Risk of Metastasis if you DON'T Treat Prostate Cancer

[@davefranryan5566]

Thank you for going into what data is available and providing context. I'm going on two years since radical prostatectomy. Since the surgery my PSA = 0. Self advocacy is important as my GP considered my rising PSA level to not be serious. On my own I went to a urologist and explained my family history of father dying from metastatic cancer and my uncle having his prostate removed and still alive at 89. My urologist did a biopsy and found cancer of Gleason 7 (3+4) and we decided to watch and wait. I insisted on a follow up biopsy eight months later and we discovered cancer now on both sides of my prostate. We quickly went to surgery and removed the prostate without incident. So far, no signs of cancer and I am able to urinate without issue. Additional note: the MRI showed no indications of cancer.

[@kerrylattimore2684]

I'm researching for my husband. Lots of testing and waiting. I appreciate your informative video.

[@philstanton231]

Thank you for posting. I was diagnosed with PC (gleeson 3+4) and was advised to watch and wait. PSA continued to rise, and i was then advised to have surgery. So far so good, but metastatic spread was never EVER discussed. No disrespect to those involved in my case, but I think it would have been helpful to discuss this aspect To those thinking of surgery, I had 90% control of my bladder in 6 weeks. The last 10 % took about another 6 weeks. I pee freely, but viagra does not work, so that department is gone, BUT i am alive with a PSA of

[@georgeschilens8557]

Underlying cause, steps to prevent would be a nice addition to your information! 😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊

[@MarkThomasMedia]

Re underlying cause look up Dr Seyfried on cancer as a metabolic disease. Essentially, that is as a disease caused by chronically raised insulin as a result of diets based on carbohydrates e.g. bread, pasta, rice, potatoes and all the ultra processed derivatives with corn syrup. I find it to be a compelling argument. 1. Insulin is a growth hormone, stimulating cells to multiply. 2. All cancer cells are metabolically dysfunctional. Their mitochondria are unable to fully oxidise glucose, they can only ferment it. So, stop the glucose supply by not eating carbs and two things will happen. 1. You won't have the cancer stimulus from insulin. 2. Your body will switch to burning fat in the form of liver produced ketones instead of glucose. This starves cancers as they cannot use ketones and don't have the abundant supply of glucose that had been spoiling them for energy. This is ridiculously simple compared with the genetic theory of cancer. It has been known since Otto Warburg discovered it in the 1930s but largely ignored until Seyfried stumbled upon it following his research into epilepsy and ketosis. If I had known this before surgery I would have gone for a zero carb diet and seen what happened to my 3+4 rather than having a prostatectomy.

[@michaelcasey6546]

Firstly thank you for your videos. I was diagnosed with gleason 7 ( 3÷4). I had 12 core's taken and 4 came back positive. I had 3 cores gleason 3+3 and 1 core 3+4. I took the advice of my urologist as Im a young man at 52, she said that I'd get away for a few years if I left it but because of my age it would ultimately start causing trouble. Im 3 weeks over robotic radical prostatectomy and surgery went well. Im a young man doc and I dont regret my decision in anyway and hopefully I have given myself a long and happy life with my family and friends.Thanks for your informed videos and for the time and detail you put into them.

[@cancerbetter]

Thanks for sharing your story

[@roryhaymanphotography8882]

Great video. Great data explanation. I'm 72 years old and have to practically beg my doctor to have a PSA test since he doesn't think it's necessary and we're all going to die with prostate cancer and not from it. This in spite of having both my younger brothers diagnosed with prostate cancer (one going through radiation now and the other had his prostate removed) and an uncle who died from it. Would be interested in what you think of my docs attitude.

