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    Old 02-04-2020, 12:28 PM   #16
    Michael F
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    I thought that hormone therapy always went along with RT? Is ADT a hormone drug, TIP?
    Hi Skipper3! IADT3 has provided a concise explanation of HT/ADT.

    If RT will be your treatment of choice, then getting a 2nd Bx Review from Dr Epstein's group may be advisable to confirm your Bx result = G3+5. This may determine whether on not your are a candidate for ADT leading up to RT.

    It is most important to have this discussion with both a URO RO and URO MO. Also, discuss if having an MP 3T MRI would be of value in determining if RT is a better option than Surgery and if ADT is needed.

    Keep asking questions and keep us updated. You are doing a good job!

    MF
    __________________
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free =13%)
    Jan '12: Biopsy: 1/12 = G7 (3+4) & 5/12 = G6
    March '12: Robotic RP: Left: PM + EPE => MD excised additional adjacent tissues
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    uPSA Range: 0.017 - 0.032 at 94 Months Post Op: Mean = 0.023 (n = 23)
    LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%) ED = present

     
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    Old 02-13-2020, 05:43 PM   #17
    skipper3
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi Skipper, you definitely qualify for a card!

    An important question to ask is the extents and locations of that Gleason grade 5 cancer. Sometimes there is only a small bit and well-confined, but, because it is aggressive, it is the one to worry about.

    A GS 3+5=8 would be somewhat more aggressive than a GS 4+4=8, but short of a GS 9 of course.

    Jim
    Just got good news! Johns Hopkins downgraded that "oddball" 3+5 to a 3+4 placing me at a G7. Scans today came back negative also. Meet with uro on Monday to discuss treatment. I will tell him first thing to "holster that scalpel".
    __________________
    Born 1947, 73 yrs old, 5'10", 180 lbs, active
    PSA- 12-2019 11.0
    Clinical T2a, Biopsy 1-27-20, G7 Score, 7 of 12 cores positive
    Right Side- One 4+3(40% G4) Two 3+4(8% G4 )Three 3+3, PNI in 1 G4 core
    Left Side- One 3+4(10% G4)
    Scans Negative

     
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    Old 02-14-2020, 06:11 AM   #18
    Michael F
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    Just got good news! Johns Hopkins downgraded that "oddball" 3+5 to a 3+4 placing me at a G7. Scans today came back negative also. Meet with uro on Monday to discuss treatment. I will tell him first thing to "holster that scalpel".
    This is Welcome News Skipper3! This lowers your Biopsy (Bx) results from High Risk to Intermediate Risk.

    Keep in mind that Bx is a very small sampling of the prostate gland. It is possible to harbor more serious PCa that is missed on Bx. Since RT will likely be your treatment choice, I would get input from your URO MD, RO and an MO if ADT should be added to your treatment "Menu."

    Glad that the level of concern has dropped a notch!

    MF

     
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    Old 02-14-2020, 07:50 AM   #19
    Prostatefree
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    Re: Are Club Membership Cards Mailed?

    You are a candidate for treatment and have been for some time. Late treatment increases risk.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    12-8-19 PSA less than 0.02, zero club 3.5 yrs

     
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    Old 02-14-2020, 08:21 AM   #20
    skipper3
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by Prostatefree View Post
    You are a candidate for treatment and have been for some time. Late treatment increases risk.
    Oh, I want treatment, just not surgery, which you have replied to me in an earlier post, that you probably would have declined at my age.

    Treatment will have to probably wait 'til mid to late March, since I want to get the opinions from the Duke PC team at their Feb 28th day long clinic.
    __________________
    Born 1947, 73 yrs old, 5'10", 180 lbs, active
    PSA- 12-2019 11.0
    Clinical T2a, Biopsy 1-27-20, G7 Score, 7 of 12 cores positive
    Right Side- One 4+3(40% G4) Two 3+4(8% G4 )Three 3+3, PNI in 1 G4 core
    Left Side- One 3+4(10% G4)
    Scans Negative

     
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    Old 02-14-2020, 09:57 AM   #21
    Prostatefree
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    Oh, I want treatment, just not surgery, which you have replied to me in an earlier post, that you probably would have declined at my age.

