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  • Dr Walsh's Guide to Surviving PCa

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    Old 09-03-2020, 06:48 AM   #1
    JWPMP
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    Dr Walsh's Guide to Surviving PCa

    Another excellent book, just arrived yesterday.
    I have a question.
    I have read (but not totally understood if I'm reading correctly)
    if the cancer is outside the prostate sometimes they don't do surgery?
    This book is a proponent of removal regardless, which actually makes more sense to me.
    I know Dr Carroll will advise and we're not even to the MRI yet, but I'm interested in input/clarification from you all with experience.
    Also, the more I read the more I am IMMENSELY relieved we canceled the original biopsy with a local UR and waited on a "center of excellence. "
    Thank you and thanks for recommending the two books.
    Jim & Paula

    64 years old
    First ever PSA 7/14/20 = 53.5
    DRE 7/29 = indurated multinodular prostate

    Last edited by JWPMP; 09-03-2020 at 06:50 AM. Reason: additional sentence

     
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    Old 09-03-2020, 07:28 AM   #2
    Steve135
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    Re: Dr Walsh's Guide to Surviving PCa

    Some don't like this answer, but the reasons for Pet Scan's and other test to see if the Pca has escaped the organ is required by insurance companies based on charts. There is little sense to remove an organ that has metastasize to the bones or other organs! Follow the money (cost) its a real shame. BC&BS would not pay to do a biopsy because I didn't reach the magic number of 4.0 psa. I agreed to pay out of pocket and when they found high grade Pca at 2.4 they paid the billing! This also follows getting drugs, you need to be coded to get tier III drugs. You need to go through the steps!
    Not sure if Medicare does this but you look one year shy?
    steve

    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins No tPresent inked margins 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.05610/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02 4/20 <.02 5/20 <0.02 6/20 <.02
    7/20 <0.014 8/13 <0.014

    Last edited by Steve135; 09-03-2020 at 07:39 AM. Reason: sp,sig

     
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    Old 09-03-2020, 07:55 AM   #3
    Southsider170
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    Re: Dr Walsh's Guide to Surviving PCa

    Quote:
    Originally Posted by JWPMP View Post
    Another excellent book, just arrived yesterday.
    I have a question.
    I have read (but not totally understood if I'm reading correctly)
    if the cancer is outside the prostate sometimes they don't do surgery?


    Actually, they usually don't do radical prostatectomy if the cancer is stage 4, with distant metastases. Surgery isn't considered curative in that situation.

    Of course, if the cancer is causing obstruction to the urinary flow, they'd still remove it.

     
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    Old 09-03-2020, 08:36 AM   #4
    JWPMP
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    Re: Dr Walsh's Guide to Surviving PCa

    Quote:
    Originally Posted by Steve135 View Post
    Some don't like this answer, but the reasons for Pet Scan's and other test to see if the Pca has escaped the organ is required by insurance companies based on charts. There is little sense to remove an organ that has metastasize to the bones or other organs! Follow the money (cost) its a real shame. BC&BS would not pay to do a biopsy because I didn't reach the magic number of 4.0 psa. I agreed to pay out of pocket and when they found high grade Pca at 2.4 they paid the billing! This also follows getting drugs, you need to be coded to get tier III drugs. You need to go through the steps!
    Not sure if Medicare does this but you look one year shy?
    steve

    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins No tPresent inked margins 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.05610/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02 4/20 <.02 5/20 <0.02 6/20 <.02
    7/20 <0.014 8/13 <0.014
    Fortunately my husband is retired from operating engineers union and has excellent insurance...we're so blessed
    Hope to get through the worst of this before February when he turns 65 and we have to switch to Medicare although the OE offers a very good supplemental insurance at that point.

