Treating High-Risk Gleason 8: A Modern Approach | Mark Scholz, MD | PCRI

[@peterwbryce]

Such a lucid, informational, and empathetic Q&A session. You are inspirational in educating and allaying fear. So thankful I found your organization.

[@fredhearty1762]

Great information. I have Gleason 8 high risk prostate cancer and have just finished IMRT (45 increments). Have also been on ADT, first and second generation drugs, for 12 months. My PSMT showed nothing outside the gland/seminal vesicles; PSA dropped from original 1,150 to zero in 6 months. Am due to 'have the talk' with Urologist about finishing ADT at 15 months. Found your video in nick of time. Thank you.

[@josephrabick967]

I had a biopsy at age 74 with a Gleason score of 9 and PSA of 12.5. Scans revealed no spread outside my prostate. Surgery was followed by Lupron and Bicalutamide. PSA went to basically zero. Genetic testing showed highly invasive cancer resulting from BRCA 1, 2 gene mutation. At age 78 my PSA rose again and I had a PSMA scan at UCLA prior to FDA approval. Back on Lupron plus Zytiga and prednisone along with radiation therapy for tumors in my pelvic bone and soft tissue near the prostate cavity. At age 80 my PSA is at 0.04. Biggest impact of therapy has been to my cardiovascular system. Other minor side effects persist but otherwise life is slowly returning to normal.

[@duaneluchsinger5736]

Dealing with recurrent metastatic prostate cancer. Started with Gleason score of 9. Initial treatment: prostatectomy, hormone therapy, and 38 radiation treatments. After 3 years and a PSMA scan, 7 met spots: 3 in vertebrae, 2 in ribs, 1 in the skull base, and 1 in a lymph node. Two of the Mets are grade 5(big bright spots on the scan). Path forward, 6 cycles of taxetere, then another PSMA scan. Getting a second opinion next week to see if targeted proton beam radiation used the grade 5 lesions asap would be a good idea. Thankful for 3 years of quality living but with this recurrence comes the fight. No notable pain at this point, so we’ll see what the future holds(and I know who holds the future…and He is good. My life is in His hands….Jesus Christ is Lord.)

[@daviddougan6961]

Good Luck. I am an MD Anderson patient and will be pulling for you.

[@peterdelbove2838]

Be strong brother. Sounds like you've got a plan.

[@justsonaalli3622]

Àaàaaaàaaaaaaaà

[@justsonaalli3622]

Aaaàa

[@aloysiussusainathan5639]

​@@justsonaalli3622

[@EagleOne49]

Excellent video! I am 75, in the high risk group with Gleason 8s, and a PSA of 4.34. In June, I had a PSMA scan with no spread outside the prostate. Last month, the recommended treatment was LDR Brachytherapy, 18 months of hormone therapy and 5 weeks (25 sessions) of external beam radiation. After watching this video, the treatment seems excessive! Back to the drawing board... Thank you, PCRI, for producing these fine, informative and insightful videos!

[@iamric23]

The information that you are providing to the watcher/listeners, is priceless. I am about to see my doctor in about a week to learn how bad my cancer is. I was classified as a pirad 5 and had my targeted biopsy so I know that there is cancer there, but will learn to what degree soon. Knowing about this PSMA pet is awesome. Thank you so, so much you too.

[@wayneredd6776]

All I can say is thank god I found this channel & it should be suggested when a person is receiving or before receiving treatment or surgery, by a hospital administrator.

[@daviddougan6961]

Well done. Sounds like my story as I am 80 years old . Originally diagnosed in 2011, did 44 days of pin point radiation, later it resurfaced, then salvage program which included cryosurgery in 2018 and again in 2020. PET scan discovered the cancer had jumped to seminal vesicals and lympnodes in 2022 and Gleason went from 7 to 9, so for the time being am doing Luperon plus Xtandi. Your video's are very helpful for a layman. Keep up the good work.

[@ThePCRI]

Thank you! Hope you are doing well, and if you ever have any questions feel free to contact us at pcri.org/helpline.

[@patpegasus]

Votre courage me fait plaisir Continuez

[@FrankFerraro-uf3wz]

What risk if your psa is 5,5

[@FrankFerraro-uf3wz]

What risk if your pca is 5,5

[@brucemcclelland904]

This series of videos from Dr. Scholz, Alex and others at PCRI has been extremely valuable for me, who was recently discovered to have “advanced disease” (high Gleason, some regional lymph node “reactivity”). I have not yet had a comprehensive discussion about the treatment plan with my radiation oncologist, so these videos arm me with an enormous amount of knowledge which I can use to ask the right questions and validate the answers. So, thank you for making prostate cancer seem like less of a death sentence than I might initially have thought.

[@leonarddorr9240]

do all the. research you can - I felt I got railroaded into my ADT plus RT for a similar discovery - I really regret that now

[@trevorhoskins7643]

On behalf of all the viewers here in Trinidad we would like to say to dr.sholtz And Mrs sholtz thank you all for the info

[@nc5007]

Just what I needed. Newly dx and you eased my anxiety alot. You have a natural talent for expressing knowledge. 💯

[@billwestervelt2393]

Gleason score of 9, 60 year old, about to have my PET scan. Extremely informative thank you. Update : PSMA showed no spread so this conversation is very relevant to my case.

[@andygrey6378]

Hi Bill what was the scan outcome?

[@andygrey6378]

And your decision on surgery?

[@billwestervelt2393]

@@andygrey6378 I am doing 44 sessions of IMRT plus ADT for 2 years.

[@robertmonroe3678]

Was there an option of brachytherapy seeds + IMRT (and avoiding ADT)? Great news on the PSMA PET scan.

[@billwestervelt2393]

@@robertmonroe3678 My RO believes that given the location of my lesion (up against the rectum wall) that we are better off going with IMRT + ADT with no Brachy. Also does not believe a spacer is a good idea given the location. Just started Lupron - so far no side effects which I am grateful for.

[@thomaskraincuk9815]

Hi Alex & Dr. Scholz! I am 62 years old and was recently diagnosed with Gleason 8(4+4). My doctor proposed a PSMA petscan which will be done in 13 days. Unfortunately he already emphasized very strictly I undergo prostate operation. So if the scan will hopefully come up with no alarming result, I will have to get a second opinion. My father had prostate cancer as well and sadly died a terrible death of bone cancer. Fun fact, my PSA is 2,16. Thanx so much for your great in-depth videos. Kind regards from Vienna, Austria.

