#ProstateCancer Diagnosis Over 80 Years Old | #MarkScholzMD #AlexScholz | #PCRI

0:07 How is prostate cancer approached for men diagnosed over 80?

2:14 PSMA PET Scans

3:41 Would it ever be advisable for a man over 80 to undergo radiation treatment?

4:57 PROSTOX Genetic test

5:17 What should an older patient do if their hormone treatment is too intense?

7:37 How is metastatic treatment approached for men over 80?

10:22 Can some patients with Gleason scores higher that 6 attempt active surveillance?

11:07 Alex's conclusion

Who we are:

[EarlBritt]

Hi, Thanks for this video. It confirms my recent actions in my case. I'm 75. My PSA before 2018 has been below five. In the last two years my PSA is about 7.2. Still under 10. My prostate MRI in 2021 was PI-RADS 4. I started eating totally plant based in Nov 2022. My most recent prostate MRI in April 2023 showed my PI-RAD score was 2. Significant improvement in my book All of my Biopsy's prior to April 2023 were Gleeson 3+3. I fired my urologist for wanting to do another BIOPSY because I felt I was being over treated. My new urologist wants me to continue with the plant based diet but get a PSA every 6 months with office call in one year. Any in my book, 75 is close enough to 80 so I don't want to be over treated so my corpse will not have prostate cancer. Thanks again confirming my thoughts about my treatment.

[Russ]

I am 81 years old. During several years of watchful waiting, my PSA steadily climbed, but MRI scans with a 3T scanner showed nothing of significance. When my PSA finally reached 50, my urologist ordered a PET scan, which showed locally advanced prostate cancer, with seminal vesicle invasion. I started on ADT monotherapy with Eligard a little over one year ago, and my PSA has dropped to 0.31. Not only was it effective, I did not experience any side effects. I have maintained a regular exercise program, walking 3 1/2 miles each day, and working out with resistance bands three times a week. Each individual reacts differently to ADT, and all the warnings about awful side effects do not necessarily apply to everyone.

[jonmcphee]

In late 2020, I had SBRT radiation with HDR brachytherapy and 24 months of Lupron for Gleason 4+4, PSA 11.8. The Lupron got tougher as time went on. Hot flashes, no energy, impossible not to gain weight, and even with carrying on my weight training regime, I lost muscle, until I was unable to get my bodyweight up from a deep squat. I cut the Lupron short at 21 months. It's now been almost 2 years and I'm back. Almost as strong as before and active again, and my weight is under control. I won't do Lupron again. At 78, 2 years of Lupron would put me into a wheel chair. If there is any recurrence, then PSMA/PET with spot radiation would be my choice.

[TK-]

God Bless you guys. You guys are a guiding light..

[rickcertano]

Thank you for your videos. I am a 77 year old very active person. Walk, hike, lift free weights 3 days a week in the summer ski over 100 days in the winter. Have had bph having to urinate at night 2-3 times. Still have a decent stream. Psa was 4 3 years ago, stopped talking saw palmento, 6.5, 7.2, 6.8, now 11. Free psa test showed low probability, over 25. Read somewhere that hard physical exercise could increase psa 40-50% and that ejaculation would also raise psa. I will not do hormone treatment. Cure is worse than the disease. But frankly rising psa does worry me. Try to eat right get plenty of sleep and of course exercise, but not sure what eating right is. Obviously with bph psa will rise just due to the increase in size. Lots of questions here I know, but very distrustful of drug and treatmesnt marketing. Thanks again for your videos. I feel im getting an unbiased answer! Please keep up the good work!

[bglrj]

Thank you for science-based, commonsense approaches that exhibit compassion towards the patient.

[richsparkman]

I'm 73 and on hormone treatment and radiation and it is terrible I have no energy I tried to quickly it is life changing I thank you for all your useful information

[josephmaher]

Very informative and helpful, especially regarding hormone therapy. I’m a healthy 78 year old in Acttive Surveillance at MSK, Gleason 3+3, PSA<10.

[hokkitt]

This channel is liffe-saving (mentally) Love you guys. Greetings from northern Sweden

[robwells]

The best, most honest video PCRI has produced because it, for the first time, acknowledged that the ADT CASTRATION effects can be horrific and quality of life destroying.
men at 80 should be spared the harms of these TOXIC drugs, certainly men mid or late seventies should give every consideration to avoid or minimize ADT results
... shorter duration
... milder drugs like Bicaludamide monotherapy
.. perhaps NO ADT at all.

You are so right that patients need to be assertive and consider their quality of life before doctors coerce or deceive them into ADT CASTRATION which results can be permanent in up to twenty percent of older men.

