Podcasts about gleason score

In "Episode 4" of the series on "Present and future of diagnostics in Prostate Cancer", Dr. Rossella Nicoletti (IT) and Prof. Eva Compérat (FR) present the case against renaming Gleason score 6 Prostate Cancer.They discuss the strong pathological arguments for keeping the "cancer" designation, pointing to the morphological and molecular evidence that supports this classification. Prof. Comperat highlights the risks of causing confusion within the clinical and research communities if Gleason score 6 were no longer considered cancer.The episode also addresses the potential impact on prostate cancer reporting and the broader implications for treatment decision-making. This discussion presents a compelling counterpoint to the proposal of renaming Gleason score 6, emphasising the importance of consistency in cancer classification.For more EAU podcasts, please go to your favourite podcast app and subscribe to our podcast channel for regular updates: Apple Podcasts, Spotify, EAU YouTube channel.

Dr. Hoffman continues his conversation with integrative urologist Dr. Geo Espinosa.

In this emergency episode of the Intelligent Medicine Podcast, Dr. Ronald Hoffman and integrative urologist Dr. Geo Espinosa discuss the recent announcement of former President Joe Biden's advanced prostate cancer diagnosis. They delve into the nuances of PSA testing, the implications of prostate cancer staging, and the treatments Biden may face. The conversation also highlights the importance of an integrative approach, including dietary recommendations, supplements, and exercise, to manage side effects and improve quality of life for patients undergoing androgen deprivation therapy. Dr. Espinosa shares his expertise on the subject and offers insights into managing advanced prostate cancer.

In "Episode 3" of the series on "Present and future of diagnostics in prostate cancer", Assoc. Prof. Paweł Rajwa (PL) and Prof. Scott Eggener (US) engage in a thought-provoking discussion about renaming Gleason 6 (Grade Group 1) prostate cancer.The episode digs into the reasons why many experts believe this change is necessary, and the potential benefits it could bring to clinical practice, particularly in reducing overdiagnosis/overtreatment and improving patient outcomes. Prof. Eggener discusses the argument that Gleason 6 (Grade Group 1) might not behave like typical cancer, as it rarely leads to metastasis or death, and that renaming it could positively guide management decisions, particularly with active surveillance.The conversation touches on the implications of this change on prostate cancer screening and how it could alter the way clinicians approach diagnosis and treatment in the future.For more EAU podcasts, please go to your favourite podcast app and subscribe to our podcast channel for regular updates: Apple Podcasts, Spotify, EAU YouTube channel.

It's estimated that this year, on average, 76 Canadian men will be diagnosed with prostate cancer every day. In Canada, prostate cancer makes up 22% of all cancer diagnoses in men. However unlike many cancers, prostate cancer is a condition that you can live and even thrive with. Here, Dr. Peter Nord and Dr. Rajiv Singal hear from two Medcan clients who were diagnosed and treated for prostate cancer here at Medcan. Hear about their experiences, how you can prevent prostate cancer, and why a diagnosis does not have to hold you back from living a long and happy life.  LINKS Visit our Men's Health webpage to learn more about your prostate cancer risk and stay up to date on your screening. See more prostate cancer statistics from the Canadian Cancer Society Read some of the latest research on prostate cancer prevention and management: ”...higher intake of plant foods after prostate cancer diagnosis was associated with lower risk of cancer progression,” from this 2024 study in JAMA Network Open KEY MOMENTS 00:57 How common is prostate cancer? 03:44 Your risk goes up with age 4:58 It might not affect your quality of life at all 6:54 Men don't always advocate for their health 7:55 Meet two Medcan clients who were diagnosed with prostate cancer 9:19 What is PSA? 11:59 Prostate cancer screening: MRI, PSA ratio and biopsy 14:08 Experience and risk of getting a biopsy 16:22 The Gleason Score, and stages of prostate cancer 20:50 Is it cancer or BPH? (benign prostatic hyperplasia) How to know 23:47 Does testosterone increase your risk of prostate cancer? 25:02 Your PSA trend matters more than your current levels 26:24 A regular GP may not have caught this Medcan client's cancer 27:55 Treatment options: radiation vs surgery 30:55 The importance of being proactive about your health and recovery  31:34 One man's post-surgery 10,000 step streak 34:36 Surgery results and recovery 36:52 Lifestyle choices that can prevent an enlarged prostate 37:36 Tips from two of Dr. Singal's patients  

Drs Sandhya Srinivas and Tanya B. Dorff discuss metastatic hormone-sensitive prostate cancer, which patients are the best candidates for doublets vs triplets, and how we pick these patients. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/988737). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Prostate Cancer https://emedicine.medscape.com/article/1967731-overview Metastatic Hormone-Sensitive Prostate Cancer: Toward an Era of Adaptive and Personalized Treatment https://pubmed.ncbi.nlm.nih.gov/37220335/ Triplet or Doublet Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Updated Network Meta-Analysis Stratified by Disease Volume https://pubmed.ncbi.nlm.nih.gov/37055323/ PSMA PET in Imaging Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/35155262/ Risks and Cancer Associations of Metachronous and Synchronous Multiple Primary Cancers: a 25-Year Retrospective Study https://pubmed.ncbi.nlm.nih.gov/34556087/ The Promise of Metastasis-Directed Therapy for Oligometastatic Prostate Cancer: Going Beneath the Surface With Molecular Imaging https://pubmed.ncbi.nlm.nih.gov/35058322/ Gleason Score https://www.ncbi.nlm.nih.gov/books/NBK553178/ Luteinizing Hormone-Releasing Hormone (LHRH) Receptor Agonists Vs Antagonists: a Matter of the Receptors? https://pubmed.ncbi.nlm.nih.gov/23418666/ The Role of CYP17A1 in Prostate Cancer Development: Structure, Function, Mechanism of Action, Genetic Variations and Its Inhibition https://pubmed.ncbi.nlm.nih.gov/29372682/ Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Long-Term Survival Analysis of the Randomized Phase III E3805 CHAARTED Trial https://pubmed.ncbi.nlm.nih.gov/29384722/ Abiraterone for Prostate Cancer Not Previously Treated With Hormone Therapy https://pubmed.ncbi.nlm.nih.gov/28578639/ Abiraterone Plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/28578607/ Health-Related Quality of Life in Metastatic, Hormone-Sensitive Prostate Cancer: ENZAMET (ANZUP 1304), an International, Randomized Phase III Trial Led by ANZUP https://pubmed.ncbi.nlm.nih.gov/34928708/ Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/35179323/ Abiraterone Plus Prednisone Added to Androgen Deprivation Therapy and Docetaxel in De Novo Metastatic Castration-Sensitive Prostate Cancer (PEACE-1): a Multicentre, Open-Label, Randomised, Phase 3 Study With a 2 × 2 Factorial Design https://pubmed.ncbi.nlm.nih.gov/35405085/

Dr. Geo converses with Dr. Herb Lepor, the esteemed Chairman of Urology at NYU Langone Health. (Quick note: He's also Dr. Geo's boss, so expect some fun dynamics!) Dr. Lepor's deep involvement in this field, particularly alongside Dr. Patrick Walsh, makes him an authority. Together, they delve into their co-authored research on the nerve-sparing technique, tracing its origin and understanding its significance in today's medical paradigm.In this episode, they explore:- The latest breakthroughs in prostate cancer treatments.- A comparative discussion on open versus robotic prostatectomy.- A deep dive into focal therapies and where prostate cancer treatments are headed.But there's more to medicine than just procedures and techniques. Dr. Lepore is approaching a rare milestone: 30 years as the chair of a medical department. What does leading with consistency and vision take in an ever-evolving domain like urology? Dr. Lepore shares his insights, challenges, and the human side of his extraordinary journey.Join Dr. Geo as he engages with Dr. Herb Lepore, exploring the advancements in prostate cancer care and the stories behind a stellar leadership legacy._____________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy...

Join Dr. Geo in today's insightful episode, where he unravels some surprising facts about the male porn industry with our guest, Dr. Justin Dubin, an acclaimed urologist and andrologist from Memorial Healthcare Systems in Miami.They delve into a lesser-known side of male porn stars, unearthing their struggles with erectile dysfunction. But that's not all. Dr. Dubin throws light on the risks associated with telehealth TRT (testosterone replacement therapy) clinics, revealing some shocking truths about the lack of appropriate patient evaluation and over-prescription of testosterone.A specialist in male sexuality, Peyronie's disease, and testosterone treatment, Dr. Dubin's work isn't confined to the walls of a hospital. He extends his expertise to a broader audience through his podcast "Man Up: A Doctor's Guide to Men's Health." In this episode, he shares his unique experiment: calling several TRT clinics with a faux case, only to be met with uninformed treatment suggestions.Get ready for an informative and engaging episode with Dr. Geo and Dr. Dubin where they talk about the myths and introduce us to the actualities of male health concerns. Dive deep into the intricacies of the male porn world, TRT clinics, and more!Tune in, and let's demystify the complexities of men's health together!___________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate...

Join Dr. Geo in a captivating conversation with Dr. Eric Yarnell, a renowned naturopathic doctor, and urology specialist, as they explore the intriguing world of urinary tract health. With their shared narrow specialty, they delve deep into urological conditions, including the notorious kidney stones that affect both men and women. Dr. Yarnell's commitment to personalized care and addressing the root causes behind symptoms aligns perfectly with the principles of naturopathic medicine. With his extensive expertise in herbal medicine and urology, Dr. Yarnell offers invaluable insights into the use of botanical remedies for treating various urological problems. Discover their dynamic exchange, where they discuss prescribing techniques, tinctures versus pills, and uncover the most suitable botanicals for specific conditions. Don't miss this enlightening episode featuring Dr. Eric Yarnell, the expert who shares Dr. Geo's passion for narrowing the focus in urology, as they bring you closer to a holistic approach to urological well-being.___________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement...

