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Board: Cancer: Prostate 05-13-2022, 07:48 PM
Replies: 55
Views: 8,337
Posted By ASAdvocate
Re: New User - Active Surveillance Changes

I agree with DJin and ProstateFree about doing a genomics test on your positive biopsy cores, as well as a second opinion on the Gleason assessments.

But, I have participated in many tens of...
Board: Cancer: Prostate 05-11-2022, 06:16 AM
Replies: 4
Views: 763
Posted By ASAdvocate
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...
Board: Cancer: Prostate 05-06-2022, 07:50 AM
Replies: 55
Views: 8,337
Posted By ASAdvocate
Re: New User - Active Surveillance Changes

You are very low risk.

Looks like the only thing you need to be thinking about prostate cancer is the date of your next surveillance appointment.
Board: Cancer: Prostate 05-06-2022, 06:29 AM
Replies: 55
Views: 8,337
Posted By ASAdvocate
Re: New User - Active Surveillance Changes

Thanks for the mention of the LeapMed device. It appears very similar to the Precision Point TPUS system, which was used in my last two biopsies. Always great to see more options and improvements in...
Board: Cancer: Prostate 05-04-2022, 10:46 AM
Replies: 6
Views: 1,028
Posted By ASAdvocate
Re: Tumor in Prostate, Peripheral Area, What to do!?

Research a procedure called “simple prostatectomy”. That is a surgery to remove most of the inside of the prostate to de-bulk it’s size. This is a procedure for enlarged benign prostates, not for...
Board: Cancer: Prostate 04-04-2022, 07:13 AM
Replies: 55
Views: 8,337
Posted By ASAdvocate
Re: New User - Active Surveillance Changes

The genomics testing is done on the biopsy cores. I had an OncotypeDX run on biopsy cores several months after that biopsy. No pre-planning was involved.

You may want find out what a genomics test...
Board: Cancer: Prostate 04-03-2022, 12:15 PM
Replies: 55
Views: 8,337
Posted By ASAdvocate
Re: New User - Active Surveillance Changes

As far as “individualized” AS protocols for patients, I can tell you that is not the case at Johns Hopkins, where we have the strictest and most successful AS program on the planet.

Everybody has...
Board: Cancer: Prostate 03-17-2022, 04:16 PM
Replies: 21
Views: 3,431
Posted By ASAdvocate
Re: Higher Risk Patient: Waiter, Can I Have a Serving of ADT with My Prostatectomy?

In 2020, i got into an epic firefight with a surgery advocate in a prostate cancer group on the big social media site. He was adamant that surgery was the only solution for every incidence of...
Board: Cancer: Prostate 03-03-2022, 12:31 PM
Replies: 20
Views: 10,118
Posted By ASAdvocate
Re: Newly Diagnosed

Jim, It’s like politics. PF has very strong opinions, and you or I aren’t going to change him. He has been adamantly consistent that any man with the smallest amount of PCa should have an RP without...
Board: Cancer: Prostate 02-15-2022, 01:39 PM
Replies: 7
Views: 1,293
Posted By ASAdvocate
Re: 1 year out from MRI ERBT, concerning PSA value

Jim has given you the authoritative advice from ASCO’s Phoenix Definition.

Too many times, men who had primary radiation will read posts by guys who had surgery and think their criteria apply to...
Board: Cancer: Prostate 12-04-2021, 07:14 AM
Replies: 14
Views: 2,862
Posted By ASAdvocate
Re: Types of radiation

This is the long-running debate that DJin and I have had comparing recurrence rates against mortality rates. Part of the difference may be that some men who did RT were not healthy enough to do RP. ...
Board: Cancer: Prostate 11-25-2021, 05:57 AM
Replies: 10
Views: 3,394
Posted By ASAdvocate
Re: What next?

In my opinion, the PA is mistaken. A Gleason score of (3+4)=7 is only part of the risk calculation. The high percentages of core involvement, the cribriform morphology, and the perinureal invasion...
Board: Cancer: Prostate 10-11-2021, 06:28 AM
Replies: 9
Views: 2,524
Posted By ASAdvocate
Re: Causes of high total PSA other than aggressive cancer

You are assuming a worst case scenario that, while possible, is not supported by the two data points he provided. Certainly, he needs to keep following up his consultations and tests.
Board: Cancer: Prostate 10-10-2021, 12:16 PM
Replies: 9
Views: 2,524
Posted By ASAdvocate
Re: Causes of high total PSA other than aggressive cancer

Benign prostate hyperplasia, inflammation, bacterial prostatitis, chronic non bacterial prostatitis all can cause elevated PSA.

