Treating Micro-Metastatic  

My deep gratitude to Dr. Scholz and Ms. Alex Scholz for this video.This video is absolutely stellar. It gave me a clear insight into the PSMA PET SCAN technology. I was diagnosed with an advanced, donovo metastatic adenocarcinoma of Prostate, Seminal Vesicles and Pelvic Lymph Nodes. I have undergone 2 months of radiation, 1 year of Orgovyx, 1 year of Orgovyx, Abiraterone and Prednisone. My last treatment will end on June 29, 2024. I am in complete remission for at least 18 months. My PSA has been non detectable for 18 months. I have a question for PCRI. Can someone at PCRI please tell me what should be my treatment strategy after I stop all my Meds at the end of June 2024. Thank you PCRI in advance for your kind info.

In 2019 I had a PSMA PET scan that lit up only in the prostate and shortly after, radiation and ADT, Three years later, I have multiple bone mets. So much for Dr. Scholz's theory.

Thank You So Much for such a helpful and informative video. I've just had a relapse after 9 years post RP; just had my first PSMA-PET scan ever and am awaiting an appointment with my specialist in two weeks time. Whereas I was quite fearful before watching this video, I am much more informed and relaxed about my meeting now. Again, Thank You and God Bless.

I was diagnosed with prostate cancer, via multi core biopsy, in 2016 with one core Gleason 3+4. The core was sent to genetic testing and came back with only a 3% probability it would kill me in 10 years. My doctor and I decided on active surveillance and I've been doing that since. Three years ago I had another biopsy with no growth. This past October I had another MRI and the prostate had grown by 50% in 2 years. The following month I had my 3rd biopsy and no cancer was found. The urologist told me that doesn't mean I'm cancer free, it just means it's difficult to find. He did note that I had acute and chronic inflammation. In 2016 my PSA WAS 4. It has gone up as high as 9, but was 5.4 at the time of my last biopsy. Three questions: 1. How common is this in your practice? That is, the disease not "progressing"? 2. What prevents the cancer from spreading from a needle biopsy? 3. What would you recommend for a patient like me? I know this question is difficult for you to address with the limited info provided. Thank you for your videos, they're very informative.

Thanks for this update. Eleven years ago I had my prostatectomy for Gleason 7 cancer. After surgery my PSA was undetectable until a year ago, ten years after surgery. Over a year or so it rose from 0.18 to 0.21 then to 0.41 I got a PSMA Pet scan at .18 that showed nothing, and a second PSMA pet a year later when the PSA was about 0.41 which was also negative. I got several opinions but all of them concluded I should go on hormone treatment and get radiation to the prostate bed area. So I have done that. My oncologist prescribed 18 months of ADT with lupron but I have elected to stop after nine months, which are now up and my radiation treament was completed two months ago. I am 78 years old and the ADT has been very difficult and damaging to my overall health, with sleeplessness, weight gain, muscle loss, more aches and pains and somehow a reduction in energy level. So my intention now is to have my now undetectable PSA monitored every 6 months or so and if it starts rising again to get another PSMA pet scan then take appropriate action. Of course my hope is that the combination of 9 months of ADT therapy and the 7 weeks of radiation will have taken care of whatever cancer I had. Time will tell. I will get another PSA in 2 months and if that comes back undetectable I may ask the oncologist if I can go on testosterone supplements. I feel like this hormone therapy has aged me ten years in 6 months. The radiation was not bad at all, a few minimal and short term side effects only. So I am optimistic, and more worried about the effects of this ADT than I am about the prostate cancer. Any thoughts or comments are welcome.

Wow, excellent video! Thank you very much. My most recent PSA was 0.128. Getting my PSMA-PET scan in 2 days (on 4/8/24). Radical prostatectomy was in August 2014.

Dr. Scholz, thanks so much for this update. I’m one of those patients who had 8 biopsies taken with my surgery. The results from 7 of the 8 were clear; however, one had a Gleason of 3+4. The options presented to me seemed overwhelming: 39 radiation treatments and 24 months of Lupron shots. Being an active person, I decided to go on active surveillance, with PSA tests every three months. I also, switch to a Mediterranean Diet. It’s been 2-years now, and my PSA has remained undetectable. I know I’m not out of the woods. I’m so grateful for all your videos, especially this one! 😊

Thanks Dr Scholz and Alex for very informative micro metastatic prostate cancer video.

Wow such an amazing video, for me. Because I fall into that category. And if my PSA starts to rise again, will demand a PSMA PET scan only. Thanks a million, because like y’all conveyed in the video. The PCRI is not giving advice. But, information and knowledge so we can know how to move in an (excuse the English), “ A more better way.” lol I love it and it has given me hope and inspiration. Please keeping up the good work. R Chef A a Ron

Thank you I feel so much better your videos are great I've had surgery and had my prostate removed my PSA only went down to 0. 3 did all the scans all clear on hormone right now PSA was 5.6 before surgery it's undetectable now put on hormone for 3 months starting radiation in about 2 weeks your videos made me feel better that I possibly could be cured even though my cancer is so small they can't see it microscopic left over from the surgery

Thank you so much for this information !

