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Pi-Rad 5, PSA 8.4, (last year, 5.3)

User
Posted 24 Dec 2023 at 22:43

I watch quite a lot of videos by an American doctor by the name of Mark Scholz  MD on YouTube and I like his balanced views with regard to prostate cancer and for example his advice and reluctance to treat patients of a certain age aggressively for prostate cancer.

For example, tonight I was watching a video with the title "prostate cancer diagnosis over 80"  in which Dr Scholz was commenting that giving aggressive treatment to someone in that age group might be counter-productive because at that stage in life the cancer is usually so slow progressing that it might be of little or no benefit to treating the cancer aggressively. 

Does anyone else reading this have any other favorite "gurus," for want of a better words, spreading the word about different treatments for prostate cancer on YouTube? Thank you.

The basic message I get from this doctor is that prostate cancer is very age dependent and there is not just one size fits all and that one should look at a lot of options including active surveillance or words to that effect. 

 

I like the fact that he's very frank about the side effects of different options in treatments of prostate cancer. One should look at the situation in a global way. Dr Scholz advocates second and third opinions before opting for potentially dramatic life-changing treatments like hormone therapy.

Edited by member 24 Dec 2023 at 22:48  | Reason: Not specified

User
Posted 25 Dec 2023 at 09:05
Firstly I have to say that I avoid Youtube for pretty much anything except entertainment as it is a free for all and completely unregulated. It's also a money making enterprise that encourages outrageous claims, comments and activities designed to create more views and thus money for the creator.

Having said that, the idea that only performing the minimum amount of treatment based on age, quality of life and life expectancy is nothing new and has been around since the dawn of modern medicine. Someone in their 80's is far more likely to be offered palliative care than a radical medical procedure.

Given that PCa is a slow growing cancer, and that it is generally accepted that most men will die WITH PCa and not because of it - non-treatment is definitely an option in the older generation in order to maintain QUALITY of life in their final few years.

Now, you mentioned that this doctor was American and that adds another slant to it. Having lived in the US for 14 years, you develop an understanding of how the American health system works and the huge power, both financially and politically of the drug and medical care companies. The system works of action and procedures - not on let's wait and see. You are much more likely, regardless of age etc, to be offered a full set of procedures aimed at cure in the US than probably anywhere else simply because, for those that can pay and/or have the insurance, the medical resources are virtually unlimited.

The idea of getting a second and third opinion is also a stateside process - you might manage it under the NHS but you will probably be waiting a very long time.

You don't mention your age and where you live - both will influence what treatments are offered.

User
Posted 25 Dec 2023 at 09:44

Thank you, Doctor.

Age 67, North of England, near Leeds. 

I'll keep those things in mind. 

User
Posted 26 Dec 2023 at 21:19

I'm having a biopsy tomorrow and if the result indicates that cancer has spread outside the capsule and potentially later becomes metastatic (almost a certainty ) making surgical procedure such as prostatectomy impossible or ill advised I'm wondering if anyone has ever considered to opt not to be treated with hormone therapy and radiation in the following months and years because especially with hormone therapy it does not appeal to me at all with the side effects and everything else. 

The side effects of hormone therapy including diabetes, impotence and other things are of great concern I feel but it seems many people or most prostate cancer patients accept the hormone therapy and chemical therapy if their Gleason score is in that number range (9/10) where surgery is not advised or possible. It is stressful just to think about all of this.

Thank you. 

User
Posted 26 Dec 2023 at 21:52

Originally Posted by: Online Community Member

I'm having a biopsy tomorrow and if the result indicates that cancer has spread outside the capsule and potentially later becomes metastatic (almost a certainty ) making surgical procedure such as prostatectomy impossible or ill advised I'm wondering if anyone has ever considered to opt not to be treated with hormone therapy and radiation in the following months and years because especially with hormone therapy it does not appeal to me at all with the side effects and everything else. 

The side effects of hormone therapy including diabetes, impotence and other things are of great concern I feel but it seems many people or most prostate cancer patients accept the hormone therapy and chemical therapy if their Gleason score is in that number range (9/10) where surgery is not advised or possible. It is stressful just to think about all of this.

Thank you. 

 

maybe try not to over think, and wait until you know for certain. Then listen to your doctors advice, have a list of questions. Then decide.

 

User
Posted 26 Dec 2023 at 22:15

Thank you, Sir. I'll keep that in mind. 

User
Posted 27 Dec 2023 at 00:07

Originally Posted by: Online Community Member

I'm wondering if anyone has ever considered to opt not to be treated with hormone therapy and radiation in the following months and years because especially with hormone therapy it does not appeal to me at all with the side effects and everything else. 

I considered doing nothing when first diagnosed but had a prostatectomy. I'll probably consider doing nothing if I get a recurrence, but I bet I do, because considering the consequences if I don't, will make me see sense.

 

User
Posted 27 Dec 2023 at 00:22
My father-in-law was diagnosed at age 79 with a fully contained T2 Gleason 7 (3+4) adenocarcinoma. He refused RT / HT because he was worried about the impact on his sex life - his wife was 18 years younger than him. He died within 4 years as a result of metastatic spread to the liver & kidneys leading to sudden onset oedema which stopped his heart 24 hours after the mets were identified.

Just for the purpose of clarity, HT does not cause impotence - it causes a loss of libido. In other words, many men can still get an erection but have no desire to use it. The impotence is caused either by radiation damage to the nerve bundles (often 5 - 10 years after the RT was actually delivered) or by penile atrophy, which is irreversible.

Also, prostate cancer can be fully contained within the gland but still be metastatic.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 27 Dec 2023 at 00:31

I think Turkeys advice is best. I can't see any point in trying to resolve this moral and philosophical problem until it becomes a practical one, which it will be when you get the biopsy results. Then you will have a diagnosis and know what you are dealing with.

Dave

 
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