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Board: Cancer: Prostate 05-12-2021, 05:17 PM
Replies: 7
Views: 1,259
Posted By DjinTonic
Re: PSMA Scan

Hi Paula. IMO, the best place to begin a serious dive into a medical topic is with recent review articles: (1) the authors have done the research for you and have selected the better studies; (2)...
Board: Cancer: Prostate 05-08-2021, 08:03 PM
Replies: 18
Views: 2,630
Posted By DjinTonic
Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

One of the best is the Gallium 68 PSMA, which was recently FDA-approved, but somewhat limited in geographic availability. The other is Fluciclovine F 18 (commercial name Axumin PET/CT), which is more...
Board: Cancer: Prostate 05-05-2021, 07:54 PM
Replies: 18
Views: 2,630
Posted By DjinTonic
Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

John, did you have your imaging done yet --- MRI or CT? Did it show any evidence of (1) local spread out from the prostate or (2) any enlarged lymph nodes suggestive of metastases?

Yes, a PSA...
Board: Cancer: Prostate 05-03-2021, 07:23 PM
Replies: 21
Views: 2,092
Posted By DjinTonic
Re: positive lymph node removal during prostate removal

Locally advanced means the cancer has spread outside the prostate, but is still thought to all be located within the pelvis. This can be (1) contiguous, but non-metastatic spread, e.g., through the...
Board: Cancer: Prostate 05-02-2021, 07:25 PM
Replies: 21
Views: 2,092
Posted By DjinTonic
Re: positive lymph node removal during prostate removal

I think you are confusing two separate issues, which I may not have explained clearly. Yes, the advanced scans are full-body. They are also more sensitive than the standard bone scans done before...
Board: Cancer: Prostate 05-02-2021, 08:56 AM
Replies: 21
Views: 2,092
Posted By DjinTonic
Re: positive lymph node removal during prostate removal

You husband has metastatic PSA, as documented by the post-op path report. Please obtain and post the complete details of this report. It is more important than the MRI results now and any other doc...
Board: Cancer: Prostate 04-10-2021, 04:20 AM
Replies: 8
Views: 1,794
Posted By DjinTonic
Re: Is it prostate cancer??

Hi Mac11 and welcome to the Forum! There is no point in worrying before any diagnosis of prostate cancer (PCa). Don't be surprised if your husband's uro still wants an initial biopsy even if the MRI...
Board: Cancer: Prostate 02-25-2021, 11:36 AM
Replies: 16
Views: 4,080
Posted By DjinTonic
Re: Elevated PSA/Urologist Felt Small Bump

About half of nodules felt on DRE are benign. My last biopsy was triggered by a new nodule felt on DRE (as well as a slightly elevated PSA). The nodule turned out to be benign; however, the same...
Board: Cancer: Prostate 02-21-2021, 08:25 AM
Replies: 33
Views: 32,974
Posted By DjinTonic
Re: Surgical removal vs. EBRT

While G 6 (3+3) cannot metastasize, it does sometimes grow locally out of the prostate in the form of EPE (extraprostatic extension). One study found this happens in about 4% of cases. But the real...
Board: Cancer: Prostate 02-15-2021, 09:42 AM
Replies: 18
Views: 8,038
Posted By DjinTonic
Re: Worry with PSA of .03 3.5 years after surgery?

Correct. The usual definition of biochemical (but not clinical) recurrence after RP is a PSA of 0.2 and still rising.