[@GunInstructor]

68 years old here and my PSA is 3.8. My PSMA Pet Scan is in a week. Urologist does not believe it has spread due to my low PSA.

[@andyg4490]

I am 72 and am grateful to have found PCRI! I received biopsy results 1 week ago, Gleason 4+4=8, PSA of 5.6. First recommendation from my urologist was prostatectomy with hormone therapy. My urologist is part of a large group that runs its own pharmacy, so I've already received cost estimates for types of hormone therapy. I'm awaiting a PSMA PET Scan. If there is cancer outside my prostate, I'll strongly consider changing my medical care team, and going NO hormone therapy, but have some treatment that has a reasonable cure rate. If "high-risk" pc is defined as >=Gleason 7 with PSA >20, then I am not there, yet. The question is where/how to find a medical team that isn't focused on the easiest/quickest $$-making options for doctors, but focused on what's best for patients. It seems imperative that men with pc become thoroughly educated rather than to just follow the doctor's orders. Thank you again!

[@EagleOne49]

I feel your pain. I feel like my "team" consists of my wife and the internet with HUGE thanks to PCRI! There is little communication between my Urologist & his recommended radiation oncologist with very little information filtering down to me. I was given a treatment plan with very little explanation. Trying to get a second opinion, so far, has been daunting. Good luck!

[@robertmonroe3678]

2:30 is very reassuring for those of us newly diagnosed who have recent ‘clear’ PSMA PET CT Scans.

[@smone5591]

I am 63 years old undergoing ADT -Elgart and Abiraterone after surgery and radiation due to 2 lymph node positive in pelvic region recurrence. PSA undetectable at this point. The ADT is difficult but I intend to stay on it as long as it works. I fight every day with a pure plant based diet and aggressive exercise consistently. As we all know, your life gets turned upside down. More and more evidence that behavioral adjustments help!

[@schmingusss]

Is the diet making a difference?

[@johnnysalazar3951]

Great Doctor, Authentic & excellent lady that does the interview. I learn everytime.

[@leonarddorr9240]

watching these has really helped my mental health and given me hope . mine only got found because my PSA was 17 for blood work for a hip replacement (im only 61) and so shocked that the biopsy (48 cores !! ). came back with couple of 6s and one 8 (4+4) in 7% of one core . PSMA Scan showed borderline positive in local lymph nodes and doctors really insisted on RT (now 30 done of 45) and 2. years of ADT . The ADT has been brutal and Im trying to justify the trade off between QOL and and continuing the ADT ( next 6 month shot of Eligard due in May) for possible life extension . My PSA has fallen to 0.08 in 3 months ( testosterone down to 10) so looking to see if PSA plus PSMA PET monitoring are an option or at least intermittent ADT . Im not prepared to risk the permanent side effects more than Im already resigned to having a min of 7 months of ADT. Getting a 2nd opinion in the UK in Feb (Clatterbridge) to see if they have a differing views to the US docs treating me. Really feel for everyone facing this disease and find it hard to be objective at the moment as my business partner died from colon cancer last week at age 53 . These vids really help keep me focused .

[@georgefitzhugh6455]

Thank you for sharing

[@georgerios7491]

Thanks 😊 u guys for ur hard work we really appreciate ur expertise great 👍 info ❤️👌

[@BronzeAgeSwords]

thank you for putting clarity in my own journey

[@josephmaher1350]

Very helpful A welcome , intelligent dialogue that’s quite informative. Thank you.

[@tributetomama]

Thank you so much. My husband has been diagnosed with prostate cancer and will have his first visit tomorrow in Boston with a physician that can detail all of the options. We will be vigilantly pursuing the PSMA PET scan if it is not offered.

[@economyheating]

Please do get a PSMA PET Scan

[@barrie888]

Dr Scholz is a very straightforeward physician, tks

[@Wunderpus-photogenicus]

Dr. Scholz, you are great in conveying information! One question: If even high grade prostate cancer patients might survive for so many years, then why the death rate from prostate cancer is number 2 in the US?

[@ThePCRI]

Hello, There are a few issues that go towards explaining that. I will also add your question to our list for future videos to see Dr. Scholz's take. First, the survival data that are currently published are all going to be at least a few years old, which means that the subjects of these studies could have been diagnosed decades ago -- before MRI, before PSMA PET scan, before second-generation anti-androgens, targeted radiotherapy, regular PSA testing, and so on and so forth. Second, prostate cancer is much more common than most other cancers (2nd to skin cancer). For example, according to SEER data, prostate cancer (268,490) is diagnosed about 330% more often than colon cancer (80,690), but the number of people who die from them each year is much closer at 34,500 and 28,400 respectively. Many of the people who die from prostate cancer have metastases at the time of diagnosis. Now, there are better treatment protocols for these men that prolong their survival compared to the data that is currently published--some are even able to achieve durable remissions; however, this situation is going to be the most dangerous. High-Grade prostate cancers are usually amenable to treatment if they are localized, but if prostate cancer has spread to bones or distant lymph nodes, then it can be as life-threatening as any other cancer; (although, it does still tend to grow slower and it is usually treatable for longer than other cancers because of hormone therapy.) Going back to the first issue -- before MRI and PSMA, there was no reliable way to see if a person has already developed metastases. So, many men assumed they had local disease only, were treated as such, and would ultimately their disease would "go on" to progress, but really, it was never properly treated because there was no way for doctors to know it was already metastatic. There are cases of men with high-grade truely localized disease who are treated and relapse, but this is a rare situation.

[@Wunderpus-photogenicus]

@@ThePCRI Thank you. I guess the percentage of deaths is more important than the number of deaths, for any cancer.👍

[@daveh893]

Great information. Thanks.

[@michaelmcnair6126]

Great video and very good information

[@fredjackson5316]

Thanks for your great information.I have learned a lot from your great videos.Keep up the great work. All the best.

[@davidmilne1678]

Such a great channel I have learner so much from this being a newby to prostate problems he makes my hospital team look neanderthal in the way they want to approach my problems Thankyou for all that you are doing.

[@monicawidjaja1]

thank you so much Dr. Scholz and Alex ... you guys are sooo soo amazing !!!!!!!! keep up the good work !!!!!

