Casodex, SpaceOar, and Biopsy Reports | Ask a Prostate Expert
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- čas přidán 21. 08. 2024
- Alex sits down the PCRI's Executive Director, Mark Scholz, MD, to discuss commonly asked questions from the PCRI Helpline on the topics of Casodex (bicalutamide), SpaceOAR, and questions related to pathology (e.g. biopsies, Gleason score).
1:01 Why is Casodex added to everything?
Originally Casodex was added to Lupron (or another hormonal agent) to counteract the testosterone flare that occurs in the first month of hormonal treatment. Additionally, studies showed a slight survival advantage-without significant additional side effects-in men who continued to use the Casodex and the Lupron together for the entire duration of the treatment. However, in the past, Casodex's high cost made it impractical to use for longer than the first month to suppress the Lupron flare.
3:01 Is Casodex Chemotherapy?
While Casodex is often designated at a chemotherapy for billing reasons, it is in a totally different class of medications than chemotherapies like Taxotere and Jevtana.
3:50 What are the side effects of Casodex?
The side effects of Casodex are similar to Lupron, except usually milder; when added to Lupron, some men will experience increased fatigue. In a small number of patients, Casodex can cause liver irritation, and so it is recommended that patients speak with their physician about checking their liver function with a hepatic panel about 4-6 weeks after starting Casodex. When used alone, Casodex can cause breast tenderness and enlargement. This can be counteracted by radiation to the nipples prior to treatment, the use of an aromatase inhibitor, or both.
6:18 What is SpaceOAR?
SpaceOAR is an injectible gel (administered through the perineum) that separates the prostate from the rectal wall to prevent radiation proctitis. Although increasingly rare as technology and practices improve, radiation proctitis can be disastrous if it occurs, and so the use of SpaceOAR is a wise choice.
10:16 Which doctors provide SpaceOAR? How do I find one?
You can find doctors that use SpaceOAR on the SpaceOAR website, or you can ask your radiation oncologist if they are familiar with the technology. If they are not, then that may be a good indication that this physician is not up to speed with the latest developments in the field.
11:37 How do I interpret my biopsy report?
Biopsy reports are given for 12-core random biopsies. Each core ought to be labeled with the location within the prostate from which it was taken. This is not universal, unfortunately, but it is good practice. Physicians are looking for the number of cores that contain cancer cells. If a core has cancer cells, then the biopsy report will say what percentage of the core involved cancer cells. The Gleason score is the final significant component of the biopsy report. Essentially, your doctor wants to know "How big is the tumor?" and "What grade is the tumor?"
15:03 How accurate are biopsy reports? Should I get a second opinion?
There is oftentimes disagreement among pathologists as to the exact grade of a given sample. It's a good idea, then, to get a second opinion on a pathology report. There are many good options. Jonathan Epstein of John Hopkins, for example, has a good reputation and a convenient system for sending in reports for a second opinion.
16:53 What can I do with my Gleason score?
Gleason score, among other factors, determines the best treatment (or non-treatment) for a man to balance achieving a cure (if necessary) and avoiding the side effects of overtreatment.
Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website or call our free helpline at 1 (800) 641-7274 with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
The information on the Prostate Cancer Research Institute's CZcams channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
#ProstateCancer #Prostate #MarkScholzMD
SpaceOar worked great to protect my husband during his 44 IMRT treatments.
I take Cosodex now thank you for sharing the Information for me.
The information about SpaceOar was very informative. Thank you sharing
I had SpaceOar hydrogel inserted under general anesthesia. When I woke up 1 hour later, it was all over. Didn't feel a thing and no side effects.
My Urologist has done over 200 SpaceOar Gel procedures and the UR does it with the patient under General Anesthesia in Hospital OR. My UR told me that too many men were complaining of moderate/elevated discomfort when awake with a Local. I definitely recommend SpaceOar Gel when doing EBRT [42 IMRT sessions in my case] and under GA if you can withstand the GA.
