I watched Brian grow up on Stoney Lane in Rtathcoole. He was a wonderful young man, born to wonderful parents, and he did wonderful work down here on Earth. My heart goes out to Margaret and his extended family. May his soul continue in eternal love. Dara.
@martinaryan21211 күн бұрын
Rest in Peace Brian.You sure have won your wings in Heaven for all the wonderful work you have done.I can see he was loved by many People.❤ Condolence to his Family.
@LindaWoods-xh3sz12 күн бұрын
A beautiful tribute to a beautiful man.i am crying writing this as i think of our beautiful son who also was a surgeon who lost his .life in new zealand in 2008.paul woods 29 years old.the pain of a childs loss never leaves you.paul like Brian was an amazing human inside and out.sounded very similar to our boy paul.paul loved newzealand but Liverpool england was his forever home.sending love to Brians mum brothers and sister.we know how heartbroken you are feeling.R.i.p Brian
@normajean285517 күн бұрын
😥
@catherine107217 күн бұрын
Future investigations needed
@catherine107217 күн бұрын
What was he investigating?
@nickywilks792818 күн бұрын
So sorry to hear this news.
@user-fl6zu2sm5v19 күн бұрын
Thank you for a very moving tribute to Brian. Heartfelt condolences to family, friends and kind colleagues. May Brian`s memory be your blessing. Love from Éire
@trishaprett772115 күн бұрын
💔
@petergourlay316220 күн бұрын
Such a loss. Peace every stop Brian ... and care to his family, friends and colleagues.
@michaelmcgoldrick862320 күн бұрын
Thank you for such a beautiful tribute to your colleague and friend. May he rest in peace.
@hilarymiley18620 күн бұрын
What a beautiful tribute to a beautiful man ,he was obviously loved by all who's life's he touched around the world. I'd imagine wherever he is right now his face is beaming with that huge big smile of his. As a cancer survivor going on 16yrs i am eternally grateful for Dr's & Surgeons for the work they do, may God bless you all. To Brian's mother, sister, brother's & son i offer my heartfelt condolences, may his gentle soul rest in eternal peace . Hilary, Wicklow, Ireland.
@fionawhite425021 күн бұрын
We are very sad to hear about Brian's death. Our sincere condolences to his family, friends, colleagues and patients.
@wladyslawkoros724521 күн бұрын
Very sad 😢
@opencurtin21 күн бұрын
A sad loss of such a talented man who used his gifts to heal and give hope to so many people.. God bless all medical staff who serve to heal and give hope to all !
@speck58422 күн бұрын
Here is an idea for prostate cancer researchers. I am an 85 yr old specialist physician with metastatic prostate cancer . There needs to be an analysis of what the life extension is for patients in age cohorts - e.g. Aged 50+, 60, 70, 80 and 85. When a patient decides what treatment he is going to be subjected to he wants to know the answer to two questions a) quality of life - side effects of treatment and b) how long am I projected to live based on the many studies that have been done on many ADT and Chemotherapeutic agents? The research into life extension in the various age cohorts would help inform patients and their clinicians.
@BazAkladios23 күн бұрын
Sending LOVE & prayers to Brian’s family, loved ones & all of you ❤
@speck584Ай бұрын
I enjoyed this Olympics episode. As an 85 yr old (retired specialist physician) with metastatic prostate cancer I would like to hear commentary on the decisions based on age group (suggest 5 year cohorts to analyze studies).
@gu_castАй бұрын
Thanks Shaun! And thanks very much for reaching out through our website also. We are very sorry to hear of your diagnosis and hope that you are going well. You make a great point about age groups. An issue with clinical trials is that they pretty much only recruit patients in quite good health, with not enough older patients. Real world data needed for this. You messaged us separately about how important quality of life is for you and many older patients. It's not always about prolonging life by a modest period, if the quality of life is not great. We must talk more about this. Declan and Renu
@RhondaMcL1Ай бұрын
I’m listening with interest in the hope there is some new treatments being considered. My husband had his prostate removed in October last year. He had a Gleason score of 4+5 and post surgery it was upgraded to 5+4. It was borderline breaking out he was told after the pathology, however they were content with how things had gone. He has had 2 PSA tests since surgery, both negligible score but the most recent has showed a PSA level of 0.89. He is pretty devastated and we are waiting for a PET scan. Until this is done we have no idea where it’s popped up again and so I’d appreciate any advice you can give us.