[@tedrick4713]

Excellent, thank you.

[@ericcampbell6370]

Gleason score : 10 PSA : 700 ( as of last month ) Age : 49

[@JamesBond-td7li]

Your question ?

[@terrellwilliams5829]

How are you?

[@USARobert59]

Yes your video's are educational however the title of this particular video was Treating High-Risk Gleason 8 and most if not all the discussion was for those who did not have this type of score. For me I have cancer in my prostate, lymph nodes, pelvic bone and spinal cord with a Gleason score of 8 and PSA of 104 was hoping for more information when this type of cancer gets into ones bones and the treatment and outcome. Scans also only confirm where the cancer is I would like more about treatments with Gleason score 8.

[@ThePCRI]

Hello, This video is about men with newly diagnosed Gleason 8 prostate cancer that is believed to be confined or mostly confined to the prostate gland. In this context, the Gleason score is used to help predict the likelihood of there being metastatic disease that is too small to be seen on scans (called 'micrometastases') or the metastatic potential of the cancer to determine how aggressive treatment should be to best prevent metastatic spread in the future. If metastatic disease has already been discovered on scans in the distant lymph nodes, bones, or organs, then the Gleason score is less relevant because there is no longer a need to predict whether it can spread or has spread, and the spread itself is the most important factor in determining the best treatment. We have this playlist with videos for men with metastatic and/or hormone resistant disease (called 'Royal' by our organization): kzbin.info/aero/PLHj3V3RB2V-iRh_hnLqajcFpTXyVzW_Oi We also have this 2021 ASCO update in which Dr. Scholz discusses the presentation of preliminary results from a phase III study looking at the optimal treatment for men with newly diagnosed metastatic disease: kzbin.info/www/bejne/a2jImX2hi7qkg7c (at 0:42 into the video). If you would like to discuss your case with one of our patient advocates, please do not hesitate to get in touch with us. Our helpline is a free service. You can find our contact information here: pcri.org/helpline.

[@daviddion3731]

Another very informative video! TY

[@georgefitzhugh6455]

Very informative. Thanks for sharing.

[@RonWondga]

77 years old , have completed Indy and am just closing in on 9 months of an 18 month hormone (Zoladex and bicalutamide) treatment and am finding the side effects so difficult to endure that I am thinking of quitting the hormone therapy now!!! Going into this experience my psa was 4.2, Gleason 8 , small normal sized prostate: my psa as of 10 days ago was .03 and testosterone level of .37!! Any feed back on this would b greatly appreciated!!! I’m a 77 year old man who a year ago felt like 60 and now am feeling like 107!!!

[@RonWondga]

Spellcheck 🤪, not Indy but radiation!!!

[@JamesBond-td7li]

What is INDY ?

[@okaymate1079]

I’m 57 similar position but just diagnosed PC cancer & spot in a vertebrae in my neck They want me on hormone therapy but I don’t want to,researching it,it’s confronting They say it will put cancer in a holding pattern while they decide treatment,I’m avoiding starting hormone treatment till my next appointment & inform the specialist Surely there can be treatment without it

[@dmyhre943]

I recently reviewed a study reported at Johns Hopkins where high PSA scores can be attributed to high levels of testosterone in some men that have no cancer. I recently experienced an elevated PSA (24 ng/mL) and had a multiparametric MRI of the prostate, expecting cancer, but the scan showed I had no cancer... I was to have a targeted biopsy which was canceled due to no detectable lesions. I am 76 years of age. I have tracked my T levels, both serum and free, for several years, due to a condition of hypogonadism, and found that when my free T levels were higher than normal, my PSA was elevated. When the T levels dropped, my PSA score dropped. My question is, why is there an assumption that the cancer has returned when a patients' PSA goes up, when it could very well be a simple increase in free T levels?

[@ThePCRI]

It depends on the context. After surgery, for example, there should not be anything left in the body that can produce PSA (unless some gland is left behind), and so any level of PSA is a sign of cancer. Prior to any treatment, it is just a general guideline. Doctors should know that a PSA of 24 does not necessarily mean a patient has prostate cancer, which is why imaging and/or biopsies are required for a diagnosis, but a majority of men with a PSA over 20 will have prostate cancer, and so it would be negligent for a physician not to investigate that possibility further with the knowledge that it is still possible that no cancer is present. Glad the MRI spared you from a biopsy! If you have more questions, feel free to contact our helpline at pcri.org/helpline.

[@daxmac3691]

"why is there an assumption that the CANCER HAS RETURNED when a patients' PSA goes up"....Patients who have Pca with rising PSA need evaluation. You said you have NO CANCER by MRI. (Was MRI exam at a major center) Look at PCRI video about PSMA PET scans....many oncologists will say "you don't have CANCER when the PSMA PET scans are CLEAR. Call PCRI help line, they are very good people.

[@thomaslehmann5981]

I would get a trans perineal biopsy regardless of negative MRI. My MRI showed a single Pirads 4 14mm target lesion which turned out negative however in the same side of the gland was found (on a random stab) a single core of Gleason 4+4 cribiform pattern.

[@daleval2182]

​@@thomaslehmann5981did it now spread from biopsy?

[@thomaslehmann5981]

@@daleval2182no

[@garyedwards1359]

I was recently diagnosed with Prostate Cancer with 12 cores of which 7 were Gleason 3+4 and 4+5. I am 71 and don’t know what to do. Urologist wants to do either Robotic RP with an option of seeds. Everyone in my family has had cancer and now it’s my turn. I have watched every video on your site and am leaning towards seeds with ADT. Is there other considerations I should research before doing something I might regret? The only thing I fear from treatment is loss of bladder control. Thank all of you for the excellent information! I think Dr. Schulz rocks!

[@daxmac3691]

Look at your biopsy report, Gleason is important...but rarely mentioned by Uro Docs is "tumor burden" (% of core with Ca). Use the PCRI Staging tool. RP with a seed option?....after RP...no prostate gland, no place to put seeds. CALL PCRI HELP line....They are terrific people !!

[@garyedwards1359]

@@daxmac3691 Thank you!

[@okaymate1079]

I’m 57 & don’t know what to do also The more research I do doesn’t help The hormone treatment is diabolical

[@rthappens]

Thats what I needed to hear, as far as the patient's option of hormone therapy....I'm diagnosed as high risk and do not want surgery as my doctor is pushing for, plus researching HT and finding all these crazy side effects are very worrisome to me,, I don't want to turn into this completely different person. Speaking with my radiation doc today.