[@cancerbetter]

Sounds overly simplistic in my opinion. On a population basis his view makes sense but on a per individual basis there are exceptions that can be investigated. Really makes most sense when a person has an life expectancy of well over 10 years

[@JuanPerez-bn2jo]

1000 views in 7 hours... Great job Dr. Ahdoot. I have reviewed all your videos; your channel not only has very good information in reviewing solid randomized studies but your narrative is unbiased which is greatly appreciated. I've been followed for a borderline and then high PSA (still < 10) for over a year and was diagnosed with PCA mostly 3+3 but one sample 3+4. In my early 60s I have been told I should get it treat it while it is contained, following the advise of a panel of 2 rad onc, med onc and onc surg I am booked for RALP. Many thanks for your contributions to patient care.

[@cancerbetter]

Maybe you are a focal therapy candidate? Try looking at my video about that. HIFU is now covered by several insurance providers

[@JuanPerez-bn2jo]

@@cancerbetter Thank you. I had looked at all your videos and researched focal treatment, despite being seen at two top major Harvard affiliated hospitals in Boston, none of them have a solid focal therapy center or operator with enough experience to go to.

[@michaelmiddleton3311]

So glad I found you! Youre final thought really sewed it up nicely! I'm 3+4, and so conflicted... THank you!

[@johnmchale8308]

how much grade 4 is in that 3+4? anything 20% or over can quickly turn to unfavorable......

[@richardmartin9591]

Great video, I’m in England currently on Active Surveillance with Gleason 3+4, T2. Biopsy was 28 cores taken only 4 showed cancer & only 10% of those were Gleason 4. I’m being monitored with a three monthly PSa blood test & follow up MRI in 12/18 months. I was diagnosed in January 23. I’m hoping to stay on AS for as long as possible to avoid radical treatment

[@cancerbetter]

Makes me very happy to see I’m able to help!

[@RichardKelleyMD]

Great video. Thank you for sharing this information!

[@cancerbetter]

Glad you enjoyed it!

[@beam3819]

As a nurse we used to say that elderly men did not die from prostat cancer. They died with it. But recently the new turbo cancers has changed everything about cancers. Now elderly men gets agressive prostate cancer and a friend of mine live with extreme sweating and cant take it anymore. He cant go back to work and he is depressed. According to new studies zero testosteron are causing cancers. And doctors have started giving testeron to post prostata cancer patients. He wants to bc his at his witts end sweating extremly and night. Anyone know how to help my friend ? Norwegian ret nurse👋❤️🇺🇸🇧🇻

[@napaman2104]

Dr. Ahdoot thank you for your videos. My psa showed a gradual rise over 18 months from a .8 to a 2.6 so at my pcps advice saw a urologist. Dre negative but did a t3 mri to be safe. Found a 1.3 cm lesion on the left apical anterior transition zone. I was given a pirads 4 rating so now scheduled for a transperineal fusion biopsy which i dont want to have at this stage. I read on another video that area of the prostate is rarely cancerous and my psa density was .06. I know you said anything less than .05 was was likely not cancer. I'm getting a 2nd opinion of the mri because im wondering how subjective the pirads rating is. If the next guy says im a pirads 3 then active surveillance seems reasonable. Im 68 and as the mri also showed i have a history of chronic prostatitis as well. The lesion is contained inside the prostate and no signs of any other issues currently. I'm really leaning towards waitng for now and getting additional psa testing and possibly another mri early next year if the psa shows continued increases. Thank you

[@cancerbetter]

Thanks for sharing your logic. It all seems reasonable! Prostate cancer diagnosis at a PSA below typical abnormal values is a bit of an all bets off scenario because most studies required a psa of >4 for study enrollment.

[@whizzo55]

Thanks for the video. Keeping up with prostate cancer information has helped me deal with this problem. I am lower level and am in the monitoring stage checking PSA every 6 months and yearly MRI.

[@cancerbetter]

Sounds like you are on a good protocol

[@bryanmanderville4196]

Had prostate cancer did cyberknife radiation therapy Gleason score 7 it spread to lymph node in pelvic area more radiation and no more cancer yet

[@cancerbetter]

Very happy to hear that! Hope it never does

[@raymondrust9084]

I'm 77 yrs old, last year PSA was 6.1. Review videos decided to do Hifu with Dr Daniel Su. After months PSA 2.84, next 3months 2.0. Very happy with Dr Su's treatment!

