It depends on where you live. I live in northern Virginia. Now, I and all of my friends who are 75, have gotten two Moderna shots. Most of my 65+ friends have gotten their first shot. Yes, there was...
62gal, High dose brachytherapy does not use seeds, it uses catheters that temporarily place radiation inside the prostate. From what I’ve read, the prostate size limitation only applies to low dose...
Very interesting. Thanks, Djin. I recall seeing studies where there was more toxicity from SBRT over 36 gy. I guess that will be an area of concern and more study. What is a "treatment-effect" biopsy?...
I have seen a handful of men posting in forums with PSA of over 60, and then multiple biopsies not finding cancer. But, in those cases, the spikes quickly moved down, and the history of readings were...
I view this announcement very optimistically. It appears to be able to assign a risk level that could separate the AS men from the treatment men. Then, (in my fantasy) a PET PSMA scan could determine...
By high dose radiation, I suspect that Dr. Epstein was referring to the protocol of IMRT plus a boost from either brachytherapy or SBRT. Often, ADT is used to form a powerful "triple play" to stop...
You really haven’t been following an AS protocol. That would have required an MRI and a targeted biopsy every 2 years (varies among programs). But, hopefully the MRI and subsequent biopsy will...
Ultrasensitive PSA tests are not applicable to men who still have prostates. Men who have had primary radiation or focal ablation treatment have recurrence threshold as stated in the Phoenix...
For radio-recurrent salvage, HIFU and TULSA-PRO are gaining popularity. A problem is that they are currently not covered by any insurance, so the expense is out-of-pocket....
I am going on 77, but am very agile and active. Hiking, jet skiing, and swing dancing are my hobbies. In my Johns Hopkins AS program, they tell me that I must have six month PSA, annual DRE, and...
This may or may not happen, but the possibility is exciting. I can envision a future where a man is diagnosed and selects a treatment (or AS) based on this test to determine diagnosis and risk, and...
There are prostate size limits for some types of radiation and also ablation treatments. But, those limits vary. For example, low dose brachytherapy (seeds) has a limit of 40 or 50cc. But, high dose...
Last year, I wrote up a list of all the approved and available primary treatments for prostate cancer. I had to make various judgement calls on what is truly different. I posted it all over the...
A TURP is not a substitute for a biopsy. Modern biopsy techniques like the Precision Point transperineal biopsy device do not cause infections and do not need antibiotics. And, they only require an...
Some of my friends have had both shots of the similar Pfizer vaccine. First shot was no problem. The second shot made all of them sick for 24-36 hours. They are all glad they did it....
The standard for recurrence after primary radiation therapy is set by the Phoenix Definition. If your PSA rises two points above your post-treatment nadir (lowest reading), recurrence can be assumed....
DJin, as usual, has offered sound advice. Any genomics test is a worthwhile additional data point. If you have insurance coverage, or don’t mind the expense, they can give you more confidence, or an...
Those 141 patients were treated between March and May 2020. After reviewing several large scale trial data, the World Health Organization issued this statement in July: "hydroxychloroquine does not...
I agree with the others. You already have biopsy targets from the MRI. A combination biopsy using both systematic samples and additional MRI seen targets should give a good assay of your condition. A...
Here is the video of Dr. Jonathan Epstein’s December 30th webinar on Active Surveillance. Epstein is the world’s most experienced prostate pathologist, and is considered the successor to the late Dr....
A PiRADS 3 usually triggers a biopsy. But, there are some blood or urine tests that could add more data to that decision. These are the PHI and 4K Score blood tests, and the PUR urine test. Low risk...
I have been taking aspirin every day since 1985. Changed to low dose about 2004. I believe that it has had several benefits for me. I have had no progression in my minimal PCa over the years. No...
As Jim said, your pathology is as good as it gets to still have the disease. All the medical associations that issue guidelines for the treatment of prostate cancer recommend active surveillance for...
I totally support what Jim has written. Your second lesion was probably there before, but just not picked up. No sense seeking treatment with your low risk pathology. Last night, I was talking with...
On December 30th at 8pm Eastern, Dr. Jonathan Epstein, Chair of Urological Pathology of The Johns Hopkins Medical Institutions, will present a webinar concerning critical issues of grading prostate...
