Hi-Risk/Recurrent/Advanced PCa Video Chat, July 1, 2024
Hi-Risk/Recurrent/Advanced PCa Video Chat, July 1, 2024
Apologies for the delay this week… it was a GoTo issue because we had a double session with a lot of slides. The ASCO24 presentation can be found at https://ancan.org/patient-highlights-from-the-2024-asco-annual-conference/
Men Speaking Freely is on for July 4 – we’re talking parent-child relationships with Dr. John Happy July 4th to all
If you missed any recent recordings, you’ll find a full list either on our YouTube Playlist (click above) or visit our Blog Post https://ancan.org/our-recent-blog-posts-in-case-you-missed-them/ Sign up for our Blog by checking the New Blog box at https://ancan.org/contact-us/
- You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/
- Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
- THIS WEEK… Men (Only) Speaking Freely…1st & 3rd Thursdays @ 8.00 pm Eastern https://ancan.org/men-speaking-freely/
- Veterans Healthcare Navigation… 4th Thursday @ 8.00 pm Eastern https://ancan.org/veterans/
Editor’s Pick: Dr. Jeff advises you read your medical records carefully – he’s found mistakes and typos in his! (rd)
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Norm Pollock
sent: 5:19 PM
Monistat chafing relief powder gel
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AnCan – rick
sent: 5:22 PM
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Joel Blanchette, Reston, VA
sent: 5:40 PM
Invitae gene test
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GARY Z
sent: 5:42 PM
Hi, Dr. John. I’m 66. Inova Oncology Genetic testing ~ 2018. No BRCA. No prostate cancer history immediately family (father, uncles, cousin). Mother breast cancer (survived 30 years) died of uterine cancer (BRCA, I think). After an ADT vacation three years – 2020 > 2023. Orgovyx February 2024 and scheduled to stop end of July 2024. (Received continuous ADT 2017-2018. Had intermittent ADT 2018 through 2019.) Thank you, Doctor.
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John A
sent: 5:49 PM
Color includes PTEN.
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Richard Fiske
sent: 5:56 PM
Long Term AnCan title: BSd
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dan straub
sent: 6:02 PM
I just received my COLOR genetic test results… it does NOT analyze P10 or RB1
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AnCan – rick
sent: 6:04 PM
BSd….. I like it
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Frank Fabish Columbus OH
sent: 6:12 PM
Thanks everyone gotta sign off.
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AnCan – rick
sent: 6:35 PM
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Julian – Houston
sent: 6:43 PM
Thanks again everyone – Great discussion: See you next week
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AnCan – rick
sent: 6:44 PM
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Larry
sent: 6:44 PM
should be cautious about rushing to see surgeon and opting for surgery before not knowing a lot more
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Stephen
sent: 6:49 PM
Nope – Not a vet – I’ll be back for more info – I have time to explore my best options. Thanks guys!
Our Recent Blog Posts – In Case You Missed Them
Editor’s Note: We know you’ve missed receiving email notifications about our blog posts. Now that we are up and running on the new system via mailchimp (the same system you receive our group reminders on), here are the posts may have missed. They are categorized for your connivence. Enjoy!
Hi-Risk/Recurrent/Advanced PCa Video Chat Recordings
- April 1st
- April 9th
- April 15th
- April 23rd
- May 6th
- May 14th
- May 20th
- May 28th
- June 3rd
- June 11th
- June 17th
- June 25th
General Prostate Cancer
- Talking Estradiol (E2) for Recurrent and Advanced Prostate Cancer: Wassersug et al
- Where in the world is best for a radical prostatectomy?
- Transperineal Prostate Biopsies – AnCan’s favorite Standard Bearer explains!
Solo Arts Heal
Veterans
Webinars
- Is Pre-treatment Active Surveillance for Prostate Cancer Safe?
