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    Old 11-15-2020, 06:33 PM   #1
    JJPeabody
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    Radiation oncologist recommendation Phoenix/Scottsdale area

    Can anyone recommend a specific, or 2 or 3, radiation oncologist in Phoenix/Scottsdale area. Just moved here and I'm going numb researching, so thought I'd take a break and ask. Thank you for any help.

     
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    Old 11-16-2020, 11:55 AM   #2
    IADT3since2000
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Hi JJ and welcome to the board! Here are some paths you could follow, andI'm hoping they won't increase the numbness you sense.

    Have you checked the Phoenix location for the Mayo Clinic for radiation oncologists? I'm thinking that Mayo would be careful to only employ top flight people.

    Here's another approach you can take: go to www.pubmed.gov, our US government sponsored national electronic library of medicine, and search for strings like - prostate cancer AND Phoenix Arizona . I just did that and got a list of 132 publications. Then click on the ones that look like radiation would be involved, and for each one, expand the authors list so you can see the authors from Phoenix (likewise for Scottsdale). You could also add - AND radiation - to the search string, which reduces the list to 52 papers. Adding - AND Department of Radiation Oncology, Mayo - reduces the list to 25. You can tailor the search as you wish.

    Dr. Fabio Almeida, MD, is a well-known radiologist with a lot of experience in prostate cancer that practiced in Phoenix at least until recently. His office might be willing to provide leads.

    You might also contact the Us Too Northeast Valley prostate cancer education and support group that meets at the Mayo Clinic facility. The group leader might have some good leads. (ustoo.org, and then navigate to the find support information)

    Good luck!

    .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 PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 11-16-2020, 12:59 PM   #3
    JJPeabody
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Jim, thanks for taking the time and the helpful reasearch, I benefitted from your profile history as well. I am a Gleason 4+3=7 with extra-capsular ext, but margins, nodes, vesicles negative after RP on 2/2019. Recurrence less than 2 years (.009 until 2/2020 0.41 and started doubling 6mths until 10/9/20 at 0.124 and jumped to 0.19 1mth later 11/13/20). I see radiation oncologist tomorrow for consult. It may be worth to enroll in Medicare at open enrollment and pay the extra cost to get in Mayo? At this point debating going back to a urologist for guidance and contemplating Intermittent ADT over salvage radiation until a "magic bullet" comes along. Mild incontinence after 2 yrs RP at 2 pads is doable for now. Thanks again.

     
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    Old 11-17-2020, 06:30 AM   #4
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Hi again JJ. You're welcome. I'm glad I could help! This forum runs on "pay it forward" energy.

    Regarding insurance and access to Mayo or other care, Medicare has been very helpful for many people but comes with at least one concern: some doctors do not take Medicare; they "opt out" of the system. Two doctors I see or have seen are in that group, and both are very highly respected for their expertise. My BCBS covered me very well with one, and covered a small portion for the other - his charges were really high for a single consult, but my first consult was three uninterrupted hours long! I have elected to rely just on BCBS for myself and my wife rather than to couple it with Medicare, and that has worked well for me; our personal circumstances make a difference; neither my wife nor I qualify for social security, and my impression is that Medicare has recently been made more attractive for those who do qualify. It would probably help to contact the business office at Mayo and see what they would advise. Also, do you have access to "Doctor Radio"? An expert on insurance, including Medicare, hosts a phone access program called Health Care Connect every Thursday from 12 pm to 2 pm ( https://www.siriusxm.com/servlet/ContentServer?c=SXM_Channel_C&childpagen ame=SXM%2FSXM_Channel_C%2FChannelProgram List&cid=1282009842363&d=&pagename=SXM%2 FWrapper )

    Regarding the "magic bullet," on the one hand, modern radiation and supportive technologies, especially imaging for planning and daily and even adjustment within the session targeting have greatly improved effectiveness against the cancer and reduction of side effects. On the other hand, ADT would almost certainly work for many years, likely at least ten based on current technology, and that would allow time for other technology to develop. Perhaps the biggest impact new technology now coming down the pike is a hunter/killer combo of a PSMA affinity molecule for hunting linked to a radiation emitting isotope, Lutetium (Lu) 177. The molecule seeks out cells with PSMA, almost all of which will be attached to the surface of the cancer cells, and then the Lu-177 kills those cells while not affecting cells where no PSMA is attached. However, not all prostate cancer cells, about 20% as I understand it do not. (I'm not sure of the important question whether that's 20% of patients or 20% of a patient's cells; maybe someone reading this can help.) The downside is that some healthy cells also have PSMA attached, such as in the salivary glands, so there can be some side effects. Here's a link to a video about it at the PCRI (Prostate Cancer Research Institute) site, pcri.gov, or directly here: https://www.bing.com/videos/search?q=lutetium+177&docid=608041819089 341969&mid=7A36826D9F856D7F1C907A36826D9 F856D7F1C90&view=detail&FORM=VIRE

    .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 PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 11-22-2020, 09:56 PM   #5
    NMguy
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    You mentioned maybe seeing a Urologist again. Mine at Mayo Clinic Phoenix is Dr. Paul Andrews who is very good. Also Dr. Scott Cheney at Mayo Clinic Phoenix is very good.

