Low/Intermediate PCa Video Chat, December 8, 2025

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Editor’s Pick: Focal therapy sounds great but has higher risk of recurrence. (bj)

Topics Discussed
Importance of getting a second opinion on your biopsy slides by a specialist; don’t rush into a treatment without getting all the information; focal therapy sounds great but has higher risk of recurrence; active surveillance is a viable treatment option—it depends on your risk factors; cryotherapy vs HIFU—effectiveness vs side-effects; fears about erectile dysfunction (ED) and incontinence make focal therapy make it easy to jump on the focal therapy bandwagon; heart disease and hormone therapy (ADT) interactions; balancing open-heart surgery and managing prostate cancer (PCa); symptom management concerns cause me to lean toward IMRT (Intensity-Modulated Radiation Therapy) vs SBRT (Stereotactic Body Radiation Therapy); concerns about ADT side effects.

Chat

AnCan – Stuart sent a chat · 7:56 PM
Dr. Ming Zhou Mount Sinai Health System Department of Pathology, Box 1194 Annenberg Bldg. 15th FL 1468 Madison Ave New York, NY 10029 Email: Ming.zhou@mountsinai.org Telephone: (212)241-8881

AnCan – Stuart sent a chat · 7:56 PM
Dr. Jonathan Epstein – https://advanceduropathology.com/ Tel:516-760-2037 jepstein@imppllc.com

AnCan Bill sent a chat · 8:17 PM
If you are new, feel free to share your email address here and we will ensure you get our reminders.

AnCan Bill sent a chat · 8:32 PM
Steve, we were getting a lot of mic noise from you. We muted you.

Larry (Veteran, Alaskan) sent a chat · 8:33 PM
Do not overlook the potential value of getting a consult from a Medical Oncologist as opposed to Surgical or Radiological.

Martin Uthe sent a chat · 8:35 PM
Stuart, What is your email? Thank you.

Martin Uthe sent a chat · 8:36 PM
Larry, Thank you. M

AnCan – rick sent a chat · 8:36 PM
stuart@ancan.org

AnCan – rick sent a chat · 8:40 PM
I would disagrree with Larry at this time. With just a mm or two of 4+3 that we are checking with a 2nd opinion, most Genitourinary medical oncologists would not see you. You will not be able to get an appointment with Maha Hussein or David VanderWeele. Just seeing a general med onc will only confuse you.

Martin Uthe sent a chat · 8:41 PM
I am already confused!

Tom O NJ sent a chat · 8:44 PM
Martin confusion is why this group exist… keep coming keep doing research. I am new also and struggling w/ decision making.

Martin Uthe sent a chat · 8:45 PM
Thank you, Tom.

AnCan Bill sent a chat · 8:47 PM
Thanks Tom. We are here to help as best we can.

AnCan – Boykin sent a chat · 9:02 PM
Active Surveillance https://ancan.org/event/active-surveillance-prostate-cancer-2/2025-12-10/

Steve sent a chat · 9:10 PM
I was wondering if I should push for a Decipher test now?

Steve sent a chat · 9:11 PM
I tried to get one but its a bit hard from a foriegn country without a US Dr.

AnCan – rick sent a chat · 9:12 PM
Speak with Epstein first and also ask him. May help but I don’t know enough about Decipher. Dr. John does.

AnCan – rick sent a chat · 9:13 PM
We’re awae that it’s hard to get Decipher outside the country.

Steve sent a chat · 9:13 PM
ok 👍

Steve sent a chat · 9:13 PM
Yes I had Invitae genetic test … all negative.

Steve sent a chat · 9:14 PM
12 genes tested

AnCan – rick sent a chat · 9:14 PM
From Dr. John …. Steve: since there is some ambiguity, why not, if Epstein agrees

AnCan – rick sent a chat · 9:15 PM
Invitae is a germline test – very different to Decipher.

Steve sent a chat · 9:16 PM
Yep understand re: germline … I might have used wrong terminology

Steve sent a chat · 9:16 PM
Thanks Rick

Steve sent a chat · 9:17 PM
Any thoughts on state of the air radiation treatments if I end up there?