Great job Alex

[edwardbertorelli]

Great topic ....as a man who is 75 and undergoing treatment involving darolumide and radiation as part of the INTREPID study...so far going well

[Giovan_Nino]

Such a good video..please continue to educate..👌

[kanelliscalcoyannis]

Thank you for your video & this awareness. My dad at 78 was told to have robotic surgery for his prostate cancer whilst he also had a aneurysm that they wanted to do surgery for, doctors suggested first to do robotics and two weeks later to do the aneurysm surgery. The robotic prostate surgery 3 days after developed post operative ileus, went back to ICU, then had a aneurysm in his leg, so more surgery, had to learn to walk and stand again so spent more time in rehab. Had little bladder control for a long time afterwards. Six months later had a stroke and a year after this procedure died. If he had just lived with the cancer probably would have lived longer. Invasive treatments are to be considered especially after a certain age and surely robotics was not for him as a history of high blood pressure etc.

[maxthemagition]

In August 2007 I got a private health check and my PSA was 5.64.
Early this year 2023 I went ot the doctor for frequent visits to the toilet during the night and the doctor took a blood sample for a PSA test which was foun to be over 10 at 11.5.
So my PSA went from 5.64 to 11.5 over a period of 15 to 16 years during which I have been very healthy other than the frequent visits to the toilet during the night for a wee.

Anyway this was followed up from early this year ...scans, biopsy etc to find that I have Gleeson 4/3 and now I am on Hormone therapy for 6 months during which I will receive radiation therapy over 3 weeks.

My testostorone level is going down and I feel aged, body sweats and fatigued.

I read that my PSA should come down to near zero after Ratiation Therapy, but if it goes up slightly, I could be back to square one as it indictes that the cancer could still be present.

Is there no escape for this nightmare?

I will be 77 years old come December this year....

[johnfowler]

Great video. I'm 76 and getting the feeling that I'm being put through a system. The radiology report indicated a lesion with a PIRADS of 4 . However there was no involvement of any other tissues (vesicles, urethra, etc.) and my urologist wants a TRUS biopsy with 16-20 cores. Should also mention my PSAD density (PSA 4.99, prostate volume 58cc) is .086. I just get the feeling I'm being put in the system. I wouldn't have any objections to a PSMA PET scan but not available under medicare without a biopsy which is insane.

[ChristianBaer-krwt]

At the age of 72, I took part in a study for the early detection of PCa (Stockholm 3) with the following result: PI-Rads 4, PSMA-PET negative, Gleason 8. Interesting: My PSA was 3.0 and the increase compared to earlier measurements was age-appropriate.
Nevertheless, radical prostatectomy due to Gleason 8 nine months ago. Erectile function restored 14 days after surgery, incontinence very stressful for four months ( leakage of up to 1, 000 ml/day), steady improvement since then. Today continent except during running training with severe tiredness. - PSA not detectable since surgery. - Because of possible long-term consequences of radiotherapy and because I didn't want hormone therapy under any circumstances, I preferred the operation. I would do it again, even if the incontinence was severe.

[robgerety]

I'm 72. Just had prostate mri and then biopsy. The MRI shows that I have a tumor that involves nearly my entire prostate. The gleason assigned is 7 (4+3). I am getting a second read of the slides. There are some details in the mri and pathology reports are concerning (at least to me) for possible existing spread. My most recent PSA is 16. It has been weeks and I have yet to have a conversation with a surgeon and/or an radiation oncologist and they are initially talking about scheduling these meetings in November. There is almost no communication unless I push hard. I am working on that and it looks like they may schedule appointments mid October. My mri and my biopsy were completed in August. My concern is that we won't even begin to discuss treatment options until mid October and I assume it will be a good long time after that before the treatment option we settle on is implemented. I feel somewhat like we are fiddling away while Rome is burning. Are these sorts of time frames typical? I know they are all terribly busy. But...

[danielswenson]

Really good video and advice, thank you.

[victorlionelnazaire]

Hi, thank you for this video. I am 81 diagnosed with a PSA in the 2 000s. My urologist sent me 1) to a lab for blood test through my arms and 2) a Bone scan and 3) a CT Scan .
After all this my urologist aware of a metastatic situation put me on Hormone treatment with LUPRON Depot 22.5 mg/syringe with 2 injections over 6 months and told me my body was reacting well.
He then referred me to a cancer Surgeon who told me at my visit that surgery would not be useful because of the metastasis; this cancer surgeon then wanted me to do another test, a Biopsy, after previously going through a Fleet Enema.
I decided to avoid this Biopsy because of the risks of bleeding and possibly infection.
What should I do now ? I live in Ontario, Canada.

[salamawaad]

thanks a lot for both of you I am 64 years old l diagnosed recently with prostatic cancer Gleason 6 I am complaining of BPH symptoms since 7 years your opinion about robotic prostatectomy