Treatment Strategies for Gleason 3+4=7 vs. 4+3=7 | Ask a Prostate Cancer Expert, Mark Scholz, MD

PCRI's CEO, Alex Scholz, asks medical oncologist, Mark Scholz, MD, about the distinctions between Gleason 4+3=7 and 3+4=7, temporary versus permanent seed implants, and the significance of seminal vesicle invasion.
0:05 What treatment options are available for men with Gleason 7 (3+4, not 4+3) prostate cancer?
1:23 How should Gleason 7 (4+3) be treated?
3:22 What seed implant therapies do you suggest, temporary (HDR) or permanent?
4:07 How should cancer in the seminal vesicles be treated and what are the risks?
5:23 What are the next steps after discovering spread to the seminal vesicles?
Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website or call our free helpline at 1 [phone] with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
The information on the Prostate Cancer Research Institute's KZbin channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
#ProstateCancer #Prostate #MarkScholzMD

[@markbrown5117]

I REALLY BENEFIT FROM DR. SCHOLZ KNOWLEDGE. HE ROCKS.

[@glenrose7925]

This 3+4 talk is spot on to my situation. Thank you so much!

[@Jc-lk7wn]

U are doing a wonderful job with these pod casts… thank you SO much 🙏🙏🙏

[@spanky1998]

Great information. Thanks.

[@tomas6451]

I have one sample out of 18 3+4 very small. Getting hdr brachytherapy at Stanford with 5 treatments of sbrt radiation. Going aggressive. Want to retire in Alaska, so need to battle this now 😊

[@kerstinandersson8378]

Sa glad I found this site! My husband just having high radiation for prostatacancer gleason 3 +4 and I learnt a lot Thank you! Kerstin Andersson Sweden

[@daveyeddie8176]

How is your husband on radiation therapy only, hope he's well.

[@robertconway1722]

Thank you very informative

[@steve122140]

Thanks!

[@alvarovallejos3019]

Alex, you are so good !!🙌

[@clintcarter]

Thank you thank you! 😊🙏

[@joegallo1362]

Did you know that some Gleason 6 and 7 are eligible for Active Surveillance? Dr. Peter Carroll, of UCSF, one of the pioneers in active surveillance is kicking off the FREE "Active Surveillance & Beyond" webinar series for AnCan and UsToo at 8 pm Eastern July 30. Register for the July 30 webinar

[@bhagmeister]

What a difference 10 years or so make in Dx and treatment options.

[@hafben876]

Very informative, thank you. Could you please address the relevance of family history. Thank you

[@ThePCRI]

Thanks and great suggestion! We added that to our video ideas list.

[@steinshaw2490]

Thanks again. Seed implant was not an option for me as my cancer had escaped the prostate. I was a bit disappointed.

[@RahulBhatnagar]

How are you doing now Stein? Hope all well

[@steinshaw2490]

@@RahulBhatnagar I'm currently off treatment against the recommendation of my urologists and original radiation oncologist. I went to get a second opinion at a facility that also teaches, Huntsman in Salt Lake City, and I told them was I was doing. They said that puts me 3 months ahead of schedule because they were going to have me stop treatment and use the axumin scan. If it is localized they think they can get rid of the cancer.

[@RahulBhatnagar]

@@steinshaw2490 happy to hear that. I pray for you my dear friend and I am sure that you'll be cured really soon.

[@tomkuneman9139]

How does the PSA number relate to the duration of ADT for Gleason 7 (4+3). My PSA was 29, biopsy report was from John Hopkins.

[@HFH-Official]

Well.... This sounds reassuring. I am a 47 year old PCA 4.8 and 3+4 and my doctor mentioned removing the prostate completely as one of the options.

[@ChrisPaulPf]

I m 3+4 but didnt choose yet. What did you choose ?

[@martinmilton-white5172]

@ChrisPaulPf I was the same as you the cancer hadn't left the prostate however after having the op the pathology determined it had just started to go through the margins. Caught just in time. The after effects only lasted about a month thankfully.

