Focal Therapy for

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Here, Medical Oncologist Mark Scholz, MD, discusses the ins and outs of focal therapy and what the potential sexual side effects may be.
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Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website at pcri.org or contact our free helpline with any questions that you have at pcri.org/helpline. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
The information on the Prostate Cancer Research Institute's KZbin channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
#ProstateCancer #MarkScholzMD #PCRI

[@mah1788]

Thank you from the uk if i had the money i would let mr scholz treat me, having prostate cancer is bad enough but choosing the right treatment is a minefield your videos have been a massive help, thank you very very much 😊

[@robertmizek3315]

I had focal brachytherapy on 1/2 of my prostate with Dr. Brian Moran from DuPage Medical in the Chicago area. My PSA never dropped below 2.21 and unfortunately cancer came raging back in 2023. It’s been a disaster. The new diagnosis is high risk aggressive Gleason 9 Stage 3 locally metastatic cancer all because I was under diagnosed and received the wrong treatment. I needed salvage radical prostatectomy, salvage radiation, and two years of androgen deprivation therapy. I was the local “poster boy” for focal treatment, and I would never recommend it again.

[@VimMitt]

Please help me because i chose brachtherapy and would like to explore more. I have three small cancer in prostate which needs to be removed by this.

[@schmingusss]

Did you get the seeds that you leave in your prostate or the ones that come out?

[@spitfirekid1]

⁠@@schmingusss I received low-dose brachytherapy, which are the seeds that stay permanently in you. Unfortunately, 3 years later I found out that my biopsy missed significant high risk disease, and that focal brachytherapy was not appropriate treatment. I now have stage 3 metastatic prostate cancer, have had surgery to remove the prostate, am on androgen, deprivation therapy, and receiving radiation. My point in sharing this is before you pick any treatment, make certain that you’ve had a biopsy that you can trust. The gold standard today is an MRI guided fusion transperineal biopsy and I suggest you explore that if you have not already received one.

[@schmingusss]

@@spitfirekid1 Thank you for posting this and helping other people out.

[@unapologetic7900]

@@spitfirekid1 Did they do a PSMA PET CT prior to the first focal therapy?

[@steveg6978]

What if you have two lesions , one on each side. One is Gleason 6, the other is Gleason seven. Can one still do focal on the Gleason 7.

[@masoudsaeedinia2191]

Cryotherapy had done just 2 hours ago. I would be happy to answer any questions and updates

[@coilnchamberlain6506]

Thank you from Australia.I learn so much from your professional information.Thank you.Please keep up this great work.

[@foropera]

You are not talking about “focal brachytherapy” (for low-risk or “favorable intermediate” prostate cancer). Is it because, as they say in France, there were too many cancer recurrences when they tried it?

[@stakwalderbak5331]

Thank you from Oz.This series of PCRI videos are outstanding and reassuring for me as a recently diagnosed cancer patient.

[@mikerose6835]

Thank you from Australia.

[@colemant6845]

Can you do a Video on Re-Current Prostate Cancer after Radiation Therapy. It is SO much more complex and a still Unknown treatment. (Cryo, Hormonal, Surgery... etc. ) Your Experiences and Opinions would make a very informative Video. Thank You

[@rickwashek478]

My medical oncologist retired in December. He had me on Lupron Depot 22.5mg. and Casadex. This was for return of prostate cancer from 8 years ago. Just seen new oncologist this week. She told me Casadex is an old drug that is no longer used. My PSA went from 214 to 39 and now is just over 5. So it seems to me that the treatment is working. So my question is. Do doctors still use Casadex for treatment?.

[@robertmonroe3678]

In an earlier PCRI video, I gave a quick look but can't find it, Dr Scholz, does talk at length about Casodex. As I recall he noted how well-tolerated it is, its current role in therapy, and the fact it seems to be less-often prescribed and why that is.

[@billyjohnson9166]

You both are great. Thank you

[@mperloe]

It's important to consider if the disease is focal and has not spread beyond the prostate. Another consideration is that the MRI often understates the actual tumor size. Most insurance does not pay for focal treatment for cancer so out of pocket expense is often quite large. Are there well designed studies that show that Focal therapy is any better than AS?