Generally, PSA from prostate cancer is a steady rise, whereas PSA...
Board: Cancer: Prostate 09-02-2021, 12:22 PM
Replies: 11
Views: 2,392
Posted By ASAdvocate
Re: My insurance doesn't cover Viagra...

Forget your insurance. This issue has been posted on every prostate board, and the consensus is always to use GoodRX and save probably 85 percent off the regular price.

For example, I can go to...
Board: Cancer: Prostate 08-08-2021, 06:42 PM
Replies: 7
Views: 1,404
Posted By ASAdvocate
Re: PSA spiked in 7 months; qualify for PAE?

If you are on FFAACCEEBBOOKK (this site does not allow mentioning other sites), please join the Enlarged Prostate (BPH) group there. Lots of discussions every day about PAE, aquablation, and other...
Board: Cancer: Prostate 08-02-2021, 02:17 PM
Replies: 6
Views: 2,896
Posted By ASAdvocate
Re: 3 months after MRI guided SBRT, w/ SpaceOAR

To understand the monitoring protocol that applies to men who have had radiation as their primary treatment for prostate cancer, you need to Google "prostate Phoenix Definition".
Board: Cancer: Prostate 07-29-2021, 02:11 PM
Replies: 10
Views: 3,394
Posted By ASAdvocate
Re: What next?

I addition to Djin’s advice, I would suggest that you ask if you can have a transperineal, rather than transrectal biopsy. That is because a transperineal biopsy, like the Precision Point system, can...
Board: Cancer: Prostate 07-05-2021, 05:35 PM
Replies: 5
Views: 1,340
Posted By ASAdvocate
A Possible Advance in Surgery Accuracy

Saw this on another forum, and thought it would be of interest here. Being able to see the possible spread of cancer outside of the prostate during DaVinci surgery seems like a possible game-changer....
Board: Cancer: Prostate 06-24-2021, 05:10 AM
Replies: 38
Views: 35,746
Posted By ASAdvocate
Re: Surgical removal vs. EBRT

You still have a prostate, so expecting a PSA of zero is not realistic.

To understand the criteria for monitoring PSA after primary radiation, Google “prostate Phoenix Definition”
Board: Cancer: Prostate 06-17-2021, 05:59 AM
Replies: 9
Views: 1,574
Posted By ASAdvocate
Re: MRI result

There are now less destructive procedures for a man with low grade cancer and an enlarged gland.

Both aquablation and prostate artery embolization can greatly reduce the prostate volume without...
Board: Cancer: Prostate 06-16-2021, 08:32 AM
Replies: 9
Views: 1,574
Posted By ASAdvocate
Re: MRI result

This is nothing to worry about. I’ve been in JH’s AS program since 2009, and this would be a typical MRI result for me. Possibly a small amount of Gleason 6, if anything.
Board: Cancer: Prostate 06-01-2021, 12:32 PM
Replies: 13
Views: 4,622
Posted By ASAdvocate
Re: I've decided on surgery

Hi John, Actually, I was replying to Franks’s post.

No matter. Best wishes for for your surgery.
Board: Cancer: Prostate 05-27-2021, 06:57 PM
Replies: 8
Views: 2,570
Posted By ASAdvocate
Re: Young very very worried

You are talking about a multi-parametric MRI, which is a very valuable diagnostic tool to identify any suspicious areas that could then be targeted by a biopsy.

But, PCa at age 39 is very, very...
Board: Cancer: Prostate 05-26-2021, 03:11 PM
Replies: 13
Views: 4,622
Posted By ASAdvocate
Re: I've decided on surgery

An informed choice is a confident decision.

