Is PSA Density Still Relevant?

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0:20 What is PSA density?
2:47 What forms of imaging are used to determine prostate size?
3:40 At what point in the screening process would a patient get an MRI?
5:02 Are MRI scans usually covered by insurance?
5:27 Can PSA density play a role in deciding a treatment?
6:53 Is there a correlation between prostate volume and cancer severity?
7:49 Is a clear MRI on a large prostate often indicative of BPH?
9:33 What should a patient do if they are told they need a saturation biopsy?
12:28 Can a PSMA scan replace an MRI in the screening process?
14:28 Alex's conclusions
16:03 If you need more help
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Опубликовано:

9 июн 2024

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Комментарии : 31

@mmazkoory3628 22 дня назад

Thanks, Dr Scholz and Alex for this very useful information about PSA density.

@dw566 22 дня назад

Great wrap up at the end Alex. I can personally vouch for an approach to prostate ca which uses the many sources of sound scientific clinical information available on the internet. Your channel is certainly one of the best and I am eternally grateful for the knowledge you and Mark provide.

@homebrewer7 22 дня назад

My psa after radiation years ago of prostate cancer is now .05 the latest revealed count .09 I have no problem urination at age 88 this year.

@TERRY-cb2ku 22 дня назад

God bless you. I hope you have many years left.

@jabster58 22 дня назад

Can you do a show about upcoming vaccines that are showing such promise in other cancers...vaccines that use the patient's own tumor antigens.

@alfredbinzenhofer7509 21 день назад

Many Thanks Alex and Dr. Scholz. Great Program 👌. Understanding the MRI is very helpful esp. avoiding the biopsy and no radiation needed but what about the contrast medium?? They found a very high Gadolinium score in my blood work! afterwards. Diagnosed with a leaky gut so the blood brain barriere might be open to the gadolinium as well! What about a MRI without a contrast medium and or a liquid biopsy, f.e. an EDIM Test available in Germany via TKTL1 Enzym and Apo10, in lieu?? Any Experience? And what does the pirads score, lets say 5 and/or 4, really tell ??

@JDinky652 22 дня назад

A saturation biopsy would logically increase the risk of spread of prostate cancer outside the prostate, unfortunately the situation in the U.S. is that no treatment center (to my knowledge) will even consider treating you if you don't have a histological diagnosis from a biopsy.

@charlesblumenstock9160 14 дней назад

Yes my doctor is a fan he said the trus test is cost effective he said it's great to know my size so as much as it is necessary accurate test useful and avoid biopsie 4:47 4:48 4:48 4:49 4:49 4:51 4:52 4:52 4:53 4:53 4:55 4:56

@TERRY-cb2ku 22 дня назад

I will have a biopsy done on the 26th. of this month because of an 8mm lesion in the left anterior portion of my prostate seen on MRI. Should I ask my doctor if I can have a PSMA PET scan before the biopsy to see if the lesion lights up and possibly avoid the biopsy ? I was diagnosed with prostate calcifications 15 years ago, and this may have been what was seen on recent MRI. Just a thought.

@sandrastewart9581 22 дня назад

Thank you. This was a very helpful video!!!

@barrie888 22 дня назад

practical useful advice ,tks

@TiHerr74 22 дня назад

My prostate measured 74cc and my PSA is 5.4. PSAD = .073. Random biopsy was negative but MRI showed a 7mm lesion and was scored at PI-RADS 3. Now I’m on the fence as to next steps. Leaning towards an MRI-guided biopsy.

@ernesthanks6125 22 дня назад

I'm not a doctor, but I've been doing active surveillance for 10 years. I wouldn't worry if I were in your place with those numbers, but I'd probably do another MRI in a year or 2 to see if that lesion is growing.

@TiHerr74 22 дня назад

@@ernesthanks6125- thanks for the note. I neglected to mention there is prostate cancer on both my maternal and fraternal sides of the family.