AnCan Bill sent a chat · 9:18 PM
bfranklin@ancan.org

Steve sent a chat · 9:19 PM
My connection dropped so not sure if I missed any texts

Steve sent a chat · 9:19 PM
re: Radiation.

AnCan – rick sent a chat · 9:20 PM
My bad…. didn’t realize the mic was on.

AnCan–John A sent a chat · 9:21 PM
Steve: likely SBRT

Steve sent a chat · 9:21 PM
ok, does that imply MRI Guided?

AnCan–John A sent a chat · 9:23 PM
Steve: probably at a state of the art center. Maybe CT

Steve sent a chat · 9:23 PM
CT?

AnCan–John A sent a chat · 9:23 PM
Computerized Axial Tomography

Steve sent a chat · 9:24 PM
Got ya, thanks 🙂

Steve sent a chat · 9:25 PM
SBRT with Real-Time Tracking (CyberKnife)?

AnCan–John A sent a chat · 9:26 PM
that’s an example yes

Steve sent a chat · 9:26 PM
MRI-Guided SBRT (MR-Linac: ViewRay MRIdian or Elekta Unity)

AnCan Bill sent a chat · 9:27 PM
Dr. Sanoj Punnen

Steve sent a chat · 9:27 PM
I will also check with my oncologist who I am seeing for Pet scan in a few hours

AnCan Bill sent a chat · 9:30 PM
https://sylvester-doctors.umiamihealth.org/

AnCan – rick sent a chat · 9:32 PM
https://sylvester-doctors.umiamihealth.org/

Steve sent a chat · 9:32 PM
I’m considering adding Dr. Kishan at UCLA to my trip.

Steve sent a chat · 9:36 PM
Did you have side effects?

Steve sent a chat · 9:37 PM
I like the idea he is on west coast as its already about 20-25 hrs flight time to get to CA 🙂

AnCan – rick sent a chat · 9:45 PM
dr.john@ancan.org

AnCan – rick sent a chat · 9:46 PM
https://www.uwmedicine.org/bios/effie-andrikopoulou

Steve sent a chat · 9:50 PM
Who was the Dr at UCSF who I should talk to re: Active Surveillance?

AnCan – rick sent a chat · 9:53 PM
UCSF – Peter Carrroll is the expert but winding down. Matt Cooperberg is one. If you can’t get to him, Sam Washington.

Steve sent a chat · 9:54 PM
Thanks Rick 👍

Steve sent a chat · 9:55 PM
Did you have the name and contact of the guy in Malaysia (I think it was you who mentioned him).

AnCan – rick sent a chat · 9:57 PM
Read this metastudy …. https://jamanetwork.com/journals/jamaoncology/article-abstract/2841671?guestAccessKey=d03b0908-90c8-497e-85cd-aebb43ec2a63&utm_medium=email&utm_source=postup_jn&utm_campaign=article_alert-jamaoncology&utm_content=olf-tfl_&utm_term=112025&mc_cid=0fa42784f6&mc_eid=838454d636

Steve sent a chat · 10:01 PM
Thanks so much for all the help guys. Makes my path alot more focused on best next steps. Much appreciated 🙏

Steve sent a chat · 10:05 PM
My connection dropped again… back on now

AnCan Bill sent a chat · 10:05 PM
We are glad you found us. Please keep coming to the group.

Steve sent a chat · 10:06 PM
You guys give us alot more confidence dealing with PC

Steve sent a chat · 10:10 PM
Rick/Stuart do you guys mind sharing your email?

AnCan Bill sent a chat · 10:11 PM
rd@ancan.org and stuart@ancan.org

AnCan – Stuart sent a chat · 10:11 PM
https://www.uclahealth.org/providers/amar-kishan

AnCan – Stuart sent a chat · 10:12 PM
MR-Linac

Paul N. sent a chat · 10:14 PM
Ask Keeshan about the Prostox test

AnCan Bill sent a chat · 10:20 PM

Special Presentation: What if You Could Predict the Risk of Radiation Effects – Prostox and Beyond

Carl S. sent a chat · 10:21 PM
Thanks guys, see you next time.

Manuel sent a chat · 10:21 PM
Thanks for a great session!

Steve sent a chat · 10:22 PM
Thanks Guys 🙂

Low/Intermediate PCa Video Chat, December 8, 2025