In this episode, Dr. Geo interviews Dr. Muhammad Minhaj Siddiqui, a renowned urologic oncology and robotic surgery specialist at the University of Maryland Medical Center. They explore the topic of active surveillance for prostate cancer, particularly focusing on Gleason 7 cases. Dr. Siddiqui shares his insights on determining the ideal candidates for active surveillance and discusses the correlation between prostate cancer metabolism and diet. They also discuss Dr. Siddiqui's research on the association between vasectomies and lethal prostate cancer. Join us for this enlightening conversation on urologic oncology and gain valuable insights from Dr. Siddiqui's expertise._______________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement Store____________________________________DISCLAIMER: This audio is educational and does not constitute medical advice. This audio's content is my opinion and not that of my employer(s) or any affiliated company.Use of this...

On this episode, join Dr. Geo for a captivating conversation with Dr. Alan Christensen is a distinguished board-certified naturopathic endocrinologist specializing in thyroid care. Dr. Christensen, a celebrated New York Times bestselling author, recently penned the enlightening book, "The Hormone Healing Cookbook," which takes center stage in today's podcast.In this engaging conversation, Dr. Geo and Dr. Chritensen explore the fascinating relationship between food and hormones. Departing from the realm of laboratory values and numbers, Dr. Christensen takes a practical approach, focusing on five key symptoms indicating hormonal imbalances, including night sweats, fatigue, insomnia, and more, and further suggests that a hormonal imbalance might present if you identify with these symptoms. Dr. Christensen delves into testosterone, sharing insights on natural approaches to increase testosterone levels for individuals seeking to optimize their hormone balance.Tune in to discover practical ways to address hormonal imbalances through the power of nutrition. Join us for an intriguing conversation with Dr. Alan Christensen, esteemed author of the Hormone Healing Cookbook, and gain valuable insights to help you control your hormonal well-being._____________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition:

In today's episode, Dr. Geo sits with Dr. Philip Pirurazio, esteemed Chief of Urology at the Penn University of Pennsylvania, Department of Urology in Philadelphia. Dr. Phil is also a renowned lecturer on wellness and physician well-being, and he has even created his podcast called "Operate with Zen." This podcast delves into the intersection of mindfulness, medicine, and surgery, offering a scientific and data-driven approach to these subjects. Join us for this enlightening conversation with Dr. Phil, a leading figure in the field of urologic oncology and an expert in prostate cancer. Together, Dr. Geo and Dr. Phil explore the transformative power of mindfulness in medicine, offering a glimpse into the future of holistic patient care. Get ready to be inspired as we embark on this learning journey with Dr. Phil from the University of Pennsylvania. Let's dive in!____________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement...

In today's podcast episode, Dr. Geo sat down with Craig Weiss, a venture capitalist, serial entrepreneur, and published author. Craig is the managing member of Flagstaff Ventures, a venture capital firm that focuses on early-stage consumer products and services. He co-founded and was CEO of the Venture-backed Retainer Club and Mouthguard Club. Additionally, he spent three and a half years as president and CEO of NJOY Inc. and Joy, leading the company to a remarkable $1 billion valuation.Craig's distinct viewpoint on venture capitalism added an extra layer to the conversation with Dr. Geo. While venture capitalists' perception often revolves around focusing solely on financial gains, Craig challenges this notion. Join Dr. Geo in exploring the realm of holistic venture capitalism with Craig Weiss, gaining insights into a more conscious and purpose-driven approach to investment and entrepreneurship.____________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement...

In this special Father's Day episode, join Dr. Geo in a candid conversation about fatherhood. From prostates to penises and testosterone to tender moments, Dr. Geo talks about the multifaceted realm of being a father.While he admits he hasn't always had all the answers, Dr. Geo's commitment to growth shines through. Through introspection and self-discovery, he shares his evolving process of being a Father and the valuable insights he gained this past year. Get ready to laugh, learn, and be inspired as Dr. Geo unveils his three key takeaways from this transformative year of being a Dad to two young ladies and an 11-year-old boy.________________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement Store____________________________________DISCLAIMER: This audio is educational and does not constitute medical advice. This audio's content is my opinion and not that of my employer(s) or any affiliated company.Use of this information is at your own risk....

In this episode, Dr. Geo talks to Dr. Stephen Scionti, a renowned urologist and prostate cancer specialist. Dr. Scionti founded the Scionti Prostate Cancer Center, a leading facility that provides comprehensive diagnostic services, including MRI fusion targeted biopsy. With over 20 years of experience, he has become an expert in thermal ablation technologies such as HIFU, TULSA, and cryoablation.Join Dr. Geo and Dr. Scionti as they embark on an insightful journey into focal ablation therapy for prostate cancer, leveraging Dr. Scionti's wealth of knowledge and expertise. Together, they unravel the concept of focal therapy, delving into its diverse technologies and how they revolutionize the treatment of prostate cancer.In this engaging conversation, they delve into critical considerations: Who are the perfect candidates for these groundbreaking treatments? What sets focal ablation apart from conventional approaches? Prepare to have these and more thought-provoking questions answered as they navigate the intricacies of focal therapy, offering valuable insights and shedding light on this innovative approach to prostate cancer treatment.___________________ Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy...

In this enlightening podcast, join Dr. Geo as he engages in a fascinating conversation with Jim Dew, an advisor to entrepreneurs, CEOs, and the visionary founder of Dew Wealth Management. With an impressive track record spanning nearly three decades, Jim's unparalleled expertise in building virtual family offices for entrepreneurs has earned him a reputation as a trusted guide in finance.Together with his wife Mimi, Jim leads a highly successful wealth management company that has transformed the lives of countless individuals. Their unwavering commitment to providing invaluable guidance and support in finance has empowered individuals to achieve their financial goals and aspirations.Dr. Geo and Jim delve into the intricate relationship between wealth and health in this thought-provoking conversation; they explore the profound influence of our money stories on our overall health. They emphasize the significance of understanding the origins of our money mindset, often rooted in childhood experiences. Unbeknownst to many, these stories can shape our financial behaviors and affect our physical and mental health.Through their insightful dialogue, Dr. Geo and Jim shed light on strategies and practical approaches to cultivate a healthier relationship with money. Tune in to today's podcast as Dr. Geo and Jim Dew unravel the secrets to achieving wealth and health. ____________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines:

Join Dr. Geo in this episode as he engages in a fascinating conversation with Dr. Rana McKay, a renowned medical oncologist specializing in prostate, bladder, kidney, and testicular cancer. As an associate professor at UC San Diego School of Medicine, Dr. McKay delivers exceptional patient care and imparts her extensive knowledge to medical students, residents, and fellows.In this enthralling discussion, Dr. Geo and Dr. McKay explore the intricacies of Androgen Deprivation Therapy (ADT), a vital approach in the treatment of prostate cancer. Together, they shed light on the characteristics defining an ideal candidate for ADT and clarify the true nature of advanced prostate cancer.They uncover valuable insights into the average duration of ADT's effectiveness for men confronting advanced prostate cancer. The conversation also encompasses exploring the various types of ADT, including the intriguing concept of chemical castration. This approach offers significant promise by utilizing medications to lower androgen levels and impede the growth of prostate cancer cells. Furthermore, Dr. Geo and Dr. McKay delve into the fascinating realm of bipolar androgen therapy, an alternative approach that involves carefully calibrated testosterone doses. This discussion challenges conventional wisdom and expands our understanding of the potential benefits of this therapeutic strategy.Prepare to enrich your knowledge and gain a deeper understanding of the crucial role of androgen deprivation therapy in patients' lives. Join us for an insightful journey with Dr. Rana McKay and Dr. Geo as they explore the intricacies of this essential treatment approach.__________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook,

In this episode, Dr. Geo provides valuable insights into the role of these often overlooked nutrients in reducing the risk of heart disease and strokes. By incorporating them into your daily routine, you can take proactive steps toward maintaining a healthy cardiovascular system.Don't miss out on this episode packed with evidence-based information and practical tips to improve your heart health. Subscribe to the podcast and join Dr. Geo as he delves deeper into the five essential nutrients that can significantly reduce the risk of heart attacks and strokes.---------------Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also sponsored by Calroy Health and Sciences, presenting their revolutionary combination of products for vascular health. Arterosil HP® supports the structure and normal function of the endothelial glycocalyx, and their New Nitric Oxide Support with Calroy's proprietary Vascanox HP formula targets nitric oxide metabolism using multiple pathways.This Dr. Geo Podcast is supported by AG1 (Athletic Greens). AG1 contains 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, nervous system, immune system, energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations

On today's episode of the Dr. Geo podcast, we have a special guest, Dr. Mohit Khera, a renowned urologist and professor in the Scott Department of Urology at Baylor College of Medicine. He holds the F. Brantley Scott Chair in Urology and has extensive experience treating male and female sexual dysfunction, men's health, and hormone replacement therapy.This captivating episode reveals the intricate relationship between testosterone and the prostate. Throughout the episode, we explore the nature of testosterone, its receptors, and its effects on the body. We also address controversies surrounding testosterone and its relationship to the prostate, including the development of prostate cancer. Join us as we gain insights from Dr. Khera's wealth of knowledge on this fascinating topic._________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement Store____________________________________DISCLAIMER: This audio is educational and does not constitute medical advice. This...