@hyway62 22 дня назад

U shud get a mri guided MRI why not, get it done and catch it early and u cud get focal therapy on it and get no side effects

@TiHerr74 22 дня назад

@@hyway62- thanks. That is the direction I’m leaning now.

@BMT-by5ve 22 дня назад

I have BPH but PSA density is .007 Finasteride adjusted and considered normal. My PSA is 2.2 for Yeats with Finasteride. Has 2 precious MRIs with PIRAD 4. Urologist wanted biopsy but i said do another MRI. The latest MRI showed PIRAD 2, no lesion but just inflammation. Don't rush into biopsy if other indicators are good.

@BrainBodyExercise 22 дня назад

I now this is not relevant this video, but can you have Dr. Scholz address MRI Linac. I've been told that this could be better than IBRT or SBRT because of the use of MRI to target the lesion

@hyway62 22 дня назад

To Target the Lesion or Lesions, i have 2 one in the front and one in the back but seed radiation is blasting them into the stratosphere 😊 at the moment, hopefully

@BrainBodyExercise 21 день назад

@@hyway62 Blast away!

@frankm2752 22 дня назад

Can you discuss PSA results after salvage radiation treatment for biochemical recurrence after radical prostatectomy. There are many of us not finding reliable information concerning how long it takes to determine cure vs failure.

@JustaReadingguy 22 дня назад

Wow. This is where I am at. What a relevant topic for me. Also, her comments at the end should put on a poster, the comments about the more you know the better off you will be. The only problem is with knowledge is I am exposing doctors lack of state-of-the-art practices, confinement to fast medicine reather than good medicine and insurance companies controlling treatments instead of shape medical reasoning. - in fact I would like see a video on how to navigate the almost non-functional medical system. -- But thanks so much for this video.

@TomChau-kg1zg 11 дней назад

Thanks for this informative video! Last year my MRI showed 1.6 cm lesion with PI-RAD 5, then I had 12 core biopsy and it gave me a gleason score 6. I just had MRI again and now it shows no lesion at the same area with PI-RAD 2. Can the 2nd MRI miss it that much? I am so confuse. Wonder if I should do MRI or biopsy again. My PSA went down from 4.06 to 3.5. Appreciate any comment or someone have similar case like me!

@MM-sf3rl 6 часов назад

On my first and second MRI in 2022 I had two lesion, 1.3 x 0.6 x 1.2 cm and 0.8 x 0.4 x 0.6. The MRI on 12/4/23 did not see the smaller lesion; the doctor said, I’m paraphrasing, “it must have resolved itself”. ???? What. Due to my PSA rising 7.12 - 9.07 in four months I got another MRI. Again, only the larger lesion showed on the left side - so I will take, “it resolved itself”. But, now there is a lesion on the right side measuring 1.1x0.6cm. Previously the right side was benign. So, without a biopsy I will not know it is cancerous. It is likely cancerous as they scored PIRADS 4. However, if the second MRI in 2022 showed a lesion, which resolved itself by 12/4/23, and they scored it PIRADS 4, but it resolved itself, was it true that “clinically significant cancer is likely to be present”. What was also very confusing was the doctor said that the “cancer was outside of the lesion”. So is the lesion I found out about today, on the right side really PIRADS 5, and “clinically significant cancer is highly likely to be present”? Could it resolve itself? Maybe it’s not cancerous within the “lesion”, but upon doing a targeted and random biopsy per quadrant, they would find 3+3 or 3+4 (as that’s been my pattern) on the right side of the prostate. If you had a PI-RADS 5, but just Gleason 6, then why was it not PI-RADS 3? In my opinion, having Gleason 6 means you can observe, not do a biopsy, but do Active Surveillance. I would get test for BRCA1&2 and have a Decipher test done. These two tests will just add to the rational to remain on AS or treat. I may have confused you even more but it’s interesting that a lesion can “resolve themselves”, not have cancer, but, maybe, are the indication of cancer in that area. Best of luck!!! FYI: my care was at top institutions. I’ve found of that there are different camp and approaches at these institutions so we must do what’s right for us.