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  • MUST READ: New Prostate Cancer Guidelines

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    Old 05-11-2022, 06:16 AM   #1
    ASAdvocate
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    MUST READ: New Prostate Cancer Guidelines

    The American Urological Association and the American Society for Radiation Oncology (AUA/ASTRO) just issued new guidelines for the treatment of localized prostate cancer.

    There are major changes for active surveillance, being the preferred treatment for all low risk cases. Also, AS can now be considered for select favorable intermediate risk men.

    There are cautions about the lack of high quality data for focal ablation, and a statement that proton has not been shown to be superior to other radiation choices in outcomes and toxicities. Lots of good information here that patients, especially those deciding treatment, should be aware of.

    These new guidelines are the result of studies and discussions of new findings since the last publication five years ago.

    https://www.auanet.org/guidelines/guidelines/clinically-localized-prostate-cancer-aua/astro-guideline-2022?fbclid=IwAR0puAJC0ROsyY_04pbG0B8CAw jXKdGDbn7pbIRCuD6HYV2ruF4ywGEVXJc

    Last edited by ASAdvocate; 05-11-2022 at 11:40 AM. Reason: Typo

     
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    Old 05-11-2022, 08:37 AM   #2
    Prostatefree
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    Re: MUST READ: New Prostate Cancer Guidelines

    Thank you very much. I will read in more depth, but was pleased to see life expectancy consideration included under risk management.
    __________________
    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, upgraded to G3+4, Tumor vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months
    7-9-21 PSA less than 0.02; zero club 6yrs

     
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    Old 05-11-2022, 08:45 AM   #3
    CentralPaDude
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    Re: MUST READ: New Prostate Cancer Guidelines

    Good stuff, thanks!

     
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    Old 05-11-2022, 10:46 AM   #4
    Michael F
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    Re: MUST READ: New Prostate Cancer Guidelines

    Thank you ASA! Just downloaded and about to print. Have some upcoming airplane time this weekend to read.
    Hoping all is close to perfect with you.

    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 => Surgeon went back and excised additional adjacent tissues on Left side down to (-) Margins
    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 - 0.057 at 120 Months Post Op: Mean = 0.025 (n = 28)
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    Old 05-12-2022, 09:02 AM   #5
    IADT3since2000
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    Re: MUST READ: New Prostate Cancer Guidelines

    "Localized Prostate Cancer" in New Guidelines is Based on Conventional Imaging

    I'm just starting to study these guidellines, and my main viewpoint is whether surgery is a generally unfavorable approach for patients with high-risk disease or whether it is generally a reasonable option, which is the position expressed in the new guidelines. A key question for me is whether advanced, modern imaging (sometimes referred to as Next Generation Imaging - NGI), such as with PSMA (Prostate Specific [not really entirely specific but close] Membrane Antigen) scans, Axumin, and carbon-11 (C-11) scans, can determine with high confidence that the cancer for high-risk patients is truly localized, in other words, that it is where surgery can reach it and wipe it out, and/or whether a course of ADT (Androgen Deprivation Therapy) in support of surgery is wise.

    With that in mind, the guidelines state up front that the term "localized" is based on conventional in contrast to NGI (Next Generation Imaging). Conventional imaging means CT scans, mainly for lymph node assessment, and technetium-99 scans for bone assessment.

    So far I have just poked around just a bit in this long document, but it's clear there is hesitancy in the new guidelines to embrace NGI [Next Generation Imaging] at this time, and comfort with waiting for future study results before changing practice. Indeed, the study notes that the ability to pick up cancer in lymph nodes in the OSPREY trial by one of the PSMA NGI scans was about 40% - that's great in the context of probably a very low capability to pick it up with CT scans, but far too low to dispense with extensive lymph node dissection based on a negative result. It is known that PSMA scans miss about 20% of metastases, those with cancer cells that do not have PSMA on their cell surfaces. It's possible that tandem use of one of the NGI scans that does not require PSMA on cell surfaces would raise the sensitivity to an acceptable level, but that raises cost-benefit/availability issues. My impression is that some centers, particularly the Mayo Clinic in Rochester, Minnesota, are now using tandem NGI scans at least some of the time.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - --
    22 years as a survivor. Doing well. 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, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) 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. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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