Question about Watchfull Waiting

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NY-Sooner
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Date Joined Sep 2009
Total Posts : 463
   Posted 5/12/2010 6:35 AM (GMT -6)   
My cousin who is 55 just got diagnosed with a low grade PCa. He had 1 out of 12 samples show positive with <5% cancer and Gleason 6 and PSA of 3.1.  He was curious about watchfull waiting and wanted me to ask on this forum if anyone knew of a person who has been doing watchfull waiting for 10 or more years and if his cancer has continued to remain low grade for all these years. 
 
I guess what he wants to know is if it is really true that a low grade unagressive Gleason 6 cancer will stay unagressive and not progress into something that can cause problems in the future.  If untreated, do Gleason 6 cancers eventually change into Gleason 7s and then 8s over time, or do they just stay at Gleason 6?  Can a gleason 6 cancer kill you? Or does it have to change to a 7 or 8 before it can kill you?
 
Age 56, Biopsy 6/2007 - PSA 4.5, 2 of 12 with  <5% cancer Gleason 6
Surgery 9/2007 Strong Memorial,  Rochester  NY with Dr. Jean Joseph (1300 plus surgeries)
 Path - Negative margins, cancer in 20% examined tissue, Gleason 6
 Post Op - No ED issues, full erections without drugs,  used 5-7 pads a day for 3 months. Now dry except for stress leaks now and then.
 All post op psa's <.04


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 5/12/2010 8:09 AM (GMT -6)   

While inputs from a chat group (like this) on the internet has a place in the universe, I would strongly recommend a search of authoritative resources.  What one finds here is that there are often very unauthorative (and simply wrong) inputs provided…probably with innocently good intentions, but poorly researched and not based on proper science. 

I can help you get started with a keyword search, and others will, hopefully, also provide good keywords that you can also search on.

Dr Laurence Klotz of the University of Toronto is one of the leading prostate cancer/active surveillance medical experts.  Start by Googling these three key words:  Klotz active surveillance

Start here:  http://jco.ascopubs.org/cgi/content/abstract/23/32/8165


medved
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Date Joined Nov 2009
Total Posts : 1096
   Posted 5/12/2010 8:35 AM (GMT -6)   
If you are interested in learning a bit about active survailance (watchful waiting), I recommend you listen to this podcast from the doctor who runs the active survailance program at Johns Hopkins. It describes the approach. http://www.hopkinsmedicine.org/mediaII/Podcasts/CarterPod.html

The basic answer to your question -- at a high level -- is that some low-grade cancers never progress, while others do. But the active survailance programs monitor patients carefully, with the goal being that if the cancer ever shows signs of progressing, the patient can still pursue curative treatment before it is too late. Meanwhile, some patients avoid any need for treatment because their cancers never progress.
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/12/2010 8:53 AM (GMT -6)   
NY-Sooner,

As far as your cousin's situation goes, do you know if he has any PC in his family, i.e. father, uncles, brothers, etc? Do you know any more about his PSA history other than his current number? I.e., has it jumped up fast in the past year in particular?

The 1 core of 12, with <5% Gleason 6 sounds good at this point, but he needs to understand, that a biopsy is an estimate at best, on what is actually found. There is always the possibility that there is more cancer, even with 12 needles, the one positive core could have been right on the edge of a large area of tumor. THen of course, his one core might be all there is.

There are several men here at HW, that are doing AS, not sure I remember reading of any that is 10 years out though. AS is not about doing nothing, its about careful monitoring, including very regular PSA readings, DRE's, and if warranted, additional biopsies over time.

As far as the aggressivess issue, too many variables there for a straight answer. Depends what strand of PC your cousin really has. The "3" cancer cells in a Gleason 6 may or may not mutate and turn into "4" or "5" cancer cells over time. Most times, it could take years for this to happen, but there are also agressive strands that can make this transformation in a matter of months.

The smaller and earlier that a cancer like PC can be located, the better the chance as a general rule that it can be treated and erradicated.

On the surface, without knowing any other information, it would seem like your cousin could beging with AS. Has he gotten at least a second opinion from a radiation or medical oncologist? Or has he only been seen by a urologist or a uro/surgeon?