Salvage therapy below 0.2 (often 0.1 to 0.2) is usually referred to in the...
Board: Cancer: Prostate 02-14-2021, 07:08 PM
Replies: 10
Views: 2,625
Posted By DjinTonic
Re: Very Low Risk of Secondary Cancer After Radiation for Prostate Cancer - Low Enoug

My point is that in comparing BCR-Free survival stats for treatment modalities for high-risk men, one also has to include the high-risk men who had RP only. Some of us go on to experience BCR and...
Board: Cancer: Prostate 02-12-2021, 06:56 PM
Replies: 10
Views: 2,625
Posted By DjinTonic
Re: Very Low Risk of Secondary Cancer After Radiation for Prostate Cancer - Low Enoug

There are recent studies also, you just have to look for them. This paper is from the International Journal of Radiation Oncology, Biology, Physics ASTRO

Clinical and Treatment Characteristics of...
Board: Cancer: Prostate 02-08-2021, 05:18 AM
Replies: 8
Views: 1,835
Posted By DjinTonic
Re: Seeking input on SpaceOAR (or equivalent spacer tech)

There have been several papers published on the SpaceOar detailing various adverse events resulting from its use. Here is a recent editorial in The Lancet (the full text requires access).
...
Board: Cancer: Prostate 01-25-2021, 06:21 AM
Replies: 15
Views: 3,481
Posted By DjinTonic
Re: BCR of My Protate Cancer - Advice Please

Why some G6 (3+3) men are high risk for metastases even though G6 disease cannot metastasize

I'd like to clarify something I said above: "Metastasis risk cuts across all Gleason scores and...
Board: Cancer: Prostate 01-19-2021, 09:10 AM
Replies: 9
Views: 4,970
Posted By DjinTonic
Re: Second Opinion on MRI?

Johns Hopkins has perhaps the strictest AS protocol. (Strict is good when it comes to AS.) They require a follow-up biopsy 6-12 months after diagnosis. Both MRIs and biopsies can miss significant...
Board: Cancer: Prostate 12-18-2020, 10:58 AM
Replies: 1
Views: 1,048
Posted By DjinTonic
Best Evidence So Far: Metformin Has No Benefit for Prostate Cancer

Best Evidence So Far: Metformin Has No Benefit for Prostate Cancer

https://www.prostatecancer.news/
(Prostate Cancer News, December 16, 2020)

"In studies of men with diabetes, men taking...
Board: Cancer: Prostate 12-01-2020, 04:27 PM
Replies: 4
Views: 3,996
Posted By DjinTonic
Re: Up-Date From Big Al

Hi Big Al. Sorry about the PSA rise -- although I can't explain the dip down and subsequent rise. Just today the FDA approved 68Gallium-PSMA-PET scans. I don't know what insurance coverage will be at...
Board: Cancer: Prostate 10-15-2020, 11:20 AM
Replies: 21
Views: 21,766
Posted By DjinTonic
Re: Treatment Options for an Insufferable Horndog

I fail to see how the OP is a candidate for AS according to the entry criteria of the programs at any of the major institutions. Of course, that doesn't mean one can't do AS with one's uro, but I,...
Board: Cancer: Prostate 09-27-2020, 08:12 AM
Replies: 21
Views: 21,766
Posted By DjinTonic
Re: Treatment Options for an Insufferable Horndog

The penis itself is not changed during a prostatectomy. The perceived shortening is usually temporary (<12 months) and is probably caused by several factors: the urethra is shortened and pulled back;...
Board: Cancer: Prostate 08-05-2020, 11:13 AM
Replies: 15
Views: 6,522
Posted By DjinTonic
Primary Treatment for High-Risk Disease

For men diagnosed with G8-10 disease facing a treatment decision, I highly recommend these recent papers. The first is a recent review article that also discusses quality of life. The second is a...
Board: Cancer: Prostate 07-22-2020, 04:55 PM
Replies: 15
Views: 4,824
Posted By DjinTonic
Re: PSA Rise

Many men have their Gleason score upgraded (or downgraded) after their biopsy. A biopsy samples a small amount if tissue and can easily miss the most serious lesion(s). The post-op Gleason score...
Board: Cancer: Prostate 06-18-2020, 12:17 PM
Replies: 13
Views: 13,931
Posted By DjinTonic
Re: Post Radical Prostatectomy