    Treatment will have to probably wait 'til mid to late March, since I want to get the opinions from the Duke PC team at their Feb 28th day long clinic.
    Why? What more do you need to know?
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    12-8-19 PSA less than 0.02, zero club 3.5 yrs

     
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    Old 02-14-2020, 10:15 AM   #22
    skipper3
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by Prostatefree View Post
    Why? What more do you need to know?

    I nwould like to know what kind of treatments will be recommended. Did you make your decision sans doctors' consultations?
    __________________
    Born 1947, 73 yrs old, 5'10", 180 lbs, active
    PSA- 12-2019 11.0
    Clinical T2a, Biopsy 1-27-20, G7 Score, 7 of 12 cores positive
    Right Side- One 4+3(40% G4) Two 3+4(8% G4 )Three 3+3, PNI in 1 G4 core
    Left Side- One 3+4(10% G4)
    Scans Negative

     
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    Old 02-14-2020, 10:28 AM   #23
    IADT3since2000
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    Uh, maybe I need to know what kind of treatments will be recommended. Did you make your decision sans doctors' consultations?
    [SEE LATER "CORRECTED" REPLY IN POST 26; FORGOT HERE THAT CASE IS NOW A GS-7 CASE AND NOT A GS-8 CASE]

    Hi skipper3. Here is what I think will be recommended: image guided IMRT plus a brachytherapy boost, with two years of ADT in support. There is a lot of research behind a course of IMRT and brachytherapy plus ADT for cases like yours. You might want to check out what the guidelines say, plus referenced key evidence, at https://www.nccn.org/professionals/physician_gls/pdf/prostate_blocks.pdf (The blocks for efficacy, safety, quality, consistency and affordability are described on page 4 of the 4.2019 blocks edition.) I am not fully convinced that the IMRT plus brachy and ADT is superior to IMRT (at a somewhat higher dose) plus ADT, but studies indicate that. My caveat is that I haven't looked closely at the studies, and I often find that study design is inadequate for answering the key question, often because of apples-to-grapefruit issues.

    I'm really curious whether the Duke folks (whom I naturally suspect of lower competence as I am a Wake Forest grad ) will recommend that you should take metformin.

    You could probably start ADT soon or even now as it will almost certainly be part of the recommended treatment regimen, and it will knock the cancer back on its heels unless you have a fairly rare form of the cancer.

    Good luck.

    Jim

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.


    Last edited by IADT3since2000; 02-14-2020 at 02:54 PM. Reason: Inserted bracketed correction note.

     
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    Old 02-14-2020, 10:47 AM   #24
    skipper3
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi skipper3. Here is what I think will be recommended: image guided IMRT plus a brachytherapy boost, with two years of ADT in support.
    I was hoping to avoid the external radiation, thinking that there might be more collateral damage than with just the seeds. Is that correct?
    __________________
    Born 1947, 73 yrs old, 5'10", 180 lbs, active
    PSA- 12-2019 11.0
    Clinical T2a, Biopsy 1-27-20, G7 Score, 7 of 12 cores positive
    Right Side- One 4+3(40% G4) Two 3+4(8% G4 )Three 3+3, PNI in 1 G4 core
    Left Side- One 3+4(10% G4)
    Scans Negative

     
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    Old 02-14-2020, 02:12 PM   #25
    Prostatefree
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    I was hoping to avoid the external radiation, thinking that there might be more collateral damage than with just the seeds. Is that correct?
    I'd anticipate a high risk it has advanced beyond the prostate beyond the reach of seeds, whatever type. Your PSA, volume, grading, age and time developing call for a more aggressive view of the cancer, imo.

    Seminal vesicles are in play. Someone will probably want an MRI to help see more.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    12-8-19 PSA less than 0.02, zero club 3.5 yrs

     
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    Old 02-14-2020, 02:52 PM   #26
    IADT3since2000
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    I was hoping to avoid the external radiation, thinking that there might be more collateral damage than with just the seeds. Is that correct?
    It probably is correct, but I'm thinking the difference would not be much of an addition to side effects as modern radiation is so good. However, my earlier post was still based partly on a lingering impression of GS 8 cancer, even though I should have been thinking you had an intermediate case with GS 7.

