Book review on Invasion of the Prostate Snatchers

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zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/29/2010 6:49 AM (GMT -6)   
Maybe we can discuss Ralph Blum and Dr. Scholz book more openly as what kind of book is this, what is the basic messages or content in it and then others might decide pro or con if they intend to read it or buy it.  Here is my observation (simplistic) synopsis on the book:
 
1) it is Ralph Blum's biopgraphy and his book, his name precedes Dr. Scholz and spent years writting his 20 year journey of PCa and how he tackled it, analyzed it, processed what he heard and believed in and quest for consulation and advisement from even educated laypersons
 
2) Dr. Scholz has at the end of the chapters his summary on Ralph's decisions and some input on his perspective and sometimes more in the book from his own mouth on occassions
 
3) so the book is much more about Ralph Blum and that is why the two of them collaborated on this, and the fact that Blum a little later in his PCa journey hired Dr. Scholz for advisement (historically)
 
4) Ralph Blum's journery and history although non-conformist and Ralph highly skeptical of anything including biopsies, is very interesting to see his logic, journey and some leap of faith, hind sight of 20 yrs. without major treatments looks almost like a genius  (per se). Maybe all luck???
 
5) The blurb put out there by like amazon.com, about the weirdness of Ralph Blum, as to the acupuncture thing and 'releasing negative energy out from his ear' is really a cheap shot at the messenger. Sure that seem completely weird, but his wife is a qualified acupunturist and it was their own little experiment. Other than that weird dig to discredit the author, Ralph seems very normal and very sane and maybe more sane because he doesn't just jump into anything. He analyzes and studies it, questions it at all levels including even spiritually (laugh if you want...his journey speaks loudly). (fyi- He is man of means from somewhat wealthy family which gave him more travel optiions and access to major people and players).
 
6) Ralph's sense of humor used throughout the book is entertaining and very funny. Myself I liked the guy almost immediately  (questioned everything, and was humorous in the face of the unknowns) and back in 1990 when diagnosed, this was the stone age in comparison to today.
 
7) tidbits included in this book include- the story about Combidex and how the FDA ended up not approving it here in the USA and Ralph researched with transcripts, interviews and more.
 
8) Ralph incorporates the value of mind, body, spirit in fighting PCa. Your whole system is a biology lab with an immuno system of its own...we are designed to heal ourselves as a generality. He elaborates of some of those intangibles with some substance and resources...not pulled out of the blank. Not as worthless as some might conceive.
 
9) he also incorporates the plus side of men getting PCa (what?)  You will be monitoring via your doctor other health issues that you didn't have checked, like heart, and blood work etc., and some people found other conditions needing faster treatment than PCa issues and got them handled. Plus the fact you look at life much different when you believe you have a time and date stamp (my words).
 
10)Book (234 pages+) is hard bound with paper slip on cover, black cover and wording written in white. Has two fists on the cover running North to South one of the patient (stripped shirt cuff shown) and the other of the doctor with the infamous rubber glove on and the title:
Invasion of the Prostate Snatchers- No more unnecessary biopsies, radical treatment or loss of sexual potentcy  (Ralph H. Blum-Mark Scholz, MD)    I would say the title is shock-jock concept and would improve sales even if the rubber glove scares off a few. Objectively the title is mis-leading when quarantined by itself (not the intent of the whole book), it does discuss that not all PCa's are this less serious and many do require quicker choices (being in high risk categories). The majority of men diagnosed do fall into the lower risk categories and some indolent status.
 
Personally, I wondered what Dr. Scholz was getting envolved in with that title and partner. It is Ralph's book in essence but it is a good read and unique read, glad I read it. Discounted you can get it for like $16 otherwise it is  $26 approx.   This book is less useful for high stats patients or maybe even intermediate risk, but don't let that stop you from reading it. cool

Post Edited (zufus) : 8/29/2010 5:59:43 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/29/2010 10:39 AM (GMT -6)   
zufus,

i liked how you outlined and laid out this book for us. so, i might be taking this too literally again, isn't it a bit misleading to people to think that this is "dr. scholz" work, or a work by "scholz" on prostate cancer? like you said, it sounds like a personal journey of ralph, taking paths least traveled (not saying anything wrong with that). your remark on him coming from or with money, does make a big difference. for the bulk of us that have limited means, either financially or in some cases insurance, all the wishing in the world isn't going to allow you to travel to the great centers or speak to the guru's of the prostate faith. i agree, that was a cheap shot at the messenger about the acupuncture part.