Excellent scan results! Regarding the psychology of it all, just anticipate the last day of your RT, when your cancer has been zapped away. Stay positive, take one day at a time, and let your...
Board: Cancer: Prostate 03-10-2020, 03:10 AM
Replies: 15
Views: 4,101
Posted By DjinTonic
Re: PSA Seven Years Since 2013 Radiation

Here is the study:

Three-year postoperative ultrasensitive prostate-specific antigen following open radical retropubic prostatectomy is a predictor for delayed biochemical recurrence (2011)
...
Board: Cancer: Prostate 03-08-2020, 05:07 PM
Replies: 15
Views: 4,101
Posted By DjinTonic
Re: PSA Seven Years Since 2013 Radiation

Staying on top of things has undoubtedly contributed to your successful treatment! Well done!

Djin
Board: Cancer: Prostate 03-06-2020, 06:30 AM
Replies: 44
Views: 20,090
Posted By DjinTonic
Re: Lack of Evidence That Surgery Is As Good As Radiation for Higher-Risk PC Patients

Gerald, if I were you, I'd be measuring my PSA every 3 months preferably with Labcorp's 3-decimal test, but certainly with a test that returns at least 2 decimal places. With a post-op PSA history of...
Board: Cancer: Prostate 03-04-2020, 10:18 AM
Replies: 4
Views: 2,984
Posted By DjinTonic
Information on the Labcorp <0.014 PSA test

Several Forum Brothers, here and elsewhere, have reported a Labcorp PSA result of <0.014. The < sign did not appear to be an error, but it wasn't clear what was going on. It appears this indeed was...
Board: Cancer: Prostate 03-04-2020, 06:11 AM
Replies: 25
Views: 15,380
Posted By DjinTonic
Re: Just Had 1st Meeting with my RO

Stereotactic Body Radiotherapy for Primary Prostate Cancer (2018, Review)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069023/



[Emphasis mine]

There is at least one ongoing trial, a...
Board: Cancer: Prostate 02-13-2020, 09:53 AM
Replies: 4
Views: 3,366
Posted By DjinTonic
Individual & joint effects of metformin and statins on high-risk PCa mortality

Individual and joint effects of metformin and statins on mortality among patients with high‐risk prostate cancer [2020, Full Text]

https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.2862


...
Board: Cancer: Prostate 01-31-2020, 11:33 AM
Replies: 41
Views: 18,272
Posted By DjinTonic
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...
Board: Cancer: Prostate 01-22-2020, 05:16 PM
Replies: 24
Views: 3,201
Posted By DjinTonic
Re: Psa prostrate Levels

My understanding is that the first step after any unexpectedly large PSA increase is a repeat test, to rule out lab error. Often sufficient blood is taken that a repeat test can be run simply by...
Board: Cancer: Prostate 01-22-2020, 11:49 AM
Replies: 17
Views: 9,103
Posted By DjinTonic
Re: Choosing between conventional and hypofractionated RT

Yes, that statement is one of the ASTRO statements quoted in the Decision Aid; in fact, it continues...



So the patient can see one example of what "small" means in terms of the increased risk,...
Board: Cancer: Prostate 01-17-2020, 09:35 AM
Replies: 16
Views: 4,632
Posted By DjinTonic
Re: Some Pre-Biopsy Questions

A nodule (at the prostate apex) on DRE (along with a larger than expected PSA jump) triggered my last biopsy, which found two G9 and G10 lesions (one at, and one near, the prostate base). I mentioned...
Board: Cancer: Prostate 01-16-2020, 06:58 AM
Replies: 27
Views: 6,393
Posted By DjinTonic
Re: Starting my PCa journey

With regard to your interest in proton vs. other RT modalities:

Proton versus photon-based radiation therapy for prostate cancer: emerging evidence and considerations in the era of value-based...
Board: Cancer: Prostate 01-13-2020, 01:53 PM
Replies: 33
Views: 12,642
Posted By DjinTonic
Re: what to do now with Prostate Cancer?