DJin, this year with all the Zoom sessions and seminars has been an eye-opener for me. Many AS activists are very much into “doctors know nothing” mindsets, and ignore monitoring while ingesting all...
I, also, have never heard of PIRADS 3a or 3b. But, PSADensity calculations and MRI target plus systematic biopsies are required in my AS program at Johns Hopkins. You wouldn’t believe all the...
HIFU was FDA approved about 2015 for ablation of the prostate. The same approval as a scalpel. The lack of a specific approval for PCa has hurt its insurance coverage. There are HIFU patients and...
Best wishes, Vic, that this treatment will all that you will ever need. I have a question about a catheter during an MRl. I’ve had nine prostate and abominai MRIs and a catheter was never mentioned....
He has had a negative biopsy and negative TURP pathology, which is good, but still has a huge prostate. It could be BPH, with an infection spike, but I would recommend an MRI as the next step. With...
One trend that I have noticed are the trials to hypofractionate PBT, which I guess would impact the cost. The standard protocol was 44 sessions, but, recently, men have posted about having 28, 20, or...
You may not see men posting here about protons, but I see it everyday on the large Facebook groups, and over at inspire.com. The number of proton centers has grown from like 10 to 32 in recent years....
You need to get the biopsy and know what you are dealing before you can decide on possible treatments. Your biopsy will not be blind, as there is at least one MRI target. If you are on Facebook,...
What I’ve read about post RP PSA monitoring is that recurrence officially is assumed at .2, although some specialists will recommend RT at .1 if there has been a steady rise. You are still way below...
Great post, Dan. Words to live by, sick or healthy. Best wishes for your continued success in being undetectable....
Does his practice have an online patient portal like MyChart? If so, all his tests and pathology reports are there. No need asking the doctor’s office for copies....
I’m going to make my guess that they did some test beyond PSA as part of his routine blood work. Such as free PSA, PHI, or 4K Score. That result caused the MRI with a PIRADS 4, which caused the...
Thanks, Djin, you are always a meticulous poster, and your explanation matches my understanding....
DJin, please provide a link for the study that said that Gleason(3+3)=6 can metastasize. I thought that this issue was settled last year with studies and conclusions that no evidence was found to...
These free and highly informative seminars are for men on, or considering, active surveillance. There is a limit of 500 registrants, so sign up soon if you are interested AnCan and UsToo are holding...
It’s not just radiation with ADT anymore. I am seeing posts from men in the PROTEUS clinical trial who recommend using ADT both before and after RP. Dr. D’Amico wrote an article stating his opinion...
In a strict AS program like Johns Hopkins, PSA is not as important as PSADensity. That is because of prostate enlargement, and density takes that into account. IMHO, way too many men say that they...
Garyi, I attended a community lecture on prostate cancer about 2010, where Dr. Pavlovich was the presenter. He was enthusiastic about the daVInci system, and showed us a video of the robot peeling...
Cryotherapy is still used as a post-radiation salvage treatment. I was recruited for a cryotherapy clinical trial at Johns Hopkins in 2013, but turned it down. It’s still being performed....
garyi, Certainly your caution is well understood. In my case, Dr. Pavlovich of Johns Hopkins was one of the participants in the TACT clinical trial, so, he has been performing TULSA-PRO procedures...
Active surveillance is considered to be “curative” by its founders and the institutions who offer those programs, That is because a stated goal of the programs is to defer interventional treatments...
As far as AS being a treatment, I know that can seem counter-intuitive, but the NCCN, ACS, and other major advisory bodies do consider it a “treatment”. All of the listed treatments are approved and...
I was thinking about all the confusing treatment choices facing newly diagnosed men. This is my imperfect attempt to list them. Let me know of any that I’ve missed😀 . Active surveillance (intense...
A PSA of 8.5 is not unusual with BPH. I know two people who have PSA ranging from 8 to 12 for many years, and both have had multiple negative biopsies. There are several new treatments for BPH. These...
I had my routine active surveillance followup at Johns Hopkins yesterday, and they have tightened the rules on protocol biopsies. They had relaxed their rules to a biopsy every 2-4 years if MRI...