤
Thank you very much. I’m glad I could be helpful.
Under MRI results show as PIRADS -2 & 3. Is here Biopsy test required?
depends on other factors like PSA density, age, prior biopsy status
Know this vid is a bit dated, but thought I'd add something not addressed in other comments, see if cancerbetter has any thoughts. my case: PCa biopsy confirmed Gleason 3+4, with quite narrow 4, and full workup confirmed prostate only, but 70y.o. & great general health so watchful waiting ruled out. Meanwhile, BPH symptoms quite serious, IPSS ~ 19-20, gland size ~150cc, so we opted first for PAE. PAE obviously for its own likely benefit, but also for possible indirect impact on PCa, with the working theory that PAE-induced size reduction, if significant, could impact PCa therapy risk/benefit decision-making. I have found almost no research for this theory (one paper did conclude a successful "proof of concept"). MRI at 3 months post-PAE, prostate size down ~35%, IPSS maybe 12, I will probably do focal HIFU, waiting for my uro's hospital to get the latest Focal-One unit installed. Any thoughts on potential synergies with these two therapies in some cases?
Embolization has been tested for numerous cancers. It can slow the growth but doesn’t eliminate the cancer as new blood vessels eventually grow to re-feed the prostate and the are of cancer. Volume reduction through TURP, HOLEP, Simple prostatectomy have all been done to make focal therapy viable in cases where it might not have been viable prior due to prostate volume. Hope this helps and let us know how it goes
@@cancerbetter Thanks for the response. Yes, to be specific, none of the decision-makers (me, and IR and Uro docs) were thinking of PAE for BPH symptoms as a potential PCa therapy, adjuvant or otherwise, only that PAE-induced shrinkage of a quite enlarged prostate might help reduce off-target side-effect risks of any subsequently applied focal cancer therapy, by potentially pulling the prostate boundaries back a bit from rectum, bladder, and penile nerves and arteries.
And don't forget , boat and condo payments HAVE to be made. So you will see Doctors pushing test after test after test.
I assure you I have no boat and where I practice I don’t make a dollar more or less based on how many tests I order. Only perk to my job is the satisfaction of feeling someone and an occasional gift from a happy patient.
Thank you so much for telling me what the options are. 👍
Happy I could help.
Thank you dear doctor. I have a lump on my prostate test psa was 1.0
The low PSA is reassuring. Most of the time prostate cancer is unlikely at this psa.
One of the best videos I’ve seen, I like that you present actual data as I’m a numbers guy. One question I have not found an answer to: if you have a PSA>20 but all other measures are consistent with intermediate or low risk, the PSA overrides everything else and you are lumped in the high risk group. What is the evidence to support this decision? And is it really justified to group those w high PSA with those that have high Gleason scores? Thanks!!
The high psa resulting in high risk is a bit of a factor influenced by the past. There most important things in a persons cancer risk are cancer stage (ie metastatic or not) and Gleason score. Historically imaging to assess for metastatic disease was poor so PSA level was used as a surrogate because as psa rises the risk of metastatic disease also rises.
@@cancerbetter thank you for the quick response I really appreciate it. Yes this is the situation I'm in. Super high PSA- 45, Gleason 3+4, PSMA Pet negative. Yet my risk category is high due to the PSA. Am told it's possible for some tumors to produce a lot of PSA OR that perhaps micrometasteses could cause it. But I was just wondering if any literature exists disaggregating these risk strata a bit more
@@cancerbetter was just reviewing the NCCN guidelines. It's fascinating to me that the classifications they refer to are at least 7 years old.. I do wonder what would happen if PSMA Pet scan data was also used in risk prediction, I guess it will be ten years before we know...
@jazandriz exactly we need time to see how PSMA PET will affect long term outcomes. Presumably we will have improved staging resulting in higher cure rates per stage. The data in this video is from clinical trials data. The studies are referenced in the video prior to the data
@jazandriz I don’t know studies on high PSA producers but I can confirm I have seen people with PSA as high as 50 with localized disease. It’s not common but it can happen. Once you get treatment you can see what your psa does
Is the bottom line a complete removal of bladder when you are talking about muscle- invasive Dr? Thks...jc
Not always. There are actually alternatives but the most definitive option is removal of the entire bladder. If cancer is just in one spot in the bladder you can potentially remove that section of the bladder and reconstruct the bladder or you can do a combination of radiation plus chemotherapy. A small percentage of urologist specialize in bladder cancer, and your best bet is to speak with one of them.
Thks Dr. Ahdoot
Hope you can give me some insight.56 white male,been dealing with chronic Lyme disease for a little over a decade.Haven’t been treating it the way I should because I’m also a full time caregiver to my 91yr old mom who has Alzheimer’s/dementia in this same time period.I get all over body inflammation,brain fog and my adrenal glands are shot from the stress of watching my mom deciine.Shortly after my diagnosis of Lyme my psa started rising.Had a biopsy 6-7 years ago when psa was 7.8,I think my Gleason was 6.Came back negative.It’s steadily risen over the years.Last April it was 11.3 this April it’s 13.1.Can my cortisol levels being high and the chronic bacterial infection of Lyme be causing this continual rise?I also consumed way too much sugar.I’m cutting back on my sugar and my physician wants me to go back to the urologist.They didn’t do an mri last time they just went straight to the biopsy.Unless they’ve figured out a lesser evasive way of biopsy I want no part of it and my urologist seems to have a very aggressive manner of treating things.I truly feel that the continuous stress I’m under and bacterial load from Lyme can be causing this,what are your thoughts?Thanks for any input.
