Who should get a prostate biopsy? | Peter Attia & Ted Schaeffer

[@comfortablynumbly]

I don't see the risk calculator link mentioned at 3:57 mark??

[@charlesgair8608]

AT 65 I Had A Prostate Cancer That Was Gleason 4+4 And I Refused To Take The ADT Shot And I Got 4 Weeks Of EBRT And Permanent BRACHY SEED IMPLANTS .10 Months Later My Oncologist Said My PSA Was 0.3 And My Cancer Is Undetectble.

[@thailandbuddy4451]

Are you on any therapy now, such as Lupton injections. Lupron may be a testosterone blocker also.

[@charlesgair8608]

@thailandbuddy4451 No. I Refused To Go On ADT Hormone Therapy. But They Did Try To Get Me To Get On FIRMAGON Injections .All Have Brutal Side Effects.So Far It Looks Like I Definitly Made The Right Choice.

[@charlesgair8608]

@@thailandbuddy4451 FIRMAGON Is The Testoterone Blocker That The V A Hospital Uses.

[@sychophantt]

Congrats Boss!

[@charlesgair8608]

@thailandbuddy4451 No! The V A Wanted To Give Me FIRMAGON Shots But After Studying About Hormoe Side Effects I Refused All ADT Hormone Therapy..But My Cancer Was Still All In The Prostate And The Tumorr or Lesion WascVery Small.IHad 4 Weeks Of Radiationn And Permanent Seed BRACHY Therapy Implant At Mary Bird Perkins Cancer Center ,Baton Rouge .La

[@denniswhite5215]

I have had 2 prostate biopsies with no lesions either time psa was 7.2 and 10. That was 14 years ago. I have not gone back .

[@Columbusappraiser]

I also had 2 biopsies with no lesions. I believe my psa was 4 for the 1st biopsey and 4.5 for the 2nd, My last psa was 7.5. This time I'm getting an MRI

[@sychophantt]

Bless you! I got my results and of course the fear is setting in!

[@ytinf1090]

What? Psa 4 and biopsy???​@@Columbusappraiser

[@Columbusappraiser]

Unless it's spread things may not be that bad ​@@sychophantt

[@sychophantt]

@@Columbusappraiser I have a biopsy scheduled soon, trying to educate myself as to whether I should get it or not.

[@DeuceDeuceBravo]

Where are the reference materials mentioned in this video?

[@jameskelley3365]

Both the MRI and PET scans at Kaiser are the same price on Medicare. ($225) I would not want to damage the prostate further by puncturing it multiple before a PET scan. 😮

[@hypolitej]

I’m 71 and in 2011 my psa was 4 but I did not get a biopsy. My psa rose to 7.1 two years later but I still did not get a biopsy. Three years later my psa was 21 but still no biopsy and three years later my psa was 28 and still no biopsy. Throughout this entire period I experienced no difficulty or discomfort passing urine or pain of any kind. My quality of life from my view was unaffected. My psa declined first the first time the following year to 26.7. I still have no symptoms that bother me or affects my daily routine. No pain or obstruction symptoms and still no difficulty passing urine. I will be 72 in June and at this point don’t think I will ever get a biopsy unless something drastically changes to affect my quality of life. I respect the decisions taken by others as they see fit but for me these are my decisions for which I’m prepared to take responsibility. I’m left to wonder had I gone in for a biopsy 14 years ago what would have been my situation right now health wise at age 71 with all the risks involved. I feel no different now than I did 14 years ago.

[@Troyboy2121]

As an African-American. do you feel that the rising PSA levels are a concern? It sounds like your PSA was at the limit of 4 at the age of 58 and increased steadily over the years. Did you get an MRI?

[@physicsprof.9639]

That's good but of course it's all about statistics. Some smokers live a long time without getting cancer, but that doesn't mean smoking isn't dangerous. I hope readers don't take your experience to mean they shouldn't follow up if they have similar tests. Statistics of one case mean almost nothing.

[@MM-sf3rl]

The MRI will give you factual information and direct your next action: to have or not have the biopsy. The biopsy should be your second choice.

[@michaell3711]

​@@physicsprof.9639,,, Sometimes it is great to AVOID Doctors invasion of your person. I have proven that they're keen on saying "You need treatments " ..... Blah, blah, blah..... Sorry,,, BE your Doctor FIRST!!!!!!