[@suzannahwhite4292]

Thank you from the UK! This is such a great resource. I have a question: My partner has/had prostate cancer and is on ADT and Enzalutamide, plus he underwent 39 sessions of IMRT; what is the "tissue" that is left after radiotherapy please? If the radiotherapy kills the cancer cells, what's remaining? It's not like the prostate is "empty" so what's left? Thank you.

[@Lola.1952]

That's my question too.

[@derickdevindavis]

If I understand your question correctly, and, I'm only guessing, the left over cells should be both dead "healthy" cells as well as dead "cancer" cells in that treated area. The untreated area (assuming no cancer was there thus the reason why it left untreated) should be health, normal prostate cells which produce a PSA value only from "healthy", untreated prostate cells. Thus, routine MRIs would be needed to keep an eye on that area in conjunction with a new baseline PSA that doesn't abnormally rise (abnormal velocity in the rise). This part of the video appears to talk about that aspect. kzbin.info/www/bejne/bnbNeGijbN5jrKM

[@willbraswell4906]

I'm no expert but a recent video I watched made a comparison for their explanation... they said to think of when a woman gets her breast(s) radiated. The radiated tissue doesn't disappear or go away, it just gets radiated so the cancer cells are poisoned to stop them from multiplying.

[@MrGuitar1458]

Great information as always. Thank you both!

[@daisuke6072]

Practitioner is important, however I understand that different types of FT may be suitable for differently located cancers e.g. apical v peripheral

[@bigike1313]

Those interested should check out Tulsa-Pro. Highly controlled and specific but also can treat BPH.

[@lesleymorris]

What’s .BPH

[@Neilpedersen]

Hello, Thanks for sharing such helpful information. With one Gleason 7 (3+4) lesion is 5% grade 4 and 3 lesions of grade 6 on both sides of the gland. Does anyone know if that qualifies for focal therapy?

[@gerrym5299]

I have a PSA of 9.7, elevating over a period of 12 years. MRI/Bone Scan and a PSMA all point to an area on the left outside of my prostate, with no further spread. Two weeks ago I started Degrelex (2 shots) and am having side effects of constipation/diarrhea, headaches, hot flashes... which I believe are 'common'. I also have burning and pain during urination, a culture is in process. My doctors plan is for my next shot in 2 weeks to be a 6 month level of Eligard (if I am recalling correctly). My quesiton is are these urinary problems I'm having something that will dissipate over time or will I experience them for the duration of my ADT? My doctor wants me to start on radiation therapy in 3 months, with I believe 28 treatments over 5.5 weeks, which I'm thinking could introduce another possible cause for these same symptoms. ?

[@pinotwinelover]

Well, I do know who's an intervention radiologist. Dr. David woodroom at the mayo clinic is doing my cryotherapy tomorrow. He's been doing that since 09. He may be on par with the doctor from ensure that the tire so definitely put his name in the mix. I'll report back I'll be in a five-year research study after tomorrow, April 24, 2024. It looks like my research he has done as many or more than any doctor in the United States any also because of his expertise in interventional radiology ablation other type, tumors on other organs, besides prostate

[@michaeldunphy3887]

I am concerned about dementia and Alzheimer's disease occurring with patients taking ADT therapy for over 12 months. There is a Meta-analysis available in the medical literature that shows a relationship. Can Dr Scholz address my concerns in a future presentation? Thanks

[@LorenzoAscali-np1jv]

Does Breaky therapy also take care of BPH symptoms?

[@sylviagall5523]

My husband has a Gleason score of3+4 with a psa of 6.374 what can be done

[@wormsnake1]

What did your husband decide to do in the end?x

[@joeturner1195]

Have tumor 6/6 ,1.6 mm and PSA 4.5 have heard that there is radiation pellets that can be used what are your thoughts of this thanks

[@CharlesHarkerSanJose]

Regarding recurrence with focal therapy after tulsa, laser, cryo, hifu etc. it's said a 2nd treatment is possible. But what about focal radiation? Is a 2nd treatment possible? (Since full gland radiation isnt rec'd a 2nd time.)

[@mikimoto99]

Brachytherapy only way to go if you can afford it👍🏻

[@alanaldpal950]

They “ buy instruments and start practicing on patients”. ….. great who wants to go first.