the description of the cover alone made me laugh. Do you think there's much to be gained in the book for anyone that is post surgery and post radiation? Unfortunately, I couldn't reverse any of my path if I wanted to.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/29/2010 11:35 AM (GMT -6)   
I would agree that the book is really Blum's. There are alternating chapters where Blum will talk about his experiences then Scholz will give the medical perspective citing studies and his own patients experiences to back up what he recommends. There is a lot of good data in the book and all studies are well documented in the notes. There is also a very useful bibliography that gives patients a good reference on other books they can reference as well as a list of all the prostate oncologists practicing in the US.
So it is really two books, one written by Blum about his experiences and the other written by Scholz about the latest thoughts and advances on how to diagonose and treat PC.
The major thread is that PC is not one disease, but three distinct diseases, low risk, intermediate risk and high risk that have completely different charisteristics and each must be viewed and treated differently.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/29/2010 1:25 PM (GMT -6)   
John, I think more should be done to promote this "three prong" look and approach with PC. Each involves a different kind of strategy.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 8/29/2010 2:33 PM (GMT -6)   
I haven't finished reading he book but Blums journey is not one that I would duplicate. He talks about the negative side effects of aggressive treatments but his wasn't exactly a walk in the park. He lost impotency for long period of time while on TIP which isn't any better than having ED for some period of time after surgery. Also, not many people have the resources of flying around the country consulting with specialist and doing all the testing that he was able to do. I don't know how many people will follow his path rolling the dice at every turn.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/29/2010 3:47 PM (GMT -6)   
John T- good further expansion on the books contents, hope you don't mind my book report, I got the news of because of you.

Purg- thanks for your take on this presentation, alot of people whom are post major treatments would only read this for entertainment,further knowledge about the world of PCa

Ed C.- as you might see I was looking at this being objective, I have some skepticism and can agree this book does not mean everyone can do this, it does give perspective on PCa and possibilities which is refreshing to see vs. the rush, rush panic mode, most of us throughly understand that world.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35 normal, ct and bone scans appearing clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off for 1 yr., controlled so well, resumed, using intermittently, pleased with results

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/29/2010 5:05 PM (GMT -6)   
Ed,
I totally agree with you; never in a hundred years would I have done what Blum did. But as one of those individuals that was rushing headlong into surgery without having all the information as to side affects, probability of success and other viable options that were available, I now appreciate his hesitation and skepticism. When it comes to PC, hesitation and skepticism are good things to have, along with a good flow of information and education. There are some patients that just want it out and others like Blum that will do anything to avoid the side effects of treatments. I think that both of these views are on the extreme.
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


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3895
   Posted 8/29/2010 7:18 PM (GMT -6)   
Blums other 4 or 5 books have been about Runes (a bag full of little "special" stones with markings on them, used like Tarot cards, and earlier, UFO's and flying saucers..

I'll wait until I have a copy in my hand before I pass further judgment..

AN38 dug this info up..

"In many settings, Gleason pattern 3 PCa, previously the most common pattern, has become less common than pattern 4. In one recent study comparing the original and modified Gleason systems on needle biopsy material, Gleason score 6 cancers decreased from 48% to 22% of the total, whereas Gleason score 7 cancers increased from 25% to 68%. Not surprisingly, the magnitude of this shift depends somewhat on the study population, and it is less dramatic in clinical settings with a greater proportion of early stage disease, as seen in a study by Billis et al. [24] where the proportion of needle biopsies with a Gleason score of 6 was 68%, decreasing to 49% using the modified grading scheme. Correspondingly, Gleason 7 went from 26% to 39% with application of the modified grade criteria."

This seems to say that today, when you look at all the needle biopsies performed, 78% of them have tissue that was graded G-4 or G-5 with only 22% getting a pair of threes.

Can it be that 78% are given Gleason scores of 7, 8, 9 while only 22% are graded Gleason 6??

If true, that would put a whole new light on the wisdom of watchful waiting before having a biopsy to determine for sure what the Gleason number is...

Post Edited (Fairwind) : 8/29/2010 11:04:59 PM (GMT-6)


cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 8/30/2010 7:41 AM (GMT -6)   
The Book Of Runes!!!!!Based on a tradition over one thousand years old, this contemporary Oracle has established itself as a remarkable aid in practical decision making.

I had no idea that this Ralph Blum was the same author!!!!!! No wonder I had an affinity to the prostate snatcher book without even reading it [which I will now] Blums thinking must have alot of spirituality mixed in w/practical thinking. I know men do not always think in these terms,but don't discount it!!!There was something about Dr Lee that was intangible but definitely peaceful,spiritual whatever you want to call it that I noticed right away.He is also a 20 yr survivor of prostate cancer! Don't know what it means,but interesting [to me at least LOL!!!] I know most on here are seeking practical advise,and rightly so, but keep your minds open!!!!

