Radiating Lymph Nodes When The PSMA is Clear | Treating Gleason 9 | Cachexia & Chemo | PCRI

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Medical oncologist Mark Scholz, MD, answers patients' questions from our RU-vid comments about the implications of PSMA PET scans on deciding on treatments for Gleason 9 prostate cancer and whether cachexia is a common side effect of chemotherapy.
0:09 "I have Gleason 8 and 9 prostate cancer. PSMA PET scan did not show any spread. My radiation oncologist wants to treat the seminal vesicles and lymph nodes. I want to know if I can get away with just treating the tumors within the prostate.
2:50 "I have Gleason 9 prostate cancer and the PSMA PET scan showed that there was spread. How aggressively should I be when considering treatment?"
5:18 Is cachexia a common side effect of chemotherapy?
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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. 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 at pcri.org or contact our free helpline with any questions that you have at pcri.org/helpline. 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 RU-vid 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 #MarkScholzMD #PCRI

Опубликовано:

31 июл 2022

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Комментарии : 25

@yoberckage6253 2 года назад

Mostly manageable side effects from chemo is a relative term. I just finished 6 rounds, and I learned to prepare for ‘6 days of hell.’ Rounds 1-4 weren’t really terrible, and I managed to keep riding bike, working, and pretty much living a almost normal life. The “ditch” got worse and longer each time. Rounds 5 and 6 were significant hell, with insomnia, days of headaches, extreme dehydration, and joint/bone pain. No, I didn’t have debilitating nausea, but that’s about the only side effect I missed out on. (For perspective, I’m 53, was very fit before diagnosis. Gleason score 8, PSA 55 when I started chemo, and metastasis to lymph nodes.) My question is about radiation treatment. You’ve provided lots of information about the options, but I’d like to know how to best interview Rad Oncologists. What questions should be asked? We have good access to doctors, but not like the super centers in UCLA, sloan Kettering, or MD Anderson. I just want to know I’m getting the best treatment path I can. Thanks for the great info - keep it up.

@grateful7839 2 года назад

Dr Scholz is great. Advice is so helpful. My favorite was “I wouldn’t recommend surgery to my worst enemy”. Like the beard ! Ver scholarly looking.

@stanknowlton7043 Год назад

During my prostatectomy my seminal vesicles were removed. My lymph nodes recently became swollen but my PSA was unchanged at .001. My team suspected an infection and started penicillin V. A dental exam located the source in the upper gum and surrounding bone.

@geraldharam988 2 года назад

Please address the potential role of whole body hyperthermia in the treatment of indigo metastatic pc

@nanner8761 Год назад

Is Gleason 10 treated, with metestatic to the distant bones? Is there a survival rate and how much longer after 6 rounds of taxatere

@user-ov7zr6zo3w 10 месяцев назад

Hi. Can you please do a video on treatment for de novu oligometastatic prostate cancer with people who carry the brca gene mutation

@salsamink 2 года назад

I hear many state advice, but then say, “unless it’s an older person”. So what is the treatment for older men such in their 70s or 80s after they have gone through second generation medicine and it has stopped working. Should they not get certain types of radiation or chemo, and why? What would be a treatment for them?

@stanleydickerson8098 2 года назад

Is Burning during urinating a side effect after completion of radiation treatment for Prostate cancer having had 42 treatments with the last ten being directly targeting the Prostate , now experiencing SERIOUS BURNING!

@salsamink 2 года назад

Can you do a video about different types of radiation such as cyber knife, spot radiation, proton, Lu177, SBRT with viewray, aggressive radiation, etc? Who is eligible for each one? Side effects short term and long term? Can these be done again in the future? Cons and pros? Can these be done if someone never had chemo first? What outcomes are seen for these treatments when casodex, zytiga, and xtandi has stopped working?

