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    Old 01-31-2020, 10:19 AM   #1
    skipper3
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    Question Are Club Membership Cards Mailed?

    Or is it just a "cyber card" that I carry in my head?

    Sorry, just trying to lighten up my, and my wife's mood. Just got a call from uro on my biopsy done on Monday. Haven't seen the full report yet. But am a little confused on my "G8 verdict". Doc said it was a 3+5, and I can't find that listed in the PC Groups in the Scholz book. Group IV is 4+4, and Group V is 4+5 and up. Am I sitting on the edge? Hope to get more details as soon as it gets up on the portal.

    Update 02-14-2020:2nd Opinion from Johns Hopkins (see signature)
    __________________
    Born 1947, 73 yrs old, 5'10", 180 lbs, active
    PSA- 12-2019 11.1
    Clinical- T1, 41gm gland
    Biopsy 1-27-20: Group III
    Gleason 7, 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)

    Last edited by skipper3; 02-16-2020 at 03:17 PM. Reason: 2nd Opinion from Johns Hopkins

     
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    Old 01-31-2020, 10:25 AM   #2
    IADT3since2000
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    Re: Are Club Membership Cards Mailed?

    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

    - - - - - - - - - - - - - - - - - - - - - - - -
    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; 01-31-2020 at 12:14 PM. Reason: Changed erroneous 5+8 to 3+5 about 2 h after original post.

     
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    Old 01-31-2020, 10:57 AM   #3
    skipper3
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    Re: Are Club Membership Cards Mailed?

    Well now I can see the report on my portal. And I corrected above, it is a 3+5. Here are some details:

    12. Left base of prostate, needle biopsy:
    - Prostatic adenocarcinoma, Gleason grade 3 + 5 = 8 (Grade Group 4), measuring 4 mm, involving 1 of 1 cores and
    approximately 19% of the prostatic core tissue submitted.

    3. Right lateral base of prostate, needle biopsy:
    - Prostatic adenocarcinoma, Gleason grade 3 + 4 = 7 (Grade Group 2; 30% pattern 4), measuring 5 mm, involving 1 of 1
    cores and approximately 42% of the prostatic core tissue examined.
    - Perineural invasion is present.


    What does this mean?
    __________________
    Born 1947, 73 yrs old, 5'10", 180 lbs, active
    PSA- 12-2019 11.1
    Clinical- T1, 41gm gland
    Biopsy 1-27-20: Group III
    Gleason 7, 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)

     
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    Old 01-31-2020, 11:33 AM   #4
    DjinTonic
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    Re: Are Club Membership Cards Mailed?

    Hi Skipper. It's a good idea to have one's first biopsy slides sent to Dr. J. Epstein at J.H. for a second opinion from the top guru of prostate pathology. It's not that expensive.

    You biopsy means that you will need treatment and you can start doing your homework, if you haven't already, regarding the surgery vs. radiation decision that so many of us have to make.

    When PNI (perineural invasion -- tumor cells seen growing into the nerves withing the prostate, it does increase the statistical risk of the cancer being found outside the prostate (if surgery is your choice). This an be EPE, extraprostatic extension, positive surgical margins, or seminal vesicle invasion. It does not mean any of these are certain, just that the risk is greater than in men with no PNI+.

    What your final G score would be (again if the whole prostate is examined after surgery) is anyone's guess. It's likely the the pattern 5 will be there somewhere. Perhaps a G8 (3+5); a G7 (3+4) -- or G7 (4+5) with "tertiary 5" which means the amount of 5 pattern is small, usually <5% of the cancer; or a G9 (4+5).

    If you consult with surgeons, ask what the G8 core found at the left base may mean in terms of nerve-sparing on that side. (There are a L and R nerve bundle entering at the base of the prostate, these nerves control the blood flow responsible for erections. Each bundle can be spared completely or in part. Generally speaking, one intact bundle is enough to achieve an erection.) You doc will probably want to see imaging before answering (see below).

    The next step will be imaging to help assess the extent of the cancer -- whether or not it is prostate-confined. These will likely be a bone scan and some CTs. While a patient's focus is often on the Gleason score, just as important (or perhaps more so) is whether or not the cancer is confined. If it is, surgery or RT has a very good chance of getting it all!