Good luck to him, and bring us up to date on his situation.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


John T
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Date Joined Nov 2008
Total Posts : 4223
   Posted 5/12/2010 9:55 AM (GMT -6)   
I agreee with Casey; sometimes you get emotional comments like "get it out while you can" that have no scientific purpose. The Prostate Cancer Research Institute website has a section on Active surveillance that is very helpful.
Bacically the facts that are supported by Klotz's studies, Hopkins and UCSF all come to similar conclusions. Approximately 30% of G6s progress within 3 to 5 years. It is believed that most of these are due to biopsies inaccuracies and not the actual progression of a G6. If progression is discovered, either by a rising psa or an upgrade from a biopsy, treatment is given and the cure rates are exactly the same as if the pc was treated immediately.
A good diet has significant impact in keeping psa low and stable. Age is not an issue in AS. The longer you are on AS the less chance of progression.
It is critical to get a doctor experienced in AS or get into a trial at Hopkins or UCSF. Dr Doug Chin and Duke Bahn in California are two doctors familar with monitoring AS.
The other fact is that only about 7% of men having PC actually die of it and these are usually always in the higher gleason grades, so it is pretty obvious that the vast majority of PC will never hurt you.
It is also true that about 90% of men treated will have some side affects from the treatments and some are pretty severe.
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


Sunbird
Regular Member


Date Joined Apr 2008
Total Posts : 140
   Posted 5/12/2010 2:49 PM (GMT -6)   
NY-Sooner

I think you or your cousin should google "Active Surveillance in Prostate Cancer Patients may not be best option."

This is an April 28, 2010 Medscape Medical News article, so it is not "old" material.

As the article states......"Although active surveillance has been shown to be a valid treatment option for patients with low risk disease, clinically low risk prostate cancer does not necessarily translate into indolent or insignificant disease on final pathology, he (Dr. David Samadi) added. Given the difficulties of accurate preoperative staging and grading of prostate cancer, upgrading and upstaging are extremely common at the time of prostatectomy."
1996, Age 48, Stage III Colon Ca, Colon Resection followed by 18 chemo treatments.
 
2000, Colon Ca Metastasis to upper left lung lobe.  Lung lobe surgically removed.  24 chemo treatments scheduled.  Took 1, declined the rest.
 
9/08 PSA is 2.8, 12/08 PSA is 4.56??  Chalk it up to prostatitis due to urinary retention after Nissen Fundo Surgery.  VA docs prescribe 30 days of Septra.  Prostate feels normal.  PSA hovers around 4.1.  VA docs want prostate biopsy but can't seem to get me into the schedule.  Continue through Spring and Fall of 2009 thinking I have prostatitis.  Bacteria cultures are always neg.  PSA drops to 3.1 10/09.
 
12/09 Prostate Biopsy performed
3 of 10 cores positive, 5%, 25%, & 35%, 3 + 3= Gleason Six with perineural invasion.
 
Doc wants CT Scan due to prior Colon Ca. Findings: "The seminal vesicles are irregular & there is nodularity in the periprostatic fat such that local extension cannot be excluded.  Shotty lymph nodes in both groin measuring 2.3 cm."
 
Doc wants Endo-rectal MRI (OUCH!) Findings: Mild central zone BPH, no discrete focus of carcinoma is identified, no evidience of invasion into the periprostatic fat or seminal vesicles.  Normal size iliac chain lymph nodes.
 
2/08/10 Open RP surgery.  Findings: Gleason Six upgraded to Seven.  3 + 4, Stage pT2c, Bilateral w/perineural invasion, No pos lymph nodes,  margins uninvolved, no extraprostatic extension, no seminal vesicle extension,  39 grams, blood loss 1200 ml (didn't want a transfusion & didn't get one) nerve bundles spared bilaterally.  current age-61


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/12/2010 3:14 PM (GMT -6)   
Sunbird said...
"...upgrading and upstaging are extremely common...."
 
I've also seen this article.  In fact, the reported upgrading from Gleason 3+3=6 to 3+4=7 was so "extreme" (using Sunbird's term) in this report that it was called into question by Dr. Samadi's peers.  They frankly didn't believe this result because so many other believable studies had a consistently and statistically significant lower rate of upgrading. 
 
By the way, there is growing comfort in a number of the AS programs to including 3+4=7 patients in addition to the 3+3=6 patients.
 
Also, keep in mind, NY-Sooner (for your cousin) that AS is a possible "deferred treatment" strategy.  Your Gleason score is what it is, and so are your other stats, until such a time as they change.  If they change, then you use the most current information to determine whether to stay the course or change.  Many patients never have treatment; but, depending on the study, some 30-40% do eventually choose to have treatment at a later date because their case characteristics changed.  Hopefully, with a commitment to diet & lifestyle (exercise/stress reduction) changes which can be helpful in keeping the PC in-check, the serious trauma of an aggressive treatment can be avoided.
 
