National Conference on Prostate Cancer-2009

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Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/17/2009 7:58 PM (GMT -6)   
First time poster...
 
Can anyone here give us a report on learnings from the National Conference this past weekend in LA?

Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4835
   Posted 9/18/2009 8:14 AM (GMT -6)   
Here's the web site for it:
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/18/2009 1:40 PM (GMT -6)   

Thanks, Steve, for the link.  I've had that link for a while and had tenative plans to attend, but those plans did not work out.

Was wondering if there were other inquiring minds from this site who had attended the conference procedings themselves and could share their first-hand account of learnings. 

The conference looks like an excellent opportunity for both medical professionals AND patients to learn the latest info from many of the leading PCa medical experts...thought some on this site might be tuned-in.

Anyone?


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 9/18/2009 4:05 PM (GMT -6)   
Casey,
I was there and enjoyed the show. I met many folks I have been writing or reading about. The two stars of the show were Provenge and Abitaterone. Moyad spoke about diet, Sholz and Myers spoke about ADT and survivability. I only went on Saturday and I was representing Prostate Cancer International (Mike Scott and Arnon Krongrad's group). Our booth was right next to Myers and I spoke with Myers several times during the day. I met Ralph Valle and Chuck Maack for the first time in person, but I spoke to both and I have wrote to them many times. It was like a innagural reunion...:-)

Mike Scott still owes me dinner and I will still tell the web that this is now a two year promise that has yet to be kept. (He owes my Yorkshire Pudding, I have had many dinners with the bloke). Anything you were looking for?

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Franchot
Regular Member


Date Joined Jun 2009
Total Posts : 130
   Posted 9/19/2009 3:37 AM (GMT -6)   
I went on Sunday and watched Dr. Scholz give the review of the highlights from Saturday.

I went to the Exhibition Hall and while there were some earnest vendors there, there were also the "snake oil" merchants hoping to cash in by offering vitamins and such which have not been proven to be effective in treating prostate cancer.

I checked out a few of the conference rooms where the doctors were giving their expert opinions on the particular brand of prostate treatments that they specialize in. You were free to ask questions and they readily answered them.

Let me say up front that Dr. Scholz and Dr. Bahn are my prostate doctors and I went with them after interviewing several doctors because Scholz and Bahn are of the same mindset as I. They are of the thinking that ten years from now all these surgeries and drastic radiation treatments will be passe because newer and more precise ways of treating prostate cancer will have arrived. Vaccines are on the horizon. Removing the entire prostate will not be needed except in extreme cases. They are also of the thinking that Active Surveillance is currently a good treatment option for all ages of people who have prostate cancer IF the patient falls within the guidelines for Active Surveillance. They provided studies that showed that people who had surgery for early stages of prostate cancer as opposed to doing Active Surveillance (which includes adopting a healthy diet and increasing exercise) had close to the same survival rates. Sholz is big on promoting keeping your heart healthy because heart disease kills a tremendous amount of people versus prostate cancer.

Scholz went on to promote three things for a healthy lifestyle (which he said could also help in combating prostate cancer):
1. Diet
2. Exercise
3. A Positive Attitude

(One study that they produced showed that people who smoke and exercised were significantly more healthy than non-smokers who didn't exercise.

One study showed that men in a town in China suffered almost no instances of prostate cancer which they attributed to diet. When men from this town moved to the United States the instances of prostate cancer dramatically increased. They attributed this to changing from a more vegetable-based diet to a diet which was heavy with animal proteins and animal products.

They had a lot of studies...)

The most interesting event that I attended was the "Ask The Experts" where all the doctors shared the stage and looked at patient case studies and answered questions from the audience. Surprisingly, the doctors who favor Active Surveillance were quick to prescribe some sort of treatment (radiation, hormone therapy, even chemo) if the patient looked as if he was in serious trouble. I don't recall anyone on the panel recommending prostatectomies. Maybe because there was no doctor who specialized in prostatectomies on the panel. Maybe because they have seen too many bad side effects from the surgeries.

There was one "dust up" between Dr. Meyers and Dr. Rossi and the radiation doctors. For the early stages of prostate cancer, the radiation docs recommended radiation treatments (of course.) Dr. Meyers in essence said, 'I know on these panels that we all try to be collegiate and support each other, but I need to break away and state that I disagree with some of the other doctors. I didn't always used to think this way, but I now believe that Active Surveillance is a very good option for many patients who have prostate cancer. We have to take into account the serious side effects and how the quality of life changes for patients who we advise into taking these treatments. Sometimes the treatments are worse than living with the prostate cancer which may well not kill a patient. And we should be accountable for giving that advice.'

In fairness a case study which had a patient with an early stage of prostate cancer was discussed. The radiation guys wanted to give the guy radiation treatments immediately while the other doctors sought much more conservative methods of treating the disease. After several years, the patient's disease grew worse and the Active Surveillance guys were quick to recommend radiation treatments as soon as possible.

Scholz also talked about how people living longer lives is forcing the medical community to come up with better cures for prostate cancer as well as Alzheimer's Disease.

And so it goes. I could write a lot more of my observations, but this post is too long as it is. Dr. Scholz put together the conference so you could argue that it was slanted a certain way. Then again, if the other doctors had proof that their treatments were better they were certainly welcome to present them. Me, I read and question everything. And I second guess doctors a lot.

As I left through the parking lot looking for my car, one of the doctors on the panel was cursing madly as he walked far ahead of me looking for his car. I realized long ago that doctors are just as human as you and I and make as many mistakes as you and I. It's always best to get as many opinions as possible and not believe that the first doctor you speak with has the only correct answer.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/19/2009 1:21 PM (GMT -6)   
Franchot,
I am sorry we could not hook up. My schedule only permitted Saturday's attendence. And yours only Sundays. Maybe we get it right next years...peace to you...

