Combidex back and operational?

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 2/1/2011 9:24 PM (GMT -6)   
Posted on the PPML was an indication that the combidex scans are available but with referrals from only three doctors ~ Dattoli, Strum, and Myers. The radiologist doing them is Dr. Stephen Bravo.


This technique is used to attempt to identify which patients have positive lymph nodes without dissecting any of them. I still am not sure of the value of this technology. In the recent post by ChrisR on surgical outcomes with a median of 18.6 years, it was also noted that high risk patients that had extensive lymph node removal did far better those who left them in. Dr. Myers is on record as indicating, and through his own experience, that lymphadenectomy can be beneficial in stage 3 and 4 patients. Therefore my question is do we need to identify lymph node positive patients with imaging or simply radiate or remove a more significant number of regional nodes in high risk cases to improve prostate cancer specific mortality...?

Stay tuned...

Tony

Edited to re-state the last sentence with specifics...
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:
Da Vinci Surgery ~ 2/17/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 2/2/2011 12:48:32 AM (GMT-7)


Jerry L.
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Date Joined Feb 2010
Total Posts : 3072
   Posted 2/1/2011 10:19 PM (GMT -6)   
Tony,

I wonder if one can voluntarily sign up for a lymphadectomy? I'm assuming we're talking about nodes other than the ones they biopsied and I assume took out at surgery.

Btw-in the process of getting an appt with Myers - also just read his book.

Thanks,
Jerry
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

John T
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Date Joined Nov 2008
Total Posts : 4268
   Posted 2/1/2011 11:39 PM (GMT -6)   
Jerry,
You have to know which lymphnodes are affected. Unless you have some type of imaging that shows the affected nodes, removing them would be a shot in the dark.
This is why Combidex was so valuable; once you knew which nodes were affected you could either remove them or do targeted radiation.
It was also used to indicate which patients should go on HT because their PC was no longer localized and local treatments would not result in a cure. The Combidex answered the most basic question needed in any PC treatment. Is the cancer localized or has it matastized. It did this at a 96% accurracy rate.
Tony,
Do you know what imaging agent they are using? The last I heard they were looking for a substitute for Sirnium.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 2/2/2011 12:59 AM (GMT -6)   
John I don't know. I will try to find out. Terry Herbert led me to the info that it's up and running here in the US. I know the doctor but I don't know how or when the program can be expanded. I also don't know if it as effective as stated before with the Sirnium.

Regardless of it's accuracy, there is evidence that men who under go the lymphadenectomy (correct spelling) without Combidex can see a significant survival advantage regardless of the number of nodes found positive. If you could identify which ones were positive it may reduce the number taken out however it may or may not reap the same benefits as those who do the entire region of the prostate ~ regardless of positive or not as indicated in the "Brosman" cohort. You do not need Combidex to find lymphnodes. My understanding is that it can be done with a lymphogram and MRI-s. Perhaps you can't tell the difference between cancerous versus non-cancerous nodes but they can be mapped for the procedure according to the document.

Lymphogram: en.wikipedia.org/wiki/Lymphogram

The lymphogram is used commonly for other cancers as well.

Tony

Post Edited (TC-LasVegas) : 2/2/2011 12:53:11 AM (GMT-7)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/2/2011 2:17 AM (GMT -6)   
John I think the agent is Feraheme, a USPIO or ultra-small super paramagnetic iron oxide

It has been used in other MRI's as well.

Just a maybe FYI...

Tony

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 2/2/2011 6:14 AM (GMT -6)   
Yeah the guy getting the scan says it was Feraheme, I just wonder is it as good as Combidex was in Holland and if so Dr. Branntz over there should be running again soon. Weird that FDA did not allow Combidex into USA, but now we can circumvent that by this other oxide material????

I inquired about a lymphendectomy sampling prior to getting surgery to see if PCa had already spread, a doc from U of Mich. (surgeon), he claimed yes it could be done but had some risks to your legs via lympendema issues, plus as John T has mentioned before it is somewhat of another crapshoot and not all that reliable in total definitiveness, but it still can be done. I darn near decided to do that prior to jumping into surgery for RP, but ended up walking away from it.
 
FYI-Dr. Strum was advising patients to seek Combidex in Holland (only venue available) way back in 2005 in his book and maybe prior to that. idea

Post Edited (zufus) : 2/2/2011 4:19:30 AM (GMT-7)


JNF
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Date Joined Dec 2010
Total Posts : 3886
   Posted 2/2/2011 9:55 AM (GMT -6)   
A client of mine was just diagnosed with PCa. His PSA was about 7 and biopsied at G6. He has not decided on his initial treatment yet as he is assessing surgery, LDR brachytherapy, and HDR brachytherapy. As part of his pre-treatment routine his urologist used laprascopy to remove the abdominal lymph nodes. The ones removed were all clear. He spent one day in the hospital and was a little sore for a week.

Removal of lymph nodes around cancerous areas is common in other forms of cancer. My wife has had two bouts with breast cancer and each time she had several nodes removed for testing.

As I remember from Dr Meyer's book he had his pelvic lymph nodes removed for study before he decided on IMRT and brachytherapy. He also had a node removed from the back of the abdomen as it looked suspicious on the CT, but it was benign. So the answer as to whether we can have them removed pretty much depends on what the doctor orders.
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