So, Dr. Scholz, we have a patient who's trying to choose the best course of action. He didn't list
his age, but usually the median, you know, caller that we get in is about 68—between
68 and 72—so they had a clear MRI, clear bone scan, the genomic test came back as high-risk
and their first PSA was 4.7 and then it is currently 3.0. The biopsy found two positive
cores — one core was 4+4 with fifteen percent involvement and the other one was 3+4 with
ten percent involvement, and they want to know should they pursue aggressive treatment? You
know, does the 4+4 put them in the high-risk category? What do you think the next steps are?
The Gleason score drives the dialogue as the number one thing; it's more powerful than PSA;
you could argue it's more powerful than percent biopsies and even tumor size.
So, 4+4 is high-risk, and that doesn't really lend itself to any kind of monitoring unless someone's
maybe in their 80s you could watch it. So, it's time to treat it, and that opens up a big can
of worms. There's so many different options and could he could he undergo focal therapy,
radiation treatments, some sort of, you know, systemic therapy is usually part of the mix, but
I'd say the one thing we could say fairly confidently is that
it's not active surveillance time unless they're in their 80s.
So our next question is regarding prostate cancer symptoms. Now, we get a lot of questions about
this. Obviously with our YouTube channel and our website we're encountering a lot of people who are
trying to figure out if they have prostate cancer, maybe they haven't had an official diagnosis, and
this person has blood in their urine, and they're wondering, "Is this a symptom of prostate cancer?"
Almost certainly not. One thing that's missing in that analysis is
what is their PSA? My feeling is that if people are checking their PSAs and
their PSAs aren't ridiculously out of whack say over 20 or even much higher than that,
symptoms are almost invariably from prostatitis or BPH or infection or some other unrelated cause,
not cancer. Cancer is a silent problem and this is why PSA was so revolutionary when it came out
in the late 80s. PSA gave us some insight into what we considered a totally silent illness.
So symptoms are a clickbait for people. "Prostate cancer symptoms" we're all
obviously very protective of our own health and the thought of cancer is quite frightening
and we listen to our bodies carefully, and especially people that have dealt
with cancer in the past there's, you know. does this ache or pain represent cancer?
But PSA has changed that. If people's PSA is in check—which means if it's normal or it's,
you know, say less than in the 20s, picking the number I used previously—guaranteed,
symptoms are not from prostate cancer, not at such low levels.
So our next question is regarding PSA readings. This person has been on Lupron for six months
and they'd like to know what is a good range for their PSA to be at
since the Lupron seems — is it working or not?
It's a very relevant question. The things that we use to predict how people are going to turn out
long-term with prostate cancer — How's the Gleason score? PSA responses, this person's talking about
or we call it PSA nadir, the six-month time period is very apropos. After a person begins hormone
treatment, we expect the PSA to bottom out within about six months, and where should it bottom out?
Ideally less than 0.1, and in patients who are not seeing their PSA get down to less
than 0.1 after six months, those individuals may have a more vigorous type of cancer,
and further investigation may be necessary to make sure that this is not something a little worse
than what was initially thought. Most patients will have their PSA drop to 0.1 within 6 months.
Hey everyone, it's me and SirHuntertheDal, our PCRI mascot.
Please subscribe to our YouTube channel; Hunter definitely wants you to, and if he can high-five
me, you have to subscribe right now. Oh, you're already high-fiving me, good job! Thanks so much
visit our YouTube channel and also our website for more information at PCRI.ORG. Say "bye!"
you