In today's podcast, Dr. Geo discusses the importance of understanding successful aging. Defining aging is the first step in this process, as it provides a clear target to aim for.How can we age successfully? That's the question we'll be exploring in today's podcast. Join Dr. Geo as he dives into the factors contributing to successful aging and how you can optimize your health and well-being as you age.______________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement Store____________________________________DISCLAIMER: This audio is educational and does not constitute medical advice. This audio's content is my opinion and not that of my employer(s) or any affiliated company.Use of this information is at your own risk. Geovanni Espinosa, N.D., will not assume any liability for any direct or indirect losses or damages that may result from the use of the information contained in this video, including but not limited to economic loss, injury, illness, or death.

In this inspiring episode, join Dr. Geo as he interviews Dr. Ralph Moss about his personal journey through prostate cancer. From their initial acquaintance to the friendship they share today, Dr. Moss opens up about the life-changing diagnosis and the emotional rollercoaster he experienced. Listen as he recounts the story of finding a comprehensive cancer center and his determination to seek the best care. This conversation is filled with heart, humor, and insights. Tune in to learn more about Dr. Ralph's Moss journey. _____________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement Store____________________________________DISCLAIMER: This audio is educational and does not constitute medical advice. This audio's content is my opinion and not that of my employer(s) or any affiliated company.Use of this information is at your own risk. Geovanni Espinosa, N.D., will not assume any liability for any direct or indirect losses or damages that may result from the use of...

In this episode, Dr. Geo and Dr. Bilal Chughtai explore the topic of an overactive bladder, providing a detailed explanation of the workings of the bladder and how it functions. The hosts also touch upon the receptors around the bladder and, in men, between the bladder and the prostate that assist with urination. They then delve into the causes and symptoms of overactive bladder, characterized by an overstimulation of the muscarinic receptors, leading to sensitivity to even low volumes of fluid in the bladder. The hosts note that an overactive bladder is more prevalent in women than men. Overall, this episode provides a comprehensive overview of the bladder's mechanisms and sheds light on the causes and symptoms of an overactive bladder.More about our guest, Dr. Chugtail https://weillcornell.org/bchughtai1Link to the book, Healing in Urology: https://amzn.to/3LgWmQ4----------------Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement...

Scott Eggener, MD, University of Chicago, and Jonathan Epstein, MD, The Johns Hopkins Medical Institutions, join the show to debate whether Gleason Score 6 prostate cancer should be renamed to non-cancer. The trio hit on what should happen upon diagnosis and Gleason grade 6, which patients should be offered active surveillance, the benefits and risks of not calling this diagnosis “cancer,” how often and how frequently to biopsy, overscreening, and many other discussion points. Read Dr. Eggener's editorial in the Journal of Clinical Oncology. https://ascopubs.org/doi/full/10.1200/JCO.22.00123 Read Dr Epstein's response in the Journal of Clinical Oncology. https://ascopubs.org/doi/full/10.1200/JCO.22.00926 Check out Chadi's website for all Healthcare Unfiltered episodes and other content. www.chadinabhan.com/ Watch all Healthcare Unfiltered episodes on Youtube. www.youtube.com/channel/UCjiJPTpIJdIiukcq0UaMFsA

Getting a cancer diagnosis is never easy especially if it comes without warning. My guest today is JW Cheatham, a prostate cancer survivor, and a family friend. JW is Project Compliance and Management Consultant who has spent the last 25 years in the Space Satellite Technology field. Hearing about someone's cancer journey can really help convey a different aspect or a unique viewpoint from that of someone such as myself. Listen in as JW reveals what his experience was like going through his own cancer journey and his advice for others on a similar path. You will hear how JW came to his “pause point” when he found out he had cancer, how he weighed his options for treatment, and what life was like after his prostatectomy. He also shares why he believes it's crucial to get a full health check-up early on rather than waiting till later in life.   What You'll Learn: Why I think it's important to have interviews with people who've gone through their own cancer journey. (2:12) What to look out for when approaching retirement age, medically speaking. (4:13) Reasons why it's critical to have the prostate gland checked periodically. (8:02) JW reveals how his health care provider explained JW's Gleason Score. (9:25) The value of talking to others around us about what we're going through. (13:05) JW wasn't overwhelmed with all of the options and where he was with his decision on how to move forward. (18:11) The possibility of recurrence after JW's surgery. (20:02) Life after surgery. (23:23) Although JW was informed about what he would expect after surgery, he feels the details weren't there. (27:24) The pre-op discussion about the differences between incontinence and erectile dysfunction. (30:21) The importance of honesty in healthcare. (32:45) How JW is feeling today and what advice he's given to others. (35:17) Incontinence was easier for JW at night. (38:50) The difficulties of dealing with erectile dysfunction. (42:30) Talking about “it” helps you get over “it.” (45:01) The benefits of connecting with others who've gone through similar experiences. (47:44) JW shares his final thoughts. (51:12)   Ideas Worth Sharing: “We're always looking for pain as an indicator that you have a problem of some sort, and that was not really the case.” - JW Cheatham   “There's a pause point that you get to when someone says, ‘You have cancer.' It makes you stop.” - JW Cheatham   “I think it's better to talk to people every chance you get [about what you're going through].” - JW Cheatham   “Your body has its own time to heal… [but] you have to get past your own thoughts.” - JW Cheatham   “I think it's really important as healthcare providers that we be very honest about what are the potential side effects [and] what are the potential toxicities associated with our treatment.” - Dr. Rosalyn Morrell   Resources: Rosalyn Morrell, MD: Website https://www.centerpointoncology.com/ Episode 10: My Cancer Journey with Kimberly Sizemorehttps://www.cancerfromatoz.com/episodes/10 Episode 17: From Cancer to Cameras; My Cancer Journey with Beth Younghttps://www.cancerfromatoz.com/episodes/17

In part two of this two-part episode, KP continues to share his personal story about his diagnosis of early-stage, moderately aggressive prostate cancer. As a young black male with no known prior history, he was significantly under the age to be screened for this condition. But he got screened early, and is thankfully cancer free after treatment from great physicians. In this conversation, KP is joined by Ahmad Garrett-Price MD, a board certified family physician and the founder of GP Health. As a top family physician, Ahmad brings the clinical view as well as the context surrounding this issue. The two discuss KP's cancer journey, Ahmad's clinical expertise and experience, and the importance of examining the context surrounding men's health in the Black community.Main Topics Receiving the diagnosis, beginning the treatment journey, and navigating both a professional and a personal life (1:34) Understanding options for treatment, the Gleason Score, and how KP made the choice to take an aggressive treatment plan (9:40) How surgical treatment options can present roadblocks especially for communities of color (16:25) How lack of information and education prevents early detection and treatment (24:05) KP's journey to choosing a radical prostectomy via a robotic procedure and the key differences between open and robotic procedure (28:34) KP's pivot from indecision over treatment to moving forward in making a decision to treat as soon as possible— and the importance understanding the risks and potential outcomes of any procedure (35:27) KP's relationship with his “cancer buddy” and how he was armed with information that removed anxiety from the treatment and recovery process (39:40) The preparation, procedure and recovery journey, and the challenges of navigating the process as an entrepreneur, a father and a husband (42:35) Preparing for life after the procedure and the importance focusing on mental and physical wellness (51:30) The importance of getting screened early (1:00:00) Show Resources: https://www.pcf.org/about-prostate-cancer/diagnosis-staging-prostate-cancer/gleason-score-isup-grade/Connect with Ahmad:https://www.linkedin.com/in/ahmad-garrett-price-md-3438b0148/Connect with KP:linkedin.com/in/kaakpema-kp-yelpaala-379b269/https://twitter.com/inonhealthinonhealth.com/podcastinonhealth.com/Listen, rate, and subscribe!Apple Podcasts Spotify Google Podcasts

Men are about performance. Men have a desire and drive to perform. But when the word cancer is spoken to them by their doctor and they get told they have a Gleason 6 score, a man's entire world changes. For the first time, a man is facing mortality and thinking they could die sooner rather than later. Men - having a Gleason 6 score is not the end of the world. In fact, it's a blessing. In this episode of the Dr. Geo Podcast, Dr. Geo breaks down the Gleason score and why being given a Gleason 6 score is a good thing. He also goes into treatment options for Gleason 6 and why a proactive surveillance method around prostate cancer is the most optimal. Listen to this episode to learn: -How a Gleason 6 Score Can Change Your Life for The Better -What's the Gleason Score for Prostate Cancer -What Are the Treatment Options for Men With Gleason 6 -- Thanks for tuning in to this episode of the Dr.Geo Podcast! If you loved what you heard, please leave a review and rating on https://podcasts.apple.com/us/podcast/id1609860250 (Apple Podcasts). You can also listen to this episode and future episodes on many of the major podcast platforms by clicking https://link.chtbl.com/8Z6hUclo (here). -- For the latest research in men's health and more, visit https://drgeo.com/ (drgeo.com). Follow Dr. Geo on Social Media https://www.facebook.com/drgeoespinosa/ (Facebook) https://www.instagram.com/Real_DrGeo/ (Instagram) https://twitter.com/drgeoespinosa (Twitter)