[@cancerbetter]

Congrats on the outcome. A PSA decline of >40% after HIFU is usually associated with success. It definitely reassuring when I get this for my patients. None the less a biopsy 6-12 months after treatment is recommended

[@raymondrust9084]

Yes, in 6 months a MRI scheduled

[@daisuke6072]

Well with most early stage PC men are advised to have active surveillance rather than immediate radical treatment.

[@cancerbetter]

Yes that is the current standard to most gleason 6 prostate cancers. There are some uncommon exceptions such as high volume gleason 6 or gleason 6 with a very high PSA but for the majority of people with gleason 6 prostate cancer surveillance is a safe strategy with the lowest risk of side effects.

[@keepitsimple007]

Hi Doc. Thanks for the vids. I recently had some sort of viral infection with swollen gland in the neck area. I had a PSA test about a week later. It seemed to give a spiked reading. From 8 to 11. Should I have another test in a month or so to recheck. Cheers.

[@johnmchale8308]

Also you should have a Decipher test....you can be Gleason 7 3+4 favorable but a high decipher score would put you out of active surveillance......

[@cancerbetter]

This is absolutely another useful data point in many cases.

[@johnmchale8308]

@@cancerbetteryes my RO used my .29 low risk decipher and told me I won’t need ADT! My original pathology report was 4+3 Gleason 7 but MSK downgraded it to 3+4 Thank you, Doc I like your videos

[@cancerbetter]

@johnmchale8308 thanks for sharing your story

[@Liquid_People]

Unfortunately the effects of prostate cancer treatment can be absolutely devastating. It's like deciding to get punched in the face everyday from now, or having this start in 10 years - but with a slightly harder punch.

[@Nordic_Sky]

I'm 63M. My PSA went from 4 to 7 in one year after I began TRT. My urologist recommended stopping TRT until he figures out what is going on, saying testosterone can cause some existing cancers to grow quickly. But I saw Abe Morgentaler's interview with Rena Malik 10 days ago in which he said the Traverse study showed no difference in growth of existing prostate cancer from TRT. So that's very confusing. I'm also confused as to whether to do a biopsy (which the urologist will recommend) since I have seen information indicating biopsy can lead to metastasis. What a mess.

[@thesqaanalyst]

appreciate your valuable info

[@cancerbetter]

Happy I can share my knowledge with those who can benefit.

[@brucecampbell6133]

I was thinking that you would differentiate between Gleason 7(3+4) and 7(4+3).

[@charlest4525]

Thank you Sir

[@cancerbetter]

Most welcome

[@jeffhansche6105]

Thank you for the data.

[@cancerbetter]

Any time!

[@johnmchale8308]

Hey Doc, thanks for your videos pretty informative and yes it was a disservice not to talk about the suffering for metastasis…..the one thing about Gleason 7 favorable 3-4 is the amount of grade 4 in those cores….. I had two cores that were favorable 3+4 ….One of my cores has 20% grade 4 and the other core has 35% grade 4 that puts me out of active surveillance and I don’t want this thing to metastasize because being on hormone therapy is the worst…..ADT is brutal. I belong to at least prostate cancer groups and the amount of men suffering from metatstic disease is so sad...there quality of likfe.....yeah sure these drugs can extend life but at what cost......? I'm having MRI guided Radiation, 5 sessins SBRT.....I have a low decipher .29

[@cancerbetter]

I wish you well and a speedy recovery

[@michaelschollian761]

Thank you for latest info, I am new here at 69 years old. PSA hit 4.9. Retest from urologist showed it went back to 3 something but 4K was high risk 19 I think. Father and brother both had prostate cancer, both had prostatectomy’s. DRE shows no abnormalities, no enlargement. Not very big in size but firm. Urologist want to biopsy (or mri was mentioned) I am EXTREMELY reluctant and put it off. I will agree to MRI for now.