Best of all your videos. Thank you so much.

Thank you so much for this video. Incredibly valuable to a have such a modern viewpoint of todays treatments.

Great insight! This info is very timely to me on this journey. I recently discovered my prostate cancer and that I'm in the intermediate risk category.

Great topic! It seems that the profession are only now starting to see the possibilities of PSMA PET scans.

Thank you for this video. You answered a few questions for me in this video.

Thank you Dr. Scholz and Alex! You are doing amazing work!! To: Anyone who may be able to help, I am a 65 y/o, (active and otherwise very healthy male) who had a radical prostatectomy 12 years ago- and after being undetectable for years I had a PSA of 1.44 in 2022 and then measuring 8.53 on 1/4/24 and6.97 on 01/12/24. With recent Pet/CT and MRI, 2 small lesions were found.(the larger of the 2 is a 0.8 cm restricting and enhancing lesion within the right side of the prostatectomy bed adjacent to the anterolateral aspect of the rectum) I believe proton therapy would be appropriate treatment as opposed to photon radiation and intermittent hormone therapy (following an initial long period) if the PSA becomes and continues to be undetectable instead of 2 years of continuous hormone therapy. Is there anything in my situation (All Chart data Below) that would require me to have photon radiation instead of proton or preclude me from intermittent hormone therapy? ------------------------------------------------------------------------------------------------------------------- Date: Feb 13, 2024 Dx: Prostate CA-Gleason score of 4+3=7 (GG 3) iPSA 4.21 involving 15%of the specimen, negative margins, positive extraprostatic extension. His final pathologic stage was T3aN0. Current Tx: bi/Pred, Eligard, XRT Prior Tx: Radical prostatectomy May 2012 Oncology History: This is a 65 y.o. caucasian male referred re: rising PSA remote from his radical prostatectomy in 5/2012 at U of C. He underwent a robotic assisted laparoscopic radical prostatectomy in May of 2012. His final pathology revealed prostate adenocarcinoma with a Gleason score of 4+3=7 involving 15%of the specimen, negative margins, positive extraprostatic extension. His final pathologic stage was T3aN0. No adj XRT or hormone therapy was administered. His PSA since the time of surgery had been undetectable. Date Value 3/10/2012 4.21 11/29/2012

Fantastic information as always, thank you. Your channel in many ways is the light at the end of the tunnel. ❤

Excellent video.

Amazing video! I’m reading your book now; The Key to Prostate Cancer🙏🏽

Great information

This is great information

Why is that biopsies are never mentioned as a possible or likely source of metastatic PC?

Dr Scholz , can you address the Decipher testing in this micro spread enviroment? You never did talk about the usefulness of Decipher. Thx for all your discussions, great learning always.

This was such refreshing information from a patient with Gleason 9 and positive margins on the pathology. My first PSA was undetectable. This information takes the guess work out of just Radiating an area without knowledge of where if any is lingering. Thank you for such and informative video!!! Knowledge is Power and this is great information going forward!

The holy grail is a scan that detects/locates all ECE/EPE and micrometastatic spread. For staging purposes. As far as reoccurrence goes, an agent that consistently locates PSMA at .1 PSA is a worthy goal for researchers. Closing the gap between detectable and locatable /targetable.

Timely video! I saw this about 2 hours after leaving my doctor's office talking about this very situation. I had an RP in 2011 that failed with a very slowly increasing PSA that allowed me to wait until July 2022 to have salvage radiation therapy. It, too, appears to have failed with my post-SRT PSA now higher than before starting SRT (0.37 ng/mL), I've had two PSMA PET scans, one with my PSA at 0.22 ng/mL in November 2021 and the other earlier this month with my PSA at 0.37 ng/mL. Both had "no signs of recurrent prostate cancer or metastases." On the one hand, that's a good thing, but we know those little bugger cancer cells are somewhere. The conversation with the urologist today was about timing of ADT and whether it's worth letting the PSA continue to increase to the point where a PSMA PET scan can actually locate the lesion(s). A conversation with the radiation oncologist revealed that he's more inclined to find the lesions and zap them if they are few and well-defined. I've asked for a medical oncologist to weigh in on the case, too. (I'm getting my care through the VA.) My PSA doubling time according to the Memorial Sloan-Kettering PSADT calculator is just over 6 months, which is concerning. For now, we decided to retest my PSA in 3 months and see where we're at then.