[@rthappens]

@@garrypatrick6097 thank you , I greatly appreciate your feedback

[@petershimkin7726]

Take liposomal vitamin D3 20000. Brian Hollis Phd on you tube

[@tumalo710]

@@rthappens just wondering how your treatment is going? Just viewed this video. I’m a Gleason 9. Having surgery in 2 weeks. Been waiting 5 months. Had a PSMA scan showed no bone cancer, but some possibility of one lymph noid suspect. But seems to be all in the Prostate. Good luck to you.

[@robertmonroe3678]

In my decision regarding surgery v radiation, several docs (and not just surgeons) noted the definitive pathological exam of the prostate as a plus on the side of surgery. That was by no means the only surgery v radiation factor but was one argument I really hadn’t anticipated.

[@okaymate1079]

G’day from Australia I’ve just had PC confirmed with PET scan,the bloody thing is full of it,not just a speck plus a spot in a vertebrae in my neck Urologist wants me on hormone therapy while they decide treatment Hormone therapy is horrendous from what I’ve researched I’ve got the prescription for the tablets but haven’t used it to start the blockers I’m 57 So much variation in opinion and treatment,only consistent opinion,side affects are bad Good luck

[@davidvasko6300]

I just my prostate and limp nodes removed last night at the Huntsman in Salt Lake city. They used a robot took 5 hours. I was a 8 hight risk they said one limpnode had some cancer and lower half gland. The robot is said to avoid nerves that could not have thought possible. I will wear a pee bag for 2 weeks. Said up to 8 or more weeks healing.

[@toddhupp]

super reasonable comments by the doctor.a lot of high pressure sales over treatment going on.

[@commenter3194]

Thank you PCRI for what you do. I just want to ask further. Dad (79 yr old) is Gleason 9 with numerous bone mets.He is having ADT Pamorelin + Xgeva. We are considering vmat to target bone mets. He is not feeling pain at all despite the mets. Is Vmat a good option ro clear the mets despite his age？or do we wait for ADT to work on the bone mets then consider vmat later on？ He just started ADT 2 weeks ago after diagnosis.

[@pankajbarick9758]

My father also prostate cancer Gleason score 9 his surgery is done in 3/02/2022 now what treatment for him please tell🙏

[@ThePCRI]

Hello, Feel free to contact our free helpline. We have a patient advocate who will call you and may be able to provide you with some information: pcri.org/helpline

[@johnlovric5896]

Hello.Dr.Sholz, Which Therapy would you suggest to 53 years old Man with Gleason score 9? (4+5) in one sample. 4 samples taken in a prostate biopsy .The other 3 samples are all (4+3) . PSA is 26,6 nl .

[@basackard]

I had my prostate removed in 2006, radiation in 2011 and my PSA has raised from .36 in 2021 to 1 in 2022. I am trying to decide what treatment would be warranted.

[@ThePCRI]

Hello, if you would like to speak with one of our patient advocates about your case, feel free to contact our helpline at pcri.org/helpline.

[@timoherron657]

Hi and thank you for your great videos. I am 66 years old and I have a Gleason score 8 one core and 9 another core as well as eight other cores 6 and 7 . I have decided on proton therapy radiation and was scheduled to begin treatments but my oncologist is now telling me that I need to be on hormone treatments for two months before starting radiation but my radiologist says it doesn’t matter, basically said before during or after is okay for hormones. I would like to know what is the best way to proceed.

[@ThePCRI]

Hey Tim, Thanks for the good question! We got your message and one of our patient advocates, John, will be contacting you shortly to discuss that; be on the lookout for a call from a "private number" in the next couple of hours (we're trying to get that changed so it shows our office number, but for the moment, unfortunately, it will come up as private). I will also add it to our list of questions for future videos too because I don't know if that specific question has ever been addressed in one our videos.

[@michaeltouchette8156]

two years ago I was 3+4 7 I was put on AS. MRI showed now lesions in april... they did biopsy to confirm it went dormant..... came back 3+5 8... my psa has never gone above 5 and earlier this year it went down to 3.8 then back up to 4.9 now faced with radiation or surgery but dr. is recomending surgery...

[@israelschurek9046]

I am 70 years of age. On February 2021 was diagnosed with a Gleason 8. Completed radiotherapy [SBRT] of prostate and lymph nodes in Jul 2022. Also being treated with Hormone Therapy since Jun 2021 Triptodur [Also called Decapeptyl 22.5mg injections 3 times every 6 months] and took 30 Tabs of casodex prior the injections. My PSA currently is undetectable. Overall Feeling well. Doing a lot of workouts, including walking for 1 hour - 4 Km every day 7 days a week. I am positive to BRCA2 and My question is, since I am in at high risk, should a regular PSA test every year are enough? Or should I do a scan every year also, due to BRCA2 issue? Thank for your great shows on KZbin.

[@ThePCRI]

I will add your question to our list for future videos. In the meantime, one of our patients advocates may be able to help with your question. You can find our contact information at pcri.org/helpline.

[@Benb55]

I start ERBT next week. My Gleason is 7 4+3. The PSMA Pet scan showed the cancer is localised. Any advice for me as I go through my treatment?

[@wilfredmotosue7526]

Dr. Scholz, can I take PSMA PETSCAN every year to check for lesions outside of the prostate, even though I am still undetectable?

[@ravneetsingh7196]

My dad has prostrate cancer with Gleason score 9 but his PSA has always been under 2. Hence even in PSMA pet scans his disease does not show up. What options do we have to monitor the spread of the disease in the future.

[@ThePCRI]

Our helpline can discuss your case with you at pcri.org/helpline. They will probably want to know a few thing, for example, if there is a second opinion on the pathology report? Does the cancer show up in the prostate itself on the PSMA PET scan? And probably more.

[@jimschaff8487]

I am a Gleason score 8. 65 years old. PSA 106. I had a Lupron shot and my PSA went to 1.8. Genetic testing did not show anything. I had the PSME scan and shows it is contained in the prostrate. My doctor wants me to do 44 Radiation treatments. I think that I will wait another 6 months and see what the blood PSA tests show.

