There are probably a half dozen current treatments for BPH. These include Uro-lift, Rezume, Prostate artery embolization, HOLEP, TURP, and various shrinkage drugs. There certainly will be more by in...
Make sure that any studies you read about radiation only involve patients treated since about 2007. That is when the now-available types of equipment came into general usage. I often see where...
A new study of Active Surveillance for Grade Group 1 men with 5, 10, and 15 year results. The results should settle any doubts about the safety of AS....
Any lesion with a PIRADS of 3 or higher will likely result in a biopsy....
Insist on getting a copy of the MRI report. You will have that to refer to long after the exact verbal discussion has faded. It should be available on the practice’s online patient portal, or they...
John McCain had glioblastoma multiformae, the usual deadly type of brain cancer. Jimmy Carter has melanoma skin cancer which metastasized to his brain. Totally different. He was treated with Keytruda....
Great! You are stable😀 Since diagnosis, have you had an mp-MRI and a confirmatory targeted biopsy? Those are usually first-year requirements of active surveillance protocols....
So, did you have IMRT? I’m not quite sure, even after reading your post multiple times. If so, many men are satisfied with both the curative results, and the fewer side effects. There are local...
Djin, thanks for this extensive and powerful essay on the necessity for systemic biopsy plus any MRI targets. Yet another example of your scholarly contributions. There are a couple of forums that I...
The usual criterion that I see cited as PSA velocity being a concern is a rise of .7 or more in a year. That said, PSA is so easily affected by so many factors, as folks have mentioned, that you...
Logo, to answer your “blind spot” question, transperineal biopsies Can access that anterior segment. And, the new Precision Point transperineal biopsy system can do that in an exam room with local...
Over ten years for me😀 Continued good luck to you👍...
I have to agree with the others that some type of treatment is necessary. I’ve always used the criteria of two cores with 10 percent Gleason(3+4) as the threshold for leaving AS. If going to JH, talk...
Reply to Zen9: AS was founded by Bal Carter at Johns Hopkins in 1994. It was the default treatment for low risk men when I first consulted there in 2008. Dr. Epstein determined my pathology qualified...
Djin's opening sentence says it all, based on what what we know at this time. Perhaps one more "protocol" biopsy in a year or two, but after that, there should be 2-4 years or a test change to...
I have a cousin with the same pathology. He is doing IMRT with a high dose brachytherapy boost. That combo, with or without ADT, appears to have very good non-recurrence results compared to other...
When I made my first post on this forum about five years ago, there was what I considered to be a smart*ss reply from Logo. I instinctively went into "flame reply mode", but noticed before sending a...
Your MRI is even better than my last one, which did show one small PIRADS 2 lesion. Such findings are as good as we can get, and still have prostate cancer. You are, so far. the ideal AS patient....
More than four positive cores, even if all G(3+3) would rule out AS at all but Klotz' program in Toronto. In other words, you need to be thinking about some type of treatment. My two book...
This article should address your question. There are several treatments for recurrence after radiation. Since this was published, SBRT and HDR-BT are being used more....
I want to thank Djin for his (usual) informative post earlier today. Regarding newer RT statistics, I'm not sure that overall survival (OS) statistics are reliable indicators when comparing with RP...
There are studies showing comparatively very low BCR rates for SBRT and for protons when matched against surgery. https://www.sciencedaily.com/releases/2016/04/160418145458.htm...
During a visit last year with Bal Carter of Johns Hopkins, he stated adamantly that a targeted-only biopsy was inferior to one that did systemic sampling PLUS some extra cores from the target areas....
Test...
I am one of the 20 to 25 percent of men who have indolent prostate cancer. My MRIs and biopsies show almost no cancer, which is a reduction from 2009. BUT, I have to constantly correct...
I wish all of the above men well with their past and planned surgeries. However, the usual surgery talking point about "you can't do surgery after radiation" just keeps appearing. It is misleading....
Your father has never owned a TV? And, he’s now 93 and independent? Wow! Talk about walking your own path...and surviving!...
Has your psa volume also been increasing? Have you had a PHI, 4K Score, or SelectMdX test? What about an OncotypeDX or Decipher test on the previous positive biopsy cores. What PIRADS score was...
Greed was a big part of the problem. Patrick Walsh of Johns Hopkins was the most famous and respected prostate surgeon of the pre-robotic period of the 1980's to mid-2000's. Here is what he recently...
With a G(4+3) man having surgery, ten year studies have shown a recurrence rate of 35 percent. That is much higher than the results for intermediate risk men reported by the two advanced types of...
I fully support PSA testing, but advocate against overtreatment. The 2012 USPSTF recommendation was a desperate attempt to stop the rampant "prostate snatching" of men with low risk pathologies. The...
Biopsy trauma can cause elevated PSA. One of my biopsies doubled my PSA, and another one tripled it, for six months. My doctors at Johns Hopkins were familiar with this possibility, and were not...
Yes, after two years of MRI's and biopsies, going to a two year MRI and four year biopsy schedule makes sense. But, you will still need a PSA or PHI test every six months. And, if there is suspicion...
After using PHI for several years, Johns Hopkins is now using only PSA for monitoring their active surveillance patients. They did find PHI useful in determining if a biopsy is needed. With a result...
It is not true that Medicare will cover medical expenses outside of the USA. There are a few limited exceptions, but emergencies are not one....
Giuliani and his police Chief were diagnosed at the same time. The police chief chose surgery. I recall recall pundits commenting on Rudy’s choice being unusual....
Logo, Paul Tsongas died from non-Hodgkins lymphoma....
You are overreacting. “Invasion of the Prostate Snatchers” was a best-selling book that highlighted the practice of some urologists to rush any newly diagnosed man into surgery. It was a very...
"The doctor said to him “You have cancer. The only thing that will help you is surgery‘“" He must be the poster boy of prostate snatchers. That, plus planning to buy a bigger boat for next season. In...
I just participated in a similar thread elsewhere, where a man was treated for PCa without a biopsy. After I and several others posted that was wrong, more people joined in saying that they never had...
All the active surveillance patients at Johns Hopkins are now seen by a female nurse practitioner. Her male MD co-worker only handles the biopsies and other invasive work. Rita Abu-Jabar has...
The criteria on percentage of core involvement vary among AS programs. I’ve even had a professor of urology at JH tell me that he believed that the percentage was not a significant factor. That was...
Somehow, I missed this thread before today. Just read it from start until now. I’ve participated in many forums over several years, and think that this is one of, if not THE, most thorough,...
A relevant article just published by a former HW participant. https://pcnrv.blogspot.com/2019/09/adjuvant-similar-to-early-salvage.html...
Of course, what this entire post fails to show, is that there are no studies that show that surgery alone has better, or even equal, non-recurrence rates compared to the advanced radiation types of...
These are impressive results, but I expect HIFU to be leapfrogged by TULSA-PRO, which was just FDA approved last month. HIFU has not been offered by many centers. But, TULSA-PRO has been endorsed by...
I find that to be true of almost all doctors I deal who are not urologists or medical oncologists. Until recently, I had never spoke with a non-urologist who knew anything about active surveillance....
I tried Flomax recently, and lasted about ten days. I have a very low pulse rate, often around 45, that I have had for decades. Flomax relieved some bph issues, but dropped my pulse even lower, and I...
The numbers for recurrence after surgery are well known, and they vary widely from 5 to 73 percent at five years, depending on the Gleason score at the post-op pathology. The 35 percent “average” is...
I have been dealing with AS and various test results for over ten years, and would offer the following suggestions. Have a PHI test followed by a 3T mp-MRI. If those find suspicions that justify a...