[@HFH-Official]

@@martinmilton-white5172 Doctor wanted to remove my prostate, but now she told me there is a laser treatment where they go and burn the affected part .... I'm up for a contrast MRI in December to see if it has progressed, and then we will go from thete

[@HFH-Official]

@@ChrisPaulPf Doctor wanted to remove my prostate, but now she told me there is a laser treatment where they go and burn the affected part .... I'm up for a contrast MRI in December to see if it has progressed, and then we will go from thete

[@ChrisPaulPf]

@@martinmilton-white5172 i did also psme pet scan before surgery, no nodules, no mets…ok for surgery, done 10 days ago, negativ margin. Hope to be cancerfree for the next decades

[@Monk-Amani.]

Possible death is an issue, but I'm more concerned about discomfort and side affects after surgery.

[@stevesohinki1063]

How does the fact that a patient has had a prior BPH procedure affect whether they are candidates for radiation treatment?

[@Vng370]

What is aCL6 means for PSA blood test

[@sandraredmond4812]

Your advice is very informative and helpful. I would like to know if you are sponsored by any particular group or have any bias towards one type of treatment or another. It is so hard to know what to do when the dr tells you to do radical prostrate removal but you don’t want to live with the consequences. Is it foolish to not just have it removed or are these other treatments really safe and effective ?

[@ThePCRI]

Hello, we have sponsors for our conferences, and those can be found on the conference pages on our website, pcri.org, but generally we are funded by donations from people who appreciate our services. Dr. Scholz does not perform surgery or radiation. He has a bias towards radiation because since the advent of IMRT in the early 2000s, the cure rates of radiation have been to equal to surgery (and combination therapy using radiation has even been superior to surgery in high-risk cases) and because radiation has a favorable side effect profile compared to surgery. If you want to know more, feel free to get in touch with our helpline at pcri.org/helpline.

[@sandraredmond4812]

Could you discuss nutrition in light of prostate cancer please. Does a change of diet to illuminate sugar and animal proteins help?

[@ThePCRI]

Hello, We have a few videos on diet that you can find by searching "PCRI diet."

[@sandraredmond4812]

Do you think diet makes much difference?

[@Kalense]

I wonder how PSA interacts with these assessments. Presumably a high PSA (let's say 20) with a 3+4=7 would suggest to the oncologist a different route from a low PSA (say 2) with the same Gleason score.

[@baird5776mullet]

I m 4+3 with a rising PSA of 27 in much pain.

[@FightingProstateCancer]

How are you doing now, Baird?

[@baird5776mullet]

@@FightingProstateCancer Still around 27 in October and now can't get the VA to cover my care anymore even though i can prove the exposure i had in the svc to toxins, thanks for asking, how are you?

[@rubencostanza6379]

Good afternoon Dr, I am 61 years old and in a biopsy I have sample points 9, 10 and 11 with a Gleison 3+4 = 7, with 20%, 50% and 20% incidence... What do you recommend as a treatment? Thank you

[@SadoRabaudi]

I was diagnosed with a 3+4, with 5 cores 3+3 and 3 cores 3+4 (so a high volume, but mostly 3+3), but one core had a very minor component of cribriform on one of the cores (this was one that was only 25% of the total core showing carcinoma with 10% grade group 4). How would this affect the treatment plan? The MRI showed no signs of metastasis, but am also having more imaging tests. My urologist has me scheduled for surgery, but I'm now leaning more towards wanting radiation.

[@ThePCRI]

We have a helpline that may be able to provide you with some information. You can find our contact info at pcri.org/helpline. We also have a lecture and Q&A with pathologist, Jonathan Epstein, MD that you might find helpful. You can search "pcri epstein" to find just the lecture, and for the lecture plus Q&A search "pcri conference 2021 day 2."

[@johnj9267]

@Sado...You make a decision yet?

[@normawong123]

Is the PSMA pet scan available for all patients? Thank you

[@ThePCRI]

Hello, our prostate cancer helpline may be able to ​help with your question. Please feel free to contact us here: pcri.org/helpline

[@peacefulruler1]

UCLA and UCSF are the only places fda approved as of now. UCLA is about $3k without insurance

[@kewalkhanna9721]

I am 83diabitic,CABG,, prostate surgery and having 3+4-7.asper percet scan mycancer is about 10percent .it has not spreadeoutside Dr suggested go for radiation or chemo.whatshould Ido.

[@ThePCRI]

Hello, our prostate cancer helpline may be able to ​help with your question. Please feel free to contact us here: pcri.org/helpline

[@normawong123]

Why is it very difficult to find doctors that will do seed implantation?. We live in Florida. Even the VA does not offer brachytherapy. Thank you

[@pinktiptoes7491]

Not as many doctors are trained in this. Look into HD brachytherapy. Newer brachytherapy technology. You may have to go out of state. Call the prostate cancer research help line for guidance.