If you encounter a rising PSA after a RP and go to the MSK nomogram for your statistical outcome of SRT at

https://www.mskcc.org/nomograms/prostate/salvage_radiation_therapy

you'll read:


...
Board: Cancer: Prostate 01-11-2020, 03:26 AM
Replies: 3
Views: 755
Posted By DjinTonic
Re: Whole Pelvic vs Prostate Bed RT

You can see visual comparisons of the two for SRT in these figures:
...
Board: Cancer: Prostate 01-09-2020, 06:06 PM
Replies: 21
Views: 3,149
Posted By DjinTonic
Re: 5α-Reductase Inhibitors (e.g., finasteride) and PCa risk/benefit

Jim mentioned the SpaceOar gel:

Patients considering it should be aware that there have been serious complications. I would discuss these with your doc, so you know they are aware, and they can...
Board: Cancer: Prostate 01-09-2020, 05:02 AM
Replies: 21
Views: 3,149
Posted By DjinTonic
5α-Reductase Inhibitors (e.g., finasteride) and PCa risk/benefit

This topic came up in a recent thread. Here are some recent publications I had flagged on the question of the risks/benefits of these meds for PCa, plus a couple that turned up with a very quick...
Board: Cancer: Prostate 01-07-2020, 09:04 AM
Replies: 12
Views: 1,696
Posted By DjinTonic
Re: Benign Prostate Enlargement (BPH), PSA and Prostate Cancer: When to Biopsy?

I think there is general agreement a biopsy is warranted if there are PIRADS 4 or 5 areas, regardless of other parameters. And all the studies I've come across advocate for investigating...
Board: Cancer: Prostate 01-04-2020, 05:42 AM
Replies: 11
Views: 883
Posted By DjinTonic
Long-term outcomes of active surveillance at MSK

Long-Term Outcomes of Active Surveillance for Prostate Cancer - The Memorial Sloan Kettering Cancer Center Experience [2019]

https://www.ncbi.nlm.nih.gov/pubmed/31868556



Another consoling...
Board: Cancer: Prostate 12-29-2019, 12:47 PM
Replies: 28
Views: 4,341
Posted By DjinTonic
Re: Radical Prostatectomy OR Plant Based Diet?

While RP techniques continue to have minor improvements, surgery results are more or less a fixed target and have to be compared to what are pretty much moving targets. As RT modalities change, it's...
Board: Cancer: Prostate 12-29-2019, 09:50 AM
Replies: 41
Views: 7,378
Posted By DjinTonic
Re: First post - My history and where do I go from here

Hi gp. Elevated PSA from BPH can mask a PSA contribution from PCa, which is why there was concern for me and so many (negative) biopsies. Given your family history (father) and current PSA, I...
Board: Cancer: Prostate 12-29-2019, 06:51 AM
Replies: 28
Views: 4,341
Posted By DjinTonic
Re: Radical Prostatectomy OR Plant Based Diet?

The newer the RT modality, the shorter the followup time we have to measure results. Thus RT studies for, e.g., SBRT, have necessarily used BCR rates to judge success. However, some recent studies...
Board: Cancer: Prostate 12-26-2019, 05:32 AM
Replies: 28
Views: 4,341
Posted By DjinTonic
Re: Radical Prostatectomy OR Plant Based Diet?

Thanks, Jim. Another plus about the PDQ reports is that they are updated, perhaps as often as 2 or 3 times a year. For PCa, there are also PDQ reports on

Screening:
Professional:...
Board: Cancer: Prostate 12-23-2019, 06:20 AM
Replies: 28
Views: 4,341
Posted By DjinTonic
Re: Radical Prostatectomy OR Plant Based Diet?

Hi Stephen,

For the latest in the results of serious research and professional recommendations on plant-based supplements (phytochemicals), see

Prostate Cancer, Nutrition, and Dietary...
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