[@cancerbetter]

Sounds like a good idea. More information from an MRI will help to further stratify your risk.

[@threeftr3349]

Any talk of a PSMA Pet Scan(used in the diagnosis and staging of prostate cancer) to rule out cancer outside of the prostate before any treatment is formulated?

[@MM-sf3rl]

I heard Dr. Carroll from UCSF presentation. One major takeaway, Metastasis-free survival - GG1: 100% free by 5 years and 98% free by 10 years. GG2: 99% free by 5 years and 95% by 10 years. I have favorable intermediate (simple cribriform) 3+4 =7 with less than 15%, low Decipher, negative for BRAC1/2. If things don’t progress, with 95% metastatic-free by 10 years, why treat? Another takeaway was Metastasis-free survival after delayed RP - At 5 years after RP - 97% remained recurrence-free; 95% free after no UG, 99% free after GG2, 96% free after GG3, 87% free after GG4. If you can kick the can down the road, per AS standards, I am putting treatment off as long as possible. I realize there are many ongoing factors I’ve not presented, but “Simple Cribiform is NOT the ones we will worry about. Yellow flag, not a red flag”, per the doctor. I guess I’ll see what the next biopsy recommends.

[@jhansen3000]

Is that presentation by Dr. Carroll available on the Internet? Thanks

[@MM-sf3rl]

@ AnCan Foundation had Dr. Klotz and Dr. Carroll present. Dr. Carroll is the second pres. Title: “Is Pre-treatment Active Surveillance for Prostate Cancer Safe” on September. 16, 2024. kzbin.info/www/bejne/rYPRZZWIo6iLgtEsi=u0Gn2cl_z-72mPmM.

[@MM-sf3rl]

@ The presentation was with AnCan support group. Dr. Klotz and Dr. Carroll presented on September 16th, 2024. Title: Is Pre-treatment Active Surveillance for Prostate Cancer Safe”. What I wrote, I hope, represents the correct information. Please let me know your thoughts. kzbin.info/www/bejne/rYPRZZWIo6iLgtEsi=5DWpQBr1KaH7_HcS

[@DCGreenZone]

>>Undetectable levels of Prostate Specific Antigen (PSA) have been reported from the first patient with metastatic castrate-resistant prostate cancer (mCRPC) to ever receive two cycles of Clarity’s 67Cu-SAR-bisPSMA at the 8GBq dose level. PSA is a marker of tumour burden, clinical response to treatment and an indicator of the recurrence of disease for prostate cancer.

[@brandyyellow]

Good job tks

[@cancerbetter]

Very welcome

[@barneyclancy4312]

Good video easy too understand, but what about small percentage of Men with PSA not elevated, I don’t think it’s just small cell cancer that PSA not elevated.

[@cancerbetter]

That is a completely different situation. When I talk about prostate cancer in this video I am talking about the most common form of prostate cancer called adenocarcinoma. Small cell cancer thens to be more aggressive and respond differently to treatment. While surgery and radiation are still used for small cell the success rates are different and in some situations chemotherapy may be used. I would strongly recommend going to an academic center for small cell as its less common and people at academic centers will likely have more experience with it.

[@DavidWright-sn4tu]

Why isnt retzius more popular,currently in active surveilance at Johns Hopkins.If and when treatment is warranted will not go surgery route,couldnt deal with incontinence

[@cancerbetter]

I don’t think there is a retzius sparing provider at Hopkins. As a person who does retzius sparing and who teaches it I can tell you it’s not easy to learn or to teach. Most people have not had someone to mentor them through the learning process

[@DavidWright-sn4tu]

@@cancerbetter Thank You

[@T.Z.M4N]

I had a successful prostatectomy in 2015.The last part of August my PSA was 0.270. Fast forward in one year it is 0.520.Took a PSMA scan which showed no cancer but my urologist and radioligist still believe it is cancer unseen and want me to take lupron and radiation.I feel it is better to take another PSMA to see if and when it shows.I was a gleason 7 before surgery.Your opinion on this would be appreciated for this 74 year old confused man.