     
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    Old 11-23-2020, 05:58 AM   #6
    JJPeabody
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Quote:
    Originally Posted by NMguy View Post
    You mentioned maybe seeing a Urologist again. Mine at Mayo Clinic Phoenix is Dr. Paul Andrews who is very good. Also Dr. Scott Cheney at Mayo Clinic Phoenix is very good.
    Thanks NMguy. How does the billing work at Mayo. I have been told they do not except Medicare advantage HMO plans and saw something about traditional Medicare on their website but it was a bit confusing just what they accept and what % the patient pays. Impression is it could be cost prohibitive but I would like to pursue Mayo. I called finance dept and women there was not very helpful. Thanks

     
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    Old 11-23-2020, 07:37 PM   #7
    NMguy
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    I'm not sure how the HMO or Medicare Advantage plans work there. I have Medicare A and B with a Part G supplement plan from Aetna. Also Part D drug plan SilverScript from Aetna and haven't had any problems with Mayo Clinic with them accepting them.

     
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    Old 11-24-2020, 06:46 AM   #8
    JJPeabody
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Quote:
    Originally Posted by NMguy View Post
    I'm not sure how the HMO or Medicare Advantage plans work there. I have Medicare A and B with a Part G supplement plan from Aetna. Also Part D drug plan SilverScript from Aetna and haven't had any problems with Mayo Clinic with them accepting them.
    NMguy, thank you for your timely and informative response, I'll look into that before end of open enrollment. Thanks

     
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    Old 11-24-2020, 11:09 AM   #9
    IADT3since2000
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Hi again JJ.

    Here are some additional thoughts, including the Medicare policy at Mayo Clinic in Phoenix.

    The following link takes you to the policy for Medicare at Mayo Clinic in Arizona:

    For patients receiving services in Arizona:
    https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/faq

    Basically, it says that Mayo in Arizona accepts Part A but not Part B. That means, as I see it, that they are not bound by the limits on payment set by Medicare and can charge 15% over that limit. The patient is billed by Mayo and has to pay whatever difference Medicare does not pay directly to the patient. So Medicare will pay a big part of the bill, but you have to deal with Medicare and will likely be liable for the excess that Medicare does not cover.

    Regarding your frustrating talk with the finance person, it is often worthwhile to try again. You might try contacting someone from "Billing" rather than "Finance," as "Finance" may be thinking you want financial aid.

    Good luck.

    .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 PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 11-24-2020, 04:07 PM   #10
    JJPeabody
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi again JJ.

    Here are some additional thoughts, including the Medicare policy at Mayo Clinic in Phoenix.

    The following link takes you to the policy for Medicare at Mayo Clinic in Arizona:

    For patients receiving services in Arizona:
    https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/faq

    Basically, it says that Mayo in Arizona accepts Part A but not Part B. That means, as I see it, that they are not bound by the limits on payment set by Medicare and can charge 15% over that limit. The patient is billed by Mayo and has to pay whatever difference Medicare does not pay directly to the patient. So Medicare will pay a big part of the bill, but you have to deal with Medicare and will likely be liable for the excess that Medicare does not cover.

    Regarding your frustrating talk with the finance person, it is often worthwhile to try again. You might try contacting someone from "Billing" rather than "Finance," as "Finance" may be thinking you want financial aid.

    Good luck.

    .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 PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.
    Hi JJ, thank you for both your last two messages, I called billing today and as you suggested the guy in billing was excellent in answering all questions re medicare, supplemental plans etc and I probably will go with medicare so I can choose the No. 1 cancer treatment center in AZ at Mayo. Your first response really lifted my spirits as I was burnt out but got back on it. Thanks

     
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    Old 11-24-2020, 04:16 PM   #11
    JJPeabody
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Quote:
    Originally Posted by NMguy View Post
    I'm not sure how the HMO or Medicare Advantage plans work there. I have Medicare A and B with a Part G supplement plan from Aetna. Also Part D drug plan SilverScript from Aetna and haven't had any problems with Mayo Clinic with them accepting them.
    Hello NMguy, thanks to your example I am most likely to enroll in Medicare and Parts G and D as you have. Before this I had basically written Mayo off as unaffordable. Since you're batting a thousand you haven't heard of a pick for radiaton oncologist at Mayo have you. Once I enroll I will begin that search. Thanks again

     
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    Old 11-24-2020, 10:36 PM   #12
    NMguy
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    No I haven't. By Mayo standards I'm still undetectable and will have another psa in about 3 months. I requested the 3 months or so. Dr. Andrews said I could go 6 months but I didn't want to go that long. He said that was ok. Ask about an RO but he wants to wait as he said I'm still undetectable. We'll see next test.