I'm here because I just had my fiducia and SpaceOAR procedure under local. I risk being labeled a wimp, but it was excruciating and barbaric. The local seemed to have little effect. I was on the edge of screaming, and was definitely letting the doctors know I was experiencing intense pain. (I'm convinced that if women were undergoing either prostate biopsies or SpaceOAR procedures that general anesthesia would be the norm. Our machoism is being taken advantage of, IMHO.)
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@@patandjoe I have had atrial fibrillation in the past, whereby my heart was shocked while I was fully unconscious from propofol, which only lasts several minutes. I don't see why the SpaceOAR insertion cannot be done
in the same way. Not rendering the patient unconscious for these urological procedures is barbaric.
@@patandjoe I agree. I just had SpaceOAR done yesterday. My pain was not excruciating, but was painful. My ass definitely did leave the table a few times. A needle to your "taint" is not pleasant, and the probe in the anus felt like it was feet in diameter.
My cancer was found when the surgeon checking on polyps found a suspicious mass at the mouth of the bladder. The sample sent for biopsy showed a gleeson 7 (4+3) so the urologist decided that as it had spread locally I needed both hormone and radiotherapy. The PSA however was less than 4 and the pet scans showed no bone or lymph problem. My question is with such low PSA do I really need su h drastic treatment particularly radiation. For hormone, I have been given Firmagon supposedly less aggressive with heart.
I do not have any sample from the prostatr itself so how can they aim the radiation to the precise part of prostate? Thank you
Thankx
A general question. For someone with bone mets, undergoing treatment with ADT (Degarelix+ Abiraterone), what would be a correct definition of castration resistant prostate cancer? Will a resurgence of PSA or testosterone beyond a certain value be considered for it to have become castration resistant? I am assuming here the initial diagnosis with bone mets itself is not considered castration resistance, as this this needs to be built despite treatment with ADT.
Hi! The definition of castration resistance is that the PSA is rising and the testosterone level is less than 50 ng/ml. If you need further help, our fee Helpline is here for you: pcri.org/helpline#about-helpline
There was 3+3=6 in the ROI,LPZ,1/3 cores,2% of core tissue,1mm in length IN UROLOGIST BIOPSY REPORT
Hi team, is a grade group2(Gleason score 3+4=7)with percentage of pattern 4 in highest Gleason score cancer:40% a reason to hurry and get RT & hormone Theraphy ? psa trend dropping from 4.7 to 3.2 due to diet & exercise in a 9 month span.Any chance there was a mistake on the 40% calculations?
I am a little suspicious of mistakes becsuse;the location of the PI-RADS 4 on the mpMRI (done by an experienced radiologist) was in the POSTERIOR LEFT LATERAL BASE.
.But the urologist's biopsy says PROSTATE LEFT MID measuring 7mm in lengthGrade3+4=7,in 2/3 cores involving22% of needle core tissue.
The other was in PROSTATE LEFT APEX Gleason grade 3+4=7 in 2/3 cores involving 20% of needle core tissue measuring 5mm in length.
Could that discrepancy change the total picture or not?
Can you explain the difference between a random biopsy and a fusion biopsy????
I am just now exploring my treatment options as I have been recently diagnosed with T1 C. My question is regarding the Side effects of administering spaceOAR. How skilled are the technicians who typically administer this and what are the risks regarding puncturing the rectal wall or other complications when inserting the gel? I recently read a report that had some scary #DATA regarding rectal wall deterioration, bladder retention and pulmonary embolisms
Hello, if you would like to speak with one of our patient advocates about your case, feel free to contact our helpline at pcri.org/helpline. They will likely ask about Gleason score and other diagnostic information if you have that available.
Hi Tony, I too was diagnosed with T1C, so they got to us early. I had the HydroGEL(SpaceOAR) done yesterday, and I will start my 6-9 weeks of radiation soon. Now, if anyone tells you that it is painless, well, they would be lying. I have a moderate thresh hold for pain, and did have some pain, not great, but some nonetheless. They had me take two Ativan while I there, and prior to leaving the waiting room. I guess it was a pain reliever, so, I guess it worked, as I was not in any extreme pain during the 15-20 minute procedure. I say get the procedure done, as it is suppose to greatly reduce the likely hood of radiation damaging the rectal wall. A few doctors indicated that internal radiation burns do not heal, so you would possibly have bleeding from your rectum for the rest of your life, not to mention the possibility of infections, so, the benefit, to me, greatly outweigh any negative. Good luck.