    Post your questions as they arise.

    All the best,

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)0.015 (1 yr. 6 mo.)0.015 (2 yr. 4 mo.)

     
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    Old 01-31-2020, 11:46 AM   #5
    skipper3
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    Re: Are Club Membership Cards Mailed?

    Is surgery sometimes recommended for someone my age, 73?

    I can hope that a 2nd opinion from JH might lower that 5 to a 4, and I would drop 2 groups from a IV to a II. I wonder how often the 2nd opinions from JH grade up vs grading down?
    __________________
    Born 1947, 73 yrs old, 5'10", 180 lbs, active
    PSA- 12-2019 11.1
    Clinical- T1, 41gm gland
    Biopsy 1-27-20: Group III
    Gleason 7, 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)

     
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    Old 01-31-2020, 12:16 PM   #6
    DjinTonic
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    Is surgery sometimes recommended for someone my age, 73?

    I can hope that a 2nd opinion from JH might lower that 5 to a 4, and I would drop 2 groups from a IV to a II. I wonder how often the 2nd opinions from JH grade up vs grading down?
    The major factor with surgery is the patient's state of health. I was 69 at my RP. If you like, I can post links to studies on RP and age.

    A biopsy's G score is always that of the worst lesion found. However a biopsy samples just a tiny amount of prostate tissue, so the predominant and second-most predominant pattern can be accurately determined only if RP is chosen. Many men's biopsy G score is down- or upgraded after surgery.

    I'm not pushing surgery, but using it to discuss why biopsies are just an estimate of one's cancer pathology. I would not rule a RP out if you are in good shape and health. But a consult a surgeon can answer the question for your case .

    Djin

     
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    Old 01-31-2020, 12:50 PM   #7
    IADT3since2000
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    Re: Are Club Membership Cards Mailed?

    Hi skipper3, you wrote:

    Quote:
    Originally Posted by skipper3 View Post
    Is surgery sometimes recommended for someone my age, 73?
    Yes, patients are sometimes judged eligible for surgery at age 73 these days, especially if they are quite healthy overall. It used to be that 69 was pretty much the cut-off limit for surgery, and lower if the patient's health was poor. However, prostate cancer surgery is major surgery, and older patients generally have a more burdensome and somewhat riskier recovery than patients who are younger than 70.

    One of the virtues of radiation is that there is no age limit, and another is that it is just as effective, these days, as surgery in eliminating all cancer in and around the prostate. (That is a marked change from a couple of decades ago when surgery was definitely more effective, before radiation technology, including imaging, improved.) Moreover, it can also eliminate cancer that may have spread microscopically or via the lymph nodes in the pelvis, while surgery can only eliminate cancer found by statistics and luck in lymph nodes that the surgeon chooses to remove. Also, radiation is non-invasive. While there are some short-term side effects, they are generally quite tolerable with a fairly minimal burden (such as not straying too far from a toilet) on daily living, in marked contrast to the fairly burdensome first months to a year for surgery patients.

    If a second opinion confirms your risk status, you would almost surely have, if you choose radiation, an additional set of doses to the pelvis and ADT for 18 months to 2 years, possibly 3. I am personally convinced that the odds of non-recurrence are much better with radiation for higher-risk cases than with surgery, though surgery does a fine job if the cancer is truly confined, which is not known at the time of surgery. (It isn't usually known at the time of radiation either but does not matter as the pelvic dose hits cancers in the entire pelvis whereas surgery cannot do that.)

    Quote:
    I can hope that a 2nd opinion from JH might lower that 5 to a 4, and I would drop 2 groups from a IV to a II. I wonder how often the 2nd opinions from JH grade up vs grading down?
    I wholeheartedly endorse the idea of getting a second opinion from an expert source, with Dr. Epstein being preeminent, unless the original pathology was done by an expert, not a general pathologist. Both upgrading and downgrading occurs a fair amount of the time. Dr. Epstein wrote chapter 3, "Interpreting the Pathology Report," in Dr. Mark Scholz's (and 29 others') book "The Key to Prostate Cancer." On page 21 he says that about 20% of original biopsies are under graded and goes on to discuss this. On the same page he addresses over grading, noting that studies show that about 16% of Gleason 3+4=7 original reports are over graded.