One of our more popular episodes was with Dr. Simon Kim in Episode 7. For today, we are bringing that episode out of the vault.  Receiving a prostate cancer diagnosis can be a frightening experience that could cause much anguish for men and their loved ones. We are fortunate to have Dr. Simon Kim, a urologic oncologist, as our guest for the show today to walk you through the process. In this episode, Dr. Kim explains what it all means. He discusses the various options and clarifies where to go from there. Stay tuned for more!  Dr. Kim is a board-certified urologic oncologist at the University of Colorado's Anschutz Medical Campus. He has worn many hats including Director of Robotic Surgery. Dr. Kim's clinical practice focuses on the surgical management of prostate, bladder, kidney, testes, adrenal, and penile cancer. He has been independently funded by the NIH to develop decision aids for men diagnosed with localized prostate cancer. He has published more than 180 manuscripts and serves as assistant editor for the Journal of Urology. Be sure to listen in today to get Dr. Kim's expert advice. Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Show Highlights: What it means to be a urologic oncologist and what it takes to become one. Dr. Kim explains how he typically delivers the biopsy results. Dr. Kim shares his recommendations for men in preparing for a prostate cancer consultation. Dr. Kim recommends some reliable online resources for prostate cancer patients (see the links below!). The kind of information you can expect to receive from a pathology report. The information that is obtained from the Gleason Score. The guidelines that Dr. Kim relies on when making his decisions. The criteria that Dr. Kim uses for determining who does and doesn't need additional imaging at the time of the diagnosis. A brief rundown of the typical discussion that Dr. Kim has with his patients regarding their treatment options and the various risk groups. Dr. Kim is busy initiating a multi-disciplinary clinic for cancers. Looking at some different therapies, like cryotherapy, for prostate cancer. Dr. Kim talks about the Conquer Cancer Foundation, which recently honored him with an award. The outcome for localized prostate cancer is usually very good. Remaining fully informed is key for prostate cancer patients.   Links and resources: Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link here, on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up for the wait-list for our bonus video content.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here. Additional Resources: Journal of Urology American Cancer Society American Urologic Association  Know Your Options  Conquer Cancer Foundation 

In dieser Folge geht es um das Prostatakarzinom, die Diagnostik, die Interpretation, ob jedes Karzinom auch behandelt werden muss... Es geht jedoch nicht nur um die Medizin, sondern auch darum, wie mit der Diagnose umgegangen werden kann, welchen zeitlichen Rahmen sich betroffene nehmen können um eine Therapieentscheidung treffen zu können und viele spannende zwischenmenschliche Aspekte. Zu vielen weiteren Themen wie dem PSA, dem Gleason Score, Therapieoptionen... wird es je einen eigenen Podcast geben. Diese Wenn Ihr weitere Fragen habt, schreibt uns einfach unter: info@die-prostata-im-fokus.de Wenn Ihr Euch noch weiter einlesen wollt, kommt auf: www.die-prostata-im-fokus.de www.der-prostataspezialist.com Tumorzellen in der Blutbahn: https://www.maintrac.de/media/Presse/DZO_Forschung_Pachmann.pdf