[@MM-sf3rl]

@@thailandbuddy4451 What was your PIRADS? PI-RADS 1 - Very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2 - Low (clinically significant cancer is unlikely to be present) PI-RADS 3 - Intermediate (the presence of clinically significant cancer is equivocal) PI-RADS 4 - High (clinically significant cancer is likely to be present) PI-RADS 5 - Very high (clinically significant cancer is highly likely to be present)

[@wishdish]

I agree with comments below about Dr. Attia cutting off his guest mid-explanation. It's hard enough for us lay people to follow along so when it becomes a doctor to doctor shorthand conversation most of us can't follow along. This is a GREAT conversation, Dr. Attria is a stud for bringing so much valuable content to us but please who the audience is. Thank you.

[@hugs92104]

Where can the risk calculator be found? Thank you!

[@timelston4260]

Dr. Attia, when you interrupt your guest with the next question, you and he may be effectively communicating with each other, because you understand where the sentence he is speaking is going. But interruptions do not allow the guest to finish his sentences for those of us who need the whole sentence to be completed to know what he was going to say. The interview has to be for your audience, not for you and him.

[@abrahamkalichman6845]

All I have to comment on is , the repore that you have with your guests are extremely informative for anyone who has had the slightest fear of this subject matter. I value all of your discussions!

[@Blue_Dun]

timelston.... you were reading my mind. I found his interruptions annoying

[@arnilodeguzman8212]

Thats true he should let the other doctor to finish talking first resulting to interruption with what the other doctor is saying. As a viewer its hard for me to understsnd when dr attia intercept with the tslking

[@pt170966]

Agree…find the interview frustrating to follow due to the continuous interruptions

[@DS62581]

What about PSA levels and TSH hormone? Hyperthyreosis might be associated with higher PSA levels. What about ExoDx Prostate test vs Prostate biopsy?

[@bluesky2145]

Where's the risk calculator guys?

[@DavidDabbs-mz7ht]

The percent free PSAi s the ratio of the amount of free PSA compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not. So when my Urologist refuses to do this test and only does PSA total, how can I calculate the present free PSA myself or is it possible?

[@ialogixcorporation6316]

Buy your own test and see a different dr

[@hamsterdangler]

I am 74 and am concerned that with a PSA of 17.7 and a prostate 7 times original size, it was noticed in a prostate scan that I had a tumour in the left kidney, tumour removal scheduled for the end of July but the surgeons are not planning a biopsy of the prostate until after the kidney surgery. It seems a long time away.

[@TriciaWalls-x3k]

Where is the risk calculator link mentioned at 3:57 mark? Thanks for sharing.

[@jimpoole9800]

Has anyone found the link for the risk calculator?

[@Roger-l3m]

What is the name of the calculator? Miami ?

[@williemclean3224]

My PSA was 2.3 in 2021 3.2 in 2022 and 5.7 in 2024. I was sent to a urologist who right away wants to do a biopsy. Very confused. Should I get the biopsy, very confused.

[@williemclean3224]

If you get a biopsy, what are the risks besides infection. Can the biopsy cause a spread.

[@akashsuryavanshi8257]

Please let me know too, my father is in same situation

[@samkumar8062]

Do a mpMRI at a good urology center. If no lesion and psa density below 0.15 - maybe nothing to worry. Repeat psa in 6 months. Do an Episwitch pse blood test or ExoDx urine test to determine risk.

[@tls6362]

Get a MRI first.

[@edotero6331]

​@williemclean3224 biopsy doesn't cause spread and if you get a transperineal biopsy, infection rate is significantly lower than through rectum

[@waeldeirki2152]

please advise me where may I find all these figures and statistics mentioned in the interview....

[@christishusbandakastan7618]

Very good interview/discussion.

[@Freedom24560]

Doesn't a Psma pet scan, combined with a 3T MP MRI give you most of the critical information you need to go forward, without punching numerous holes in someone's prostate? Gleason scores are great, but are they absolutely mandatory? In addition, the biopsy procedure itself seems rather random and unreliable....."hit and miss".

[@schmingusss]

agreed

[@persistentone3448]

Where is the risk calculator link that the video said would be in show notes?

[@markfll]

My MRI showed several lesions, so I had the biopsies done. Six of them showed cancer. I have 2, 4+5s. 2, 3+5s. 1, 4+4. And one 3+4. On the Gleason scale. My doctor told me I need to take care of this as quickly as possible.

[@crpunks]

Take care how? Removal or chemo? Or both?

[@markfll]

@@crpunks I consulted with both, and in my situation, opted for surgery knowing there's still a chance of needing radiation therapy down the road.

[@crpunks]

@@markfll hope everything goes smoothly and turns out well!

[@markfll]

​@@crpunks Thank you.

[@spitfirekid1]

@@markfllhow are you doing now

[@tobyhammett6807]

Thanks for having these conversations, much appreciated - oh and I did buy your book sir :)

[@JuanPerez-bn2jo]

Any issues with delaying prostate biopsy a couple of months? In my area, earliest appointment is about 2-3 months out.