@gu_castАй бұрын
So sorry to hear this Rhonda. We do hope that you are both going well. Not everyone around the world gets access to PSMA PET/CT so we are glad to hear that. We hope that he gets some good options after that and send you all our best wishes. Declan and Renu
@RhondaMcL1Ай бұрын
@@gu_cast thanks for your good wishes.
@michealolsen1344Ай бұрын
No harm in active monitoring.
@michealolsen1344Ай бұрын
More good than harm, unless you're a patient they misdiagnose.
@michealolsen1344Ай бұрын
If the random biopsy didn't miss a Gleason 3/4 or 4/3.
@GaryTurner-pe9nr17 сағат бұрын
Did he say random?
@MrMikeWynАй бұрын
Bravo, Howard.
@doctornebulaАй бұрын
I love how you invite prostate cancer patients to tell their stories. Howard is a gift to the AS community.
@HowardWolinskyАй бұрын
Wow, Thanks. And Nebula are a gift to the entire galaxy. Thanks for the support Br. N. Where on the planet are you?
@doctornebulaАй бұрын
@@HowardWolinsky Howard, it's me Keith😊
@gu_castАй бұрын
Thanks for the great feedback @doctornebula! We totally agree. Declan and Renu
@RICHARDINTHEKITCHEN2 ай бұрын
Thank you for your channel. It is really helpful! I live in the US. My RP and e PLND is scheduled for next week. I'm really concerned about PLND due to its possible life-long complications. My circumstances are as follows: Firm yet no nodular DRE. MP MRI showed 1cm lesion in the peripheral zone with no ECE. PSA 19.4 yet at the time I had CP/CPPS. Systematic biopsy showing (1) 4+4, (4) 4+3 and (1) 3+3. Gleason 8. PSMA Pet showed avidity in only the prostate. No other avidity at distant sites including the nodes and seminal vesicles. BRCA 1 and 2 negative. I'm also asymptomatic in the pelvic region. I'm wondering that, in my setting, can I forego the ePLND? My thinking is to go ahead with the RP only, test PSA every 3 months for two years and if it starts to rise, repeat the PSMA to find it then deal with it. Thanks so much!
@gu_cast2 ай бұрын
Hi Richard. First of all, so sorry to hear about your diagnosis. It certainly sounds like an important diagnosis as that is a proper cancer. We are very happy to hear that your PSMA PET/CT is all clear. The discussion about PLND remains contentious and advice is changing. We very much respect what individual surgeons recommend and we totally respect the fact that it is up to the individual patient at the end of the day. We encourage people to use the excellent nomogram published by Gandaglia et al in European Urology Oncology a few months ago which is aimed at patients who have had a PSMA PET/CT showing no disease outside the prostate (like you). We featured this on GU Cast a few months ago with Dr Gandaglia. On that nomogram thankfully, your risk of having positive lymph nodes is extremely low indeed which is good news. We wish you all the very best with your surgery. Declan and Renu
@RICHARDINTHEKITCHEN2 ай бұрын
@@gu_cast Thanks so much for your reply and information.
@RICHARDINTHEKITCHEN2 ай бұрын
@@gu_cast Hey y’all. Hope you’re doing great. I met with my surgeon today before tomorrow’s RP to express my concerns about the PLND planned. I laid out all I learned about it and he agreed there was no benefit in doing it other than for diagnostic staging. Thank y’all for that video posted about the subject so it’s not being performed . Just wanted to let you know.
@BazAkladios2 ай бұрын
Loved it, thank you
@gu_cast2 ай бұрын
Glad you enjoyed it Baz! Declan and Renu
@Mark_Lacey2 ай бұрын
I did not understand why I had to suffer a biopsy. PSA 2000, bone scan showed extensive mets to upper skeleton, I mean everywhere. PSMA PET Scan after biopsy simply confirmed the bone scan and showed-up a met in a pelvic lymph node. The biopsy was done after the bone scan for what? All it did was raise my PSA to 3500 and I was put on ADT immediately anyway. Result of the biopsy - I couldn't sit down for a week and needed a catheter for six weeks afterwards. It's eventual removal was horrendous for two days after, pissing pure blood, then pushing clots until it cleared up. I sometimes wonder if you doctors and the guidelines you follow understand anything. From what I can make out all it did was give me a Gleason 9 diagnosis, SoC sucks.