Dr. Neeraj Agarwal, director of the Genitourinary Oncology Program at the University of Utah Huntsman Cancer Institute and associate editor of ASCO Daily News, highlights key abstracts in GU oncology featured at the 2021 ASCO Annual Meeting.   Transcript: ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. My guest today is Dr. Neeraj Agarwal, a medical oncologist and director of the Genitourinary Oncology Program at the University of Utah Huntsman Cancer Institute. He joins me to discuss key abstracts in the GU field featured at the 2021 ASCO Annual Meeting.   Dr. Agarwal has served in a consulting or advisory role for AstraZeneca, Bristol Myers Squibb, Exelixis, and Merck, among other organizations. He is a co-author of a study, Abstract 5073, that will be discussed in this episode. Dr. Agarwal's full disclosures and those relating to all episodes of the podcast are available on our transcripts at asco.org/podcasts.   Dr. Agarwal, it's great to have you on the podcast again.   Dr. Neeraj Agarwal: It's my pleasure, and an honor. Thank you very much for having me.   ASCO Daily News: Dr. Agarwal, let's start with some exciting news in the field of kidney cancer. LBA5 addressed the Keynote 564 trial, which evaluated pembrolizumab versus placebo as adjuvant therapy for patients with renal cell carcinoma. This study reported stunning results. What can you tell us about this trial?   Dr. Neeraj Agarwal: These are very important results from the Abstract LBA5, which is being presented by Dr. Toni Choueiri, from Dana Farber Cancer Institute, and colleagues on interim results from the KEYNOTE-564 trial, which showed that adjuvant therapy with pembrolizumab after complete resection of intermediate high, high-risk, localized or oligometastatic renal cell carcinoma improves survival outcomes.   So, let me give you a background first. Partial and radical nephrectomy is considered standard of care for treatment of men or women with localized renal cell carcinoma. However, approximately half of these patients eventually recur. In addition, many patients with limited metastatic disease undergo surgical resection.   Currently, there is no standard of care systemic therapy available for these patients. So, the KEYNOTE-564 study is a phase III trial evaluating pembrolizumab versus placebo--which is a standard of care, by the way, for these patients as adjuvant therapy for patients with clear cell renal cell carcinoma with intermediate high risk, high-risk, or those with metastatic disease who have undergone complete resection of metastatic disease.   Primary endpoint was disease-free survival for investigator assessment, in intent-to-treat population. Overall survival was a key secondary endpoint. In this study, a total of 994 patients were randomized, one to one, to pembrolizumab or placebo. At the time of data cutoff, median follow up was 2 years. There were no patients remaining on the study treatment.   If you look at the baseline characteristics, they were evenly balanced between the two arms. At the first, prespecified interim analysis, the primary endpoint of disease-free survival was met, though the median values were not reached for both arms. Pembrolizumab was associated with a significantly longer disease-free survival than placebo, with a hazard ratio of 0.68 and a one-sided p-value of 0.001, which translates into 32% reduction in risk of recurrence of disease or death with adjuvant pembrolizumab.   The 2- year rate of disease-free survival was 77.3% with pembrolizumab, as compared to 68% of the placebo. Overall, disease-free survival benefit was consistent across subgroups. Median overall survival was not reached for either groups, and the estimated 24 months survival rate was high in both groups at 96% and 93.5% with pembrolizumab and placebo, respectively. And really, there were no new safety signals seen with pembrolizumab.   So, I'd like to summarize these important results by saying that KEYNOTE-564 is the first positive, phase III study with a checkpoint inhibitor for patients with renal cell carcinoma, which has been surgically resected completely. And for them, right now, there is no real standard of care after the surgical resection. So, in my view, these results support pembrolizumab as a potential new standard of care for these patients who present to us after a complete surgical resection of their renal cell carcinoma.   ASCO Daily News: Excellent. Thank you for sharing those practice-changing results. There's another late-breaking abstract that people are excited about. That's LBA4 and the VISION phase III study, which used a novel PSMA-targeting agent for patients with metastatic, castration-resistant prostate cancer. What can you tell us about the VISION trial?   Dr. Neeraj Agarwal: The VISION trial was reported by Dr. Mike Morris, from Memorial Sloan Kettering Hospital, and colleagues from across the planet. And this trial investigated the use of the Lutetium PSMA-617 in patients with metastatic, castration-resistant prostate cancer. As a background, Lutetium PSMA 617 is a targeted, radioligand therapy which delivers beta particle radiation to PSMA-expressing prostate cancer cells and surrounding microenvironment.   So, VISION was a randomized, open-label, phase III study, which evaluated Lutetium PSMA-617 in men with PSMA-positive, metastatic, castration-resistant prostate cancer, who had received prior treatment with the next generation androgen signaling inhibitors, such as enzalutamide and one or two taxane therapy regimens. Primary endpoint was radiographic progression-free survival, as well as there was another primary endpoint.   So, there were two primary endpoints--radiographic progression free survival, and overall survival. A total of 831 patients--so this is a large study--where 831 patients were randomly assigned in 2 to 1 fashion to receive Lutetium PSMA-617, plus standard of care, or standard of care therapy alone. I would like to point this out, that standard of care therapy was to be determined by the investigator, but excluded cytotoxic chemotherapy and radium 223.   The median study follow up was 20.9 months at the time of data cutoff. The baseline characteristics were well balanced between treatment arms. Lutetium PSMA-617 plus standard of care therapy significantly improved radiographic progression free survival and overall survival, versus standard of care therapy alone. The median radiographic progression free survival with lutetium PSMA-617 plus standard of care was 8.7 months, as compared to 3.4 months with standard of care alone, with a hazard ratio of 0.40, favoring the lutetium PSMA- 617.   The median overall survival with lutetium PSMA-617 plus standard of care was 15.3 months, as compared to 11.3 months with standard of care, with a hazard ratio of 0.62. These results basically translate into an absolute 4-month improvement in median overall survival, and a 38% reduction in risk of death, with PSMA-617 plus standard of care over the standard of care. I would like to point out that key secondary endpoints of objective response rates, disease control rate, and time to subsequent or first symptomatic skeletal event were statistically significant, and favored lutetium PSMA 617.   Overall, if you look at the treatment emergent adverse events, they were higher in the lutetium PSMA arm, at 52.7%, compared to those on the standard of care arm, which was 38%. And these were high grade treatment emergent adverse events. So, I'd like to conclude by saying that lutetium PSMA-617 plus standard of care treatment was a well-tolerated regimen that improved radiographic progression-free survival, and overall survival, as compared with standard of care therapy alone, in men with PSMA-positive, metastatic, castration-resistant prostate cancer, after prior treatment with novel hormonal receptor signaling inhibitors, such as enzalutamide or abiraterone and taxane chemotherapy.   Once approved by regulatory bodies, I am looking forward to using this agent in my clinic for our patients with metastatic, castration-resistant prostate cancer who have had disease progression on prior therapy with normal hormonal therapy and taxane chemotherapy. So, this is indeed a great news for our patients.   ASCO Daily News: Absolutely. Well, I'd like to ask you about adolescents and young adults with cancer. As you know, AYA patients navigate a lot of challenges in their cancer experience. Can you tell us about any studies that address this patient population?   Dr. Neeraj Agarwal: Indeed. There was an abstract--Abstract 5006, which is being presented by Dr. Hellesnes and colleagues from University Hospital of North Norway. The study team investigated non-testicular cancer mortality in relation to testicular cancer treatment in a large population-based cohort. Overall, 5,700 men, diagnosed with testicular cancer from 1980 to 2009, were included and identified from the cancer registry of Norway.   Clinical parameters and treatment data were abstracted from the medical records and linked with the Norwegian cause of death registry. During a median follow up of 18.7 years--it is a long follow up, by the way--in total, 665--or 12% of men--were registered with non-testicular cancer deaths. The overall excess non-testicular cancer mortality was 23% in men with a history of testicular cancer, as compared with the general population.   So, I'd like to repeat. There was an overall excessive non-testicular cancer mortality in men with a history of testicular cancer compared to the general population--by 23%. That's the first message I'm giving here. Second, there was an increased risk observed with platinum-based chemotherapy and radiation therapy, but not after surgery. So, I thought it was very interesting that there was an increased risk of non-testicular cancer mortality seen after platinum-based chemotherapy and/or radiation therapy, but not after surgery given the context of testicular cancer.   The standardized mortality ratios increased significantly, with increasing follow up time of 10 or more years. The most important cause of death wasn't second cancer. Treatment with platinum-based chemotherapy was associated with a significant 1.69 to 6.78-fold increased standardized mortality ratio for cancers of the oral cavity, pharynx, esophagus, lungs, bladder, and leukemia. After radiation therapy given for testicular cancer, there was an increased--significantly increased--and we are talking about 3.02 to 4.91-fold increase--the standardized mortality ratio for cancers of oral cavity, pharynx, stomach, liver, pancreas, and bladder. Even non-cancer mortality was also increased by 15% after both platinum-based chemotherapy and radiation therapy.   I would like to highlight that there was an excess in suicides after platinum-based chemotherapy with a standardized mortality ratio of 1.65. So long term, overall cardiovascular mortality--and I found it interesting, because it is going against the dogma here--that long term, overall cardiovascular mortality was not increased with either chemotherapy or radiation therapy. So, I'd like to conclude--regarding this abstract--by saying that testicular cancer treatment with platinum-based chemotherapy or radiation therapy was associated with significantly increased long term, non-testicular cancer mortality, with non-testicular second cancer being the most important cause of death in these patients.   So, in my view, these results have important implications on patient counseling, selection of treatment for testicular cancer, and, very importantly, long term follow up of our young patients with testicular cancer after they are apparently cured of testicular cancer with platinum-based chemotherapy and/or radiation therapy. And usually we stop following them, in most cases, after 5 years. And how these results are going to impact the decision making regarding their long-term follow up. So, I think this study brings up a very important issue from those perspectives.   ASCO Daily News: Absolutely. Dr. Agarwal, I'd like to get your thoughts on Abstract 5004. That addresses PSA screening for African American men. What can you tell us about this study?   Dr. Neeraj Agarwal: So, this abstract, which is Abstract 5004, presented by Dr. Edmund Qiao and colleagues, examined the association of intensity of PSA screening with the disease severity of prostate cancer at the time of diagnosis, as well as prostate cancer-specific mortality in African American men younger than 55 years of age. So, I'd like to highlight two things, which this study is presenting.   Number one, the screening intensity in African American men, and second, how it is affecting the time of diagnosis, the type of diagnosis--meaning is it a high grade or metastatic prostate cancer--and most importantly, is it affecting prostate cancer-specific mortality in African American men? So, this was a retrospective review of Veterans Health Administration records of African American men, aged 40 to 55 years, who were diagnosed with prostate cancer between the years of 2004 to 2017.   The screening intensity was defined as percentage of years screened within the pre-diagnostic observation period. The cohort included 4,654 African American men, with a mean age of 51.8 years--so quite a younger population. A median pre-diagnostic observation period of 5 years, and a median follow up of 7 years. And these are pretty decent, long median follow ups of 7 years.   So, in this large national cohort, African American men aged 40 to 55 years, increased intensity of PSA screening was significantly associated with decreased risk of metastatic prostate cancer, or high Gleason Score localized prostate cancer, and more importantly, prostate cancer-specific mortality. So, in my view, these results have important implications on how to screen African American men in the age group of 40- to 55-year-olds.   Obviously, we don't screen for prostate cancer. And please note that these are the men who are more likely than others to present and die of aggressive prostate cancer. And even more importantly, these men are underrepresented in PSA screening studies. So, I think a lot of good lessons coming from this study.   ASCO Daily News: Indeed. Well, racial disparities are also addressed in a Medicare database study captured in Abstract 5073. The study set out to evaluate the real-world utilization of advanced therapies over time, and to provide data on utilization patterns among racial minorities that are often underrepresented in clinical trials. Can you tell us more about this study?   Dr Neeraj Agarwal:  Yes. Indeed. These data, presented by Dr. Steve Freedland from Cedars-Sinai, and colleagues, which highlighted a critical issue of unacceptably high number of patients with metastatic castration-sensitive prostate cancer not receiving standard of care, life-prolonging therapy in the United States. In this study, which I also had the opportunity to co-author, the investigators evaluated real-world utilization of systemic therapies backed by level 1 evidence from large randomized phase III trials, which showed treatment intensification with docetaxel, or novel hormonal therapies, such as abiraterone, dramatically improved overall survival in men with metastatic castration-sensitive prostate cancer.   In addition, the study team also evaluated the receipt of these therapies by racial minorities who are usually underrepresented in these clinical trials. So, this was a retrospective study of a Medicare database, which covered the time period between January 2009 and December 2018. Adult men with new diagnosis of metastatic prostate cancer were included. The first line treatments were grouped by prostate cancer specific drugs prescribed within 30 days prior to, and 120 days after the index date, which was the date of diagnosis of metastatic disease.   Remarkably, a total of more than 35,000 patients with metastatic castration-sensitive prostate cancer were included in the study. These comprise 12% patients who are African American, 5.3% patients [who were] Hispanic men, and 78.5% men who were white. So, the study had a good representation of racial minorities.  The results were startling to me.   Starting in the year 2015 or ‘16, when docetaxel was already approved after showing dramatic improvement in overall survival, which was soon followed by similar results with abiraterone, within a couple of years showing similar overall survival benefit--less than one third patients with metastatic castration-sensitive prostate cancer received these therapies from 2015 until 2018. The treatment intensification, which is the terminology used for combination of androgen deprivation therapy with docetaxel or novel hormonal therapy such as abiraterone, enzalutamide, and apalutamide--so treatment intensification was even lower for Black patients than white patients.   So, to summarize, in this large and nationally representative patient population with diagnosis of metastatic castration-sensitive prostate cancer, less than one third patients received standard of care treatment intensification, even in the year 2018. More importantly, the data showed even less frequent use of treatment intensification in Black patients versus white patients. A similar study, by my colleague, Dr. Umang Swami from Huntsman Cancer Institute, in the Abstract 5072, also showed that despite level 1 evidence demonstrating improved survival with intensified regimens with ADT plus docetaxel or normal hormonal therapy, such as, as I said, abiraterone, enzalutamide, apalutamide--frequent intensification was underutilized in men with metastatic castration-sensitive prostate cancer, in more than 4,000 patients studied.   And importantly, these patients were included from the claims data from commercially insured--I want to repeat--commercial insured and Medicare Advantage populations. So, these patients you would expect to have good financial coverage for their treatment. And even then, less than one third patients were receiving this standard of care, intensified treatments backed by level one evidence from phase III trials. Less than one third patients were receiving this therapy.   Even in patients with visceral metastasis--which we know is the most aggressive form of prostate cancer--there was a similarly low level of treatment intensification. So, I think these data are very important for us to know. And there are important steps for us to take down the line. We do not know why this is happening.   Why are our patients are not being offered standard of care, life prolonging therapies for castration-sensitive disease? Is it an access problem? Is it a problem with education, awareness? We do not know. So, I think a lot of works needs to be done in this direction.   ASCO Daily News: Absolutely. These data are very, very concerning. Dr. Agarwal, thank you very much for sharing your incredible insight with us today, and highlighting these very impactful studies in the GU field.   Dr. Neeraj Agarwal: Thank you very much for having me.   ASCO Daily News: And thank you to our listeners for your time today. If you enjoyed this episode, please take a moment to rate, review, and subscribe, wherever you get your podcasts.     Disclosures: Dr. Neeraj Agarwal  Consulting or Advisory Role: Pfizer, Medivation/Astellas, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Exelixis, Merck, Novartis, Eisai,   Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences  Research Funding (Inst.): Bayer Your Institution , Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen,   AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, crispr therapeutics, and Arvinas  Disclaimer:  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

Das Prostatakarzinom ist der häufigste maligne Tumor beim Mann. Jährlich werden ca. 50.000 Männer neu mit der Diagnose konfrontiert. Das Prostatakarzinom macht in Deutschland in etwa 20% aller Krebsneuerkrankungen aus. Wie man bei der Diagnostik des Prostatakarzinoms vorgeht, was der PSA Wert damit zu tun hat und welche Wichtigkeit dem Gleason-Score (benannt nach dem Amerikaner Donald F. Gleason, einem berühmten Pathologen, welcher das Scoring-System 1966 einführte) zukommt, all das hier in den nächsten 15 Minuten. Am Mikrofon wie immer: Kreimer vs. Maxeiner.