    You can make a pretty good case for just seeds (good on ya) plus a fairly short course of ADT, not 2 years. On the other hand, you might want to get some extra imaging with highly sensitive scans, to gain confidence that there is no spread to the pelvis or beyond. This would be a good question for the Duke doctors. Normally, my impression is that these scans would not be used for an intermediate-risk case, but as Prostatefree is pointing out, you have fairly extensive disease in the prostate. The especially sensitive scans include Axumin, C-11 acetate and choline PET/CT, NaF18 PET/CT for bone, and Ga68 PSMA (investigational).

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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    Old 02-14-2020, 03:12 PM   #27
    Gary I
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    .....Treatment will have to probably wait 'til mid to late March, since I want to get the opinions from the Duke PC team at their Feb 28th day long clinic.
    Treatments don't mind waiting till the cows come home, prostate cancer however "waits for no man." Best of luck putting it off.
    __________________
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    Second 3T MRI 1/17
    RALP 7/17, G3+4, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over next 4 months
    DCFPyl PET & ercMRI @NCI - 11/17
    One inch tumor still in prostate bed
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    SRT, 2ADT, IMGT 70.2 Gy, complete 5/18
    PSA 0.066 1/20

     
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    Old 02-15-2020, 06:01 AM   #28
    Prostatefree
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    Re: Are Club Membership Cards Mailed?

    It's at times like these I wonder why men want the toxicity of radiation and ADT and they will wait until radiation is the only viable choice remaining.

    The side effects of surgery seem much more manageable and shorter than those from radiation. I had mild urinary incontinence easily managed for a month. And very slight incontinence for a couple of months that was much worse before the treatment.

    The radiation left my brother with loose bowl urgency for longer than my urinary urgency from surgery. I also suspect ED from radiation is under reported since many men choose it thinking they will have none.

    Pick your treatment poison. The only real mistake you can make with this disease is wait.

    Early diagnosis early treatment is the rule for any possible success treating prostate cancer. All the other stuff is minor. Miss the window and you're in for the long haul. The irony is ADT is the most undesirable of all treatment modes and it's where most men who delay end up. So what if ADT prolongs my life beyond the 5 or 10 year mortality mark of most studies. My quality of life on ADT is not the same as a cure.

    I want to acknowledge the OP for accepting the truth when he noted himself a poster child for denial and delay. All this time, and you still don't have a plan? What have you been doing? This could all be behind you by now with the better results of being a younger man.

    Denial and delay are the two demons of cancer. Imagine the realization the cancer was treatable and your head is what failed you.

     
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    Old 02-15-2020, 06:24 AM   #29
    IADT3since2000
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by Prostatefree View Post
    It's at times like these I wonder why men want the toxicity of radiation and ADT and will wait until radiation is the only choice remaining.

    The side effects of surgery seem much more manageable and shorter than those from radiation....
    Hi again Skipper3, I have pretty much the opposite impression from the quotation above. I hope to reply further when I have time.

    One thing is clear: there is a range of opinion among survivors on these issues. Another point is that many of have been satisfied, even pleased with our experiences as radiation/ADT and as surgery veterans.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.



     
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    Old 02-15-2020, 06:34 AM   #30
    Prostatefree
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi again Skipper3, I have pretty much the opposite impression from the quotation above. I hope to reply further when I have time.

    One thing is clear: there is a range of opinion among survivors on these issues. Another point is that many of have been satisfied, even pleased with our experiences as radiation/ADT and as surgery veterans.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.


    Jim, I'd rather hear your opinions on denial and delay. While the conversation about the best treatment method seems to suck up most the air in the room the real issue is failing to screen and treat.

    The conversation about the best treatment choice is a red herring, imo, as demonstrated in this thread by the OP and most tales of woe including yours.

    Everyone is tempted to focus on the path forward and I understand it. The real and difficult work, however, is the conversation looking back at what worked and what didn't work. The treatment choices will work one way or another. They are tested, studied, and practised.

    What doesn't work is denial and delay. How quickly a man works his way in his head past this obstacle will determine his success with this disease.

     
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