@gu_cast2 ай бұрын
So sorry to hear your story Mark. That is a really tough situation and I am really sorry to read your story. That is about as tough as it gets and I hope that you are going ok and that you have good people looking after you. We still often offer biopsy in these situations (even if the diagnosis and management is already clear), as it can help when trying to get access to clinical trials and certain treatments like PARP inhibitors. But really sorry to hear this and hope things are looking up for you. Sending you best wishes from Melbourne. Declan
@Mark_Lacey2 ай бұрын
@@gu_cast I'm doing OK thanks. Eight months into diagnosis. I live in Thailand so I'm not eligible for clinical trials here. What really makes a difference to me is to receive a reply from someone like yourself and to know someone is listening and understands. Thank you for taking the time to reply. Mark.
@joeax612 ай бұрын
Had a RP in April, 4 lymph nodes removed as well. Path Report GG4, Gleason score 8, pT3aN1. Three month PSA coming up soon. I realize the risk is pretty high for metastasis, if I need radiation can i do it without ADT? Thank you, Joe
@gu_cast2 ай бұрын
Sorry to hear about your diagnosis Joe and hope that you are on the mend. Let's hope that first PSA is good news. If radiotherapy were to be recommended, then there are definitely two schools of thought on adding ADT for a period. Conventional wisdom is that it helps, but most of that is based on men having radiotherapy to the prostate itself, not following surgery. We hope that you have a good team advising you. Good luck with the PSA! Declan and Renu
@barbarameehan1132 ай бұрын
Thank you Doctors. This was very interesting. My husband was just diagnosed so we are trying to learn all we can.
@gu_cast2 ай бұрын
Sorry to hear that Barbara. We hope that all goes very well for him. Declan and Renu
@doctornebula2 ай бұрын
Regarding Dr. Flesher's lutetium PSMA-Germany story, I find it interesting that Dr. Hofman did a sabbatical with Dr. Richard Baum at Zentralkinik Bad Berka in 2016. Seems like we have Germany and doctors like Richard Baum to thank for the spread of PSMA RLT throughout the world.
@gu_cast2 ай бұрын
That's for sure! Michael always gives Dr Baum a lot of credit, and indeed many other excellent doctors/nuc med technicians/physicians/nurses working in German centres who have done so much to advance the fields of PSMA imaging and theranostics. Declan and Renu
@doctornebula2 ай бұрын
If systematic biopsy is still recommended for focal treatment planning, what happens if the initial focused biopsy turns up PCa that requires treatment? Does the patient then have to undergo a systemic biopsy for focal treatment planning?
@gu_cast2 ай бұрын
Myself and Renu don't do focal therapy so we are hesitant to answer. Focal therapy still considered investigational in the EAU guidelines so only recommended in clinical trials or prospective registries. Best direct that question to a focal therapy specialist. However, updated EAU Guidelines no longer recommend systematic biopsy in men who have an MRI lesion - recommend just target teh lesion and area surrounding it. Good discussion in this podcast. But let's do a podcast on focal therapy soon. Declan and Renu
@eksaykuiper2 ай бұрын
Good to see Alice👍
@speck5842 ай бұрын
I greatly appreciate the best academic minds giving their opinions. Being an 85 yr old retired specialist physician with metastatic prostate cancer I am glad to hear increasing discussion on how to assist patients decide with their oncologist or urologist what is the best treatment approach. Developing a regularly performed quality of life assessment would help. Patients need to know what side effects they may suffer and for how long. Also what is the expected life extension with various treatments based on the data from studies.
@gu_cast2 ай бұрын
Thanks so much for the comment, and we wish you all the best with your cancer management. We couldn't agree more, In our recent podcast with Dr Alicia Morgans (a top expert on Survivorship and QoL), we heard some really good views on this. Best of luck! Declan and Renu
@BazAkladios2 ай бұрын
Loved it, well done
@gu_cast2 ай бұрын
Thank you! Cheers!