     
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    Old 09-03-2020, 08:39 AM   #5
    JWPMP
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    Re: Dr Walsh's Guide to Surviving PCa

    Quote:
    Originally Posted by Steve135 View Post
    Some don't like this answer, but the reasons for Pet Scan's and other test to see if the Pca has escaped the organ is required by insurance companies based on charts. There is little sense to remove an organ that has metastasize to the bones or other organs! Follow the money (cost) its a real shame. BC&BS would not pay to do a biopsy because I didn't reach the magic number of 4.0 psa. I agreed to pay out of pocket and when they found high grade Pca at 2.4 they paid the billing! This also follows getting drugs, you need to be coded to get tier III drugs. You need to go through the steps!
    Not sure if Medicare does this but you look one year shy?
    steve

    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins No tPresent inked margins 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.05610/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02 4/20 <.02 5/20 <0.02 6/20 <.02
    7/20 <0.014 8/13 <0.014
    One other thing...
    Even if it has escaped the organ, isn't the prostate still manufacturing the cancer? wouldn't it make sense to get the source removed while treating the result?
    I'm sure I just don't understand the workings.

     
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    Old 09-03-2020, 09:04 AM   #6
    Steve135
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    Re: Dr Walsh's Guide to Surviving PCa

    JWPMP Everybodys treatment is different, what was good for me may not be for your husband. Even when numbers seem to line up you may be offered different treatments, some that may have not be availble when I was being treated? Many treatments are aged based, as in we can radiated and treat with ADT and prolong this person life 18 years. That's good if your 70 but bad if you 55. The longer you are able to treat and keep the Pca away the better the treatments become. Other health issue sometime preclude removal, my older brother was refused removal when they found out he is subject to blood clots. When I talked with Dr. Walsh about him he told me he had two die on the table both from blood clots, told my brother you won't be number three! This is a long operation and you need to be in the best health and that is even more important with age.
    steve

    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins No tPresent inked margins 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.05610/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02 4/20 <.02 5/20 <0.02 6/20 <.02
    7/20 <0.014 8/13 <0.014

    Last edited by Steve135; 09-03-2020 at 09:07 AM. Reason: info

     
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    Old 09-03-2020, 09:15 AM   #7
    DjinTonic
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    Re: Dr Walsh's Guide to Surviving PCa

    Quote:
    Originally Posted by JWPMP View Post
    One other thing...
    Even if it has escaped the organ, isn't the prostate still manufacturing the cancer? wouldn't it make sense to get the source removed while treating the result?
    I'm sure I just don't understand the workings.
    It depends. When the cancer has metastasized, removal of the prostate is called "cytoreductive surgery." It is being studied, but is not standard of care.

    Cytoreductive RP Beneficial in Selected Advanced Prostate Cancer Cases

    https://www.renalandurologynews.com/home/conference-highlights/american-urological-association-annual-meeting/aua-2020-virtual-experience/cytoreductive-prostatectomy-beneficial-low-volume-metastatic-prostate-cancer/

    The journal paper covered in this med news article is linked at the bottom of the article.

    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, negative 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
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 09-03-2020, 10:44 AM   #8
    ASAdvocate
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    Re: Dr Walsh's Guide to Surviving PCa

    Recent statistics show that radiation is used more than surgery for high risk cases. Actually, only about 37 percent of all men recently diagnosed with prostate cancer have chosen surgery.

    Dr. Walsh was the dean of the pre-robotic prostate surgeons. But, his book should be supplemented by other perspectives, such as Emilia Ripoll, and Mark Scholz.

     
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    Old 09-03-2020, 10:47 AM   #9
    GuyBMeredith
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    Re: Dr Walsh's Guide to Surviving PCa

    Dr. Walsh is a surgeon. Everyone's situation differs. Others can give you more information on metastasized cancer and whether the treatments affect the prostate as well so that surgery is not needed or even useful.

    I do have a couple of bones to pick with Dr. Walsh, though. It does not have to do with your decision, but speaks to the accuracy of some of the information. I went with short term ADT with IMRT as the cancer was localized and am now onto monitoring the results.

    One of the big concerns next to survival is quality of life, beginning with maintaining sexual function. Dr. Shaw states that one in ten men on ADT is able to experience erections and discounts the possibility of orgasms. I question that study has been made to find out why only one in ten can experience an erection and question having the statement in the book without factual data. In this I feel Dr. Walsh is not doing prostate cancer patients a favor as we search for information to make our choices.