[@janetw9430]

PiRad score of 2-3 with a 9mm lesion shows mild hypointense and mild hyperintense. Psa density of 0.063. Of a 83 cc prostate?

[@insane_jarvis_9857]

where's the slide mentioned at 1:54 ?

[@mitchellcollins8111]

Dr. Schaeffer I would like to come see you but your staff will not give me an appointment. Mild left sided prostate assymemtry with PSA of 3. I am a doctor in Arkansas and would travel to see you! Thank you!!

[@wapickle1]

I had a psa of 4, got an mri, found I might have something,got a biopsy (not pleasant), and discovered I have mostly 95% 3+3, 5% 3+4…Dr suggested for active surveillance (with future biopsies and psa tests), this was a week ago, not sure what to do since the big C is a shock, radiation and surgery both have effects so ..?. I’m 66. Thoughts, opinions?

[@JOEH-hn8rp]

Surgery is okay but stay away from chemotherapy go with dog dewormer.

[@allanc9472]

I thought 3+4 still in the safe side unless it is 4+3. I may consider your doctor recommendation, do AS for now.

[@JOEH-hn8rp]

@wapickle1 biopsys are no good they make the cancer spread I had a biopsy and got poked 10 times when they tell u need a biopsy it's means multiple biopsy I left never went back ,used my own system that God give me and I am healed, Herbs mixed with Dog dewormer it killed the cancer.

[@PeteHob]

Is it difficult to find a medical staff that will give general anesthesia before biopsy or do you have to really “ shop around” to find one?

[@tonyweimar2390]

dr pete after a biopsy you say even if cancer is present you can leave it alone meanwhile you just stuck the prostate with possibly 12 needles cant that spread the cancer or make it worst, im asking cause i did not get a biopsy with a psa of 4.59 and now 6 to 7 yrs later my psa is 156 and im taking alfuzosin and struggling to pee. please let me know what you think ,im 61

[@MbongeniMtimkulu-te7hu]

I like to know whether the prosted gland can be removed or not?

[@iamric23]

The guy in the white shirt interrupts the man who is trying to answer his first question frequently. It's frustrating to me because I was ready to hear the full answer, and this guy stops him and asks him another question. Next, why would a person who had a Gleason 6 have his prostate removed, that's crazy..

[@td4004]

Two prostate biopsies for me. I would not do it again. First, biospies only gather samples from half the prostate. Second, painful and expensive. Third, while most doctors would disagree, psa is a better overall indicator of a problem. Fourth, I wil go on Tippens Protocol before chemo, radiation or surgery. Fifth, inflammmation is not your friend is you have cancer. A biopsy creates a lot of inflamation in the prostate.

[@Clay54883]

Can I ask how old you are please?

[@neilbuchan-grant2328]

So where's the data relating MRI results to Biopsy results which he spoke of with such reverence and which suggested that ALL PI-RADS 3,4 and 5 turned out to be csPC? My take on the most recent studies is that maybe around 20% of PI-RADS 3 lesions might have some form of PC but only around 5-10% would likely have clinically significant prostate cancer. I wouldn't want a biopsy with a PI-RADS 3 result and a low PSAD (which I actually have!) But Ted says he'd biopsy all pirads 3 regardless of PSAD. Show me the data he was talking about

[@hencape]

I've had 3 negative biopsies and I was scheduled for another in October. My PSA has gone from 5 to 11.5. Will I need a biopsy immediately?

[@allanc9472]

Sometimes it might be due to Prostatitis that cause a high jump in PSA. Get check, maybe doc treat with antibiotics and hopefully go down and/or mpMRT. How old are you, you already have 3 biopsies coming to the fourth? I am contemplating whether i want a biopsy with PSA 7.8, Negative (Pirad 1--2) MRI with no lesions and mild BPH. The urologist recommend one but I felt like he is always pushing for biopsy $.

[@ialogixcorporation6316]

@@allanc9472what’s your PSA density

[@tonyberry850]

I refusedca biopsy with a uroligist when i was only 62 nothing since either at now 85 is thjs luck?

[@allanc9472]

Why he wants to do a biopsy? High PSA? etc?

[@Troyboy2121]

The makes no sense. If you have a high PSA and low Free PSA, but have a clean DRE, Pi-rad 1 or 2, and a low prostate density, you still need a biopsy. This process is starting to sound like witchcraft.

[@allanc9472]

Yea i was going over and over again, like did he mean high prostate density over 0.15?

