Staging Prostate Cancer, PSA Screening, and What If You Have a High PSA? | Mark Scholz, MD | PCRI

[@berg6964]

A big fan here, always great info. Thank you!

[@bglrj]

I really am grateful for all that you do.

[@JohnSmith-ug5ci]

I want to thank you so much for these videos. I am a 72 year old and I went in for green light laser surgery in January of 2022 and was told after the surgery I had cancer based on a sample that was taken. Not a biopsy of the prostate but a sample from the green light surgery. I am not sure how that works. I was told it was a gleason 6. My then Doctor (Urologist) wanted me to have a random biopsy and then do HIFU with follow-up Biopsys once a year. I asked that Doctor about a second opinion on the pathology report to verify the cancer and was told that he did not need a second opinion and did not want a second opinion. I fired that Doctor and found another. The new Doc did an MRI and it came back negative. My current PSA is 1.3 with a PSA density of 60. I am now doing active surveillance. Because of your videos I questioned my first Doctor, fired him, found another, and was not put through a lot of unnecessary procedures. Thank you again.

[@jxgardner]

A great service to millions of us with high PSA and no clue what to do …. certainly not surgery unless extremely warranted …

[@roger1uk676]

Superb info, what would we do without you guys! Thank you

[@mmazkoory3628]

Thanks for very informative explanation

[@joecastillo467]

Thank you for your information. I have learned a lot and I fall in the radar screen of your topics. I was diagnosed with low grade Gleason 6 with 1 Gleason 7(3+4) 2 years ago. My latest MRI revealed no movement in my tumors. I will continue my active surveilance (every 3 mo, psa 8.4). 75 yrs old. No biopsy needed.

[@JustaReadingguy]

Wow, great and up to date info. Thanks. I wished this was more widespread technology and experience.

[@jamespmullin21753]

My 1st symptom was terrible pain in the belly. I went to the ER ( 5 hours wait ). They discovered that I was unable to urinate. They popped in a Foley Cath and sent me home. After about 4 months of wearing the Cath and going to about 6 or 7 urology it was confirmed that I have prostate cancer. It should be noted that my primary care doctor or PA did not do a digital exam for over 10 years.

[@John-the-Bass]

Thanks for the information. A great help

[@gshenaut]

I don't recall MRI (e.g. pirad) being mentioned wrt staging. If this information is not used in staging, why isn't it? In my case, I had a pirad 5 mri with a note that there was invasion of the fibromuscular stroma. a subsequent targeted biopsy produced gleason 3+3, but on the basis of the mri, a second biopsy was done, revealing gleason 3+4. This result in combination with the mri result led to a radical prostatectomy, and the post-prostatectomy path report showed an extraprostatic extension consistent with the mri (and unfortunately a focal psm elsewhere). So at least in my case, I would say that the mri was the single most relevant information guiding my treatment so far (I haven't had my first post-surgery psa test yet; that will be another key piece of information).

[@marknorton5951]

Very interesting video, thank you.

[@leonardola9161]

Thanks

[@rutrow5294]

Please any recommendations in Washington State that do pet scans and let the patient help decide life changing decisions!

[@wiscotbanda3989]

Am 53years men l have the same prostate gland I went to hospital and l told to PSA test and my results came out 0.47ng/ml how is my PSA Doctor?

[@martinsheppard1323]

I am based in the uk and am being treated through the nhs system. I was diagnosed with prostate cancer in may 2022, investigations identified a PSA of 60.5, this was followed by a bone scan ( reported as ‘clear’), a contrast CT scan and a DRE (Enlarged,evidence of hardness), then a 12 core biopsy ( 9 positive, 6 grade 4 3 grade 5 4 ) to give Gleason score of 9 (4+5) score, with a rating of T2C. I am 70 reasonably fit and discussions with my consultant and key workers identified that a perfectly reasonable treatment would be Hormone therapy for 30 months with 20 treatments of VMAT ( ended 6/9/22), with the hormone treatment continuing throughout the Radio. I am now in the waiting zone 5 weeks to post RT blood test. (FBC, U&E, LFT, bone profile, PSA and testosterone). What triggers would I be looking for in these results that would identify further problems or failure to eradicate the cancer. Your advice would be greatly appreciated.

[@allisonward2970]

How are you today?

[@haridaasaa]

Hi Doctor, I am from AU and I am 66 years old. My father died of prostate cancer in 1982. Recently I came to know thatl my prostate has been enlarged. My prostate measures 70cc. I was admitted to hospital lately for prostate infection(prostatitis) and got cured after taking IV ABx. After 5 months of that infection my PSA measured 8.5. I under went the MRI test six months ago and my PIRADS score was 1-1-1-1. I was asked to undergo prostate biopsy by an urologist. I have all the typical symptoms of BPH now. My DRE test was NAD. I think I have BPH and I don't have to undergo the prostate biopsy. I am worried about infection from the biopsy. I am bit anxious. Could you please tell me do I have to under go prostate biopsy ASAP? I am not on any medications other than Tamsolusin. Thank you to you both.