    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 02-01-2020, 12:44 AM   #8
    HighlanderCFH
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    Is surgery sometimes recommended for someone my age, 73?

    I can hope that a 2nd opinion from JH might lower that 5 to a 4, and I would drop 2 groups from a IV to a II. I wonder how often the 2nd opinions from JH grade up vs grading down?

    My Dad was 73 when diagnosed with PC and had OPEN surgery at Mayo Clinic. If a person is healthy and robust, there is no reason that surgery could not be an option at that age.

     
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    Old 02-01-2020, 04:22 AM   #9
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    Re: Are Club Membership Cards Mailed?

    In general, the younger you are the better recovery you will have. Even more so for surgery.

    Recovery from radiation can cause major bowel issues, minor incontinence issues and sometimes ED. Recovery from surgery can cause incontinence and ED issues. I prefer the 3 months of incontinence issues from surgery to the bowl issues from radiation. I wore a lite pad in my underwear for those 3 months. Lose stool, frequent and small bowel movements are more difficult to manage. ED recovery from surgery takes a year and is more difficult to predict. Younger men recover easier. Older men not so much. Nerve regeneration is a longer and much more sensitive recovery than other tissue recovery.

    Surgery is a good option if the first level of treatment has the possibility of a cure. One and done. Your back up is radiation. If you end up needing salvage radiation after surgery the double treatment is a treatment burden more difficult for older men to fully recover from. Full surgery recovery from the side effects depends on the skill of the surgeon and the extent of the cancer. The fitness of the patient is important, but the extent and the aggressiveness of the cancer is the main risk.

    I was in my early 60s for my surgery. If I'd had been in my early 70s I probably would have chosen radiation. Life expectancy is a big factor. My genetics indicates I can live into my 90s. I wanted a long game plan if I'm starting in my early 60s. I played for a long term cure hoping to avoid the side effects of radiation. I avoided the long term side effects of surgery. So far, so good.

    My brother was in his early 70s for his surgery and has incontinence and ED issues. He had seminal vesicle invasion, but it's still undetectable after a few years with testing to <0.1.

    Early detection early treatment is the mantra. Depending on how much you missed that train by helps choose between surgery or radiation.

    It is my understanding they do not radiate the entire pelvis. They radiate the very localized prostate bed and a few millimeters beyond. If it has escaped this area then both surgery and radiation are debulking the cancer and not curing it. Ongoing treatment will be required. It will include ADT and it is my understanding this is the least desirable treatment form with the most unpleasant side effects of all the treatments. Then again, it bothers some more than others.

    The magic bullet here is early detection not your treatment choice. Men get all tied up in knots about this choice and what's the best treatment option overall. The best treatment option is early detection.

    Men will argue add nauseam about treatment options to obscure the fact they blew the pooch at early detection and early treatment.

    I had a successful surgery experience, so far. I had early detection only by luck. I denied and delayed too long, but was fortunate my cancer burden was not so aggressive and stayed contained. My younger brother had less cancer, earliar detection than me, but some G4 at a margin near his colon. He had salvage radiation after surgery and is recovering. Too soon too know more. His prostates is gone and hopefully with the cancer.

    Luck counts. What you can control is early detection and early treatment. The biggest heartbreak for me is watching friends, family, and associates learn this lesson the hard way.

    I go on and on about early detection and early treatment for two reasons. It's the best advice for newbies. More importantly for those who missed early detection, it is to disappear their bias against sharing it as experienced advocates going forward. Admitting they missed it makes them look bad. Most men will blow past early detection as the best strategy when sharing and go on to their own treatment story, or not. Imo, the best advice any survivor can give is early detection.

    Early detection early treatment. Treatment choices are much easier then.

     
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    Old 02-01-2020, 07:17 AM   #10
    Insanus
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    Is surgery sometimes recommended for someone my age, 73?