[@ThePCRI]

Hello, We have a helpline staffed by a patient advocate if you ever have any questions about your case. You can find out contact information at pcri.org/helpline. It is important to know that there are no body scans, even the PSMA PET (which is significantly better than anything we have ever had previously), can give a definitive answer about whether there is any spread. Hormone therapy is expected to take the PSA down to undetectable, but the effects of the treatment will go away if the treatment is stopped, and in most men, the treatment will eventually become ineffective (the amount of time it takes, though, varies greatly). The radiation is intended to give a durable remission so that a person can go off hormone therapy without having their cancer return.

[@kamalsh6123]

Why not look at CyberKnife radiation. Just 5 to 7 visits and generally completed in a week and with high precision.

[@thomaslawson4253]

GL9 ,RP,RT, with ADT PSA maintaining (1.5 year) at

[@wayneredd6776]

I hv Gleason 9, highest psa of 6, no nodules. 61 yrs old, had pelvic & full body scans, went through RT for a month (5 days per week) completed & psa went below .08, still on HT getting injections quarterly for 18 months. Hv 3 more left & wld love to stop now!! All bc Gleason 9, just seem like so much weight is place Gleason. So is Dr. Scholz saying w monitor w psma scans I it’s possible to discontinue HT or not as much ??

[@ThePCRI]

He does discuss it as a consideration, especially for older men (I am not sure exactly what he meant, but I am thinking late 70's-80's, but it probably varies depending on an individual's health), but there are risks involved and not much literature on it since the PSMA PET is relatively new. I know he went into more details during our last conference. Here is a link, to his segment, but I cannot remember exactly when he talks about it: kzbin.info/www/bejne/fHKwZWyXq91qn9E. If I am able to find it, I will post a new comment with the time. You can also feel free to contact our helpline. We have a patient advocate who may know more about that and be able to help you. You can find our contact information at pcri.org/helpline.

[@TheSKasson]

I was curious if, during radiation treatments, they ever target the seminal vesicles? Aren't they directly attached to the bladder? Would that be risky? I never hear anyone mention them.

[@ThePCRI]

The seminal vesicles are sometimes included in the treatment field during radiation treatments, but there may be variations between different radiation oncologists depending on your risk factors, their own preferences, etc. We have a free helpline with a patient advocate who may be able to help with any questions you have about it. You can find our contact information at pcri.org/helpline.

[@sandraredmond4812]

People die from prostrate cancer - at what point does that become a concern. How do you know when do really worry and take action?

[@ThePCRI]

Hello, there are a few ways of looking at this and the patient advocates on our helpline can help talk you through it if you are interested. You can find out contact information at pcri.org/helpline.

[@pg1716]

Am I understanding Dr. Scholz correctly when he says (at about 3:50 in the video) that typically the "high risk" patient has about a 20% chance of the cancer having escaped the prostate upon diagnosis?

[@GunInstructor]

I know that statistic is dependent on how early the cancer is detected. The earlier, the less chance.

[@sandraredmond4812]

Why would you do hormone therapy if you have a clean psat pet? Doesn’t the cancer untimely become hormone resistant? Wouldn’t you be better to save that tool until you really need it?

[@billwestervelt2393]

My question exactly.

[@eb4452]

Is there a rationale for genomic testing in the context of GG4 (Gleason 8) PCa? Would a high Decipher score or evidence of PTEN or P53 loss influence the decision to radiate lymph nodes without evidence of disease by PSma-PET?

[@ThePCRI]

Hello, I added that to our list of questions for upcoming videos. Our helpline may also be able to provide some information about that; it is free, so it is worth a try. You can find our contact information at pcri.org/helpline.

[@davethomas128]

How am I going die from prostate cancer? An axitum scan in 2019 showed 5 bone mets. Taking Zytiga, Lupron and Prednisone for 3 years. PSA undetectable for 24 months. Now have hypertension and glucoma probably from my meds. As background PSA 1.6 with Gleason 9 ar 2008 surgery followed up with salvage radiation. Swim a mile 3 days a week, weight training 3days a week. Mostly vegan. What will kill me with Prostate cancer

[@ThePCRI]

It varies from patient to patient, but the exact cause of death can usually be traced back to bone marrow malfunction (that is, blood production) which can lead to mortal infections, cardiovascular events, etc. If you have other questions or want to know more, feel free to contact our helpline at pcri.org/helpline.

[@Mary-bx8gd]

Who says you will even die from this???

[@davethomas128]

@@Mary-bx8gd I may not, however right now metastatic Prostate Cancer is the leading indicator.

[@Benb55]

Hi Dr Scholz I’m 66. Biopsy showed I have Gleason 7 4+3 prostate cancer. My Radiation Oncologist said I’m not suitable to have Brachytherapy because “the % of high grade cancer exceeds 50% (yours was 65% to be exact). The other reason is that your urinary function is suboptimal currently with an IPSS of 16/35.” Do you agree with those reasons? Should I seek a second opinion? How safe is just External Radiation Therapy these days, if that’s all I can have. I have a left hip replacement. Will that affect what treatment I can have? Regards Ben, Sydney Australia

[@ThePCRI]

Ben, I can add those questions to our list for future videos. In the meantime, you are welcome to contact our helpline at pcri.org/helpline and they may be able to provide you with some useful information to discuss with your doctors.

[@Benb55]

@@ThePCRI Thank you for your reply. I’ll contact your help centre.

[@sandraredmond4812]

Is extra capsular the same as locally advanced ? Psa pet is clear on seminal vesicles and lymph nodes and the tumor is on only right side. Psa has dropped from 12.4 down to 7.1 over 6 months with change in diet alone. Originally graded a 3+4 but was regraded as a 4+5. So not really sure if it is Gleason 7 or 9. So not sure if it is high risk or unfavorable intermediate risk. Is the clean psma pet the most important of all of this ? More so than Gleason score or extra-capsular extension?

[@donaldpiper9763]

Gleason score of 7 is high risk 9 is even greater risk ,you’ve got 2 choices surgery to remove prostate or targeted radiation treatments which there are 43 , 2and a half months about 5 minutes a day plus hormone blocker’s from 6- to 18 months. I start mine next month. I don’t like the risks involved with invasive radical surgery . Which everyone you choose good luck ,we’re all in the same boat .