@@williewade1 Thank you so much for your thoughtful and detailed response. I’m just now exploring my treatment options but I really appreciate your input. Good luck to you as well!
@@Silverpinstudios Anytime. It is a very necessary process, does not last long, and you can make it through it. A needle to the "taint" a couple of times, and blunt probes seemingly the size of baseball bats(not really) in your anus is not a good thing. I did levitate a few times. I sit here this morning with no pain at all, so think pleasant thoughts, and you will get though it just fine. After hearing one Urologist saying that even though radiation therapy is safe, and the procedure can be expertly administered, without SpaceOAR, there is a much greater chance of burning the rectum, leaving a hole that will never heal. I would not take the chance of not getting the procedure done if you are going to have radiation treatment done. I believe you would have worse side effects without SpaceOAR, and a much greater chance of radiation burn to the wall of the rectum without it. It "taint that bad, so "batters up(smile)
I’m 2 weeks from installation of Spaceoar, honestly I do not know it’s there, and had it installed under full sedation, did not have any after pain or issue whatsoever.
I am 56 diagnosed with Stage IIIc last year… had radical prostatectomy and now on hormone therapy and radiation… after PET lymph nodes compromised is that consider metastatic ?
Spread to the lymph nodes is considered metastatic; however, there is a difference between metastases in the pelvic lymph nodes and metastases in the distant lymph nodes when it comes to optimal treatments and predicting the course of the disease. If you want to learn more, feel free to contact our helpline. You can find our contact information at pcri.org/helpline.
I have 6 score 3+3 but 9 of 12 samples have cancer with 3 having 95% 2 having 65% but not sure what kind of a rating I have on the T scale
ive had possibly all the biopsy, mri and petscan taken and I was diagnosed as intermidiate. what cure am I suppose to go with based on your opinion? o and the tumor I was told is at 62ml
Can SpaceOar be used after RP when there's recurrence and IMRT is used?
Good question, I will add it to our list for one of our upcoming "Answering CZcams questions" videos.
It seems SpaceOar uses the organs to create space, but if one of the organs (prostate) is missing, there would be no structure to support the gel. If this is the case, are there any other modalities used to spare the organs at risk?
Is it essential to use hormone treatments with radiation
Could you tell me anything about the drug xtandi
Yes, here is a video that explains it: czcams.com/video/r6ohcsa1Gh4/video.html
If it had spread to the bones does it means stage 4?
I was offered to participate in a clinical trial for nano knife, I’m having a difficult time finding any data on this procedure. Does anybody have and experience with this procedure ?
Hello,
Feel free to contact our free helpline. We have a patient advocate who will call you and may be able to provide you with some information: pcri.org/helpline
What does a Gleason score of 3+4 mean
Here are a couple resources that explain 3+4:
czcams.com/video/jIAEfxYMhs4/video.html
czcams.com/video/YoTiwJMYqc8/video.html
czcams.com/video/sLYpQHiThyI/video.html
pcri.org/teal
pcri.org/news/2016/3/10/interpreting-a-pathology-report-15-biopsy-and-gleason-questions-answered-by-a-leading-pathologist
Do they numb it?!!!!
Yes, they will numb the area when they place the SpaceOAR.
Can I get radiation therapy with a prostate size of 155 grams
Frank, our prostate cancer helpline may be able to help with your question. Please feel free to contact us here: pcri.org/helpline
Pourquoi utiliser l'anglais pour ce type de question
Parce que c'est la langue que nous parlons.
Why speak French??
Is there ever a % of the higher grade cancer cells, even when it is smaller? Gleason score 3+4(?)=7.
Hello Cooper, due to the complexity of each prostate cancer case and question, PCRI answers questions like this through our free Helpline. Please feel free to contact us here: pcri.org/helpline