Correctly assessing prostate cancer’s spread is essential for staging and treatment options. Until now, scanning technology has lacked both clarity and specificity, leaving treatment recommendations to partial information and guesswork. The new PSMA PET scan changes this. This episode of PROSTATE PROS explores the benefits of the PSMA PET scan and how it can be used to make intelligent treatment decisions. READ MORE ABOUT ON OUR PROS BLOG. Dr. Scholz: [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls. I’m your host, Dr. Mark Scholz. Liz: [00:09] And I’m your cohost, Liz Graves. Dr. Scholz: [00:13] Welcome to the PROSTATE PROS podcast. Liz: [00:17] Prostate cancer imaging has improved tremendously over the last decade. Advanced imaging means safer screening, more accurate staging, monitoring, and targeting. Dr. Scholz: [00:29] Liz, I’m glad we’re going to address this new area of prostate cancer imaging because there’s one scan in particular called PSMA PET scan, which is revolutionizing the field. Liz: [00:42] So PSMA stands for prostate specific membrane antigen. This is a scan that I hear you talk about all of the time in the office. Can you tell us what it does? Dr. Scholz: [00:55] Whenever we’re talking about scans we’re always trying to answer the $64,000 question: Where is the cancer? The scary thing about cancer is it can spread and with prostate cancer, of course, ideally we want the cancer to stay confined inside the prostate gland. Historically, we’ve had a variety of scans to look throughout the body, MRI scans, bone scans. The problem has been that these scans are nonspecific, they can light up with injuries and other cancers and all kinds of confusing things. And they’re not really that accurate so they can miss cancers outside the prostate, even when they’re there. Liz: [01:37] PSMA only shows where the prostate cancer is located in the body. Dr. Scholz: [01:43] That’s right. And let’s reiterate, of course, that prostate cancer that spreads to a lymph node or to the bones doesn’t become bone or lymph node cancer, it’s still prostate cancer. And the PSMA signature stays intact, even if it gets into another part of the body. So if a spot lights up on the scan, this new PSMA PET scan that we’re talking about, it means there’s some prostate cancer there. Liz: [02:09] I’d imagine this is really important for staging. Right now you are using a lot of different ways to predict if the cancer has spread, but with this PSMA scan, you’ll know for sure. Dr. Scholz: [02:22] That’s very well stated. The historical use of Gleason Score was to try and predict the likelihood of something being outside the prostate or how high the PSA is. High PSAs were statistically more likely. This scan is so much more accurate than anything we’ve had. Now, if the scan is negative, it doesn’t entirely prove there’s no cancer outside the prostate, but it gives us a lot more confidence that the cancer is still confined inside the gland. Liz: [02:50] The scan seems pretty revolutionary, is everybody getting this? Dr. Scholz: [02:55] PSMA PET scans are available in a number of research centers, university centers around the country right now. And they are usually associated with some sort of a financial charge, but the information is so valuable, the money is usually dollars well spent. Liz: [03:13] Besides having enough money to afford the scan who’s eligible, is it every stage? Dr. Scholz: [03:19] It is almost every stage. The exception would be men with what we call SKY or Low-Risk prostate cancers, MRIs are more accurate for delineating the exact size of spots inside the prostate, but for pretty much every other stage this is the best scan experience has shown that men with PSS that are below 0.2 are not going to light up on the scan. That’s a pretty remarkable threshold because with older scans, people needed PSAs of one to two, with something like Axumin perhaps, or 10 to 20, if it was a regular bone scan. Liz: [04:00] So you mentioned Low-Risk, and these are cancers that as far as we know, haven’t spread, is there a situation where these men would want to get a PSMA scan? Dr. Scholz: [04:11] You know, I have used it. That’s not normally the way we would use the scan, but there’s a situation where men are thought to have SKY, Grade 6, prostate cancer, but many times we run into men that have high PSA levels, perhaps from prostatitis or big prostates. There’s this nervous niggling concern that could the cancer have spread somewhere outside the prostate. So it brings a lot of comfort when you have a high powered scan like this into play and show that no, indeed it is only still in the prostate. So while we don’t routinely use this type of scanning, the PSMA PET scan for men with localized disease, certain men that are running high PSA density, that means the PSA is higher than we would expect in regard to how big the prostate is. We might consider doing a PSMA PET scan, and we have done that in a few cases. Liz: [05:06] So let’s say one of these men does want a PSMA PET scan before that because they have local disease. They would probably have had a 3T mp MRI or a color Doppler ultrasound. Dr. Scholz: [05:20] Yes, exactly. So we have literally hundreds of men we’re monitoring on active surveillance. Our typical policy is to do imaging with 3T multiparametric MRI and/or color Doppler ultrasound. These provide the greatest resolution for imaging inside the prostate gland. So if a person’s previously had a biopsy and we know where the cancer is and what the grade is, and they’re under surveillance, sequential scanning can determine if those spots are growing. And so that is how we determine if someone will need further biopsies. Secondarily, we do look at PSA, but PSA is just not very accurate for this sort of purpose. Liz: [06:03] We talked about Low-Risk, but how does this new scan help men with High-Risk prostate cancer? Dr. Scholz: [06:10] So what High-Risk means, and it’s good to define terms, it doesn’t mean a High-Risk of dying, it means a higher risk of microscopic spread outside the gland so that men who would undergo surgery or radiation would be at a higher risk of not being cured. So to compensate for that doctors give men TIP or testosterone inactivating pharmaceuticals, androgen deprivation, to try and mop up those little specks that might be out there just because someone has a higher Gleason Score or a higher PSA, but this scan is so much more accurate. It raises the question: If the scan doesn’t show any spread can men with High-Risk disease skip taking the testosterone blockade and simply monitor with sequential scans annually after the treatment? And if some little tiny speck shows up in the future then treat it with radiation and perhaps some hormone therapy at that point. This would be a wonderful advantage for men because as we all know, four to 18 months of testosterone blockade is a very onerous treatment with a lot of side effects. So these scans may enable men to either reduce or eliminate the testosterone blockade. Liz: [07:24] You just mentioned sequential scanning. How often would you do that for someone with the PSMA scan? Dr. Scholz: [07:30] So if someone has High-Risk disease and they’re in complete remission, it would probably depend on how High-Risk, but it’s funny how often in the scanning world, like for instance, with SKY, we do MRIs once a year, color Doppler once a year, and annual follow up is sort of a common rhythm. Unfortunately, we don’t have any studies yet to tell us what is going to be the optimal scanning period. Liz: [07:56] I know that a lot of scans have a lot of radiation or you have to use contrast. And these are a couple of things that can make it a little messy when considering getting a lot of scans in a row, is that something people need to be worried about? Dr. Scholz: [08:10] It could be. The contrast or the radiation exposure does incur a small risk. Of course, in men with sky cancers, doing a lot of scanning that has radioactivity would be inappropriate, but as people get higher risk cancers, of course the disease itself becomes more risky than the side effects of the radiation. Liz: [08:31] We’ve been talking about a lot of applications for this, but the most common application is finding relapsed disease. Dr. Scholz: [08:40] Exactly. So people that have had surgery or radiation, their PSA should go down to very low levels and remain there indefinitely. But PSA relapse is really common about 25% to 35% of men will have a rising after surgery or radiation someday. Then the big question is, well, where’s it coming from? In the past, we really just had to deal with guesswork. There is another type of scan called Axumin, which is FDA approved, which was definitely progress because when the PSA got to be around one, two, or three oftentimes it was possible to find the location of the cancer. What’s marvelous about the PSMA PET scan is you can start scanning when the PSA is as low as 0.2. Liz: [09:27] So I would imagine if something’s found that relapsed disease is happening and there are mets that you can start treatment right away. Dr. Scholz: [09:36] Yes. And it’s directed treatment. Usually the problem is located in the pelvic lymph nodes. That’s the first jumping off spot. The doctors, now with modern radiation, can safely zap those spots and people get a second chance for cure. Liz: [09:53] Moving on to men with advanced prostate cancer. These are men that have mets outside the lymph nodes and maybe even in the bones. So in the past, these men had to get all sorts of scans. They had to get bone scans, CT scans, but now with the PSMA PET scan, they might only have to get this one scan. Dr. Scholz: [10:16] I think that’s a great advantage with these scans, but in addition, of course, this is even more accurate. So if the CAT scan showed one or two enlarged lymph nodes and the bone scan showed one or two spots, the PSMA PET scan is so much more powerful and accurate, it may reveal significant numbers of new spots that weren’t seen on the old scans. Liz: [10:42] How is that helpful? Dr. Scholz: [10:45] Well, treatment is tailored to how many spots are present because if only two or three spots are present, you can zap them with beams of radiation and try and sterilize them. But if there’s a myriad of spots out there, medicines that circulate through the bloodstream, hormone therapy, chemotherapy, immunotherapy, is the best way to go. Liz: [11:07] So the PSMA PET scan can be used for people with all different stages, and it can really help guide treatment and stage patients. Dr. Scholz, it seems like almost every person with prostate cancer should get this scan, but it’s only approved in other countries, why is that? Dr. Scholz: [11:26] There’s been a lag in the United States with the completion of the clinical trials. And I’m not sure exactly why. This technology was actually invented 20 years ago. A guy named Neil Bander came up with a PSMA antigen and thank God now fruition is near. The studies have been completed and we’re waiting for them to break the code and render proof that these scans are actually as good as we’re talking about. And we know that they will be. Once the code is broken and the studies are published, there’s usually a three to six month delay until the FDA approves the scans for commercial use. Liz: [12:04] So for now finding PSMA PET scans is usually at a university or through a clinical trial. Dr. Scholz: [12:12] Yes. And unfortunately it’s associated with a charge sometimes $1,000 to $3,000 per scan. They’re pretty pricey, but I’ve found that the information has been so useful that many patients are willing to invest the dollars necessary to get the information. Liz: [12:30] Let’s say someone doesn’t have the resources or the money to get a PSMA PET scan. What are these people supposed to do? Dr. Scholz: [12:37] Well, we’ve been getting by without PSMA PET scans for 20 or 30 years and the PET bone scans, the Axumin PET scans, and good high quality MRIs have enabled us to improve prostate care to a tremendous degree. The PSMA PET scan is definitely an advance. In fact, I’ve been billing it as the biggest discovery since PSA, but it is the way we’ve been practicing without PSMA PET scans is certainly viable. And with expert care, doctors can use these slightly inferior technologies to make reasonable decisions and gage what the best approach will be. Liz: [13:20] So this is a really exciting topic, and we are a little early talking about it as it isn’t FDA approved yet, but it will be soon. We’re posting more information about it on our blog, prostateoncology.com/blog. We’re really excited to keep you up on the latest in prostate cancer. You can email any questions or topics to podcast@prostateoncology.com. Remember to help us out by rating, reviewing, and subscribing on Apple Podcasts.