@ThePCRI 2 года назад

Hello, We have a few videos discussing the differences between types of radiation, but it would be hard to know which ones to send without details on the situation. You can see most of them by searching "PCRI Radiation." IMRT, proton therapy, and SBRT (Cyberknife being a specific brand of SBRT) are all forms of beam radiation and they can all be used to treat the prostate or to treat a small number of metastases known as "spot radiation." There are some technical differences, but the most significant difference is that IMRT and proton therapy are both delivered over several weeks and SBRT is delivered over several days. These types of radiation can be used before or after chemotherapy. Lu-177 is a type of radiation that is injected into the body if there are metastases detected on a PSMA PET scan. It is currently only approved after second-generation hormone therapies and chemotherapy, but this is just because that was the patient population that was studied for its FDA approval. It is possible that it will be approved before chemotherapy in the future. If you have any more questions, feel free to contact our helpline at pcri.org/helpline.

@emcinc9654 2 года назад

I had my prostate removed on October 13, 2020. After that the PSA went from .02 to .5 on March 30, 2022. Right after that I had a PSMA pet scan which showed a lymph node in the abdomen had been affected by prostate cancer. That was the only place in the body that was affected. In April I had 5 treatments of SBRT. The PSA went down in May and June then in July went up to .52. Right now I’m waiting on Medicare to approve another PSMA Pet. My RO is saying clean up radiation to the prostate bed and being on ADT for the rest of my life. Not too thrilled about ADT for life. The labs on the prostate were 7 3+3 with some at 7 3+4. Medicare did approve my second PSMA. That is scheduled for August 19. I hope they do find something definite to treat and that I do have to only do ADT for 18 months not forever.

@ransomcoates546 2 года назад

I wonder if the original pathology report was correct. What you report does not sound like an aggressive cancer. Best of luck. I certainly am able to sympathize.

@emcinc9654 2 года назад

@@ransomcoates546 there was some cancer along the edge of the prostate. I’m sure that was disturbed during the removal. My RO believes there is microscopic traces. All I can do is hope for the best and see what is found by the PSMA

@awdalstar Год назад

Hello

@dale1k878 2 года назад

I am 68 and just had a consultation with a RO.. my targeted trans perineal biopsy showed 1 small lesion that was graded 4+3 25% tissue and 3 other cores of 3+3.. This was a 24 sample biopsy.. The rest of the samples were benign.. I had a Decipher test that came back very high risk.. The RO is suggesting radiation AND hormone treatment pending the results of a PSMA Pet Scan that I will have this Friday( Aug 5).. Does this sound overly aggressive?? I exercise daily and I know how important that is based on your other videos.. I am concerned that the treatments will impact my ability to continue stay in shape.. Any input would be appreciated…

@ThePCRI 2 года назад

Hello, Did you get a second opinion on the pathology? If the 4+3 is accurate, then that would place you in the "unfavorable intermediate-risk category" which has historically been treated with radiation and a short course of hormone therapy or surgery. The advent of the PSMA PET scan has made it a question whether the hormone therapy is necessary with radiation if the scan is negative. It has not been rigorously studied, but using historical data, your doctor should be able to give you a sense of what the risk of relapse would be with and without the hormone therapy based on your clinical features. If the scan is negative, it will likely only be a small difference whether the hormone therapy is added or not, and then you can decide for yourself whether that difference is worth the side effects. If you have any questions, you are welcome to contact our free helpline at pcri.org/helpline. It is staffed by patient advocates who are trained to help patients with these kinds of questions, share relevant studies, etc.

@dale1k878 Год назад

@@ThePCRI Thank you for your response… The PSMA PET scan was negative.. Nothing showed up outside of the prostate and the cancer within was graded “moderate” based on the expression from the PSMA scan.. I will be getting a 2nd opinion on the pathology and also weigh my current health condition as to whether to accept ADT as part of my treatment regimen… I don’t like the idea of potentially sacrificing my active lifestyle for a treatment that may not even be necessary.. Thank you for everything your organization does.. It’s because of an earlier video from PCRI that I even learned of the value of a PSMA PET to help in an initial diagnosis…