My husband was recently diagnosed with intraductal carcinoma of prostate with perineural invasion...4 + 3. He had a myocardial infraction, (3 years ago) coded 4 times... So doctor said best to do removal of prostate but due to his health they are hesitant to do surgery. We are now waiting on an oncologist for radiation appt. Q: can you tell me what treatment is used for this type of cancer? Thank y'all for your videos, I am so knowledgeable about what the doctor was talking about and able to ask questions and understand it as he was speaking.

I’ve been on Lupron for 3 1/2 years

Excellent, define it first. And something thats important, keeping the 3+3 defined as cancer. Then the insurance will cover.

I understand that focused radiation to metastasized sites identified by PSMA PET can be very beneficial. I am curious to know how focused radiation compares to Lutecium 177 and other such radionuclide treatments. Thanks again for the valuable information in PCRI videos.

What about if no metestic through psma and when off elligard rises faster than the 10 month calculation It has been 14 years since my surgery and psa never went to 0.

Thankyou for this very informative discussion. My husband had a radical prostatectomy in 2020 and after the pathology was done, there was an indication of EPE (PIRADS 5). He was not given salvage radiation or any form of treatment or medication. Re: Patients who have EPE, are they more likely to have micro metastasis down the track ?

Thoughts on combination therapy with Abiraterone, lupron, prednisone with metastatic (bone) disease and intact prostate? Now at two years. Starting PSA over 1,000. Now undetectable. 75 years old. Previously healthy and active.

i was diagnose with PC last aug 2021 gleason 4 + 4 PSA 7.0 had robotic prostectomy oct 2021 after 2yrs all PSA were undetectable until last Nov 6 ,2023 PSA was 0.110 Nov 28/23 0.117 had a PSMA Pet scan last Dec 2, 2023 turnout to be negative of Mets last Jan 12, 2024 PSA is 0.125 my doctor wants to do a Salvage Radiation on my Prostate bed n pelvic area for preventive measure need advise do i monitor my PSA and wait or do the salvage radition ? thanks

When speaking of 18 months of hormones, does it mean the same if on the newer ones that don't take as long for recovery?

I’ve been recently diagnosed with metastatic prostate cancer. I have 2 lesions on my spine, one on a rib, and 2 in the lymph nodes in my pelvis. I started ADT 2 weeks ago. How would the doctor attach this disease?

Dr. Scholz mentioned that a PSMA-PET scan can be used to diagnose whether prostate cancer is present; but if there is no biopsy prior to the PET scan, most insurance companies won’t pay for it. But what about Medicare? Will Medicare pay if there is no prior biopsy? And if they won’t, would they pay if the patient has had an MRI that strongly suggests the patient has prostate cancer?

I had brachytherapy followed by 6 weeks radiation and have been on luperon for 3 shots. My psa is 0.08 Would it be wise to stop luperon? My body is aching everywhere

What are the limits to PSMA PET scan? I've read that the tumor has to have the width at least 4-5 mm to show on PSMA PET scan. There has to be a limit because PSMA PET scan doesn't show anything for PSA lower 0.2 (some say 0.4).

I would like to know what is Micro Metastatic Cancer. A .6 mm cancerous area has been identified in one of my lymph nodes following Radical Prostatectomy in June of 2023. Is this considered as micro metastatic? I am presently under ADT, but have not taken radiation treatments. What are the Pros and Cons of adding radiation to my treatment regime?

I am on orgovix for 4 months now. My psma scan was clean. It's hard to say whether it's the facts or the chemistry but I do not want to live anymore.

I was diagnosed with stage 2 high risk PC on April/22 and my biopsy revealed a Gleason 4+4 and PSA of 7.3. Two months after my RP on June 16/22, my PSA 0.014, 0.037, 0.043, 0.064, 0.064 and up to Jan. 10/2024 is 0.070. from this data, could this be a micro metastatic disease?

Not recommending this to anyone for any reason, however, liposomal curcumin is starting to generate papers on the NIH, not specifically for PC but others, (for now).

I think I have this problem I had a Gleason score of 7 and it showed up 8 months later in my lymph nodes after cyberknife

My concern is the time it takes for you to get the radiation started, and for that reason I think a short course of hormone therapy is beneficial to halt the growth until radiation occurs ( speaking as a patient, not a professional)

💪🙏

What happens when the cancer is in lymph nodes that can not be surgical removed or radiated?

Good Doctor are you related to Charles?

It is impossible for a urologist nor oncologist to explain what PCRI informs us.Dr. Mark Moyad , an associate of Dr. Scholz, publishes a Book," PROMOTING WELLNESS for prostate cancer patients "; my urologist suggested such to me and I follow such with vigor. I am 70 and have a personal trainer 32 x a week with HIIT training 5 x a week.

I AM PSMA NEGATIVE PROSTATE CANCER GLENSON 8

Needle biopsies i bet