[@sandraredmond4812]

@@donaldpiper9763 hi. We went to Germany and had nanoknife treatment. His psa has dropped to 0.1. Recovery time was 3 weeks. No side effects. Will keep a close Watch for recurrence. The procedure can be repeated. We felt it was better option than surgery or radiation for us. .

[@hararedeclare3839]

Thanks for the info. Does a "High Risk" score on a Decipher Genome test .69, have the same critical status as a Gleason high risk grade 4+3 =7 or 4+4=8? Is the genome test a prediction based on what other men with similar prostate cancer cell formations ended up having metasteses?

[@hararedeclare3839]

@ Joe and Karen.How and where did you get a PSMA PET scan,without reoccurring prostate cancer after treatment? I only do I d 1 doctor , Dr. Schafer at a medical research institution in New York, doing PSMA, PET trials on people with reoccurring prostate cancer.

[@hararedeclare3839]

Correction, I only found, 1 doctor,, Dr. Schoder. at a medical research institutions, doing trials with PSMA PET scans on people who had been treated i.e, radiation, prostectomy, etc, but have reoccurring prostate cancers ,only

[@ThePCRI]

The Pylarify website has a site locator that will show you PSMA PET scans in your area. That is the commercial version of PSMA scans and they are more widespread and perform the same as the Gallium-68 PSMA PET scans which are only available at academic institutions: www.pylarify.com/site-locator As for the question about the decipher test, I am not totally confident and will add that to our list of questions for future videos. My understanding is that those tests are predictive and do not carry the same weight as Gleason score. They are letting you know that there is a certain percentage chance that you have a prostate cancer that is capable of spreading, Gleason 7 or higher, but even when you have a high risk, that does not necessarily mean that even a Gleason 7 is present. They could, perhaps, cause a doctor to be more suspicious that there could be higher grade cancers that they have not been able to discover, since all diagnostic methods have limitation, but my understanding is that they would not guide treatment in the same way that a higher Gleason score would, which, if the pathologist's interpretation is correct, is much more predictive of the cancer's potential. These tests are primarily used to guide whether further and usually more invasive diagnostic tests are appropriate. Our helpline would be better equipped to help you with that question, and you can contact them from our webpage here, pcri.org/helpline, and again, I will add it to our list of questions for Dr. Scholz to address.

[@hararedeclare3839]

@@ThePCRI thank you much

[@Eclectic_RN]

My medicare advantage psma-pet scan co-pay was $2,995. The insurance limits it to TWO per lifetime. So much for "psma-pet scans every year." It's sad too as one can (and it may actually be practical) fly to India, get the scan and return the disk to you American doctor. America Psma-Pet scan bill was $14,000. India using the gallium tracer about $500. Yup, my co-pay is 6x what the scan would cost in India.

[@starstutu888]

I recently had a biopsy of my prostate and I almost bled to death. Blood poring down my legs for two days,, I couldn't stop the bleeding, I also suffer from anal fistulas from having Crohns. There has to be a better way when one has anal fistulas, Maybe having a PET scan instead of the traditional biopsy. Now my doctor wants me to have surgery to remove the prostate and my level is intermediate with a PSA of 10. My Gleason score is 4 plus 3, which is 7. I have always taken care of myself, no smoking, no coffee, no alcohol,, my blood pressure is low and my weight is good. My age is 74. I don't want surgery, with having Crohns it will be difficult to heal. I will get a PET scan in a week. I am thinking of radiation, what should I do. Thanks

[@Akira-nw4jl]

Bottom line, intestinal bleeding and inflammation is generally caused by bacteria in the intestinal walls. It is the cause of many maladies like krohns, diverticulitis, polyps and even hemmroids. You must settle this situation first. To begin killing this bacteria slowly, rather than harshly, start eating coconut products like coconut oil, coconut water, and coconut pulp. Than you follow up with improving your microbial with previous and politics in both supplements and fermented foods. Especially important if you have had a regiment of antibiotics. I wish you good health on your journey. Godbless.

[@kgoose8893]

I am 1 year post radical prostatectomy, 4+3 Gleason, no lymph nodes detected but seminal vesicle showed some. PSA has been zero now for 9 months, full bladder control and some erectile function returning, about 50%, I asked my Urologist about getting a PSMA scan but said not necessary at this stage. Do you agree?

[@ThePCRI]

Hello, I will add this to our list of questions for future videos. In the meantime, feel free to contact our free helpline. We have a patient advocate who will call you and may be able to provide you with some information: pcri.org/helpline

[@alanblack5665]

Extremely informative perspective on PC and specifically how hormone therapy is used. I have been taking 150mg of Casodex for 6 months for recurrence following surgery in Sep 20. Pathology Gleason 7 and T3a. Completed radiotherapy of prostate bed and lymph nodes in Dec 21 following a PSMA PET Scan in Oct 21 which indicated no spread. The issue for consideration is how long should I continue with Casodex. Does it “ improve” the effects of radiation over the next 12 months? My consultant has advised using it for up to two years but has indicated that this is “negotiable”. Any general thoughts on this issue? Thanks.

[@rthappens]

Can I ask how the side effects are affecting you? From I've been reading they're crazy bad, muscle loss, weight gain, shrinking testicles etc. I'm weighing my options now and need to make a decision. Thank you

[@alanblack5665]

​@@rthappens Hi! Casodex (bicalutamide) side effects are wide-ranging amongst men. I have spoken to some men who have found the side effects of Casodex to be unbearable and come off the drug right away. One man told me that he constantly experienced an upset stomach and general gastrointestinal issues forcing him to move on to another form of hormone therapy (HT). Personally, I am tolerating the medication reasonably well although I have reported gynecomastia (breast swelling and tenderness) to my consultant. Please bear aware that Casodex is an anti-androgen drug and significantly different to luteinising hormone-releasing hormone drugs (LHRH) such as Lupron which lowers the amount of testosterone produced by the testicles. Lupron is injected every three months and Casodex is a daily pill. LHRH drugs significantly reduce the production of testosterone and can cause loss of muscle strength amongst other side effects. HT is a complicated subject but I hope I have been helpful. Ultimately, it depends upon your cancer stage, Gleason score, PSA and how aggressive your treatment needs to be!