@michaelf8837 Год назад

Hi I was in a similar situation 2 years ago , My issue is I wish I had done my 6 round Xiforgo before doing radiation therapy 10 treatment ( for metastatic in hip and lower back area ) because since the xiforgo there has been no more pain in back or bones and metastasis seem to have cleared up substantially ! I'm 67, My Psa was 398 , I have grade 4+3 , and 2 years later my psa .01 and I'm still on ADT & prednisone lymph nodes are decrease in size

@rickedwards2 2 года назад

I am 71 I have stage one 3=3-6 prostate cancer less then 5% in one core. My Urologist is watching it. I got a second opinion them a oncologist and he wants to put me on 50mg of BICALUTAMIDE. what is you opinion on taking 50mg Bicalutamide for stage 1 cancer

@ThePCRI 2 года назад

Using bicalutamide for a Gleason 3+3 prostate cancer would be unorthodox. Nowadays, Gleason 3+3 is rarely treated because it does not spread to other parts of the body. Men with Gleason 3+3 are typically watched to ensure that a new, more dangerous cancer, does not develop that would require treatment. Bicalutamide is a mild form of hormone therapy and intended to lower testosterone, and it can potentially have a lot of side effects like muscle loss and related fatigue, hot flashes, weight gain, loss of libido, erectile dysfunction, osteoporosis or loss of bone density, and more. There are ways to minimize the side effects, should they occur, but since the side effects can be so challenging, hormone therapy is typically only used as a temporary treatment in some cases of Gleason 3+4 and in most cases of Gleason 4+3 and higher prostate cancer in which it is believed that small amounts of cancer may have already spread (and it is usually administered along with surgery, radiation, or some other therapy focused on ablating the prostate itself) or indefinitely or intermittently if cancer has already spread to other parts of the body and/or if it shows persistent activity in the absence of hormone therapy. If you have any questions, you are welcome to contact our free helpline at pcri.org/helpline. We have patient advocates who can share information and studies that you can use if you wanted to form questions for your doctor about his justification for prescribing it and/or whether a second opinion may be helpful.

@dennisray9603 Год назад

Identity have chemo radiation to my back for my lymph nodes Monday through Friday but the doctor says I also have prostate cancer but I don't feel like I do because I haven't had no issues all my life with anything going wrong what is the best thing to do because I really just want to have the chemo radiation therapy done only...

@ThePCRI Год назад

Hello, We have a helpline with a patient advocate who can discuss your case with your if you are interested. You can find our contact information at pcri.org/helpline.

@gvet47 Год назад

Why would you radiate lympth nodes as it destroys good tissue as well. My cancer has spread too far for anything but hormon drugs to try and slow it.

@georgemohr7532 2 года назад

Your videos are very informative. I very much appreciate the information that I have learned watching. However there is some terminology that is used consistently by Dr. Scholz that has ambiguous meaning. For example-"elderly". There are 80 year men and then there are 80 year old men. Some 80 years maybe very frail, other 80 year old remain robust and active. Are both 'elderly'? Another term that is frequently used by Dr. Scholz is "high risk patients." What parameters make a patient "high risk"?

@ThePCRI 2 года назад

Yes, there is some flexibility when it comes to age. He phrases it like that just so that the video does not go too long, but the basic idea is that when you are considering treatments, age, general health, and the cancer's potential should be taken into consideration. Many 80-year olds are frail, but not all, so you would not necessarily want to write off chemotherapy, for example, in an 80-year old if they are robust and if the cancer is a threat to his longevity and if he agrees to have the treatment, but you also probably would not want to give chemo to that 80 year old--even if he could handle it--if the cancer does not even have the potential to threaten his life for 20 or more years. There is also sometimes the option of using milder treatments knowing that there could be other treatments available if they are needed. All of this, though, is for the patient to decide and doctor should lay out all the potential avenues and consider that patients desires. If you ever have any questions, feel free to contact our helpline where we have patient advocates who are trained to talk with people about their cases, share relevant studies, etc. You can find our contact info at pcri.org/helpline.