Receiving a diagnosis of prostate cancer can be a frightening experience, and it could cause a lot of anguish for men and their loved ones. Fortunately, we have urologic oncologist, Dr. Simon Kim, as our guest for today's show, to walk you through the process. In today's episode, Dr. Kim talks about what it all means, what your options are, and he discusses where to go from there. Stay tuned to find out more.    Dr. Kim is a board-certified urologic oncologist at the University of Colorado's Anschutz Medical Campus. He has worn many hats including Director of Robotic Surgery. Dr. Kim's clinical practice focuses on the surgical management of prostate, bladder, kidney, testes, adrenal, and penile cancer. He has received independent funding from the NIH to develop decision aids for men diagnosed with localized prostate cancer. He has published more than 180 manuscripts and he is currently serving as assistant editor for the Journal of Urology. Be sure to listen in today, to get Dr. Kim's expert advice.   Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation.   Show Highlights:   What it means to be a urologic oncologist and what it takes to become one. Dr. Kim explains how he typically delivers the biopsy results. Dr. Kim shares his recommendations for men, to prepare for a prostate cancer consultation. Dr. Kim recommends some reliable online resources for prostate cancer patients. The kind of information you can expect to receive from a pathology report. The information that is obtained from the Gleason Score. The guidelines that Dr. Kim relies on when making his decisions. The criteria that Dr. Kim uses in determining who does and doesn't need additional imaging at the time of the diagnosis. A brief rundown of the typical discussion that Dr. Kim has with his patients, regarding their treatment options concerning the various risk groups. Dr. Kim is busy initiating a multi-disciplinary clinic for cancers. Looking at some different therapies, like cryotherapy, for prostate cancer. Dr. Kim talks about the Conquer Cancer Foundation, which recently honored him with an award.  The outcome for localized prostate cancer is usually very good.  Remaining fully informed is key for prostate cancer patients. Links and resources: Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd   To get your free What To Expect Guide, go to www.prostatehealthpodcast/clinic Or find the link on our podcast website - www.prostatehealthpodcast.com    Journal of Urology - https://www.auajournals.org/ American Cancer Society - https://www.cancer.org/ American Urologic Association - https://www.auanet.org/ Know Your Options - https://www.cancercenter.com/community/blog/2016/07/know-your-prostate-cancer-options Conquer Cancer Foundation - https://www.conquer.org/

Der PSA-Test war positiv und jetzt steht eine Prostata-Biopsie an. Was passiert da und wie sieht im ungünstigen Fall eine Prostatakrebs-Therapie aus. Inhalt: Interviewgast Der PSA-Test Wann behandeln, wann warten? Fragen, Anregungen und Themenwünsche Mehr Infos:  // Meine Bitte an Sie: // Pharma-Song: // Zusammenfassung: Nächste Woche: Belege Teil 3 einer Mini-Serie zum Thema Urologie in der es neben Prostatakrebs in den kommenden Folgen auch um die gutartige Prostatavergrößerung, Harnwegsinfekte und Erektionsstörungen gehen wird. WIEDER InterviewgastDr. med. Christoph Pies,  Facharzt für Urologie aus Stolberg in NRW,  und Autor zweier medizinischer Ratgeber zur Männergesundheit.   Was passiert beim Urologen - Das Enthüllungsbuch für Sie und Ihn. ,  beide erschienen im Herbig-Verlag Die Prostata-BiopsieLokalanästhesie oder auf Wunsch Narkose Antibiotikaschutz, keine Darmreinigung Zäpfchen mit Lokalanästhetikum Ultraschallsonde Gewebeentnahmen: gezielt und 12 systematisch Meist kleine Blutungen danach im Urin oder Sperma (normal und harmlos) Vorsicht bei Fieber durch Infektion (1-2% der Fälle) Kein Risiko einer Verschleppung möglicher Tumorzellen oder Wecken eines “schlafenden” Krebs Was passiert bei einer positiven Diagnose ProstatakrebsUnterschiedlich wie viele Biopsien positiv Einteilung nach dem Gleason Score (von 2-10) nach der häufigsten Zelle bzw. der aggressivsten Zell https://www.alta-klinik.de/prostata/prostatakrebs/gleason-score/  https://www.aerzteblatt.de/archiv/181220/Beurteilung-des-Prostatakarzinoms-Gleason-Score-Status-2016  Niedrigster Tumor = 6, nicht aggressiv Gleason 7 mittel-aggressiv, ab hier Überwachung und behandelt Gleason 8 und höher sind aggressiv Nach lokaler Tumor-Diagnoseweitere Untersuchung Röntgen und Szintigraphie ob der Tumor gestreut hat TherapieOperativ (entscheidend ist die Erfahrung des Zentrums und des Operateurs) offen Computer-gesteuert Bestrahlung (in den meisten Fällen gleichwertig) Arzneimittel (auch wenn nur Prostata betroffen 18 Monate begleitend zur Bestrahlung besseres Outcome) Risiko Impotenz50% Wenn nur einseitig befallen, dann einseitige PO Auch bei Bestrahlung, besser bei Hochpräzisionsbestrahlung Ferner Inkontinenz: Reizdarm, Reizblase Fragen, Anregungen und ThemenwünscheVoicelink.fm: https://voicelink.fm/gesuendermitpraktischermedizin Fb-Gruppe: Beitreten Telegram-Gruppe: https://t.me/podcastgmpm    E-Mail: harald.schmidt@mac.com Mehr Infos:  //  Facebook, https://www.facebook.com/gesuendermitpraktischermedizin/  Täglich aktuelle und valide Infos und Links zu Therapie, Vorsorge, Ernährung //   Meine Bitte an Sie: //Wenn Ihnen dieser Gratis-Podcast gefallen, kleine Gegenleistung eine Minute Zeit für einen Kommentar bzw. bei ITunes zusätzlich ein Klick, am liebsten natürlich auf 5 Sterne. Pharma-Song: //  Der heutige Pharma-Song ist Frank Zappa gewidmet “Don’t Eat The Yellow Snow” von ...  vom 1974er Album “Apostrophe (‘)” Zitat: “Watch out where the huskies go, and don't you eat that yellow snow”. https://open.spotify.com/track/1QY4TdhuNIOX2SHLdElzd5?si=aq541MMhRRmgWtSI7Rkdtw //   Zusammenfassung: Die Prostata-Biopsie ist unangenehm aber tut nicht weh, kein Risiko der Verschleppung Nur die aggressiven Tumore werden aggressiv behandelt Wenn man in Top-Zentren in erfahrene Hände gerät hat jeder Patient heutzutage eine gute Chance mit wenig Nebenwirkungen Nächste Woche:Weiter mit Prostata, dann die gutartige Prostatavergrößerung Belege Postitionspapier der Deutschen Gesellschaft für Urologie zum Vorbericht: Prostatakrebsscreening mittels PSA-Test (S19-01) des IQWiG https://www.urologenportal.de/pressebereich/pressemitteilungen/presse-aktuell/postitionspapier-der-deutschen-gesellschaft-fuer-urologie-zum-vorbericht-prostatakrebsscreening-mittels-psa-test-s19-01-des-iqwig-13012020.html  Entschei...

Research Nurse, Natalie Richards from Peter MacCallum Cancer Centre (Melbourne) is the guest host for this episode. She talks to urologist, Mr Kevin Chu about how prostate cancer is diagnosed, the tests involved and teasing out the differences in treatment pathways . Kevin is a train robotic surgeon with an interest in cancer and minimally invasive surgery.Show notes are available here: https://news.navigateprostate.com.au/2019/08/23/what-is-low-risk-prostate-cancer-interview-with-urologist-mr-kevin-chu/This Podcast is part of an NHMRC funded study sponsored by Swinburne University and a collaboration with leading academic institutions, prostate cancer organisations and hospitals . For more information: www.navigateprostate.com.au. Produced with assistance by the Podcasting Team at The University of Melbourne.