[@alanblack5665]

@Peter Ste I was offered Lupron or similar when my PSA rose after surgery. However, Casodex was the primary choice by my consultant and have been taking this for about 6 months. I know that Lupron can significantly reduce testosterone thus lowering PSA but the hot flushes, brain fog and muscle wastage need to endured and dealt with. Currently, Casodex seems to be effective for me with minimal side affects apart from the breast swelling and tenderness. Sound like you are doing everything necessary to maintain a quality of life despite cancer and medication. Indeed, it is is highly recommended on this website we are commenting that regular exercise and possibly a personal trainer are essential t9 combat low testosterone. Have you considered a holiday from Lupron to enable your testosterone to recover? All the best.

[@ThePCRI]

Hello, I will add this to our list of questions for future videos. In the meantime, feel free to contact our free helpline. We have a patient advocate who will call you and may be able to provide you with some information: pcri.org/helpline

[@bobpfister3797]

At about 4:33 you say, "What we've worked out over the last 20 years... has to be called into question with the advent of these new PSMA PET scans." This leaves me wondering exactly what you've worked out at an approach for High-Risk (I'm Gleason 9 not 8, with 2 small bone and 2 pelvic lymph node metastases). My oncologist seems to be some years behind your thinking on this and I'd love to hear what you have to say about your current approach. I've been reviewing other videos so may have missed it. But it seems to me that your current approach includes beam radiation of existing 'oligo' metastases, hormone therapy (18 months? That's the difficult part for me to accept). How to eradicate the tumor in the prostate? Focused radiation of the prostate? My oncologist recommends no focused radiation of the prostate, only general radiation of the pelvic area. This doesn't yet make sense to me.

[@ThePCRI]

Hello, So even though Gleason 9 is typically associated with "high-risk" prostate cancer, the "low-, intermediate-, and high-risk" categories are used to stage men in whom metastases have not been discovered. The "risk" is referring to the risk of having or developing metastases, so if metastases beyond the pelvic lymph nodes have been discovered and confirmed (that is, in the bones, organs, or distant lymph nodes) then there is no longer a question of risk, and it is treated as "metastatic castrate-sensitive disease" (although the Gleason score and all that may still have some significance in treatment selection). The first section of our 2021 ASCO update video (starting at 0:42) discusses a large prospective trial conducted in France looking at the best treatment protocol for newly diagnosed metastatic disease. Dr. Scholz discusses the part of the study that evaluated patients with or without chemotherapy, but if you go and look at the study itself (a link to which is in the video description), they also evaluated patients with and without radiation to the prostate. It has been controversial whether metastatic patients should have the prostate itself treated, and typically, I have heard of it being more common if there are fewer metastases and less common if there are extensive metastases. Its utilization, though, varies greatly from physician to physician, so it would probably be worth looking into since you may have to decide for yourself which doctor you agree with. Our free helpline could probably provide you with some more personalized information. You can find our contact information at pcri.org/helpline.

[@mongoose239]

@@ThePCRI I looked for the link to the French study in the video’s description and couldn’t find it. What is the name of the study?

[@fredwelf8650]

I do not understand why a Gleason Stage 6 cannot become, or grow into, a Gleason Stage 7. Likewise, why can’t a Gleason Stage 7 turn into a Gleason Stage 8, and so on. It seems intuitive to me that the cancer grows and will differentiate further over time even before metastasizing or growing outside of the prostate. In addition, how does an M-stage 0 become M-stage 1, and then 2, and so one. By growing and spreading and by the genetics of the cancer cells becoming mutated and mutating again?

[@khalidmemon1359]

Do intermediate favorable group after SBRT therapy needs ADT

[@ThePCRI]

Hello, we have a patient advocate on our helpline that might be able to help with your question. You can find our contact information here PCRI.org/helpline.

[@joemauiman]

I’m 68 Because of this video I’m considering active surveillance for my Gleason 4+4 =8 I did a PSMA PET scan without any spread outside the prostate. 6.3 PSA. I want to watch PSA and do another PSMA PET SCAN to monitor if there is any later spread I will radiate at that time. Is that now a viable option for me?

[@Fighter4Street]

Unless you want to turn into a women, right?

[@davidmilne1678]

Can you ask the question If I have a high PSA of 4 and swollen prostate Does this mean they should jump straight into a biopsy or is the pet scan a better option given that some cancers don't spread so why try and identify the type of cancer before knowing if it is spreading. Thankyou

[@Fighter4Street]

@@davidmilne1678 Hi, Dr Scholz has a webpage for his practice, you would have to find it. He discusses biopsy and doesn't really recommend the random ones as they can do damage and a targeted one. He also recommends using an MRI or imaging rather than a biopsy. He has a 30 minute audio clip on his practice home page, so best listen to that as it discusses your question in depth. His website called psotateoncology, under BLOG and under PSA screening Flowchart, he has that 30 minute audio clip you should listen to. Let me know if you find this and your thoughts.

[@mitchellfeuer7234]

Hey Joe- I'm also 68, Gleason 8 and neg. PSMA PET. I'm considering short term active surveillance as well. Just wanted to get an update on your situation, brother. Hope all is well.

[@patriciaainger1908]

My husband has a gleeson 8, and now has bone mets. He was diagnosed with prostate cancer in 2019 and was going to have bracathrapthy and hormones. But he had a massive stroke and is in a wheel chair. He went on to hormones for about 18 months then had a break to try and recover as mush as possible from the stroke. And has improved abit. They said his psa had gone up to 15 so he went back on the hormones. I then ask, well what now are you going to treat the cancer. They said no he couldn't take the treatment. My husband and I were very upset so they said OK we will see wear we are with a bone scan. I have just been told that he has mets in his bones. We are going to see the doctor next week but they said they won't treat him because of the stroke. As you can imagine I'm feeling so disprite I feel they have given up on him. He is a very young 69 years of age and the stroke was bad enough but now there seems no hope. I'm so frightened we have been together for Fifty years. And I can't see a way forward. We live in in the uk. Do have to except that they can't give treatment because he has had a stoke. To look at him he just seems so young to give up.