    I suspect some men on ADT are not experiencing sexual function because they were not encouraged to experiment with continuing sexual activity. Surgery patients are encouraged to begin sexual activity soon after surgery to ensure blood supply to erectile tissue via erections to avoid atrophy. I made the assumption that patients on ADT also need to work to maintain erectile tissue health and have continued with daily sexual activity during my stint on ADT.

    The problem here is that men on ADT with IMRT have a higher incidence of post treatment impotence than those that do not choose ADT. I question whether that would be true if we were encouraged to try to continue sexual activity.

    Also, I know for a fact that men on ADT can and do have orgasms, some have reported continuing with intercourse. I suspect that Dr. Walsh is just reflecting unsupported assumption that men without testosterone cannot be aroused or have orgasm.
    __________________
    Diagnosed at age 73 Feb 2019 DRE indicates nodule PSA 2.8 Aug 2019 PSA 3.1 Urologist suggests biopsy in Oct Results of biopsy: 2 of 12 cores positive. Low volume T2b, intermediate risk, GS 3+4, PSA 3.10, prostate cancer, perineural invasion. Followed up with MRI to help decide between surgery and IMRT. MRI shows suspicious PIRADS 5 lesion measuring 2.cm in diameter, with associated left neurovascular bundle involvement. Started 6 month lupron series Feb 2020, 28 sessions of high dose IMRT Apr 15, 2020. Sexual functions okay except ejaculate has changed. Without libido it is an academic process that requires much focus. July 27 first measure of PSA and total testosterone. PSA: .13 ng/dl Total testosterone is less than 12 ng/dl.

     
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    Old 09-03-2020, 10:55 AM   #10
    JWPMP
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    Re: Dr Walsh's Guide to Surviving PCa

    Quote:
    Originally Posted by ASAdvocate View Post
    Recent statistics show that radiation is used more than surgery for high risk cases. Actually, only about 37 percent of all men recently diagnosed with prostate cancer have chosen surgery.

    Dr. Walsh was the dean of the pre-robotic prostate surgeons. But, his book should be supplemented by other perspectives, such as Emilia Ripoll, and Mark Scholz.
    It seems he is a big proponent of surgery, and with my incredibly limited knowledge it made sense.
    So glad to get feedback here

     
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    Old 09-03-2020, 10:59 AM   #11
    JWPMP
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    Re: Dr Walsh's Guide to Surviving PCa

    Quote:
    Originally Posted by GuyBMeredith View Post
    Dr. Walsh is a surgeon. Everyone's situation differs. Others can give you more information on metastasized cancer and whether the treatments affect the prostate as well so that surgery is not needed or even useful.

    I do have a couple of bones to pick with Dr. Walsh, though. It does not have to do with your decision, but speaks to the accuracy of some of the information. I went with short term ADT with IMRT as the cancer was localized and am now onto monitoring the results.

    One of the big concerns next to survival is quality of life, beginning with maintaining sexual function. Dr. Shaw states that one in ten men on ADT is able to experience erections and discounts the possibility of orgasms. I question that study has been made to find out why only one in ten can experience an erection and question having the statement in the book without factual data. In this I feel Dr. Walsh is not doing prostate cancer patients a favor as we search for information to make our choices.

    I suspect some men on ADT are not experiencing sexual function because they were not encouraged to experiment with continuing sexual activity. Surgery patients are encouraged to begin sexual activity soon after surgery to ensure blood supply to erectile tissue via erections to avoid atrophy. I made the assumption that patients on ADT also need to work to maintain erectile tissue health and have continued with daily sexual activity during my stint on ADT.

    The problem here is that men on ADT with IMRT have a higher incidence of post treatment impotence than those that do not choose ADT. I question whether that would be true if we were encouraged to try to continue sexual activity.