el perro
Regular Member


Date Joined Mar 2010
Total Posts : 46
   Posted 8/30/2010 8:58 AM (GMT -6)   
Just curious if a coherent, systematic strategy emerges from all this for managing low-risk prostate cancer? Sounds like it is more hit-or-miss, anecdotal stuff? Not discounting that it's mostly Blum's book, but I was hoping to find out Dr. Scholz' approach if he identifies a patient as low-risk. What combination of tests, etc., to identify said patient as low risk? What periodic monitors to check to see if cancer is progressing? What "triggers" would move a patient on to curative-intent therapy? Is finasteride/dutasteride therapy useful in some low-risk patients, etc? I realize this is one doc's approach and nothing is 100% guaranteed, but I'm wondering if one gets a clear picture of his approach amongst all the other stuff going on?
Dx 11/2008, Gleason 3+3
Active surveillance for now

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/30/2010 11:02 AM (GMT -6)   
Low risk = gleason <7, No nodule, %cores 34%, psa <10, psa velocity <2, psa densty .15.
AS protocol as followed by Scholz:
Base line color doppler and MRIS
PSA every 3 months
PCA3 baseline, then every 6-12 months
DRE every 6 months
Color Doppler every 6 months
MRIS Annually
As you can see this is a very strigent protocol and a diet change and proscar are also recommended. It only requires a biopsy if a change is detected.
It is not like the other protocols that require only repeat biopsies at 1 and 3 years and psa tests every 6 months.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/30/2010 11:13 AM (GMT -6)   
John,

That looks like a very expensive protocal to follow, with MRI and multiple color doppler tests, etc. Are you sure the average health insurance policy would pay for a plan like that? Also, I know you are an avid fan of the color doppler, but I am under the impression its not used widely, and many areas don't even have access to the hardware. If that is the case, what would a person do?

David
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

el perro
Regular Member


Date Joined Mar 2010
Total Posts : 46
   Posted 8/30/2010 11:36 AM (GMT -6)   
Thank you for that synopsis, John T. Just what I was looking for. I plan to purchase book and discuss with my doc. My doc is insistent that if I continue on AS path I need specific criteria that will trigger initiation of curative-intent therapy. It seems hard to define, in a real-world situation, how to quantify how much progression (if it occurs) is allowable. My doc has poo-poo'ed PCA3, MRIS, and not discussed CDU, so I don't have a lot of data to make a decision at this point. I did have 3T MRI (without spectroscopy), so that plus biopsy plus PSA history are my baseline for now.

I am interested in CDU cost/insurance issues too. My deductible on 3T MRI was insane.
Dx 11/2008, Gleason 3+3
Active surveillance for now

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/30/2010 12:13 PM (GMT -6)   
David,
I think that is an excellent point. Dr Scholz has a color doppler in his office so it's not a problem. I never had any problems with insurance picking up any of the tests, I was on Tricare (like medicare). I can see how some insurance companies and HMOs would balk.
The color doppler costs weren't bad, but the MRIS costs 4 years ago was $4500.
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/30/2010 12:50 PM (GMT -6)   
John T said...
Low risk = gleason <7, No nodule, %cores 34%, psa <10, psa velocity <2, psa densty .15.
AS protocol as followed by Scholz:
Base line color doppler and MRIS (2500.00+4500.00= $ 7,000.00)
PSA every 3 months 4 x 250.00 = $ 1,000.00 counting the office visits)
PCA3 baseline, then every 6-12 months (450.00 x 2 = $900.00)
DRE every 6 months (Can be done with those PSA test visits)
Color Doppler every 6 months (2500.00 x 2 = $ 5,000.00)
MRIS Annually
As you can see this is a very strigent protocol and a diet change and proscar are also recommended. It only requires a biopsy if a change is detected.
It is not like the other protocols that require only repeat biopsies at 1 and 3 years and psa tests every 6 months.
JT


I added some dollar figures for Dr. Scholz AS program. $ 13,900.00 annually. If a patient stays on AS with Dr. Scholz for 10 years, Dr Scholz gets 130k. For one patient. LOL I see why he likes active surveillance and has an office in one of the most expensive areas of Los Angeles.

Wow...that's a lot to do for AS.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/30/2010 2:03 PM (GMT -6)   
To the good brothern of H.W. of PCa, I meant this to be open objective look at the book I was not endorsing nor denying the messages, staying neutral and saying it is interesting and maybe note worthy and really entertaining as a book (I questioned why Scholz & Blum on a book?). I see wisdom in all answers and do not wish to put brother against brother, so perhaps John and Tony and others whom have very valid inputs( as usual) , lets go have a beer or such in cyber space. I wouldn't want any of you to end up with loss of audience and basically love from the hood herein. Fact is we all learn a ton from both of you, let's keep it that way.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35 normal, ct and bone scans appearing clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off for 1 yr., controlled so well, resumed, using intermittently, pleased with results

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 8/30/2010 2:49 PM (GMT -6)   
My husbands CDU was $350.00 & $350.00 diagnostic fee [this year] from Dr Lee in Rochester Mi. Blue Cross picked up the first one [even as a second opinion] we're not sure yet about the second. We're an average middle class steel working family. We were willing to pay out of pocket if necessary! Through my research we felt it was an important test to have done!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/30/2010 3:16 PM (GMT -6)   
Well that's a good point Cooper. If they are just looking at CDU and not doing a biopsy then I can see a much smaller price that what Duke Bahn told us at our UsTOO group (2,500.00). Still that's a 10 grand a year active surveillance program Scholz recommends per patient he never treats.