    I can hope that a 2nd opinion from JH might lower that 5 to a 4, and I would drop 2 groups from a IV to a II. I wonder how often the 2nd opinions from JH grade up vs grading down?
    Surgery is usually not recommended if you life expectancy is less than 10 years. Usually age 75 is the cut off, but more health factors go into the recommendation. It is not likely you will die of prostrate cancer with treatment.

     
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    Old 02-03-2020, 08:59 AM   #11
    skipper3
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    Re: Are Club Membership Cards Mailed?

    Am I right to assume that the impact/side effects of ADT are usually not as harsh on us older guys, that have already been going thru a gradual decline in testosterone? "Less distance to fall".

    And another question. Can there be a choice to make between hormone therapy and immunotherapy, with something like Provenge? Or do the specific circumstances of one's PCa, location, insurance, etc. drive the choice? Or is immunotherapy usually only used when distant mets are present?
    __________________
    Born 1947, 73 yrs old, 5'10", 180 lbs, active
    PSA- 12-2019 11.1
    Clinical- T1, 41gm gland
    Biopsy 1-27-20: Group III
    Gleason 7, 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)

     
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    Old 02-03-2020, 12:35 PM   #12
    Michael F
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by skipper3 View Post
    Am I right to assume that the impact/side effects of ADT are usually not as harsh on us older guys, that have already been going thru a gradual decline in testosterone? "Less distance to fall".

    And another question. Can there be a choice to make between hormone therapy and immunotherapy, with something like Provenge? Or do the specific circumstances of one's PCa, location, insurance, etc. drive the choice? Or is immunotherapy usually only used when distant mets are present?
    Hi Skipper3! I'm sorry to read your Bx results place you in "The PCa Club!". The are still many 1-way exits out of The Club! Regardless, whether or not the G(3+5) may actually be G(3+4) or less, treatment is on the horizon.

    Now is the time to seek the treatment that best addresses your specific disease status and psyche. Having consultations with expert MDs who specialize in treating PCa should be your immediate next step.

    IMO:

    - Surgery (RP) should still be an option for you since you are active and 175 Lbs and likely physiologically younger than 73.

    - Radiation (RT): There are many RT options available! The outcomes for both RP & RT are both very good and equal.

    - Re "Can there be a choice to make between hormone therapy and immunotherapy....." At this point you are not likely a candidate for either.

    As you perform your due diligence, things will come into better focus and you and your MDs will arrive at the treatment that best suits you. Be sure to bring your wife or other advocate with you to all of your MD consultation to take notes and serve as a "2nd Set of Ears!"

    Keep in mind that 100% Cure is very possible and likely. So stay encouraged!

    Getting a 2nd Opinion from Dr Epstein could be very helpful. Even if downgraded to G(3+4) or less, treatment will still be on your menu. If you are leaning toward surgery, it would make sense to hold off getting the 2nd "Reading" and wait for the final surgical Path Report.

    Stay calm and optimistic! Keep asking questions and seeking correct answers.

    Take things 1 Step at a Time!

    We will be with you every step along your Journey to Cure!

    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 02-03-2020, 12:48 PM   #13
    IADT3since2000
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    Re: Are Club Membership Cards Mailed?

    Hi again. You asked:

    Quote:
    Originally Posted by skipper3 View Post
    Am I right to assume that the impact/side effects of ADT are usually not as harsh on us older guys, that have already been going thru a gradual decline in testosterone? "Less distance to fall".
    Essentially, generally yes, but it is still important to understand how to counteract some of the side effects, such as a decrease in bone mineral density (BMD). I can provide more detail and describe my own experience over four rounds of intermittent ADT from late 1999 - April 2014 if you wish.

    Quote:
    And another question. Can there be a choice to make between hormone therapy and immunotherapy, with something like Provenge? Or do the specific circumstances of one's PCa, location, insurance, etc. drive the choice? Or is immunotherapy usually only used when distant mets are present?
    Provenge is highly expensive, and right now it is not approved for "early" recurring patients. You need to have "asymptomatic [meaning no symptoms] or minimally symptomatic metastatic castrate resistant (hormone refractory [meaning drugs like Lupron no longer work well]) prostate cancer." Also, ADT works really well and long-term for patients with recurrences discovered by PSA and without metastases, and it is far less expensive than Provenge.