    Also, I know for a fact that men on ADT can and do have orgasms, some have reported continuing with intercourse. I suspect that Dr. Walsh is just reflecting unsupported assumption that men without testosterone cannot be aroused or have orgasm.
    what little I could understand at this point, it appears he is in favor of postponing ADT as long as possible.
    I only skimmed through however
    Thinking I'll be better off saving my research for when I know what our options are
    I value the feedback here a great deal

     
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    Old 09-03-2020, 11:36 AM   #12
    GuyBMeredith
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    Re: Dr Walsh's Guide to Surviving PCa

    ADT is used in various ways for various purposes, some short term, some very long term, sometimes alone, sometimes in combination. Each individual's needs are different.

    My personal concern is that men doing short term ADT with IMRT may be experiencing post treatment impotence that can be avoided, that providers do not have facts needed. Or that men may be needlessly avoiding short term ADT with IMRT where it has been recommended by the radiation oncologist. This is where I feel Dr. Walsh could circle back and check facts.
    __________________
    Diagnosed at age 73 Feb 2019 DRE indicates nodule PSA 2.8 Aug 2019 PSA 3.1 Urologist suggests biopsy in Oct Results of biopsy: 2 of 12 cores positive. Low volume T2b, intermediate risk, GS 3+4, PSA 3.10, prostate cancer, perineural invasion. Followed up with MRI to help decide between surgery and IMRT. MRI shows suspicious PIRADS 5 lesion measuring 2.cm in diameter, with associated left neurovascular bundle involvement. Started 6 month lupron series Feb 2020, 28 sessions of high dose IMRT Apr 15, 2020. Sexual functions okay except ejaculate has changed. Without libido it is an academic process that requires much focus. July 27 first measure of PSA and total testosterone. PSA: .13 ng/dl Total testosterone is less than 12 ng/dl.

     
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    Old 09-03-2020, 12:54 PM   #13
    IADT3since2000
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    Re: Dr Walsh's Guide to Surviving PCa

    Dr. Patrick Walsh and ADT - Use It Earlier or Late

    Quote:
    Originally Posted by JWPMP View Post
    what little I could understand at this point, it appears he is in favor of postponing ADT as long as possible.
    I only skimmed through however
    Thinking I'll be better off saving my research for when I know what our options are
    I value the feedback here a great deal
    Your skimming was right on the money!


    This is the biggest bone to pick that I have with Dr. Walsh, and I am far from alone. He was a brilliant, pioneering prostate cancer surgeon and an energetic, dedicated researcher prior to his retirement.

    But, for whatever reasons, many of us, especially expert doctors in the medical oncology community, are convinced that he did not have a good grasp of ADT. Yes, he believed it should be reserved until late, kind of a last resort. The experts I have followed fully disagree and believe that ADT is best used "when the patient is strong and the cancer is weak," in other words, early in the process, such as supporting radiation, or early for a recurrence that is not clearly mild, and even sometimes as the initial therapy.

    While not confronting Dr. Walsh directly, I specifically emphasized the role of early ADT in my own therapy for my clearly life-threatening case, and my subsequent success with ADT and radiation, when speaking during the public comments part at an FDA hearing (on HIFU) with Dr. Walsh in the audience, and I made sure to look right at him when I was going over that part. There were doctors on the panel that I knew saw it the way I did. I had a nice conversation with Dr. Walsh afterwards, but we did not go into early versus late ADT.

    Having advised so many patients over so many years to defer ADT until symptoms of metastases, Dr. Walsh no doubt would find it awkward to acknowledge that earlier ADT use saves lives and reducies suffering. It's one of the reasons, in my opinion, why he opposed the use of Proscar and Avodart at an FDA hearing. On the other hand, if I were to have a prostate operation, I would sure want the Dr. Walsh of his earlier years doing it and not a medical oncologist. If it's a knife fight, you want to bring a knife. But you don't want to bring a knife to a drug fight, to borrow and mangle a line from "The Untouchables."

    I expect that all the speakers at next week's conference will be in the "earlier rather than later" ADT camp. I know that includes Drs. Scholz and Vogelzang. You could submit the question whether and when ADT should be used early or late to the conference moderator.

    In short, I am convinced that delaying ADT as long as possible is a huge mistake. That said, while I am a well informed and thoughtful long-term patient, I have never been enrolled in a single medical class, and Dr. Walsh does have some points on his side of the ledger regarding the timing of ADT.

