Hi-Risk/Recurrent/Advanced PrCa Video Chat, 1/13/26
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Editor’s Pick: Denovo metastatic BRCA2 Newbie stumps us all!
Topics Discussed
High volume denovo Mx Gent with BRCA germline can’t fiing a treatment that controls his T or his PSA; starting IMRT along with constipation; 2nd docetaxel easier with less fatigue than the first; liver returning to normal after 6x docetaxel; so back to full daro dose; T returns within 3 months of stopping 12 mo of orgovyx; BCBS turns down Prolia for -2.7 osteoprosis – did doc ask for wrong denosumab; ‘ciiling cap’ discussion; opting for new Plan Ds (drugs); Inherited Mutations discussed;
Chat
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Alfredo in Houston, TX sent: 4:24 PM
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Larry (Alaska) sent: 4:50 PM
should we test for LH and FSH levels?
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Alfredo in Houston, TX sent: 4:51 PM
Dr. Jack, would an LH level be helpful in this case?
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Jeff Marchi – San Francisco sent: 4:52 PM
small cell= neuroendocrine (not exactly: rd)
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AnCan–John A sent: 4:55 PM
advanceduropathology.com 5162807930 Dr Epstein prostate pathology expert
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Alfredo in Houston, TX sent: 5:00 PM
the relatively long half-life of injectable testosterone undecanoate means its effects can last for weeks, but probably not months
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Jeff Marchi – San Francisco sent: 5:08 PM
has anyone had VMAT radiation?
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Gary Martin sent: 5:09 PM
I had that prostate inflammation first and second round docetaxel. my oncologist did not know cause. Suggested UTI, which have the same symptom I had in round 1 and 2. I figured it was chemo working on prostate.
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Julian – Houston sent: 5:13 PM
Jeff, I have had VMAT radiation.
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Jeff Marchi – San Francisco sent: 5:13 PM
how well did it work? any side effects?
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Jack sent: 5:14 PM
Enzalutamide blocks androgen binding which disrupts the negative feedback loop that normally supresses testosterone this leads to compensatory increases in LH and subsequent increases in testosterone
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Julian – Houston sent: 5:14 PM
It worked quite well – I have been in remission for over 5 years. I am now having some radiation effects but not severe
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AnCan – rick sent: 5:18 PM
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Bruce Schrimpf sent: 5:20 PM
I have not met or heard of him.
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Gary Martin sent: 5:32 PM
I had insurance denial of Prolia (bone strengthening)- anyone encounter denial of Prolia?
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Julian – Houston sent: 5:34 PM
Aetna no longer approves Prolia.
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Larry (Alaska) sent: 5:36 PM
Bone loss is largely drivenby estradiol deficiency (just as it is in post-menopausal women). Testosterone deprivation also lowers a man’snatural estradiol. A low-dose estradiol suppement can avoid the need for bune-building agents. Agents which are expensive and bring their own set of adverese side effects.
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Larry (Alaska) sent: 5:43 PM
Calcium + Magnesium:
AI Says: Why Separation Helps Competition for Absorption: High levels of calcium can block magnesium absorption in the intestines, and vice-versa. Optimizing Intake: Spacing them out (2-4 hours apart is a common suggestion) minimizes this competition, allowing your body to absorb each mineral more effectively. When It’s Okay to Take Them Together Multivitamins: If they are in smaller, balanced amounts within a multivitamin, the interaction is usually not an issue. With Food: Taking them with food can also help with absorption and reduce digestive upset.
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RJ Smith (Seattle) sent: 5:47 PM
Cold Cap system is https://paxmanscalpcooling.com/
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Julian – Houston sent: 5:52 PM
Volumetric-modulated Arc Therapy (VMAT)
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Alfredo in Houston, TX sent: 5:55 PM
Well, here is a longish article, but it does seem to describe the difference between IMRT and VMAT, https://en.wikipedia.org/wiki/Radiation_therapy
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Julian – Houston sent: 5:57 PM
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Alfredo in Houston, TX sent: 5:58 PM
I have to leave now, sending everyone good wishes for the new year. Good night! and thank you!
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Alan Swope sent: 5:59 PM
Thanks all. I have to leave. Good information.
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Don Rogers sent: 5:59 PM
look at Scriptco.com for generic drugs. Huge saving even with the $140 yearly fee.
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Bruce Schrimpf sent: 6:01 PM
Thanks for the good discussion!