Mark Hall was diagnosed with metastatic prostate cancer with a PSA of 4,400 and a Gleason Score of 8. Despite these terrible numbers he has been thriving the last four years with an undetectable PSA and a fantastic quality of life!Mark shares his journey, where under the guidance of Dr. Charles (Snuffy) Meyers he went through a heavy regime of hormone therapy treatments as well as the immunotherapy Provenge (sipuleucel-T). Mark has been experiencing a profound four year remission of his probate cancer. Mark attributes his remission to the Provenge treatment as well as Dr. Meyers guidance. The Cancer ABCs podcast program receives support from Genomic Health, which transforms treatment decisions in cancer by delivering clinically actionable diagnostics. Support the show (https://www.cancerabcs.org/new-page-2/)

Interview with Anthony D'Amico, MD, PhD, author of Surgery vs Radiotherapy in the Management of Biopsy Gleason Score 9-10 Prostate Cancer and the Risk of Mortality

Interview with Anthony D'Amico, MD, PhD, author of Surgery vs Radiotherapy in the Management of Biopsy Gleason Score 9-10 Prostate Cancer and the Risk of Mortality

Das Prostatakarzinom ist in Europa die häufigste Krebserkrankung des Mannes. Die Diagnostik umfasst immer die Kontrolle des PSA-Wertes und eine repräsentative Gewebeprobe aus der Prostata. Mit den so erhobenen Befunden kann die Erkrankung und deren Prognose eingeschätzt werden. Als Therapieoptionen für ein lokalisiertes Prostatakarzinom geben die EAU-Leitlinien drei Therapievarianten vor: Die radikale Prostatektomie, eine perkutane Strahlentherapie oder Brachytherapie sowie eine Überwachung mit gegebenenfalls verzögerter Therapie. Für diese letzte Therapievariante – als Active Surveillance bezeichnet – werden strenge Einschlusskriterien angegeben. Der Reiz der aktiven Überwachung liegt darin, dass nur die Patienten einer radikalen Therapie zugeführt werden, die ein Fortschreiten des Prostatakarzinoms zeigen. Patienten mit einer stabilen Erkrankung werden weiter überwacht und müssen somit auch nicht mit den Nebenwirkungen der radikalen Therapie leben. Der zugrundeliegende Gedanke ist, dass manche Prostatakarzinompatienten bis zum Tode keinen Tumorprogress erleben und somit auch keiner Therapie bedürfen. Ziel der vorliegenden Arbeit war es nun festzustellen, wie verlässlich die präoperativen diagnostischen Parameter zur Einschätzung des Progressionsrisikos sind. Die untersuchten Patienten erfüllten alle die aktuell gültigen Einschlusskriterien für eine Active Surveillance. Retrospektiv wurde mithilfe der präoperativen bzw. postoperativen histopathologischen Befunde analysiert, wie viele Patienten mit einem vermeintlich klinisch insignifikanten Prostatakarzinom anhand der präoperativen Diagnostik korrekt eingeschätzt wurden und tatsächlich an einem klinisch insignifikanten Prostatakarzinom erkrankt waren. Des Weiteren wurde untersucht, welche präoperativen Parameter die besten Prädiktoren mit der höchsten Vorhersagekraft für ein insignifikantes Prostatakarzinom sind. Die vorliegenden Ergebnisse zeigen eindrucksvoll, dass die Einschlusskriterien für Active Surveillance aktuell noch zu unsicher sind. Für viele Patienten (24% - 82%) verzögert sich dadurch der Zeitpunkt einer nötigen radikalen Therapie. Laut unseren Daten haben das Prostatavolumen, der präoperative Gleason-Score und die Zahl der positiven Stanzbiopsien der Prostata die höchste Vorhersagekraft bezüglich der Aggressivität und Ausbreitung des Tumors. Trotz Berücksichtigung dieser präoperativen Parameter wurde jedoch die Differenzierung des Prostatakarzinoms in einem Drittel der Fälle unterschätzt (Undergrading). Die Ausbreitung des Tumors im Organ wurde sogar in einem Dreiviertel der Fälle unterschätzt (Understaging). Die Überwachungsstrategie hat ohne Zweifel einen Stellenwert in der Behandlung des Prostatakarzinoms, jedoch fehlen derzeit noch zuverlässige Prädiktoren für eine sichere Prognoseabschätzung. Daher müssen die Patienten über die jeweiligen Vorteile und Nachteile der aktiven Überwachung informiert und aufgeklärt werden. Ideal für eine optimierte Diagnostik wären molekulare Marker wie sie Gegenstand zahlreicher laufender Studien sind.

Thu, 3 Jul 2014 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/17256/ https://edoc.ub.uni-muenchen.de/17256/1/Kohler_Ariane.pdf Kohler, Ariane

Dr Karim Fizazi of Institut Gustave Roussy in Paris, France at the ASCO GU congress 2014 explores the results of phase III trials looking at whether or not Gleason scores predict efficacy of abiraterone acetate therapy in patients with mCRPC. The discussion includes the potential future of treatment options in CRPC, clinical strategies overcoming androgen resistance, treatment options available to patients with CRPC, correct sequencing for the use of newly available drug for CRPC management and identification of patient sub-groups that may optimally benefit from novel treatment approaches. This programme has been supported by an unrestricted educational grant from Janssen Pharmaceutica (A Johnson & Johnson Company).

Learn About Effective Alternatives To Treating Prostate Cancer, The Best of Traditional Approaches and One Man's Passion To Educate Others Kirk Hamilton interviews Peter Starr producer, director and writer on his personal journey with prostate cancer and his current documentary interviewing physicians, researchers and patients world-wide on less invasive and alternative approaches to prostate cancer assessment and treatment, and dealing with this condition as a controllable, if not reversible chronic disease. For information go to HealingArtsMedia.net. Download or Open:

In der hier vorliegenden Arbeit wird die Wertigkeit der MRT bei 1,5 Tesla unter Verwendung einer Kombination aus Endorektalspule und Phased-Array-Oberflächenspule in der Bildgebung des Prostatakarzinoms (PCA) untersucht. Es werden zwei unterschiedliche Fragestellungen bearbeitet: Einerseits wird die sextantenbasierte Lokalisationsdiagnostik des Prostatakarzinoms beleuchtet (Kapitel VI), andererseits die MRT-basierte PSA-Dichtemessung für das präoperative Grading des Prostatakarzinoms (Kapitel VII). In der Lokalisationsdiagnostik des Prostatakarzinoms erlaubt das neu entwickelte Sextantenmodell eine exakte Zuordnung jedes Tumorherdes zur linken oder rechten Basis, Mitteldrüse und Apex der Prostata und damit eine genaue Korrelation mit dem histopathologischen Befund. Um diese Korrelation möglichst fehlerfrei durchzuführen, wurden die Prostatektomiepräparate aller 106 in diese Studie eingeschlossenen Patienten in Form von analog zu den MRT-Bildern durchgeführten Großflächenschnitten aufgearbeitet, die digitalisiert und auf einem Monitor neben dem MRT-Bild angezeigt wurden. Um eine objektive Aussage über die Genauigkeit der MRT zu erhalten, wurden die Untersuchungen der eingeschlossenen Patienten von drei verschiedenen erfahrenen Radiologen unabhängig voneinander befundet und die Befunde in einem standardisierten Auswertebogen festgehalten. Zur Berechnung von „Receiver Operator Characteristics“ (ROC)-Kurven erfolgte die Beurteilung des Vorliegens von Prostatakarzinom-typischen Veränderungen und extrakapsulärer Ausdehnung für jeden einzelnen Sextanten auf einer Fünf-Punkt-Skala. Durch Dichotomisierung dieser Werte und Auftragen der Ergebnisse in Vierfeldertafeln wurden Sensitivitäten, Spezifitäten, Treffsicherheiten („Accuracies“) sowie positive und negative prädiktive Werte berechnet. Der Grad der Übereinstimmung zwischen den einzelnen Befundern wurde mit Hilfe der Kappa-Statistik analysiert. Die Ergebnisse zeigen eine Staginggenauigkeit der MRT mit Endorektalspule von 83-92% bei Sensitivitäten für die Detektion eines Tumorbefalls einzelner Sextanten von 71-82% und einer Sensitivität für die Detektion eines kapselüberschreitenden Tumorwachstums (ECE) von 71-81%. Die jeweiligen Spezifitäten liegen zwischen 65-79% bzw. 80-89%. Die Flächen unter der ROC-Kurve (AUC, „area under the curve“) betragen 0,78-0,83 für PCA-Lokalisation und 0,79-0,81 für die Detektion einer extrakapsulären Ausdehnung. Für die PCA-Lokalisation betragen die Kappa-Werte 0,53-0,57, entsprechend einer moderaten Übereinstimmung, für die Detektion einer ECE liegen die Werte auf einem gutem Niveau (κ=0,75-0,78). Insgesamt liegt die Staginggenauigkeit („Accuracy“) der drei Befunder mit 83-92% im oberen Bereich der in der Literatur veröffentlichten Ergebnisse. Die MRT-gestützte Bestimmung der PSA-Dichte basiert auf der Volumetrie der Prostata mittels MRT. Die Einzelschichten der Prostata wurden für die vorliegende Studie in der MRT planimetriert und daraus Organvolumina berechnet. Der Quotient aus Serum-PSA-Wert und Prostatavolumen ergibt die PSA-Dichte. Diese wurde für eine präoperative Vorhersage des Malignitätsgrades, ausgedrückt durch den Gleason-Score, verwendet. Es ist bekannt, daß bei Tumoren mit einem Gleason-Score von 7 und darüber ein signifikant höheres Rezidivrisiko vorliegt als bei Tumoren mit einem Gleason-Score von 6 und darunter. Daher wird in der vorliegenden Arbeit bei einem Unterkollektiv von 61 Patienten ein optimaler Cutoff-Wert für die PSAD bestimmt, um eine präoperative Zuordnung von Patienten zu Gruppen mit Gleason-Score 6 und darunter (G6-) bzw. 7 und darüber (G7+) zu ermöglichen. Bei dem berechneten Cutoff-Wert von 0,23 ng/ml/cm3 wurden 79% aller Patienten mittels PSAD korrekt zugeordnet (Odds ratio=13,7). Es zeigen sich signifikant unterschiedliche PSA-Dichtewerte zwischen den beiden Patientengruppen (0,19±0,18 ng/ml/cm3 gegenüber 0,53±0,43 ng/ml/cm3, p