I cannot speak to your medical condition here without having seen you. If you feel uncomfortable with your urologist, I recommend you get a second opinion.
Hello Dr. I’ll be 52 years old in July, i had my 1st PSA scan 6months after I turned 50, it was 3.4, so i changed my diet lost 25-30 lbs starting eating healthier. I’ve always went to Dr appointments every 3-6 months for many years. I do have hypertension and take 1 pill a day of low dosage medication. Well, to my surprise I went to my 6 month appointment my bloodwork showed my PSA was at now 9.45. I went to a urologist, my bloodwork showed that PSA was at 10.45 in 2 week period. Prostate Biopsy was done and of 16 samples 11 test for PC, mri showed PC, PET scan showed it has spread to lymph nodes, femur bone, hip bones, spine, PSA now at 22. I have no symptoms, no pain, no signs of anything other than what I’ve shared. I actually feel great, except mentally it’s very disturbing. My Gleason score is 9 and I’m high risk. I just don’t understand this… Thanks for your input advice and videos 🙏🏿
I’m terribly sorry to hear about this. It’s very unfortunate but I’m happy you feel well. It makes sense to be shocked as most prostate cancers do not progress this quickly. The good news is treatments for prostate cancer even after it has spread can be very effective. Talk to your doctor about your medication options. Second generation antiandrogen like enzalutamide and abiraterone are often added to older testosterone lowering medications to control the cancer and maybe something to consider. Thank you for sharing your story so others know the importance of psa screening.
I’m 64 and diagnosed with Gleeson 6, low risk prostate cancer cancer. But I cannot live with this in my mind if I follow the active surveillance program. What we do not know is the probability of the Gleeson score becomes higher in future,and therefore requires treatment. So I choose to have radical radiotherapy, involving just 5 fractions of SBRT. Fingers crossed
Over a 10 year period on average about 50% of men will have an evolution of their cancer from Gleason 6 to Gleason 7 or higher. Given that over half of these people will never need treatment choosing to go onto active surveillance allows an opportunity for a person’s cancer to declare itself. Alternatively genetic tests like decipher scores can be done to help further stratify a person’s risk. The decision to treat Gleason 6 for worry was a common one made for generations but from reviewing the data of the past we have found that this did not result in improvements in outcomes for patient and risks treatment related side effects.
All I will say is get a 2nd or 3rd opinion before doing ANYTHING!
With how quickly the field is evolving I think this is good advice
Insurance companies are still rejecting PSMA PET scans even now.
Depends on the indication. In my practice to look for prostate cancer outside of the prostate or to assess for recurrence if there is a psa rise after prostatectomy they are getting approved
@@cancerbetterdoes Medicare cover at least.
@@chicagomike yes it does. All major insurances in the US cover PSMA PET
Thanks for smart advice. I like your enthudiasm and caring demeanor.
Happy I can help!
As much as the scientists and doctors like to do case studies and compare notes, I refuse to believe no one has come up with a definitive answer as to which prostate cancer treatment has the greatest success rate and longest remissions! why won’t anyone just say what the most successful treatment is? Stop pretending like you don’t know!
The data I present in my videos is very honest and direct. I am trying to life the veil of medicine so people can begin to understand prostate cancer at a level closer to their doctors. My hope is that as you gain this knowledge you will be able to have more informed discussions with your doctors and also have enough information to empower you to recognize those rare doctors who are not qualified to be treating conditions like prostate cancer. Medicine remains a human act, with some people taking their role very seriously and others less so. I hope my channel has been of help to you and thank you for the comment.
Hello Dr. I'm 57 with a Gleason of 4+3 with 5/12 cores showing cancer and all on one side of the prostate. My PSA is less than 4. Do you think I would be a candidate for brachytherapy if it is determined that the cancer has not spread beyond my prostate? I am going in for my scan later this week.
Brachytherapy can be used to treat that type of cancer. As well as external radiation sources or surgery. Speak with the doctors about the pros and cons of each
I was sixty when I was diagnosed with prostate cancer. I got two opinions, both doctors recommended surgery. I had a PSA of 15, Gleason 4+3. The biopsy found 6 tumors, the cancer was encapsulated; one tumor was close to the prostate wall. That was 21 years ago. Did I do the right thing?
Sounds like it! 21 years and I’m assuming no signs of cancer. Good chance this cancer could have killed you.
Can bladder cancer affect PSA?
Usually no. Passing catheters to put medicine in the bladder and cystoscopy to look inside the bladder can though.