The mantra being adopted:  aggressively treat PC cases that need aggressive treatment; but don't aggressively treat PC cases that don't need aggressive treatment!
 
 
best wishes...
 

Sunbird
Regular Member


Date Joined Apr 2008
Total Posts : 140
   Posted 5/12/2010 3:24 PM (GMT -6)   
Casey,

I didn't say "upgrading and upstaging are extremely common," Dr. Samadi did.
1996, Age 48, Stage III Colon Ca, Colon Resection followed by 18 chemo treatments.
 
2000, Colon Ca Metastasis to upper left lung lobe.  Lung lobe surgically removed.  24 chemo treatments scheduled.  Took 1, declined the rest.
 
9/08 PSA is 2.8, 12/08 PSA is 4.56??  Chalk it up to prostatitis due to urinary retention after Nissen Fundo Surgery.  VA docs prescribe 30 days of Septra.  Prostate feels normal.  PSA hovers around 4.1.  VA docs want prostate biopsy but can't seem to get me into the schedule.  Continue through Spring and Fall of 2009 thinking I have prostatitis.  Bacteria cultures are always neg.  PSA drops to 3.1 10/09.
 
12/09 Prostate Biopsy performed
3 of 10 cores positive, 5%, 25%, & 35%, 3 + 3= Gleason Six with perineural invasion.
 
Doc wants CT Scan due to prior Colon Ca. Findings: "The seminal vesicles are irregular & there is nodularity in the periprostatic fat such that local extension cannot be excluded.  Shotty lymph nodes in both groin measuring 2.3 cm."
 
Doc wants Endo-rectal MRI (OUCH!) Findings: Mild central zone BPH, no discrete focus of carcinoma is identified, no evidience of invasion into the periprostatic fat or seminal vesicles.  Normal size iliac chain lymph nodes.
 
2/08/10 Open RP surgery.  Findings: Gleason Six upgraded to Seven.  3 + 4, Stage pT2c, Bilateral w/perineural invasion, No pos lymph nodes,  margins uninvolved, no extraprostatic extension, no seminal vesicle extension,  39 grams, blood loss 1200 ml (didn't want a transfusion & didn't get one) nerve bundles spared bilaterally.  current age-61


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 5/12/2010 5:40 PM (GMT -6)   
David,
Actually it is fairly common for doctors to recommend AS for G7s for men in their 70s and 80s, especially if there are other health concerns present.
JT

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


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/12/2010 7:02 PM (GMT -6)   

At age 55, he wouldn't be advised to consider AS if he was Gleason 7...but he's not, so let's get back on-track...

My suggestion is to do some investigation into authorative published resources.  My intent is merely to help steer you where to look.

While there is not a "standard of care" yet for active surveillance, there is an emerging consensus for AS, with some differences, among some of the best prostate cancer institutions in the world involving some of the leading international experts.  It's not only Dr Klotz at Univ of Toronto, but also in your area (you are in NY?) at Johns Hopkins (Dr. H. Ballentine Carter, Dr. Patrick Walsh, and others); Memorial Sloan Kettering (Dr. Peter Scardino, MD), Erasmus Medical Center in the Netherlands (Dr. Fritz Schroder, MD), MD Anderson (Dr. Babaian, MD), and UCSF (Dr. Peter Carroll, MD). There are others, but these are the major ones that stand out quickly. (Dr. Warlick recently moved from the Johns Hopkins Program to the University of Wisconsin.)  All of these physician/researchers have authored papers describing their research and results.


Post Edited (Casey59) : 5/13/2010 1:17:14 PM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/13/2010 9:28 AM (GMT -6)   

NY-Sooner,  here’s some more helpful information for your cousin…

Help him to keep in mind the big picture.  Small amounts of prostate cancer develop naturally with age; but since this is not widely understood men (quite naturally) panic and overreact when they hear about prostate cancer (big “C”).  Overreaction has led to the problem of overtreatment, and overtreatment of PC commits too many men to side effects that outweigh a very small risk of PC death.  Many men with low risk or very low risk PC end up treating their anxiety, rather than treating their disease.  Probably someone like yourself who has undergone the trauma of major surgery for PC and the recovery, would be a key advocate for your cousin to look closely at the AS option…while I have gotten everything back to good working order, I do wish that I had been a possible AS candidate to avoid the physical and mental stress I went through.