[@cancerbetter]

As a rule I try not to give medical advice on this channel as each person’s case is unique and I would need to review a persons full history and see them to give well informed advice. What I can do is tell you there is strong data showing that if a persons PSA doubling time is on pace to double in less than 9 months delaying treatment has substantially worse outcomes in the case of biochemical recurrence.

[@T.Z.M4N]

@@cancerbetter Thank you so much for your Professional opinion.

[@donaldhyatt6078]

Get the Genomics Oncotype Dx Prostate tests is my path I followed. My Oncotypedx test said the cancer was very slow growing and I would die of old age first that was seven years ago. My PSA is 14 and I just had a PSMA scan it is clean other than the prostate. I have had a Gleason score of 6 in 2017. I am following Dr. Thomas Seyfried from Boston College go Keto, go water fast. Cancer can't survive in a Ketone environment is his explanation. Go watch Dr. Thomas Seyfried's video explanations. Just saying a friend of mine did the standard of care for his prostate and was dead within a year. We are 54 in the world for health care for good health care. So look to other countries, or doctors that are succeeding forget the USA MD's AMA they are always like a hundred years behind the finding of what is working. They poo pooed the discovery of the Polio vaccine for years, gave the doctor that said wash your hands all kinds of grief. The poor guy died like penniless and homeless. Gave the guy no credit for hundred of years that discovered Vitamin c stops rickets. Gave the doctor that invented the partial mastectomy a terrible time. So read up, your as smart as any doctor maybe more if your just have a little common sense to look for what is working and not a failing AMA standard of care nonsense.

[@lbaker9625]

Excellent data Doc thank you very much for taking the time and explaining it so succinctly. It’s great to have a resource such as this because you are correct some doctors out there just don’t give definitive enough information .

[@cancerbetter]

It can be tough to keep data from hundreds of studies in your head to recite during a visit. I sometimes even forget all the data points from my own publications and need to look up my own data. We need to be humble about our limitations and be willing to reference the data directly.

[@christopherstewart9874]

Just recently learned that not all Gleason 7 (3+4) is the same. If the 4 is cribriform, the only study I've seen shows the risk of both metastasis and death is much, much higher. Any thoughts on that?

[@cancerbetter]

Cribriform is an adverse feature and does mean the cancer is more dangerous. Surveillance with the presence of cribriform features is not recommended

[@christopherstewart9874]

@@cancerbetter pubmed.ncbi.nlm.nih.gov/25189638/ Small study, but scary as hell.

[@alliaj1]

​​@@cancerbetterperhaps an unusual question; what is better to have (more favorable): cribriform shape in lower gleason score (7) or higher gleasonscore (for ex.8) without cribriform shape?

[@MM-sf3rl]

@@cancerbetterI was told by me doctor that “simple cribriform” is not a back actor. “Simple Cribiform is NOT the ones we will worry about. Yellow flag, not a red flag”. But he did say, “What I don’t want is for you to come back in a year and we do see more advance Cribiform because then the risk of recurrence is greater”. It seems like with Favorable Intermediate I’m in the equivocal state. He also said that it will not become metastatic.

[@chia1799]

Very helpful . Tq

[@cancerbetter]

Welcome 😊

[@alliaj1]

thx doctor!

[@cancerbetter]

I'm trying to carve out more time in my schedule for these to help.

[@wayneduncan7164]

Excellent video.

[@cancerbetter]

Thank you very much!

[@arnoldbustos3890]

You are recommend repeated biopsy, have you ever had a prostate biopsy?