[@davidlawson4281]

Question: does more frequent ejaculation in older men, say, over sixty, ameliorate the propensity for development of prostate cancer.

[@atlskyline1]

I had the finger up the butt and doctor said there’s a nodule in there. But my PSA is 1.3 and PSA density is .024 (I’m 42) This was measured by only a transabdominal ultrasound. He wants to do a biopsy. Should I try to get an MRI first?

[@Jim-ok9zi]

I have a question. Is there any side effects from the Biopsy.

[@rteitel1974]

I believe infection in a small %

[@petegodfrey5735]

@@Jim-ok9zi Yes...defenitely. It WAS very painful, I passed blood in my urine, ejaculate, & stool, for more than a week. I would look at all the alternatives if I were you. The urologist fidnt even MENTION my Gleason score, or acknowledge the fact that my PSA DROPPED DRAMATICLY...NOTHING BUT NEGATIVITY. FOLLOW THE MONEY MY FRIEND...

[@Jim-ok9zi]

@ Thank you for your reply. I appreciate you telling me about your experience.

[@markscholz1219]

Wish that the urologists were as forward minded as Dr Schaefer implies. Sadly, lots of surgeons and radiation specialists still recommend treating Gleason 6

[@vs-yy5cx]

I am surprised he did not mention localized treatment of the cancers that preserve the rest of the prostate.

[@schmingusss]

He is a urologist. They just want to remove the entire prostate all the time. Butchers.

[@vs-yy5cx]

@@schmingusss Well, I don't know how long this has been done, or the parameters of when this is an acceptable treatment, but it is done. Should be mentioned. And I should add it is surgery that a urology surgeon can also perform.

[@NShah-rh1xi]

Dr. Attia, thanks for your excellent series to educate all of us. I wonder who your listening audience is- the public or health care professionals. It comes across as the latter. Please tone down your medical terminology to include more of us. Thank you.

[@dilrukshiprem1410]

You

[@jameskelley3365]

PSA up to 7 octogenarians is designated within normal by Kaiser.. What is going on with PSA with age?

[@scooter29]

I had a biopsy and got sepsis. I’ll pass. I do MRIs now

[@RegularJoeKnife]

Thanks for the info. I have found a lot of urologists are still living in the stone age. You have a high PSA like a 6.8 then you need a biopsy, transrectal - old school. What? I don't think so. Told him about no history in my family of prostate cancer. So he ordered MRI. By the way rectal exam negative. No lumps or bumps. MRI was negative. I have a large prostate of 67.4cc. PSA density was .08 says Doc said MRI is only 90% no cancer 10% still. my PSA went back down in the 3's. 6 months later went back up to 5.4, still .08 PSA density. I've heard some negative outcomes from transrectal biopsy not just from patient comfort but it still doesn't mean you don't have cancer if the sample don't capture the cancer especially if the MRI does not show anywhere to focus on. On TRT.

[@LeanN2Light]

Very helpful, thank you! Pardon if I missed it but what is PSA?

[@Scottlp2]

Blood test for prostate specific antigen.

[@karlpk3907]

Prostate Specific Antigen. The test for PSA is standard. www.cancer.gov/types/prostate/psa-fact-sheet

[@creez1]

I'm not a doctor but I had prostate cancer. Prostate-specific antigen, or PSA, is a protein produced by both normal and cancerous prostate cells. Its main role is to keeps semen in liquid form so that sperm can swim. A simple blood test can measure how much PSA is present in your bloodstream. In almost all cases of prostate cancer the PSA level increases. It should be less than 2.5 ng/ml. Mine was 4.7.

[@Maiden4eva1995]

@@creez1 What age were you? Mine at age 30 is 1.3

[@creez1]

@Maiden4eva1995 I was 58. My PSA was increasing year over year and I was finally referred to a Urologist. They say one in nine men get Prostate cancer. It is among the most treatable and curable and like most cancers the earlier it is treated the better.

[@BMT-by5ve]

I think i missed the conversation. If i have PIRAD 4 with,0.004 cm and PSA density of 0.07, PSA 2.5 on Finasteride, will require biopsy?

[@MM-sf3rl]

PIRADS4 indicates that “clinically significant cancer is likely to be present”. However, the PIRADS could be downgraded or upgraded. You should have an institution that deals with PC read the MRI. I would believe that a prostate doctor would tell you to have the biopsy. Only in the pathology report do you get the most clear evidence of how “significant” the cancer is that is present.

[@bradbradshaw-i4n]

my psa has been over 9 for 14 years. no cancer and the doctor has no answer. what do you say.

[@jameskelley3365]

Why don't you use a PET scan after the MRI scan before you do a biopsy?