@doctornebula2 ай бұрын
Sequencing ARPIs in a control arm isn't debatable. It's unethical, based on Phase 2 data showing that the response rate for sequencing abiraterone followed by enzalutamide is only 30%, and for enzalutamide followed by abiraterone, a dismal 5-7%. Sequencing abiraterone and enzalutamide has shown it does not improve overall survival in several clinical trials. Using ARPI sequencing as a control arm because its suboptimal overestimates the benefits of whatever is being studied in comparison. Ensuring that control arms consistently represent the best current standard of care is essential to protecting patients and maintaining the integrity of the clinical trial process.
@gu_cast2 ай бұрын
Totally agree! We have an interesting few comments coming on this in our upcoming APCCC Highlights part 2
@alanwhite91263 ай бұрын
Amazing new research and great to see Declan keeping us up to date with current clinical research over seas. Ongoing refinement and as always a man has to meet the criteria to access these treatments.
@gu_cast2 ай бұрын
Thanks Alan! Declan and Renu
@alanwhite91263 ай бұрын
An interesting study and as always research keeps improving. Urologists need to stay abreast of new initiatives.
@7aider3 ай бұрын
Always nice and fun listening to GU cast. Love you guys
@gu_cast2 ай бұрын
Thanks so much! Declan and Renu
@BazAkladios3 ай бұрын
Beautiful work & cast
@gu_cast3 ай бұрын
Thank you so much Baz 😀
@FrancoisPicanza3 ай бұрын
I appreciate the open minded discussion rather than blind fixation on a standard of care mantra. We are all different so there is no one size fits all.
@gu_cast2 ай бұрын
Thanks Francois! Declan and Renu
@Bob-lk8fu3 ай бұрын
Thank you! Outstanding episode. Super relevant to me. Diagnosed at 52 with Gleason 9, oligometastatic (lymph nodes plus one bone met) disease. Did triplet therapy plus radiation to prostate, pelvic LNs and bone met. I’m about 2 years into it and fighting the quality of life issues with long term ADT.
@gu_cast2 ай бұрын
Sorry to hear that Bob. So tough but hope you are doing great. You might enjoy listening to our two previous podcasts with Tim Baker. He was diagnosed with metastatic prostate cancer aged 49 and has some amazing insights into ADT and managing side-effects. Sending you our best wishes. Declan and Renu
@MatthewMcGillen3 ай бұрын
I had brachytherapy and 16 external beam radiation sessions as well as 4 mos of ADT in Oct. 2022. I was so miserable after six months that I begged my urologist to let me start TRT. It's been a year and my testosterone has gone from 32 to 720 and my QOL is night and day. I did have a single tumor in a single lymph node found with a PSMA Pet scan after my PSA rose from 1.5 to 3.9. I had 17 lymph nodes removed on April 17, 2024 and in addition to the tumor, they found four with microscopic Pca. I will get another PSA test in four weeks to see if the residual PSA has washed away, and then I assume start active surveillance to see if the PSA once again rises. I've told my cancer team that I would prefer 8-10 great years (I am a world class master's athlete) than 15-20 so-so years, where I am constantly fighting various side effects. I am 70. Love your podcasts here in the states. Seems you guys are ahead of the curve in some ways.
@gu_cast3 ай бұрын
Wow Matthew that's quite the story! Hopefully your most recent surgery will help avoid the need for more ADT.Your words on the misery of ADT really chime with us. And going on testosterone replacement is something we should do more of as we talked about in this episode. Your story very compelling. You might enjoy listening to our podcasts with Tim Baker who has written a great book about his experience with ADT having been diagnosed with metastatic prostate cancer in his 40's. The book is called "Patting the Shark" and his most recent GU Cast is here kzbin.info/www/bejne/mXOvZZyfqNCmgs0si=5vau1N-D2xpq7e2_
@anwarpadhani3 ай бұрын
Thank you..
@gu_cast2 ай бұрын
You're welcome Anwar!