[@bencamicia103]

My mri came back with prostate size in inches. How does that convert to a CC measurement?

[@rjvagv1]

Is it accurate / correct if cancer does spread after going through extended treatment for Stage T3a finished over a year ago. >If cancer has spread elsewhere does the PSA count go up?< This seems to be controversial topic

[@trevorhoskins7643]

Can I take neulasta after chemo and radiation four years and six months and wbc is 3.8 and not going up

[@RealRocdad]

Age 66, 6' 2", 155 lbs, 40 cc prostate, DRE little firmness left side no nodules, 1st PSA 600, weeks later 900, weeks again 1565, waiting on biopsy results meanwhile on RSO for pain and nausea. I feel so good with RSO I feel totally normal. Do I have a chance?

[@burhanhassan8989]

So what did biopsy say?

[@clydefilas-mortensen1094]

Why aren't stints used for BPH treatment? 2:25

[@sandraredmond4812]

Is nanoknife appropriate for high volume Gleason 9 if the tumor is only on the right side and PSa of 7?

[@daisuke6072]

What about number of cores within a targeted/systematic biopsy involving samples of the order of 40 or more? it is not clear whether the core number referred to is within the old 12 core random biopsy type.

[@cathum]

Great info, thank you - when I asked the oncologist why I’m not sent for PSMA-PET; the answer was that it does not alter the treatment decision, not required; what does that mean?

[@ga6589]

I am not a doctor, but I think it all depends upon your diagnosis and staging. My husband was diagnosed stage 4 over a year ago. PSA 24, Gleason 9. CT scans showed metastasis to the abdominal lymph nodes and some tiny lung nodules. HIs Mayo Clinic oncologists recommended a PSMA PET scan, which he had. It confirmed the cancer had spread to the lymph nodes and picked up a very small lesion on his sternum that the bone scan has missed. The lung nodules did not light up. The PSMA PET gives a much more accurate picture of metastasis. Anyway, with Lupron/Zytiga and 26 rounds of radiation treatments, his PSA has been negligible for the past 12 months and he's considered to be in remission. The doctor won't order another scan unless his PSA rises or he has symptoms.

[@johnnydee6659]

PSMA scans are still not standard treatment for prostate cancer but are coming much more available. I asked about them last February after my biopsy and my oncologist said I'd have to go to UCLA or to Florida for a scan. Now he does them in his office. Most insurance still do not cover them, Medicare does. Knowing how terrible ADT is, I'd gladly pay for a PSMA scan to avoid or limit ADT.

[@ga6589]

@@johnnydee6659 We were fortunate, as my husband's insurance through his employer (United Health Care) paid for his PSMA PET scan in June of last year, no problems. It definitely helps guide treatment. He says that ADT is a win compared to the alternative and his side-effects have actually diminished over time. You do what you gotta do. Good luck to you!

[@andrewminjiras5745]

What is the name of the scan you are discussing.

[@jeffell]

PSMA PET Scan

[@Mary-bx8gd]

My husband had a CT scan plus MRI one year ago, this confirmed a bone met on #11 rib, he is now getting ready to have another CT scan as well as an MRI, the doctor said she is recommending both of these scans again, so that she can compare the two new ones to last years scans. she is not recommending the new PSMS scan at this time. Most likely later. Can anyone speak to this?

[@ga6589]

My husband was diagnosed stage 4 over a year ago, confirmed by PSMA PET. (Mayo Clinic.) It determined that he had low volume disease, as opposed to high volume and guided his treatment. (He's been in remission, negligible PSA for the past year.) It gives a much more accurate picture of metastasis and is considered standard care. The old scans simply aren't as reliable. If I were your husband, I'd get a second opinion at a major teaching hospital where the PSMA PET scan is available.

[@Mary-bx8gd]

@@ga6589 did your husband have metastases? If so was he treated? Glad that he is doing well. Thank you for your response.

[@ga6589]

@@Mary-bx8gd Yes. He was diagnosed stage 4 in May of last year and the prostate was not operable. There was metastasis to abdominal lymph nodes and a tiny spot on his sternum. He received 26 rounds of radiation to the prostate and lymph nodes and has been receiving Lupron injections every 3 months, along with Zytiga oral medication every day. His PSA, which started out at 24, has been negligible for the past year and he's considered to be in remission. If/when his PSA starts to rise, he will have another scan to determine where the cancer might be growing. The next course of treatment would likely be chemo. We are encouraged that there are remarkable ongoing discoveries in treating prostate cancer that can extend life for years, so we are hopeful.

[@Mary-bx8gd]

@@ga6589 thank you, my husband’s situation is very similar to yours, my husband had chemo and is doing well, Diagnosis was a little over a year ago also. PSA 34, now undetectable. Complete change of lifestyle, plant based diet and and daily exercise. Best wishes to you and your husband.