[@whocares0316]

@@pinktiptoes7491 I am looking at a treatment method called Prostrcision which involves a combination of BOTH ldr brachytherapy followed by about 35 daily doses of EBRT....Radiotherapy Clinics of Georgia with multiple offices in and near Atlanta and they are also part of The US Oncology Network in America. I'm not too excited about the rigors of this method because it essentially provides the equivalent of TWO different treatment methods in sequence, but has a successful track record and is covered by Medicare even though very expensive.

[@photosbyjose]

Seed implant don't cure the cancer, the best way is to remove it.

[@jeffpuckett8727]

what is the treatment for people with 3+5 Gleason score

[@ThePCRI]

Hello Jeff, thanks for watching the video. We will have a video on this coming out soon.

[@photosbyjose]

I just found out I got 3+4 and my dr recommend to remove the prostate so Im planning to do the surgery soon. He didn't recommend the radiation or seed implant.

[@ThePCRI]

There are not many big differences in cure rates between surgery and the different forms of radiation in Gleason 3+4 cases-although radioactive seed implants still edge out the other options-but there are some big differences in the side effect rates. We have a few videos on the subject, for example: kzbin.info/www/bejne/l3ioh3SNrZeihNU If you have any questions, feel free to contact our helpline which is staffed by a patient advocate who is trained to answer patients' questions and to help them find and understand relevant studies. Our contact information is here: pcri.org/helpline

[@ronaldhanks2629]

Hi I live in UK, I been diagnosed with Prostate Cancer with the Gleason score of 3+4, I’m 80 years old I’m torn trying what treatment to have, unsure about Radiotherapy with all the damage it can cause to the body, and not able to have surgery if the Cancer returns, and possibly going for Focal HIFU, which would be the best treatment for me?

[@ThePCRI]

Hello, we have a free helpline staffed by patient advocates who may be able to provide some information for you based on your individual situation. You can find our contact information at pcri.org/helpline.

[@ransomcoates546]

I am 4+3 with a PSA of 6. Is this unusual? I see in the charts a number of 10 as the lowest number for this pathology.

[@ThePCRI]

That is not unusual, but it is always a good idea to get a second opinion on the pathology. We usually recommend Dr. Jonathan Epstein's second opinion service at Johns Hopkins. His contact information is here: urology.jhu.edu/jonathanepstein/ pathology.jhu.edu/department/services/consults/urologic.cfm If you have any questions, feel free to contact our helpline. Our contact information is here: pcri.org/helpline

[@ransomcoates546]

@@ThePCRI Thank you ver much for all you do.

[@ravinderkumar2809]

Respected Sir my father age 74 diagnosed 3+4 in 2018 and now PSA 20, he is taking caluran 50, plz advise.m

[@bojanreljic8310]

@@ravinderkumar2809 Hi, how are doing father My father is same 74 age 3+4=7,grade 2,psa 8,8,biopsy 4 of 12 positiv all left and left centar 1 and 2 (6%-10%) 3 and 4 (11%-20%) Surgery or radiation what is right?

[@ChrisPaulPf]

I also have psa 6 and one core 4+3 3 cores 3+4 and one 3+3 and i didnt yet choose how to cure ?!! What did you choose ?

[@vishwanathsingh3559]

My glason ratio is 3+4 which type of med.& line of treat ment sugessted please

[@ThePCRI]

Hello, our prostate cancer helpline may be able to ​help with your question. Please feel free to contact us here: pcri.org/helpline

[@randyhutchinson-fp4ic]

Hormone therapy is more accurately called chemical castration. Patients should be aware of this. Much more eye opening.

[@isabelitaalvar9765]

.

[@malcolmmcbeath927]

i find this man incomprehensible he knows too much and cannot explain in simple layman's terms to non-specialists.

[@ThePCRI]

Hello, our prostate cancer helpline may be able to ​help you! Please feel free to contact us here: pcri.org/helpline

[@gilbrook]

If U have prostate cancer he is VERY comprehensible.

[@RodinThink28]

You need to do some research. Don't expect to be spoon fed.

[@johnmchale8308]

This doctor is the best on the internet, if you can’t comprehend his technical simplicity I’ll refrain from insulting you