Active Surveillance for #ProstateCancer in 2023 | Matthew Cooperberg, MD

5:17 The Number of people on Active Surveillance is increasing?
5:37 Proper to diagnose someone with an insignificant tumor?
5:53 Do I have "cancer"?
6:28 What is cancer?
8:05 PSA is the best screening biomarker in the history of oncology if used well
8:22 Newer screening practices
9:33 Does this mean Grade Group 1, 3+3, Dr. Cooperberg says not cancer?
10:34 GG1 is not a normal finding, but A.S. is recommended
11:58 Continuum of Biology
12:57 Arbitrary line drawn for cancer
13:45 What if we don't call it cancer?
14:49 Why the largest PSA screening trial failed
19:25 Should men go for PSA screening?
20:57 Median PSA is 0.7 between 45 and 50
21:22 If it's under 1.0, you're done
22:30 PSA values vary
23:23 What does act on PSA mean?
24:50 Liquid tests
25:54 Why not have everyone get an MRI?
26:23 What inter-observer variability exists with MRI's?
32:27 Cooperberg screening policy
33:59 DRE (Digital Rectal Exam)
40:26 How should a man choose his localized treatment?
43:15 Is there an age limit for Active Surveillance?
45:45 Mental health considerations
49:31 Confirmatory biopsy
52:01 Why can't everyone diagnosed get a BRCA/Genetic test?
56:10 What do we do differently now we know you have a BRCA mutation?
1:00:25 What about Pathology?
1:01:10 Sub-types of Pattern 4
1:02:38 Cribriform patterns
1:04:14 All GS 3+4 is not created equal
1:05:25 Is PSA density of 0.15 a valid cutoff for Active Surveillance?
1:05:50 Intraductal/large cribriform patterns for Active Surveillance?
1:06:54 Cancer is driven by the worst corner of it
1:08:06 Most Gleason 7's sent for genomic test
1:08:34 Intraductal worst pattern followed by cribriform
1:09:24 DRE's for Active Surveillance?
1:09:48 How often for PSA's/MRI's?
1:10:26 Active Surveillance 2023 (one opinion)
1:12:59 How do you choose your urologist?
1:15:00 Do PSA kinetics matter?
1:16:05 MEAL trial
1:18:22 What about exercise?
1:19:35 What about testosterone replacement therapy?
1:21:32 What about the two types of PSA tests?

Who we are:

[glenrose]

Im 74. Gleason 3+3 two years ago. Doctor pronounces me a prostate cancer patient! I freak out! But now ive learned from many talks on PCRI that i should rdmain calm even though the MRI shows something. But now i kind of have to have another biopsy to see if my gleason number has gone up. My PSA fluctuates every 6 months from 5 to 7 to 5 etc. I really wish I'd never done the first biopsy. Even if i go 3+4 i dont want to do any heavy treatments at my age. I still enjoy sex and most any treatment can bring an end to that.

[lonesomelenny]

Had 45 rounds of radiation for prostate cancer at Loma Linda University Hospital 2012. So far so good. I'm 74 and my doctor put me on a maintenance dose of Tadalafil that helps with urinating.

[geoffpetersson]

Fantastic conversation. Feeling lucky, however, being in Australia where PSMA PET scans are available relatively freely which are so much better than MRIs for detecting tumours and therefore a great tool for determining whether AS is appropriate.

[tomjgrant]

Would a 4+3 score (2 cores of 12) = ever be put on AS. PSA 8.8, no metastasis on PSMA, 77 years old 80 gram prostate PSA density 0.11. Awaiting Decipher.

[wlkyitm]

When in AS should someone get a PSMA PET scan? If Gleason 3+3 does PSA need to rise above 10? Is PSA above 10 more of a treatment trigger?

[clintonboxhill]

How can I get in touch with the Urologist?

[bobcurran]

IS LYCOPENE SUPPLEMENT GOOD FOR REDCING PSA LEVELS AND OVERAL PROSTATE HEALTH, , TY,

[anthonynwanokwale]

I am 64 with Gleason 3+3 and on active surveillance since 2021 March and PSA 6.6 to 8.9 last test in May 6.9 and MRI was done 10/17/23 and the lesion have gone from 1.1x .8x .6 to .6x .6x .4 My Dr want to do a second biopsy. What do you think.