Color Doppler Thread

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Franchot
Regular Member


Date Joined Jun 2009
Total Posts : 131
   Posted 5/15/2010 2:34 AM (GMT -6)   
Casey,

I think a good way to get more doctors involved in using the color doppler test is for patients to ask/demand one when they are diagnosed with prostate cancer. If the doctor cannot provide a referral to doctor who can perform the test, ask why not. Then suggest that you will seek out a doctor who is more current in his methods of dealing with prostate cancer. If doctors lose enough business and the message gets through to them that patients want ALL avenues to be available to them, maybe the color doppler test will become more common in all parts of the country.
Age: 54 6' 0" Weight: 176 Caucasian

Rising PSA over the last six years (from when I started being tested) from 3.9 to 5.2 to 4.6 to 4.5 to 4.9 to 3.9.

Free PSA: .71 % Free PSA: 18.2%

DX with PC in January 2009 after biopsy. Bone scan--negative

Consulted Cedars-Sinai Beverly Hills urologist--recommended surgery
Consulted Cedars-Sinai Beverly Hills radiologist--recommended IMRT
Consulted San Diego Cyber-Blade doctor--recommended treatments
Consulted Long Beach radiologist--recommended IGRT
Consulted Loma Linda radiologist--recommended Hypo-fractionated Proton treatments

Insurance approved any treatment I wanted.

Consulted Marnia del Rey urologist Dr. Scholz.
Dr. Scholz referred me to Dr. Bahn for a Color Doppler test.
Scholz and Bahn recommended Active Surveillance, some diet changes, and steady exercise.

I am currently on Active Surveillance.

Post Edited (Franchot) : 5/16/2010 1:40:44 AM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/15/2010 6:56 AM (GMT -6)   

Thanks, Franchot, for starting this new thread on Color Doppler.  You must have read my suggestion to JohnT in a different thread titled "Question on Watchful Waiting" to start an informative thread for future reference on this topic because there will be a growing number of men for whom this scan will be useful and important.

Roughly 40% of men diagnosed with PC would qualify for starting on AS, but today only about 10% go that route.  More doctors and patients are becoming properly educated :-) about the benefits of AS and the downside of overtreatment for low risk men with PC, and so that percentage following AS will continue to grow.  [Some of you may also recall my prediction earlier this year that there will be a 'tsunami' which develops against overtreatment when the soon-to-be-published (August) book is released by Dr Mark Scholz (one of your doctors, Fanchot) titled "Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency."]

So, I follow your model for "social change" which you described below, Franchot; however, lets say that today I live in Mayberry, and the nearest urologist is in Mt Airy, or Greenville, or where ever...friendly and compassionate, for sure, but not necessarily up-to-speed on the latest and greatest.  (Remember the old Andy Griffith Show?  I loved that show.)  How do I find a doctor with Color Doppler capability?
 
Thanks for sharing your experiences.

Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 5/15/2010 7:01 AM (GMT -6)   
Franchot, from what I understand, the test is not as important as the expertise at interpreting the results (which is the case with most diagnostics). I was just reading Dr. Samadi's website (he's one of the top prostate guys in New York City). He discusses the various diagnositic tools but does cite that many of them do not give the doctor enough information. He seems to favor an endorectal MRI (but only for clinical stage 2 and 3 disease). He goes on to say that the Prostascinct can be useful but that the accuracy leaves alot to be desired. According to what I'm reading, the biopsy with TRUS is still the best tool we have to diagnose this disease. Like all of us, he seems to feel that we need more and better tools to help map the disease and come up with the most effective treatment plan.

We need to keep making our feelings known to the medical community and your post is a good start.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 5/15/2010 3:13 PM (GMT -6)   
Franchot,  I don't believe Medicare covers color doppler.  And, since most PCa is diagnosed after 65, Medicare would be the main player.  If you or anyone else have the CPT code for color doppler and also the appropriate ICD9 code, I can get the official status from Medicare.  If Medicare does not pay for color doppler that could explain why so few uros have it.
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, stg. pT2c, N0, MX, R0, Gleason 5+3=8 
PSA <0.1 at 20 months and each test since surgery.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/17/2010 10:06 PM (GMT -6)   
In another recent thread titled "Question about Watchfull Waiting", I had encouraged JohnT (or anyone else who had first-hand Color Doppler experience) to start a new, separate thread to help educate folks about this technology, it's pros and cons, how to find where it is used, and anything else that they could think of that might be beneficial to others.

My observation was that there is not a lot of literature out there on color doppler, but it seems like a good tool for various purposes, and I was interested in learning a more about it.

Thank you to Franchot for starting this thread. Does anyone else besides/in addition to Franchot and JohnT have direct experiences with Color Doppler to share and add to this body of knowledge?

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 5/18/2010 1:13 AM (GMT -6)   

There is a good article on Color Doppler being used in AS.

http://www.prostate-cancer.org/education/localdis/Bahn_ActiveSurveillanceCDU.html

There is also a presentation on Dr Barkin's website pcref.org wher Dr Bahn explains how CDU is used in finding and staging PC. He also gives some recommendations on Doctors that use CDU.

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

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