Johns Hopkins recommends a repeat biopsy once a year for three years and then tapers them to every other year. This with PSA tests only every 6 months. No patients would have expenses higher than 4k per year under that plan with it dropping to about 500.00 bucks per year if no biopsy...

Zufus,no beer for me. But I'm all good with red wine. I'd meet you and John anywhere for it.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/30/2010 5:49 PM (GMT -6)   
Not arguing about the costs, but My office cost was about $500 and includes all tests except PCA3. I think the CDU was in the price of the office visit, but not sure. I get psa tests locally for about $100, but I usually get them with my regular semi annual GP's visit so there is no aditional costs. PSA tests and follow up visits also occur after treatment so they are a constant.

2 office visits = $1000
2 CDU = $750
2 PCA3 = $500
Total $2250

Insurance has always paid 100%

My costs after treatment are:

2 visits to the radiologist for followup = $600
2 psa tests = $220
1 Visit to oncologist for follow up = $500
12 months of Flowmax = $2200

Total $3520
Again, Insurance pays 100%
The cost of the MRIS is the killer and I think after one or two you can cut this out.
For the unlucky ones you also have to add in the cost of pads and the cost of ED meds to get a good comparision. For the very unluck ones, you have to factor in the costs of treating severe side affects like strictures and bowel issues.
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/30/2010 6:16 PM (GMT -6)   
I was on commenting on what Scholz recommends at least as stated. It is cost prohibitive for an uninsured patient. For a guy like me who is insured very well, that would be about 200.00 per year. That would be 20.00 per visit. I can understand it dropping drastically if one wanders off what Scholz recommends for AS. JHU is probably going to revise their AS guidelines soon. There will likely be no need for biopsy after the first two unless there was a reason to biopsy. So theirs too will drop. They do not see the need for PCA3. It is more expensive for PCA3 at Bostwick, but it's too small to be concerned with...


I have no use for Flomax so my costs are lower than yours at this point. Hopefully both of us can reduce our visits to just a couple times a year with the Oncologist and a couple tests. But an AS guy has to be more diligent. We don't have to have MRIS or CDU or any imaging for that matter at this point.

Tony

Post Edited (TC-LasVegas) : 8/30/2010 6:19:50 PM (GMT-6)


el perro
Regular Member


Date Joined Mar 2010
Total Posts : 46
   Posted 8/30/2010 10:46 PM (GMT -6)   

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/30/2010 11:27 PM (GMT -6)   
Dana is a New York Times editor. He has posted a blog on their website for about two years. He has been a very entertaining writer and has advanced prostate cancer. Thanks for the post el perro. It is an interesting read.

Tony

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/31/2010 12:15 AM (GMT -6)   
el perro,

good eye for that post. i had been following dana's own PC journey for some time. Aside from the article, I read all of the reader's comments, some of them reminded me of many a HW thread that we go through here.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Franchot
Regular Member


Date Joined Jun 2009
Total Posts : 131
   Posted 8/31/2010 4:12 AM (GMT -6)   
I am one of Scholz's patients who is pursuing AS and I am beginning my second year with him. So far, all that's been required of me is a Color Doppler test, DRE, and PSA blood work every six months. Maybe John T's cancer was more advanced than mine, but no mention of any MRIS in my case.
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.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 8/31/2010 9:35 AM (GMT -6)   
Franchot said...
I am one of Scholz's patients who is pursuing AS and I am beginning my second year with him...
 
Franchot,
 
There seems to be a question on the table (which I am also interested in learning) about the patient's cost while on an AS program (Scholz's program, in particular).  You are probably the best-equiped person here to address this...
 
If you wouldn't mind sharing, what would you estimate your year #2 billed costs to be (billed to your insurance company, if you have insurance)?
 
As a follow-up question, if you have insurance, from what you've seen so far would you predict that your out-of-pocket expenses will basically be your standard yearly deductable amount?  Or, are there significant costs outside of your standard deductable?
 
Thanks in advance for your informative contribution to our body of knowledge about AS.  We have been and will be seeing more men going the AS route as time goes by, and so your contribution here, as it has been in the past, helps others who will follow.

Post Edited (Casey59) : 8/31/2010 9:40:14 AM (GMT-6)

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