     
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    Old 11-25-2020, 04:43 AM   #13
    JJPeabody
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Quote:
    Originally Posted by NMguy View Post
    No I haven't. By Mayo standards I'm still undetectable and will have another psa in about 3 months. I requested the 3 months or so. Dr. Andrews said I could go 6 months but I didn't want to go that long. He said that was ok. Ask about an RO but he wants to wait as he said I'm still undetectable. We'll see next test.
    Thank you and best of luck, Jim

     
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    Old 02-22-2021, 04:52 PM   #14
    JJPeabody
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi again JJ. You're welcome. I'm glad I could help! This forum runs on "pay it forward" energy.

    Regarding insurance and access to Mayo or other care, Medicare has been very helpful for many people but comes with at least one concern: some doctors do not take Medicare; they "opt out" of the system. Two doctors I see or have seen are in that group, and both are very highly respected for their expertise. My BCBS covered me very well with one, and covered a small portion for the other - his charges were really high for a single consult, but my first consult was three uninterrupted hours long! I have elected to rely just on BCBS for myself and my wife rather than to couple it with Medicare, and that has worked well for me; our personal circumstances make a difference; neither my wife nor I qualify for social security, and my impression is that Medicare has recently been made more attractive for those who do qualify. It would probably help to contact the business office at Mayo and see what they would advise. Also, do you have access to "Doctor Radio"? An expert on insurance, including Medicare, hosts a phone access program called Health Care Connect every Thursday from 12 pm to 2 pm ( https://www.siriusxm.com/servlet/ContentServer?c=SXM_Channel_C&childpagen ame=SXM%2FSXM_Channel_C%2FChannelProgram List&cid=1282009842363&d=&pagename=SXM%2 FWrapper )

    Regarding the "magic bullet," on the one hand, modern radiation and supportive technologies, especially imaging for planning and daily and even adjustment within the session targeting have greatly improved effectiveness against the cancer and reduction of side effects. On the other hand, ADT would almost certainly work for many years, likely at least ten based on current technology, and that would allow time for other technology to develop. Perhaps the biggest impact new technology now coming down the pike is a hunter/killer combo of a PSMA affinity molecule for hunting linked to a radiation emitting isotope, Lutetium (Lu) 177. The molecule seeks out cells with PSMA, almost all of which will be attached to the surface of the cancer cells, and then the Lu-177 kills those cells while not affecting cells where no PSMA is attached. However, not all prostate cancer cells, about 20% as I understand it do not. (I'm not sure of the important question whether that's 20% of patients or 20% of a patient's cells; maybe someone reading this can help.) The downside is that some healthy cells also have PSMA attached, such as in the salivary glands, so there can be some side effects. Here's a link to a video about it at the PCRI (Prostate Cancer Research Institute) site, pcri.gov, or directly here: https://www.bing.com/videos/search?q=lutetium+177&docid=608041819089 341969&mid=7A36826D9F856D7F1C907A36826D9 F856D7F1C90&view=detail&FORM=VIRE

    .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 PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.
    Hi IADT3since2000 aka Jim, it's been awhile since our correspondence but I am heading toward implementing a treatment plan at Mayo in AZ and have been impressed with your history and general comments. I am planning SRT but not enthusiastically. The radiologist is planning to drop casodex after 1 month and addition of only Lupron for 6 months in conjunction with IMRT. I just had PSMA scan with uptake in prostate bed near bladder with no spread of metastasis noted. I am on 1-2 pads and can live with that but not much worse. I expect 10 good years remaining. I would prefer ADT if I knew the bone loss and side effects would be manageable ie QOL, longevity decent toward 10 years and not cost prohibitive. I was impressed with your experience with ADT3 etc. I was wondering if you would care to comment on a treatment plan, whether SRT or ADT. Iam pasting my stats below. Thanks for any thoughts. Jim

    PSA before RP 5.3
    Gleason 4+3=7 (biopsy 4+4=8; surgery pathology 4+3=7)
    Stage PT3aN0
    Extra capsular extension, margins negative
    Lymph nodes and seminal vesicles negative
    Positive perineural invasion
    RP surgery 2/19/19
    PSA history 3/26/19 .008; 6/18/19 .008; 10/14/19 .009; 2/12/20 .041; 7/9/20 .085; 10/9/20 .124; 11/13/20 .19; 12/22/20 .14 after 23 days on casodex. Stopped casodex on 1/23/21 in anticipation of PSMA UCLA, PSA 0.12 on 2/12/21 3 days after PSMA scan on 2/9/21. Testosterone free 108.6, total 605.
    Started casodex 50mg 1x 11/29/20, stopped 1/23/21
    70 age, longevity 10 years
    Leaning toward ADT hormone therapy vs SRT (incontinence 1-2 pads after 2 yrs post RP

     
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    Old 02-23-2021, 11:10 AM   #15
    Prostatefree
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    Re: Radiation oncologist recommendation Phoenix/Scottsdale area

    Avoid Medicare Advantage plans if you can afford to get a supplemental plan. Advantage plans are a cost saving option and come with service restrictions.
    __________________
    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;
    1-15-21 PSA less than 0.02; zero club 4.5 yrs

     
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