Best wishes for your surgery.
Board: Cancer: Prostate 05-23-2021, 07:38 PM
Replies: 10
Views: 3,376
Posted By ASAdvocate
Re: Help please

I have seen several posts on various boards over the years where PIRADS 4 and 5 lesions were targeted by biopsies with no cancer found. Happened to me years ago. Now, that area is clear on imaging.
...
Board: Cancer: Prostate 05-02-2021, 07:19 AM
Replies: 27
Views: 6,311
Posted By ASAdvocate
Re: Results from my Seventh Prostate Biopsy

That is why the Precision Point transperineal biopsy device is being bought by more and more practices. No OR, no GA, no antibiotics, and no infections. Only 12 cores plus any imaging targets.
Board: Cancer: Prostate 04-20-2021, 07:41 AM
Replies: 8
Views: 1,322
Posted By ASAdvocate
Re: My focal Cryoablation experience

The Varian Truebeam is a competitor of Accuray’s Cyberknife. It can perform IMRT, SBRT, and VMAT. A recent article. Dr. Kishan has also done a lot of work and research with Cyberknife.
...
Board: Cancer: Prostate 04-19-2021, 09:26 PM
Replies: 8
Views: 1,322
Posted By ASAdvocate
Re: My focal Cryoablation experience

Focal cryotherapy sounds good, but it just has not shown good non-recurrence results.

On the other hand, SBRT/Cyberknife is reporting impressive non-recurrence stats, probably better than any...
Board: Cancer: Prostate 04-16-2021, 12:54 PM
Replies: 9
Views: 1,837
Posted By ASAdvocate
Replace Transrectal Biopsies with Transperineal

Howard Wolinsky, a long time prostate cancer patient activist, has asked me to help spread his petition for the replacement of transrectal biopsies with the new, simplified, transperineal procedures....
Board: Cancer: Prostate 04-07-2021, 01:50 PM
Replies: 27
Views: 6,311
Posted By ASAdvocate
Results from my Seventh Prostate Biopsy

Last Friday I had biopsy number seven as part of my twelve years in Johns Hopkins’ Active Surveillance program. This biopsy was different, as I requested the imaging be done in real time using the...
Board: Cancer: Prostate 02-15-2021, 07:44 AM
Replies: 26
Views: 13,381
Posted By ASAdvocate
Re: Worry with PSA of .03 3.5 years after surgery?

This is out of my experience, but I believe that the official demarcation for recurrence after RP is .2. Some specialists will recommend considering salvage treatment at .1.

But, .03 is far below...
Board: Cancer: Prostate 02-12-2021, 06:16 PM
Replies: 10
Views: 3,030
Posted By ASAdvocate
Re: Very Low Risk of Secondary Cancer After Radiation for Prostate Cancer - Low Enoug

Jim, I debate this “secondary cancers from radiation” almost everyday on other forums. I ask the surgery advocate who posted to provide a link to support his statement. Often they do, and often the...
Board: Cancer: Prostate 02-07-2021, 08:15 PM
Replies: 11
Views: 6,202
Posted By ASAdvocate
Re: A question on nerve sparing for radical prostatectomy

Studies have shown about a 35 percent recurrence rate after radical prostatectomy for unfavorable intermediate risk men. Also, the same amount of men are choosing radiation as are choosing surgery.
...
Board: Cancer: Prostate 01-31-2021, 03:55 PM
Replies: 9
Views: 2,046
Posted By ASAdvocate
Re: FNG with PC

It the combination of beam radiation and a brachytherapy boost fails, the cancer was probably already outside the prostate, so surgery will not be done. A PSMA scan followed by targeted radiation of...
Board: Cancer: Prostate 01-10-2021, 03:21 PM
Replies: 7
Views: 3,697
Posted By ASAdvocate
Re: ADT, Gleason 8, Radiation vs. Rad Prostatectomy

There have been studies showing good non-recurrence results after a combination of beam radiation with a brachytherapy boost, with or without ADT. That combination of radiation is termed BBT. An...
Board: Cancer: Prostate 01-01-2021, 08:54 AM
Replies: 17
Views: 7,619
Posted By ASAdvocate
Re: proton therapy vs cleveland clinic

In a word, no.

Every six months or so, I post a comment on various forums that I have never heard/read a first-hand account of any man who had PBT for prostate cancer who regretted doing it. I...
Board: Cancer: Prostate 01-01-2021, 01:30 AM
Replies: 18
Views: 20,289
Posted By ASAdvocate
Re: Newly Diagnosed

Excellent. I have been in that program since 2009. It has the best statistics for retention and almost no prostate cancer mortality.