    .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 and stable at <0.01; apparently cured. (Current T 99 6/5/20.) 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 09-03-2020, 02:27 PM   #14
    JWPMP
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    Re: Dr Walsh's Guide to Surviving PCa

    [QUOTE=IADT3since2000;5505275]Dr. Patrick Walsh and ADT - Use It Earlier or Late



    Your skimming was right on the money!


    This is the biggest bone to pick that I have with Dr. Walsh, and I am far from alone. He was a brilliant, pioneering prostate cancer surgeon and an energetic, dedicated researcher prior to his retirement.

    But, for whatever reasons, many of us, especially expert doctors in the medical oncology community, are convinced that he did not have a good grasp of ADT. Yes, he believed it should be reserved until late, kind of a last resort. The experts I have followed fully disagree and believe that ADT is best used "when the patient is strong and the cancer is weak," in other words, early in the process, such as supporting radiation, or early for a recurrence that is not clearly mild, and even sometimes as the initial therapy.

    While not confronting Dr. Walsh directly, I specifically emphasized the role of early ADT in my own therapy for my clearly life-threatening case, and my subsequent success with ADT and radiation, when speaking during the public comments part at an FDA hearing (on HIFU) with Dr. Walsh in the audience, and I made sure to look right at him when I was going over that part. There were doctors on the panel that I knew saw it the way I did. I had a nice conversation with Dr. Walsh afterwards, but we did not go into early versus late ADT.

    Having advised so many patients over so many years to defer ADT until symptoms of metastases, Dr. Walsh no doubt would find it awkward to acknowledge that earlier ADT use saves lives and reducies suffering. It's one of the reasons, in my opinion, why he opposed the use of Proscar and Avodart at an FDA hearing. On the other hand, if I were to have a prostate operation, I would sure want the Dr. Walsh of his earlier years doing it and not a medical oncologist. If it's a knife fight, you want to bring a knife. But you don't want to bring a knife to a drug fight, to borrow and mangle a line from "The Untouchables."

    I expect that all the speakers at next week's conference will be in the "earlier rather than later" ADT camp. I know that includes Drs. Scholz and Vogelzang. You could submit the question whether and when ADT should be used early or late to the conference moderator.

    In short, I am convinced that delaying ADT as long as possible is a huge mistake. That said, while I am a well informed and thoughtful long-term patient, I have never been enrolled in a single medical class, and Dr. Walsh does have some points on his side of the ledger regarding the timing of ADT.

    .Jim

    Fascinating information Jim!
    Amazing amount of research you've done...I'll think about that conference next week. The perspectives of people like yourself that have survived many many years with this disease carry an enormous amount of weight and thankful that you are willing to share it with others!

    I've kind of overwhelmed myself with information and may need to give my anxiety a break.
    One thing I read makes me hopeful, then I read something else that scares the jeebies out of me.
    The only thing I know for certain right now is that WAITING on Dr Carroll and his team was the best decision we could have made.
    Finding this forum was the 2nd

    Thank you

     
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    Old 09-04-2020, 03:32 AM   #15
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    Re: Dr Walsh's Guide to Surviving PCa

    Not sure where you got your view of Medicare, but combined with a good supplemental plan it will be the best and least expensive medical insurance you will every have. It pays all my costs. No questions asked. Premiums are less than $425/month. Deductible less than $300/year.

    Be careful of the Advantage plans. They are a lower cost option intended to help those with limited resources and they limit providers.

    I had them all; private; company group as an employee; company group as business owner; now Medicare with UHC supplemental plan F and Humana drug plan. The Medicare combination is by far the best, imo. The supplemental drug plans need some attention, but it's a small complaint.

    I am currently employed as I maneuver a soft landing to retirement for myself. I moved to Medicare as soon as I could opting out of my employer's plan because there was no comparison in cost. I still take advantage of the employer's FSA option.

    If the union is smart, they will kick you off their plan as soon as you are eligible for Medicare. Glad to hear they offer a supplemental plan, but since the requirements are fixed by regulation you will find the costs competitive and maybe cheaper on the market. Group plans tend to be more expensive.

     
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