[@Mary-bx8gd]

❤️

[@ebenezergarbrah5255]

❤️❤️

[@elijahghanbarnezad9909]

Don’t give up Patricia ❤️

[@patriciaainger1908]

@@elijahghanbarnezad9909 thank you

[@okaymate1079]

God bless I’m 57,just diagnosed with PC & a spot in my neck My wife’s reaction hearing the news & the affect on her life troubles me the most I feel I’ve let her down and I feel helpless to remove my burden I’ve selfishly but unwittingly placed on her It’s a strange feeling of guilt & of weakness & a failure of my role as protector The affect on partners ways heavily on the men I’ve talked to & myself We are so grateful to you all

[@sandraredmond4812]

What if you have a Gleason score that has decreased from 9 to 7 but a biopsy that shows mostly 4 +3 but one core of 4+4?

[@sandraredmond4812]

Sorry i Meant PSa of 9 that has decreased to 7

[@ThePCRI]

Hello, We have a free helpline staffed by patient advocates who are available to discuss this case with you if you would like. You can find our contact form here: pcri.org/helpline. The most significant piece of information when staging prostate cancer is whether a scan is able to visualize spread of the disease. The PSMA PET scan is the best available tool for that right now, but if it is not able to visualize any spread, this does not mean that there is no spread because some metastatic spread is too small to visualize, even for the PSMA PET scan, and about 10% of people's cancer does not produce PSMA, so that is something else to keep in mind. Besides this, the Gleason score is the next most important factor in a vast majority of cases (the exceptions being if there is an extreme PSA result, which can potentially go into the thousands) and the highest Gleason score is usually the most significant for categorizing the disease into the broad "low-, intermediate-, and high-risk [of spreading]" categories. If the Gleason 4+4 is correct, then the prostate cancer would be staged as some form of "high-risk" prostate cancer because it is a Gleason 8, however, with the information you have provided, there is nothing to suggest that it is anything more aggressive than "favorable high-risk" which has a high cure rate. A PSMA PET scan, if it has not been done already and if there are no contraindications, would be a good next step to ensure that there is no spread.

[@kangaroobooks7206]

❤❤❤❤❤

[@navdasone4710]

Thank you. Anything though about a VACCINE to prevent and cure cancers as suggested recently by MAYO CLINIC? What about nanomedicine? Marine Sponge based extracts as per research being carried out by University of Florida?

[@Eclectic_RN]

You say: "In the worst care scenario, a man with optimal treatment, a man that’s 80 years old may prefer to risk undergoing less aggressive therapy, because their risk of dying of other causes." But look at the vast improvement of irradiation, in just ~5 years, and look at the introduction of PSMA-PET just 4 years ago. With the advent of AI perhaps that risk might pay off with improvements in technology and knowledge? Care to comment on that?

[@jackyelaca3271]

Ask your Dr about MR LINAC treatment. It's a real time MRI guided linear accelerator. Do some research and ask questions.

[@ThePCRI]

We have a couple of videos that discuss that. If you search "PCRI Steinburg" or "PCRI Kishan" you will find lectures and Q&A's with two radiation oncologists from UCLA where they are experimenting with MR-guided radiation.

[@kevinpalamar7621]

Can someone already on Hormone Therapy get a PSMA PET scan?

[@rthappens]

Can I ask you how your hormone therapy went. I'm really stressed on what I'm reading about, muscle loss, weight gain, mood swings, breast enlargement etc. I'm weighing my options now, thank you so much for any info, Oh, I'm healthy active 57 year old

[@rthappens]

@@Sahilkoladiyam sure

[@kevinpalamar7621]

@rthappens I'm 58, fairly active, and have only been on hormone therapy for 2 months. Was very concerned before starting for all the reasons you mention. HERE'S MY EXPERIENCE: minimal side effects so far. Mostly some hot-flashes that disturb my sleep cycle. Made some BIG lifestyle changes and actually dropped over 10 lbs. Revised DIET to consume fewer calories, eat more fruits & vegetables, and minimal beer. Work out 5-days a week. (3-days cardio, 2-days lifting) Feeling real good physically. Can confirm that your frank & beans will shrink a bit, and erections are few and far between. Was prescribed Cialis, but haven't taken any yet. No noticable mood swings or cognitive issues. So far, it's not nearly as bad as I was expecting. Wish you the best. For me the psycological is much worse than the physical. It's hard not thinking about this all the time. Hoping that will change soon.

[@ThePCRI]

Kevin, I will add your question to our list for future videos. In the meantime, feel free to contact our free helpline. We have a patient advocate who will call you and may be able to provide you with some information: pcri.org/helpline

[@jojofrancisco7329]

Does psa 25.76 high risk

[@ThePCRI]

That PSA is generally associated with high-risk prostate cancer in a normal sized prostate, but it depends on some other factors. For example, if the Gleason Score is relatively low, a 3+3 or a 3+4, for example, then it is possible that the high PSA could be from BPH or prostatitis. If you know the size of the prostate, then you could calculate the PSA density to see what PSA would be expected based on the size. Prostatitis typically causes a dramatic rise and fall of PSA and can sometimes be detected on an MRI or biopsy. Even if the Gleason Score is relatively low, you still have to be careful depending on how thorough the staging process has been. If they have only done a 12-core random biopsy, for example, there is a 40% chance or so that they could have missed higher grade cancer. So it may not be safe to assume that the high PSA is from BPH or prostatitis until it has been confirmed or until through staging with MRI, target biopsy, PSMA PET scan, etc. has been performed. If you would like to learn more, feel free to contact our helpline at pcri.org/helpline. We have patient advocates who can discuss your case with you.

[@2GreenEnergyLLC]

This really IS great, but it's sugar-coated. "Some men after 18-months of ADT whose T won't recover for another 30 months (if it recovers at all) will 'never be the same.'" It strikes that NO ONE who experiences four years of castration will ever be the same. There are ADT patients who blow their brains out. They're not common, but the increased risk of suicide is not insignificant. The depression introduced by chemical castration, which some people, like me, describe as physical and emotional torture, is something to be considered, IMO. After a few consultations, my MO contacted my wife to make sure we didn't have a gun in our house. I couldn't wait to die.

[@okaymate1079]

G’day I’m newly diagnosed with PC & a spot in my neck They want me to start hormones but I don’t want to I’ve read to many horror storeys yet the Dr is so blaze,simply prescribed them,no discussion at all on the horrendous side affects

[@trevorhoskins7643]

10:55

[@walters8088]

Ties! Ties! Where does he get his ties?

[@kgoose8893]

I am 58 years old

[@wandadavis3497]

The harmonious turret ethically twist because sailboat resultspreviously listen times a unadvised fear. quixotic, cynical reduction