    That said, there is some research, such as the STAND study, that suggests Provenge will help non-metastatic but recurring patients who are still responsive to ADT. This is discussed in the chapter by Richard Lam, MD, in the 2018 book "The Key to Prostate Cancer. The STAND study paper is available in full via https://clincancerres.aacrjournals.org/content/23/10/2451.long . Among other highlights, it notes that 3 of 48 patients who recovered testosterone after ADT in the study ended were able to maintain undetectable PSAs through the end of the study. This lays the groundwork for gaining further insight into what worked so well for those patients and potentially for FDA approval of Provenge for earlier stage recurring patients.

    Dr. Lam explains, as have others, that Provenge is a good choice for recurring patients who no longer respond well to ADT. (p. 320)

    All that said, if a patient were able to pick up the entire tab for Provenge of about $90,000 without flinching, it could probably be prescribed "off label," at least at certain leading centers involved with Provenge research. That's just my layman's supposition.

    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; 02-03-2020 at 12:50 PM. Reason: Added sentence about providing more detail.

     
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    Old 02-03-2020, 02:41 PM   #14
    skipper3
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    Re: Are Club Membership Cards Mailed?

    Quote:
    Originally Posted by Michael F View Post

    - Radiation (RT): There are many RT options available! The outcomes for both RP & RT are both very good and equal.

    - Re "Can there be a choice to make between hormone therapy and immunotherapy....." At this point you are not likely a candidate for either.
    I thought that hormone therapy always went along with RT? Is ADT a hormone drug, TIP?
    __________________
    Born 1947, 73 yrs old, 5'10", 180 lbs, active
    PSA- 12-2019 11.1
    Clinical- T1, 41gm gland
    Biopsy 1-27-20: Group III
    Gleason 7, 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)

     
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    Old 02-03-2020, 05:58 PM   #15
    IADT3since2000
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    Re: Are Club Membership Cards Mailed?

    Replying to your recent post today:
    Quote:
    Originally Posted by skipper3 View Post
    I thought that hormone therapy always went along with RT? Is ADT a hormone drug, TIP?
    "ADT," which stands for Androgen Deprivation Therapy, is also known as hormonal therapy. There are a number of drugs and drug combinations that are considered ADT. The backbone, these days, is the drug Lupron, but there are excellent alternatives such as Zoladex, Viadur, Trelstar, etc. These drugs are all in what is known as the LHRH-agonist class. Another considerably stronger similar drug is Firmagon/degarelix, which is the sole drug in the LHRH-antagonist class. All of these drugs act to decrease the level of testosterone, produced by the testes.

    There are a number of drugs in another class that acts quite differently in that they do not decrease testosterone. These are known as antiandrogens, and the most common one that patients first use, unless they are already detectably (by old scans) metastatic, is known as Casodex/bicalutamide. Their main function is blocking the docking sites that serve as fuel ports on the cancer cells.

    A third class of drugs, known as 5-alpha reductase inhibitors (5-ARI), can also be considered under the ADT umbrella. These drugs are not FDA approved for prostate cancer, but they have been part of my own prostate cancer treatment, used "off label". Essentially, approved for BPH and hair restoration, they sharply decrease conversion of testosterone into DHT (dihydrotestosterone), which is far more potent than testosterone as a fuel for prostate cancer. They also shrink the prostate and reduce its blood supply in a desirable way.

    All of these drugs involve side effects that many of us experience to varying degrees, and patients should learn how to decrease these side effects.

    "TIP" stands for Testosterone Inactivating Pharmaceuticals, and actually means the same thing as ADT. To me the acronym TIP is awkward and not that great a fit for what it means. There is a backstory behind Dr. Sholz's use of TIP instead of ADT, but it is not interesting except for those of us into arcane details.

    Research has convincingly demonstrated that patients getting radiation for intermediate- and high-risk cases do a lot better if they are also on ADT surrounding the radiation. Research has also revealed that patients with high-risk cases do a lot better if they are on a long course of ADT, such as at least 18 months to two years, with some docs still wanting a three year course.

    All of the doctors I follow closely would consider ADT to be suitable for you right now, probably in conjunction with anticipated radiation.

    I hope this helps.

    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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