@dr.makarandkhochikar55965 ай бұрын
Excellent show Declan as usual. No doubt you took the lead in establishing good rapport with nuclear medicine and uro oncology in Australia and now propagating this concept all over the globe.
@gu_cast2 ай бұрын
Thanks Makarand! Declan and Renu
@drkiwitiger5 ай бұрын
Great episode - inspirational in the second half discussing surgical entrepreneurship. Now to go bother co-conspirators with my ideas!
@gu_cast2 ай бұрын
Yep very inspirational listening to Neil! He is very modest
@jontreffert5 ай бұрын
As a patient undergoing the treatment discussed (first line for locally advanced MIBC) I found this discussion extremely helpful in answering questions I had regarding its clinical application and even heard some provocative questions posed that I would very much enjoy seeing addressed in a future podcast. I am documenting my journey on the blog on my website.
@gu_cast2 ай бұрын
Sorry to hear this Jon. Please send us a link to your blog. Sending you our best wishes. Declan and Renu
@cabacronulla5 ай бұрын
What can i sayy.Speechless.. Great Insight! On my way for treatment tomorrow...
@gu_cast2 ай бұрын
Best of luck!! Hope treatment goes very well. Declan and Renu
@cabacronulla2 ай бұрын
@@gu_cast Was booked in for Surgery... But at the last minute cancelled and went with SABR Radiation treatment... I was back surfing after 1 week...Surfing every day NOW!..Just got to put up with the Wee n Poo changes... SurfForLife. Cheers Ross.
@azppmd6 ай бұрын
Audio is MORE IMPORTANT than image quality in a video. Your guest's audio has consistently been lackluster. It's due to excessively low volume (gain). To fix, consider: 1. Route the audio from your guest through the Rodecaster Pro. 2. Adjust the guest's audio level using one of the **sliders** on your Rodecaster Pro to match the hosts' levels. Rode Microphones is in Australia. Have them help you.
@spitfirekid16 ай бұрын
Respectfully, this can be a slippery slope. In 2020 I had a rapidly rising PSA. I had a PSA - 4K test, which showed high likelihood of significant cancer. I then had a 3 Tesla MRI, which showed a single lesion by the anterior apex. Knowing. Understanding that this location is hard to reach with a TRUS biopsy, even an MRI guided one, I elected to have a stereotactic perineal mapping biopsy. The results showed only a single core affected core Gleason, 3+3. I elected to have focal brachytherapy on one side of the prostate. My nadir PSA was 2.2. 33 months later in March 2023, my PSA rose to 3.41. My radiologist/oncologist thought it was a “bounce” and told me to have my PSA rechecked in 90 days. He was mistaken. He also quit practicing due to health problems. My PSA continue to rise. Fast-forward to December 2023 when I finally found another healthcare provider to take over where he left off. My PSA had risen to seven. I had a PSMA- PET scan and 3T MRI with contrast. The cancer returned with a vengeance on the right side that was treated with brachytherapy 2020 and also a new lesion on the left side. Gleason 9 and Gleason 8 respectively. Lymph node involvement on the right side. Stage 3 N1. I was devastated. A standard course of treatment was originally planned with radiation and ADT. However, the MRI revealed that the cancer was bordering the internal urethra and radiation would probably result in the need for a diversion. It’s 68 years old I had a high level of fitness for my age, low, BMI, no other underlying health issues and arguably athletic. I underwent a salvage radical prostatectomy in January 2024. Radiation to the lymph node bed will be next along with up to two years of first and second generation ADT. The prognosis for MFS for 5 to 10 years is 70% likelihood and I’ll take those odds. The surgeons, radiologist, and oncologist that reviewed my MRI and biopsy from 2020 all feel that the biopsy missed significant high-risk cancer and erroneously gave me a 3+3 Gleason score. To add insult to injury, the MRI from 2023 indicated a high likelihood that the brachytherapy seeds weren’t located in the location consistent with the lesion shown in the MRI of 2020. The reason I’m writing all of this is because while I agree that there is a reasonable argument for calling Gleason six something other than cancer, the reality is that biopsies aren’t perfect and one can never be 100% certain that a Gleason six diagnosis later won’t have to be revisited as more significant and high risk cancer.