@@cancerbetter Thank you. I did PSA test 1 month after TURB. Result is 1.9, in Aug it was about 6 . No idea why. Ultrasound shows some structure in inside area of prostate, outside area is clear. My urologist dismissed my concerns, because 95% of cancer starts in outside area, but it should be a reason for elevated PSA. There was no infection found in urine. Mystery. Anyway, one step at a time. Thanks again.
@vlado3304 there is a condition called granulomatous prostatitis where the BCG itself infects the prostate. Usually it’s not dangerous but can cause something similar to what you describe. Maybe something to look into
@@cancerbetter Thank you very much. Ultrasound was done before BCG treatment.
@vlado3304 then that is definitely not what it is.
Good afternoon doctor my ct scan said 1C filling defect lateral anterior to the left UVJ, suspicious fro a small urothelial neoplasm. normal appearance of kidneys and ureters appear so i am going in to have it removed i am 64 years old is the size good or bad and do i have it rechecked with ct scan or another bladder procedure. thank you
Usually the next step is to biopsy the mass to confirm it’s cancer.
Do any of these studies reflect a person who has changed their metabolic environment by going on a Keto diet, and doing intermittent fasting? (Kinda being rhetorical here) if the body is made more inhospitable to cancer by reducing glucose and glutamine (the two fuels that all types of cancer cells use for fermentation), then it would follow that cancer growth would slow or stop. This would have a direct effect on the 5 year, 10 year, 15 year survival rates. But these studies don't included such a variable, and were not designed to
There are numerous studies addressing nutrition and life style in the treatment of various cancers. Regular exercise and whole food plant based diets both improve quality of life and slow the rates of cancer progression, though they never stop the disease on their own.
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.
No harm in having information to make good decisions with.
Hi my psa started to rise about 5yrs ago when i was 60yrs old. My psa have risen to 14 and an mri scan was done showing i had inflammation of the prostrateand a enlarged prostrate to. My Urologist told me i had prostritis and my PRADAS was 2. I find it a little worrying as my Father passed away with Prostrate cancer. And plan on taking an MRI scan every 12 months to keep a check on it.
If you wanted certainty you could request an MRI. Or you could do one the many urinary tests to help further stratify your risk of prostate cancer.
Hello, Do you think cystoscopy or BCG treatment can affect PSA and prostate MRI? Thank you.
Yes! Cystoscopy prior to a PSAdraw will elevate your PSA. I recommend you wait a minimum of 10 days after a cystoscopy before you check a psa. Also BCG can cause changes to be seen in your prostate in MRI. These are not super common but possible.
@@cancerbetter Thank you. I have MRI scheduled in two month after last BCG treatment. Not much can be done.
I have BPH symptoms plus prostate cancer. What treatments out there would take care of both. Besides surgery.
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
I have another question. What do you think about doctor's recommendation to change body position every 15 minutes after BCG induction, front, back, left side, right side. How critical it is? If bladder is a balloon , it shouldn't matter, theoretically. Also, how critical is to empty bladder after 2 hours from the induction, not later? I have the answers from my doctor, but would like to know your opinion. Of course, if you don't mind. Thank you very much.
A little bubble of gas gets in the bladder when BCG is instilled. The idea is to move around so the bubble doesn’t stay in one place. In my opinion normal movement of life is adequate to move that bubble. The idea is just not to stay perfectly still.
@@cancerbetter Thank you.
I have a Gleason 6 grade 1. PSA 5.5. On core 8% another core 55%. How does that 55% increase my risk ?
Likely doesn’t much. Still Gleason 6
As I am a diabetic person My physician asked me to do a PSA checkup test with Hemoglobin A1C .The result was a little bit high 5.54 ng/ml , and he referred me to a specialist. An MRI and a biopsy later, I discovered I was a 65 year old living with a Gleason 6 prostate cancer. I'm so grateful that my Doctor took action, knew that there was a history of prostate cancer in my family and encouraged me to do the test. I now can do active surveillance and get on with my life. Now I changed all my life style and start ketogenic diet In addition to I stop eating dairy foods and sugar and rice and and all products that feeds cancer since 3 months also I practice prolonged DRY fasting about 17 hrs for one month and i do two Psa tests one after 2 months and it was 3.54ng/ml and the other one after dry fasting and it was 2.7ng/ml . I lost about 12 KGS since 3 months That encourage me to complete fasting hoping that tumor marker will give me more good results.
Good for you! See the film FORKS OVER KNIVES (You Tube) that proves what you are doing WILL work to destroy prostate cancer!
Congratulations on your weight loss. I have seen the best reductions in PSA levels and potentially slowest rate of prostate cancer growth with a vegan diet. This data however is rather weak so I can't strongly recommend it.
Yes I look at people like Bill Walton. A vegan always life. Healthy basketball player. Died of prostate cancer.
I am doing BCG treatments and don't feel anything, no temperature, bleeding, etc. It means it doesn't work? Thank you very much.
Nope, most people handle BCG with minimal symptoms and it still works for many patients
@@cancerbetter Thank you.
@vlado3304 anytime! More videos on bladder cancer to come. There is so much to talk about.
@@cancerbetter Thanks again, will be useful, unfortunately not very uplifting topic. It is what it is.