[@prakashkm984]

I have been having recharge of Docitoxil 120mg , my 7th cycle was on 23/9/2022 since the 1st cycle I have been experiencing heavy pain in waist,thighs and legs from the 3rd day till the 10th day, iam suffering from CRPC bone metastases from April 2018, now my PSA is 46, the Oncologist has asked me to stop Chemo, can you please help me

[@ThePCRI]

Hello, Our free helpline might be able to provide you with some information. You can find our contact information at pcri.org/helpline. I am not sure what is available where you are, but in the United States, lutetium-177 was recently approved for men with CRPC prostate cancer that is PSMA positive (as demonstrated by a PSMA PET scan) and who have done at least one round of chemotherapy.

[@sarfarazshafique]

How do i connect you ?

[@ThePCRI]

Hello, We have a free helpline staffed by patient advocates who may be able to provide you with information pertaining to your case. You can find our contact information at pcri.org/helpline. It is not the same people in the video, though, just for your information. If you are asking about Dr. Scholz, you would have to contact his practice which is called "Prostate Oncology Specialists" in Marina Del Rey, CA for information about getting an appointment.

[@sandraredmond4812]

Does a psma of 7 and a clean psma along with a Gleason of 9 make sense??

[@ThePCRI]

If you have any questions, please feel free to get in touch with our helpline at pcri.org/helpline. Yes, this can happen. The Gleason score is telling you the potential of the cancer, but not necessarily the current situation when the tissue sample is taken. So, a Gleason 9 is more likely to spread to other parts of the body (or to have already spread) and cause harm or mortality than lower Gleason scores; however, it does not tell you whether or not the cancer has actually spread. Despite this limitation, it is usually the most significant factor in treatment selection because doctors will usually be more aggressive when the risk of relapse is higher; even if the cancer is small and localized. However, there is interest now that we have the PSMA PET scan to see if there are situations in which a man with Gleason 9 could safely avoid or shorten the duration of systemic therapy (like hormone therapy or chemotherapy) without compromising the cure rate, but there have not been any rigorous studies posted yet. (Exceptions that would cause other factors to overrule the Gleason score as the most significant factor for treatment selection would be if the PSA was extremely high (in the hundreds or thousands) or if metastases were discovered on a body scan; this would place the patient in the advanced category and the treatment would be very different than for localized disease.) PSMA PET scans are the best way to see whether the cancer has actually spread (although it should be noted that about 5-10% of people's cancer does not produce PSMA and their cancer will not show up on the scan. There are other PET options for them like Axumin and Choline PET scans, but none are as sensitive and specific as PSMA PET assuming the cancer if of a genre that produces PSMA). PSA is testing for an antigen in the blood that is usually overproduced by prostate cancer, but it is non-specific for prostate cancer, and can be elevated because of inflammation, BPH, recent sexual activity etc. There are a small percentage of people that have a rare variant of prostate cancer that does not produce much PSA, so it is good to be vigilant just in case with body scans and other relevant assays. Dr. Scholz has said he tends to think of a PSA of 0-10 as low-risk, 11-20 as intermediate, and 21-30 as high-risk, but this is just a rough generalization and there are lots of situations in which it could vary.

[@sandraredmond4812]

@@ThePCRI thank you so much for your detailed and thoughtful response. We appreciate it . Do you know anything about nano knife that you could share ? Given the high Gleason level we are meeting resistance in having focal therapy in North America even though PSa is low and the psma pet shows no spread and only 1 localized tumor on right side of the prostrate. The thought of surgery or radiation with hormone therapy is very distressing to us. Looking for an alternative that is reasonable but not reckless. We have heard of clinic in Germany that will treat high risk localized tumor with focal nanoknife which apparently does not causes such devastating side effects and does not rule out future surgery or repeat treatment. Would love to hear your thoughts on this. Thank you so much

[@durv13]

my psa ,s were 17 and 18 over 6 months . im waiting for a nuclear bone scan . i cant have an mri , i have a defib . and im putting off a biopsy as i cant have general anaesthetic . and i dont want to do it awake . i need the bone scan because the ct scan showed lesions on my bones and cysts on my kidneys . i guess ill find out eventually lol .

[@ThePCRI]

I am not sure where you are located, but in the USA, the PSMA PET is widely available now and is much more sensitive and specific for prostate cancer than the bone scan, which oftentimes causes more confusion than anything. Here is a website with a site locator for the commerical version of the scan: www.pylarify.com/

[@durv13]

@@ThePCRI thank you . im in australia the cancer capital lol ill put the psma pet to my doctor , i dont think he's to smart . he keeps wanting me to have a biopsy . without looking at other ways . i only had the ct scan because i demanded it . and the imaging place wants me to have a bone scan . cancer clinic cant fit me in until mid January , im basically just sitting here waiting to find out . thanks again for the reply .