- Reflecting on a webinar: Pet Aging, Illness, and Loss
Pancreatic Cancer
RMC
Hi-Risk/Recurrent/Advanced PCa Video Chat, June 25, 2024
Hi-Risk/Recurrent/Advanced PCa Video Chat, June 25, 2024
- You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/
- Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
- THIS WEEK… Men (Only) Speaking Freely…1st & 3rd Thursdays @ 8.00 pm Eastern https://ancan.org/men-speaking-freely/
- Veterans Healthcare Navigation… 4th Thursday @ 8.00 pm Eastern https://ancan.org/veterans/
Editor’s Pick: After a 10x PSA rise on Pluvicto, it’s time for new therapy — and a new genetic test (bn)
Two RMC Superstars on World Sickle Cell Day Panel
We are so excited to announce our Renal Medullary Carcinoma Support Group partners are on an esteemed panel for World Sickle Cell Day representing RMC! This events features Ritchie Johnson of Chris ‘CJ’ Johnson Foundation (US) and Nicola Casey of The Ricky Casey Trust (UK) and several other international perspectives on Sickle Cell Trait/Disease. Every time SCT and RMC are discussed together, progress is made in our community. We are so glad these incredible ladies are talking about it! We encourage you to attend this event and learn more.
Proper Nutrition for a Pancreatic Cancer Diagnosis
Established in 1973, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins has been committed to advancing the understanding of human cancers and developing more effective treatments.The National Cancer Institute (NCI) recognizes this Center as a Comprehensive Cancer Center, highlighting its involvement in clinical and laboratory research, education, community outreach, and cancer prevention.
In this video, specialists from the Johns Hopkins Kimmel Cancer Center offer a nutritional guide for patients with a pancreatic cancer diagnosis.
Hi-Risk/Recurrent/Advanced PCa Video Chat, June 17, 2024
Hi-Risk/Recurrent/Advanced PCa Video Chat, June 17, 2024
- You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/
- Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
- THIS WEEK… Men (Only) Speaking Freely…1st & 3rd Thursdays @ 8.00 pm Eastern https://ancan.org/men-speaking-freely/
- Veterans Healthcare Navigation… 4th Thursday @ 8.00 pm Eastern https://ancan.org/veterans/
Hi-Risk/Recurrent/Advanced PCa Video Chat, June 11, 2024
Hi-Risk/Recurrent/Advanced PCa Video Chat, June 11, 2024
- You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/
- Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
- Men (Only) Speaking Freely…1st & 3rd Thursdays @ 8.00 pm Eastern https://ancan.org/men-speaking-freely/
- Veterans Healthcare Navigation… 4th Thursday @ 8.00 pm Eastern https://ancan.org/veterans/
Transperineal Prostate Biopsies – AnCan’s favorite Standard Bearer explains!
Transperineal Biopsies – AnCan’s favorite Standard Bearer explains!
If you’ve been around AnCan’s prostate cancer programming, and for sure our Active Surveillance and Low/Intermediate Groups, you are certain to know AnCan moderator and medical journalist Howard Wolinsky. He has campaigned on many issues impacting men like him with very low, low and intermediate risk prostate cancer. The list is long – and included below!
TPs avoid the germy rectum and virtually never cause infections or potentially deadly and disabling sepsis, although nothing is 100%. The biopsy needle is placed through the perineum, the space between the rectum and the testicles. This is not only patently more hygienic avoiding all fecal material, but also allows access to posterior areas of the prostate that cannot be reached with the TR protocol. Here’s an excellent short video to better explain.
Over 800 people—fellow patients and some leading physicians—have signed his petition to phase out transrectal biopsies. Wolinsky called on Medicare and Congress to intervene after a scandal in Norway caused the European Association of Urology to take on the issue in 2021 when a Norwegian died from sepsis following a prostate biopsy. The policy head of EAU told Wolinsky that transrectal biopsies were tantamount to “malpractice” in Europe. Wolinsky moderated a debate on TP vs. TR at AnCan in 2022 AnCan also ran two webinars on the topic in 2022:
So what did the American Urological Association do?
You might expect some resistance to a major change in practice that’ would cost urologists time to be trained and up to $40,000 in equipment to set up this new approach. That’s what happened. Wolinsky, representing AnCan, as a consumer reviewer, told the AUA Early Detection Guidelines in 2023 that they should recommend transperineal biopsies as the preferred method. He said men were dying while they were debating which end of the egg is better to break first.
