So, the next question we have is from a man who's 49 years old and he's Low-Teal, so he has 3+4 of
a Gleason grade, the three being the primary, and he says because of his age his doctors are
suggesting radiation right off the bat. Now I know in a lot of cases you've talked about 3+4,
those being able to be monitored through active surveillance. So, because of his age, would that
change from active surveillance to radiation? How do you feel about that treatment concept?
Well, the 3+4s, it's a pretty big range of people. The type of person
that you would select for active surveillance isn't dependent on the age.
If someone is a candidate for active surveillance then they can pretty much consider it any age,
but the more 4 that is being detected on the biopsy, the less they are a good candidate for
active surveillance. So, the ideal 3+4s are the ones where they come back and they say there's
less than five percent grade 4, those are just like 3+3s, but I found that using genetic testing
in these patients with Prolaris or Oncotype is the most useful because the report will
inform the patient what's the percent likelihood that the cancer could spread in the next 10
years? and these patients are looking at a range from like 2% to 10% risk of spread in 10 years.
I think that each individual patient has to make that decision on his own because
they're looking at the possibility of erectile dysfunction if they have any kind of treatment.
Focal therapy can cut that risk of erectile dysfunction, but it doesn't eliminate it.
The 3+4 characteristics are driving the storyline more than they age,
and the more favorable it is—the less 4—the more favorable that the genetics are
would lead one towards thinking of active surveillance, whereas if someone had a a 3+4 with
40% grade 4 in the biopsy specimen — probably not at all a good candidate for active surveillance.
So you mentioned you know those genetic tests like Prolaris and Oncotype, are those genetic
tests from a logistics standpoint ones that patients can get from their family doctor or
from the urologist? Obviously, maybe the doctors aren't going to bring it up right away, so they as
the patient need to bring it up. Can they just go ahead and ask those primary physicians for those?
Yes, the pathology slides that are generated when the person has a biopsy are kept for 10 years
at the location where the biopsy was done or the hospital where they were read,
and so the companies Prolaris or Oncotype can be contacted and they will go and track down
the slides and arrange for the studies to be done on that specimen. So, a family doctor can do it;
the patient himself can do it; the urologist can do it; it's easy to obtain.
And I know one of the things you mentioned in a previous video
is when somebody is on that line of having 3+4 and they want to confirm that it's 3+4
and have a secondary pathology reading in order to make sure that it's absolute if they're going
to choose active surveillance—obviously, no matter at any age as you just stated—so
I would suggest they go submit those to like Jonathan Epstein, MD at John Hopkins.
Yeah, one of the reference pathologists to confirm
the accuracy of the Gleason scoring because we know that can vary.
So another comment we got on our YouTube channel is how does low-grade Gleason-6
prostate cancer affect options for BPH procedures?
So, the urologist doesn't want him to have like to have a green light.
The — I'm not sure why that would be a factor. First off,
the prostate cancers tend to be around the outer edge of the prostate whereas treatments for BPH
usually are in the center of the prostate, so they don't usually cross over. If it's a confirmed 3+3,
we know that that is genetically incapable of growing anywhere else in the body
that it doesn't spread and it can't metastasize. So, I see no restrictions whatsoever in undergoing
a procedure to help men with his urination just because he has a low-grade 3+3 prostate cancer.
So this person is taking finasteride, and the urologist said that there's great concern
that he could possibly have breast growth. To your knowledge with finasteride and drugs
like that is that true, and also, if it does start what do they do?
So there is a low but real risk of gynecomastia, breast enlargement with finasteride and Avodart,
and it doesn't happen very frequently, but if people are vigilant and they start to see this
problem developing they can stop the medicine and the process will cease. So, I don't see
that as a reason to forego the medication because the incidence is quite rare; it's
you know, certainly less than 1 in 20 or fewer than that.
The next question is,
how long can a man with Basic-Teal delay treatment without the risk of cancer metastasizing?
Basic teal would be someone with a 3+4, and the risk can range anywhere from 5% at ten years
to 20% at ten years of the cancer spreading, and it's how long can someone delay treatment — this
issue comes up oftentimes in people that are planning to do treatment in the next one to three
to six months, and in that time frame it doesn't make any difference. Studies have clearly shown
that you can postpone treatment for six months if you have to while you're sorting out your options.
So the next question is somebody who's in that same situation where they have a 3+4 and they want
to know would radioactive seed therapy make sense versus SBRT if they are going to choose treatment?
I think they're both excellent options the seed implant treatment is — there are two types,
the temporary and the permanent seeds. The permanent seeds are probably
a bit more convenient; they can be done in an afternoon. SBRT
is five treatments over 10 days; it's also very convenient and non-invasive, so I think that for
this category of patient, either approach would be good, and it would be more important to seek out a
skillful doctor who has had a lot of experience doing it to minimize the risk of side effects.
Hi, everyone, it's Alex and Hunter. Hunter is our official PCRI mascot. If you'd like to learn
more about men's health tips and prostate cancer, you can follow him on Instagram:
SirHuntertheDal, and also subscribe to our YouTube
channel; we come up with new prostate cancer videos every week. Say "bye!"