Did you have a chance to meet Mike Scott?

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 9/19/2009 2:11 PM (GMT -6)   
Franchot,
Thanks for the summary. Scholtz and Bahn have seen tens of thousands cases of prostate cancer and are certainly biased in their thoughts. I once told Scholz that he was biased against surgery and he got angry and started giving stats on surgery and all of the side affects caused by botched treatments. That was the only time I have seen him upset.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Franchot
Regular Member


Date Joined Jun 2009
Total Posts : 130
   Posted 9/19/2009 8:14 PM (GMT -6)   
Tony,

I did not get to see Mike Scott. Next year, I'll try to hook up with you. Have a safe and healthy year until then.

JohnT,

I agree with you about Scholz not recommending surgery for prostate cancer. Since he runs a clinic that treats only prostate cancer there must have been some patients where surgery was ultimately the best option. I wonder who his recommended surgeon is for performing prostatectomies.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 9/20/2009 9:28 PM (GMT -6)   

Thanks, Franchot.

I was hoping someone from this esteemed group would have actually attended the technical procedings in order to continue to stay on top of things. 

There is almost always a "big picture" or "emerging trend" that one can pick up from national conferences like this one...would you say that from this conference an emerging trend seems to be that the pendulum is heading toward broader support for AS? 

Thanks again for summarizing the technical sessions you attended.


Franchot
Regular Member


Date Joined Jun 2009
Total Posts : 130
   Posted 9/20/2009 11:18 PM (GMT -6)   
Yes, Casey, it seems that the pendulum is swinging away from being overly aggressive to treating prostate cancer to treating the prostate cancer in "smarter" ways.

PCA3 testing was mentioned repeatedly as being a newer way in which to gauge just how deadly and how fast the cancer is growing. None of the doctors thought that PSA testing should not be done, but all mentioned that a big hurdle in whether to treat or wait to treat the disease would be to develop more accurate tests which could determine just how quickly the disease is developing in a person. They were of the mindset that treating a disease that is growing so slowly that it would never end up killing a person is counterproductive when you take into account the negative side effects of the treatments.

Again, this conference was put together by Dr. Scholz who is a big advocate for Active Surveillance so take that into account as you see fit.

My history in trying to decide if I should be aggressive or conservative with the disease is as follows:

January 2009--After having a biopsy, I discovered I had prostate cancer. (My father had prostate cancer, but he lived to be 82 and died of a heart attack.) My doctor suggested that I have surgery or radiation. My best friend had a prosectomy at the the age of 47 and everything turned out fine except for the need to take Viagra. He was very much in favor of me having surgery.

Doctor One--Urologist--Cedars Sinai--Said I should have a prosectomy as soon as he returned from his two week vacation. (That actually gave me some time to think about things and begin my research.)

Doctor Two--Radiation Doctor--Beverly Hills--Wanted me to start IMRT within a month. He said that there was no way to determine if I had a slow or fast growing cancer. Said I would have few side effects.

Doctor Three--Radiation Doctor/CyberBlade--San Diego--Wanted me to begin treatments within a month. He said I was an excellent candidate.

Doctor Four--Radiation Doctor (TomoTherapy)--Long Beach--Said I was a great candidate and wanted to start on me as soon as my insurance cleared.

(I had decided that radiation was the way I was going to go so I looked at the different options.)

Doctor Five--Radiation Doctor (Proton at Loma Linda)--They wanted to put me into the new hypofractionated program. I was all set to start in May and was told delays of the treatment was not wise. (It was kind of funny because when I first sought out Loma Linda they said that there would be a year wait before I could begin the program. When my insurance cleared, I was bumped to the top of the list.)

Doing all this research I was amazed at the number of doctors who specialized in prostate cancer and the many treatment options available. There were ads on the radio and in the newspapers. I began to adopt the opinion that there was a lot of money to be made in this field.

Two weeks before I was scheduled to start my first radiation treatment, I decided to look at one more option--Active Surveillance. Heck, I felt fine. I wasn't overweight. I exercised regularly and I was a vegetarian. Why not?

Doctor Six--Oncologist--Marnia del Rey. Said I was a good candidate for AS after doing a color doppler test, but was troubled by some shadows on the ultrasound. He sent me to another doctor (his friend) for a second opinion on the color doppler and a biopsy if needed. (Maybe this was a way of "padding the bill" and giving his friend a cut? I was getting confused again...)

Doctor Seven--Oncologist--Ventura. Did another color doppler test. Everything was fine. Recommended for AS.

My first PSA test number after this journey began dropped a little. My next PSA test will be in November.

Take this for what it's worth: I have excellent health insurance. Only one doctor told me that my odds of dying from prostate cancer were very, very small. (Also, I have never met anyone who has died from prostate cancer. I don't doubt that it happens. I know it happens. I'm just not sure how frequently it happens.)

Post Edited (Franchot) : 9/20/2009 10:22:36 PM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 9/21/2009 1:24 PM (GMT -6)   

Franchot,

 

Hmmm…

 

I’ve also come to conclude that low risk cases do make “good candidates” for a wide variety treatments...probably both a blessing and a curse.  Very interesting comment, however, about the Loma Linda flip-flop.  There certainly is a lot of money to be made in PC treatments, but few have hired marketing firms like the proton beam trade association which has fairly recently formed.  That bothers me.

 

Good luck with your AS.  I think you nailed the big picture with this summary comment:

 

“…but all mentioned that a big hurdle in whether to treat or wait to treat the disease would be to develop more accurate tests which could determine just how quickly the disease is developing in a person.”

 

I hope that this becomes an area of research “break-through” in the near future.

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