You will be in good hands.
Board: Cancer: Prostate 12-23-2020, 07:01 PM
Replies: 16
Views: 6,365
Posted By ASAdvocate
Re: Prostate cancer - newbie - trying to decide

Be careful reading studies about radiation toxicities. There were problems before the age of modern RT, which began about 2004. Since then, beam RT (IMRT, SBRT, and protons) have made great...
Board: Cancer: Prostate 12-15-2020, 06:59 AM
Replies: 18
Views: 20,289
Posted By ASAdvocate
Re: Newly Diagnosed

A formal AS program would require an mp-MRI six months after the diagnostic biopsy, and then a confirmatory targeted plus systematic biopsy to reduce the chances that the first one missed more...
Board: Cancer: Prostate 11-28-2020, 10:05 AM
Replies: 38
Views: 35,746
Posted By ASAdvocate
Re: Surgical removal vs. EBRT

Newly diagnosed men are choosing active surveillance, surgery, and radiation in equal numbers, There is no gold standard. Some men with G(3+4) do active surveillance, but that has more risk than for...
Board: Cancer: Prostate 11-14-2020, 04:03 PM
Replies: 3
Views: 2,893
Posted By ASAdvocate
Free Webinars on Active Surveillance

These free and highly informative seminars are for men on, or considering, active surveillance. There is a limit of 500 registrants, so sign up soon if you are interested

AnCan and UsToo are...
Board: Cancer: Prostate 10-12-2020, 04:17 PM
Replies: 13
Views: 10,796
Posted By ASAdvocate
Re: 75 years old started treatment for prostate cancer

He is having a brachytherapy boost to his IMRT treatment. It has a very impressive non-recurrence record.

https://www.medpagetoday.com/hematologyoncology/prostatecancer/71560
Board: Cancer: Prostate 10-07-2020, 05:32 PM
Replies: 1
Views: 1,304
Posted By ASAdvocate
Re: Lessons - 2020 PCRI Conference: #3 - High Resolution Micro-Ultrasound Biopsies

Thanks, JIm.

Some of the biggest objections to MRI are the contrast, expensive facility, and claustrophobic environment. Some of the biggest objections to biopsies are infections and ineffective...
Board: Cancer: Prostate 08-01-2020, 06:04 AM
Replies: 3
Views: 1,826
Posted By ASAdvocate
Re: “ExoDx” – Impressive New Urine Test for Biopsy Decision Making!

Here's the link:

https://ancan.org/event/active-surveillance-prostate-cancer-webinar-series-1-dr-peter-carroll-as-beyond/
Board: Cancer: Prostate 05-03-2020, 04:46 PM
Replies: 7
Views: 4,954
Posted By ASAdvocate
Re: SABR for Metastatic PCa

Jim,

SABR is MSKCC's version of SBRT. I think that Dr. Zelensky has published ten year results for it. He evidently considers it enhanced enough to deserve it own name.
Board: Cancer: Prostate 04-01-2020, 05:40 AM
Replies: 17
Views: 3,015
Posted By ASAdvocate
New Active Surveillance Study

A new study of Active Surveillance for Grade Group 1 men with 5, 10, and 15 year results. The results should settle any doubts about the safety of AS.
...
Board: Cancer: Prostate 03-23-2020, 08:45 AM
Replies: 6
Views: 1,782
Posted By ASAdvocate
Re: Termination rates and reclassification of AS patients

These results are more than twice as pessimistic for AS as any other known study.
This statement of intent explains it:

"Based on the available data at that time, a randomized trial (PREFERE) was...
Board: Cancer: Prostate 03-13-2020, 08:01 AM
Replies: 44
Views: 20,589
Posted By ASAdvocate
Re: Lack of Evidence That Surgery Is As Good As Radiation for Higher-Risk PC Patients

PF, Regrettably, You don't know Jim personally, as I do. He is a pillar of our area prostate cancer support group, and is indefatigable in his efforts to counsel and educate newly diagnosed and...
Board: Cancer: Prostate 03-02-2020, 11:23 AM
Replies: 25
Views: 15,615
Posted By ASAdvocate
Re: Just Had 1st Meeting with my RO

The T2a is detemined by a DRE feeling a tumor on one-half or less of one side of the prostate.

The TNM staging system is well defined and published by the National Cancer Institute at NIH.
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