AUA still put TP on par with TR in its guidelines. A small step for men, as Neil Armstrong said on the first moon landing. The AUA is conservative and says it requires high levels of evidence from research before changing its guidelines—even though EAU counterparts consider TP their preferred method. Daniel Lin, MD, vice chair of the AUA committee, said in 2023 that randomized clinical trials would be the key to resolving the issue and several were coming in the next year.
Here’s an analysis on the different approaches taken by AUA and EAU to TP vs. TR: “Urology Groups Endorse Two Prostate Biopsy Approaches”. The randomized trials have started to come out and essentially only muddied the waters. “U.S. debate on transperineal vs. transrectal drags on despite randomized trials”
- Dr. Badar Mian’s single-center RCT at the University of Albany showed TR and TP essentially had the same results in terms of infections. It was widely criticized for not having enough patients to reveal rates for sepsis.
- Dr. Jim Hu’s multi-center study based at Weill-Cornell “almost” showed a statistical benefit to TP in a paper presented last January. But no cigar. The study was expanded and it is clear that TP wins in this research. Hu told the recent AUA meeting about it, but won’t talk about the results until the study is published.
But TP, meanwhile, is in increasing demand. A poll of 145 AS-educated readers of TheActiveSurveillor.com
None of this is say biopsies should be eliminated, just that they should be done as necessary and as infrequently as possible. A decade ago, urologists recommended annual biopsies. As their confidence in AS has increased, the frequency varies by practice: from every other year to three to five years as in Dr. Klotz’s practice in Toronto. Wolinsky’s own care as a peer in this Active Surveillance cohort has de-intensified with annual visits to his doctor, Dr. Brian T. Helfand | NorthShore He has not had an MRI or biopsy in eight years–though his doctor still considers Wolinsky on AS. At age 76, he is considering hopping off the AS train.
Just in case you think Howard is a one-track (or even three-track) pony, here are a few other issues he has undertaken on behalf of men living with very low, low and intermediate prostate cancer.
- how AS can help reduce the toll created by overdiagnosis and treatment of prostate cancer
- potential risks of contrast agents for men undergoing MRIs
- the need to prescreen patients with MRIs before rushing into biopsies
- the need to screen men diagnosed with PCa for mental distress
- the abuses of focal therapy salesmen pushing the technique to men with Gleason 6 cancers
- how micro-ultrasound may help supplement or replace MRIs
Where in the world is best for a radical prostatectomy?
Where in the world is best for a radical prostatectomy?
Ever wondered whether medical tourism makes sense for a radial prostatectomy? After all, most of us are well aware that a RP comes with significant expectations for erectile dysfunction and incontinence. A recent paper in JCO Global Oncology analyses surgical outcomes in 10 countries covering almost 22,000 men, although by far the most (72%) come from Germany. Notably none are Scandinavian where we already know Active Surveillance (AS) for men with Low/Intermediate risk prostate cancer (PCa) is highest.
If you’ve been paying attention to our AS Mods, in particular Howard Wolinsky, you will already know that the US lags far behind when it comes to treating suitable men with AS. This study confirms 84% of men treated in the US were Stage 1 and 26% were Grade Group 1. Only the Barbers of Seville performed more aggressively treating 88% of T1 and 27% in GG1. The Brits were way out ahead treating just 13% of men with T1, 9% in GG1. G-d Bless the National Health Service and its cost saving measures.
Sexual dysfunction reported a fairly tight band between 40-53%. The happiest campers were those singing Waltzing Matilda in Oz, while the Brits were the loudest complainers, although Canada was slightly higher when weighted. US was in the middle.
Those Spanish toreadors caused the most urinary bother at 54% (33% when weighted) albeit 29% reported issues going in. The Italians only reported 1% after surgery and 10% before… either those Italian surgeons are true maestros, or the Signore are not being honest. USA was right around average at 9%.
The main caveats in the study are the huge variance in respondent numbers between countries with a heavy bias to Germany. The researchers also recognize that men in different countries may answer the survey referencing different standards. All told, this is the fist ever comparative study… and for me personally, I’d stick to the beaches and the Prado when visiting Spain!
There are a lot of numbers to plough through here, and a Mike Wyn deserves a big shout out for helping us get through them. If you want to dig into them yourselves, you’ll find the link at https://ascopubs.org/doi/pdfdirect/10.1200/GO.23.00420