So far, with the info you provided (PSA = 3.1, 1 out of 12 biopsy cores positive, and <5% cancer in that sample, Gleason pattern 3+3), your cousin appears to be a candidate to be classified “low risk” or “very low risk.”  The National Comprehensive Cancer Network (NCCN) designation (http://www.nccn.org) for “very low risk” consists of:

·         Stage T1a (nothing palpable)

·         Gleason score of 6 or lower

·         PSA level below 10 ng/mL

·         Fewer than 3 positive cores (with <50% cancer in each)

·         PSA density below 0.15 ng/mL per gram

So, many here say that “knowledge is power” or “knowledge overcomes fear.”  A starting point for your cousin in his PC journey ought to be acquiring the knowledge of whether he is a “very low risk” case, or a “low risk” case, or something else.  Sounds like all he needs to add to the info you provided is his DRE result (confirming T1a) and the ultrasound estimation of prostate size (to calculate density).

One well-known urologist/surgeon at Johns Hopkins (Dr James Eastham) advises many of his low risk PC patients with these words, “Let’s wait, and see what your PC is going to do.”  In other words, let’s not rush into an aggressive treatment.  Previous research indicates that there is a period of observation during which low and very low risk men can safely forgo treatment.  Many AS programs start with an 18-month observation period (enough time for 3 more PSA tests) to assess PSA doubling time, which is one of the indicators of possible disease progression. 

While building knowledge of AS, your cousin should also keep in mind the NCCN definition to “actively monitor the course of disease with the expectation to intervene if the cancer progresses.”  Many of the men in the studies I referred to in an earlier post stay on AS for the rest of their lives, but if & when the PC is found to progress, it is usually time to move to a more aggressive treatment plan.  The Klotz study (which has recently published, by the way, 10-year results) shows 97% actuarial survival among low-risk men treated with AS; about one-third of men were reclassified as higher risk and moved on to aggressive treatment…but two-thirds did not have to!

Education is a key to patient acceptance of AS.  I hope that you can find good info here to help guide your cousin.  Today, statistics show that 90% of men with PC receive a radical treatment, but 40% would be candidates for AS.  As patient education increases and more evidence emerges about both the problem of overtreatment and the value of AS, I expect that the 90% number will be declining.

best wishes…

Post Edited (Casey59) : 5/13/2010 1:16:29 PM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 5/13/2010 10:07 AM (GMT -6)   

Casey said it very well. I can add that of the 3% that died of PC 1.7% had a major varient that even with treatment results in death. This appears very soon, in a matter of months. so the real survival rate of low risk PC without treatment is 98.3%. This is just as high as any treatment for loow risk PC.

It is also important to know that if progression is noticed, treatment can be given and has the exact same cure rate as if treated immediately.

I personnally would never go on AS or choose any treatment option without having a color doppler ultrasound first.

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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/13/2010 4:18 PM (GMT -6)   
John, at least the color doppler scan would take a lot more out of the guess work before choosing even AS.

I have to admit, with all PC dx cases, there is always that unknown factor, even after a biopsy that provides the dx. We all know that the bone and other scans they usually do after the biopsy for the most part is an expensive waste of money.

So in reality, a major life changing medical decision is often being made on the basis of a single biopsy test, assuming that only one is needed to confirm the PC. Still doesn't show you how much cancer there really is, or if the biopsy is only seeing the proverbial tip of the iceberg, or in some cases, if a single core coming in positive with <5% cancer is really cancer or not (Gleason 6), or just the result of a bad and subjective pathology call.

Would seem like a second tool should be required before any treatment is chosen or reccomended.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/14/2010 9:35 PM (GMT -6)   
JohnT, you are absolutely right, a color doppler scan would certainly be a step for anyone going down the path of AS. I keep forgetting to mention this, and you are reliably there to add it in...thank you.

I didn't have a color doppler scan, and so my knowledge of it is only "book knowledge", but there is limited good info available (that I've been able to find). I'd like to learn more, and to be a more active supporter because I do believe it has an important place, but I need to become smarter. :-) You have first-hand experience. Not that many others here have had one, either, that I am aware of.

Would you consider starting a separate, informative thread centered on educating us more on color doppler? I think it would be a helpful thread that can be a reference for others in the future. One of the questions I have, for example, is: Let's say I live in Mayberry. How do I go about finding a doctor or a facility with a color doppler?

thanks in advance for your consideration...
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