[@cancerbetter]

I haven't and I admit it doesn't seem fun but its currently the best option available to get certainty that a person's cancer has not chnaged into something more dangerous.

[@arnoldbustos3890]

​@@cancerbetter Thank you for the reply. You are absolutely right, it was not fun when I had it 10 years ago. Now I refuse to do it again.

[@michaelmiddleton3311]

@@arnoldbustos3890 I had one a couple months ago. Was pretty sore after but recovery is quick. Not crazy high on the pain scale. I think there is a lot of mental apprehension and stress. It's just weird! Definitely would not want to be a frequent flier.

[@peterscott9640]

I had a trans perineal biopsy 3 years ago. It was painless and I had no post operative pain or discomfort. The only thing that made me flinch was an unexpected blast of freezing spray prior to the local anaesthetic injection. Obviously other people have had different experiences but perhaps worth flagging up that it needn't be unpleasant.

[@drewwho4512]

I've had two in office biopsy procedures in recent years. It's a pretty quick procedure once insertion is made. The most painful part is the actual insertion. The local anesthetic helps. For me, recovery was quick with no complications. The reward is worth the risk of temporary discomfort. I'd rather know than not know where my cancer stands.

[@danny6905]

Hi Doc, Im a gleason 6 and my psa was at 7.3, in Dec 2023,, Now in Nov 2024 just took a psa exam and now its 11.3 ,, Should i take out or keep waiting?

[@cancerbetter]

I don’t recommend any treatments based on PSA alone as it can fluctuate due to non cancer causes. I would speak with your doctor

[@mperloe]

Consider ExoDX or Episwitch PSE and MRI focused fusion Transperineal biopsy.

[@DCGreenZone]

Brio Medical. Fenbendazole, Ivermectin, Glutamine blockers, Liposomal Curcumin, Artemisinin, IV C there's a lot of options you will never be given.

[@mperloe]

Can you offer any clinical trials showing benefit? Most simply look at a single clone of cells in a lab not clinical trials.

[@DCGreenZone]

@mperloe I'm sure if I try to point you to where the evidence is I will be silenced by the KZbin censor drones. Let's see if this simple response gets evaporated.

[@DCGreenZone]

@mperloe YT playing games again. They are insufferable.

[@DCGreenZone]

@@mperloe EEEEEEE M a i ell me

[@DCGreenZone]

@mperloe Your inbox.

[@futureinventor]

First cannabis oil.

[@KDean22]

CREATING HYSTERIA. NOTHING NEW HERE

[@cancerbetter]

I’m just trying to help people have access to the data. Most of these studies are behind expensive paywalls (usually $45 to access each article) and interpreting the studies can be challenging for those not well versed in the field. I’m not sure what motivates this kind of comment but I suspect there is likely mistrust of medicine. This is understandable as medical care is imperfect and we don’t always succeed in our goals to help people. Wish you well and thank you for giving the videos a chance.

[@KDean22]

@cancerbetter NO ONE READS MORE THAN 4 LINES OF 5 MIN VIDEO. KEEP IT SIMPLE. NO CHARTS

[@rojoreds524]

@@KDean22 I have to disagree with you. I read them and also listen to the entire videos. Part may be that I have worked in the medical field, specifically in Radiology, so I may have a higher understanding of the content but the main reason I watch and listen is because I have prostate cancer Gleason 7 (4+3) and at 73 years old and 6 years post quadruple bypass I am interested in the content as I navigate my options. Lots of good information here to help my decision process. No hysteria here and the information helps me make the best decision for me.

[@danny6905]

Hi Doc, Im a gleason 6 and my psa was at 7.3, in Dec 2023,, Now in Nov 2024 just took a psa exam and now its 11.3 ,, Should i take out or keep waiting?Im 55 this month

[@cancerbetter]

Definitely speak with your doctor. I generally do not recommend any treatment decisions on PSA alone as PSA can vary based on several factors beyond only prostate cancer