[@samkumar8062]

Because PET scans are expensive in the US and insurance may not cover.

[@BobRothman]

why are some doctors suggesting not to have a PSA test done !

[@brucecampbell6133]

It would be helpful if you would let your guest answer the current question before interrupting with a different question.

[@Adamas11]

💯 What a douche!

[@petegodfrey5735]

Thank you for explaining so clearly!!

[@Ralphdc19]

I attended a talk by Dr. Scott Eggener of University of Chicago!

[@johnjordan9538]

I just had a biopsies when i went he said it was enlarged but my result came back nomad

[@longnshorttpa]

psma pet with MRI will be the new gold standard before biopsy?

[@petegodfrey5735]

The urologist I went to DIDNT EVEN OFFER an MRI. Im 74, will be 75 in Feb. Im taking herbs and supplements. Like they say...follow the money.

[@geoffmccoll4640]

Well, I have been invited to get a Biopsy, should I just give no less than twenty medical people something to do in Australia?

[@petegodfrey5735]

Im 74, & dealing with the PSA roller coaster. God has done more through prayer than these urologits...

[@frannybgood]

So you're relying upon your imaginary friend? Good luck with that one 😮

[@petegodfrey5735]

@@frannybgood I dont need luck. You will find out just how real God is, when you leave this life.

[@FallKingPepe]

Tomato paste

[@PorteñaCali]

😂😂😂

[@schmingusss]

Same here.

[@DaWorstBroadcastingNetwork]

Dose a Psa 0.02 mean non detectable

[@allen7175]

Get a biopsy, spent 3 months fighting an infection, lost 2 friends killed by biopsies

[@John-hq6em]

Whatever you do, don’t let anyone do the Urolift procedure on you, the metal implants cause an MRI to be totally useless (my personal experience).

[@geoffmccoll4640]

Is having a bald head another indicator, or should sack all of the female medical people that I am going to meet briefly during the next two years in Australia

[@wayneredd6776]

Very confusing

[@AllenTweed]

What about 3+4=7? Inquiring minds want to know!

[@ИгорьИжщенков]

Those 3 + 4 = 7 are a part of the biopsy pathology report and are for determining the Gleason score which is the aggressiveness of the tumor. The best is 3+3=6 because Gleason 6 never grows. Gleason 7 is by two ways: 3+4 and 4+3. 3+4 Gleason 7 means that the tumor is mostly Gleason 6 but has some aggressive Gleason 8. 4+3 means that it’s more of a aggressive Gleason 8 with a bit of Gleason 6. 4+3 types need surgery to treat their cancer.

[@threeftr3349]

@@ИгорьИжщенков Your explanation is a generalization from person who does not specialize in cancer, your explanation "4+3 need surgery to treat cancer" is so absolutely incorrect.

[@threeftr3349]

Gleason Score 7 =3+4---Grade 2--Risk Group Intermediate (favorable) Gleason Score 7 =4+3----Grade 3--Risk Group--Intermediate (unfavorable) A Decipher Test-is a tissue-based genomic test that helps in treatment decision-making for localized prostate cancer. It uses the tissue samples from the biopsy. You can get a 2nd opinion of the pathology of the biopsy to check the accuracy of the Gleason Score Your oncology can order a 3TMRI of the prostate

[@threeftr3349]

When it comes to the possibility of cancer a doctor never says it will never grow Gleason score 6 is the lowest grade of prostate cancer. This rating means that the prostate cancer is considered to be low- or very low-risk disease, or group 1.1 Most of these tumors are found during routine prostate cancer screenings. Gleason 6 prostate tumors grow slowly and may never cause a problem-or even need treatment. Still, they should be monitored

[@normturcotte4206]

@@threeftr3349 YOU ARE CORRECT. The statement “4+3 need surgery to treat cancer.” Is TOTALLY FALSE.

[@malvindertiwana]

If h

[@garyeverling7555]

Straight to biopsy due to a high PSA result?? This guy is way out of touch with tons of science. Get a good MRI first! Even a poorly done MRI is more accurate than a good biopsy.

[@jaybrox1652]

The best solution of ANY kind of tumor in prostate if if it is 3+3 is to remove it immediately...the longer you wait the bigger and worse it becomes.Forget monitoring with treatments available today.I have plenty of experience with tumors talking for the sake of talking And gor sure I would NOT use this expert. Hahaha.

[@johnmchale8308]

Gleason 6 3+3 is not cancer

[@jaybrox1652]

@@johnmchale8308 I can guarantee you that in time it will be!

[@fingerlakeshiker]

@@johnmchale8308 that is true.

[@PatLeni]

Never again