For the final webinar of 2021, we went out with a bang with “How Do You Know When to Enter Active Surveillance and When to Leave?”
Featuring Kirsten Greene, MD (Paul Mellon Professor andchair of the University of Virginia’s Department of Urology), Dr. Greene stated that the goal for most men on AS is delaying active treatment.
“Both you and your physician should know if you are on watchful waiting or active surveillance and it should be the one YOU WANT. Know your destination!”, she said. Patients and doctors should recognize that AS involves close monitoring and is different from the hand’s off approach of watchful waiting.
She shared:
• Active surveillance involves close PSA follow-up, serial biopsies, MRI, and maybe genomic testing.
• The goal of active surveillance is to safely delay treatment but preserve your option to treat for cure.
• Watchful waiting is a hands-off, approach. PSA periodically with no biopsies, no imaging.
• The goal of watchful waiting is to allow the prostate cancer to take its natural course (which means maybe spread) and to treat symptoms when they arise. No plan for curative treatment ever.
Some men with very low-risk prostate cancer may never be treated.
Dr. Greene stated that the triggers for intervention are:
• Consistent change in PSA
• Progression found on follow-up biopsy
• Patient anxiety
• Clinical or radiographic evidence of local/distant progression
• Identification of more concerning pathologic variants of prostate cancer (cribriform or intraductal patterns)
Hear all about this, and more by watching the recording:
Dr.K very generously agreed to answer addtional Q&A after the session ….. you’ll find a whole bunch more great information here – and thanks to Howard W for writing them up. Click AnCan After Hours Greene Q&A
Special thanks to Myovant Sciences – Pfizer, Foundation Medicine, and Advanced Accelerator Applications for sponsoring this webinar.
We also learned recently that in 2021 almost 15,000 visitors have watched 258,000 minutes in viewing time on our YouTube Channel – THANK YOU!
All AnCan’s groups are free and drop-in – join us in person sometime! You can find out more about this and our other 10 monthly prostate cancer groups at https://ancan.org/prostate-cancer/
Editor’s Pick: We all know this group is for men living with advanced prostate cancer. It’s also for men lviing with advanced bladder cancer …. listen in to find out why! (rd)
Topics Discussed
PROMISE may be the ticket; advanced bladder cancer may not be so different from PCa; disease recurs after 20 years; Provenge on the Islands; dexamethasone vs prednisone with abi; dex and heart rate; nocturia and how to deal with it; Agent Orange and otehr VA issues; BAT experience; entering hospice; GU Med Onc recommends RT
Chat Log
Herb Geller (to Everyone): 4:10 PM: On a Mac, the chats are in Documents>GoToMeeting Chats
Peter Kafka (to Everyone): 4:13 PM: psma scan time
Peter Kafka (to Everyone): 4:15 PM: Oliver Sator at Tulane would be a good option.
Carl Forman (to Everyone): 4:18 PM: I had tried to get a telemed appt with Sator for a second opinion, but was told he only sees new patients in person. Didn’t want to get on a plane to see him.
John Antonucci (to Everyone): 4:20 PM: HIya Jake
Jake Hannam (to Everyone): 4:20 PM: pylarify
Alan Moskowitz (to Everyone): 4:22 PM: Could he have had C 11 Choline scan?
Joe Gallo (to Everyone): 4:27 PM: Invitae
Jake Hannam (to Everyone): 4:28 PM: I might have some input on oxycodone. I’m an old pro.
Julian Morales-Houston (to Everyone): 4:30 PM: I got the Color this week?
Bill Lewis (to Everyone): 4:34 PM: I’ve done more than 8000 self catheterizations. lewis.bill@gmail.com
AnCan – rick (to Everyone): 4:45 PM: You ain’t going to hear this type of stuff anywhere else, Gents!!!
Alan Moskowitz (to Everyone): 4:48 PM: Avoid any gas causing foods –
Mark Horn (to Everyone): 4:53 PM: Many thanks everyone
Bill Lewis (to Everyone): 5:02 PM: To Steve: my oncologist would give you a special version of Chemo, including Taxotere and 2 other drugs right away. Love to talk.
Jake Hannam (to Everyone): 5:02 PM: axumin PSMA Pet
Vic (to Everyone): 5:05 PM: from the PEACE 1 study/trial and be sure to talk with the GU MO
Erwin Zoch (to Everyone): 5:10 PM: I suggest that unfamiliar acronyms be defined when 1st used for newcomers e.g,, SBRT is Stereotactic Body Radiation Therapy (or RadioTherapy).
Bob Smith (to Everyone): 5:12 PM: Regarding Steve’s comment on head bump, is it common for concussions to lead to PCa brain or other?
Herb Geller (to Everyone): 5:13 PM: I have not seen any suggestion that a concussion can promote a PC metastasis
Peter Kafka (to Everyone): 5:13 PM: I have never heard of incidents like this leading to cancer metastasis. But I am no expert.
AnCan – rick (to Everyone): 5:16 PM: Bob – not sure there is any correlation that I have heard of.PCa spreads without any interference from outside forces – unfortunately.
Steve Barber (to Everyone): 5:22 PM: My imaginatve, “pet” theory is that 35 years of cell phone use/radiation conpromised the integrity of bone in my skull on the right side.
Vic (to Everyone): 5:24 PM: what study supports the abi with meals?
Jake Hannam (to Organizer(s) Only): 5:30 PM: bone scans are notoriously insensitive
AnCan – rick (to Everyone): 5:31 PM: Vic – we have articles around abi with food. But only re. reducing the dose with food.
Jim Marshall, Alexandria, VA (to Everyone): 5:41 PM: Jiimmy – Count your blessings you ARE. Think of what happens if you are not. Jim Marshall
Joel Blanchette, Reston VA (to Everyone): 5:41 PM: I am on the exact schedule as Jimmy and Herb.
Julian Morales-Houston (to Everyone): 5:42 PM: This is my schedule to a T!
Stan Friedman (to Everyone): 5:43 PM: I have obstructive sleep apnea and the therapy reduces the number of times I get up to one, maybe two.
Vic (to Everyone): 5:44 PM: I’ve had some success just ignoring the urge to go an being able to fall back to sleep without leaking
AnCan – rick (to Everyone): 5:44 PM: Myrbetriq
Bill Lewis (to Everyone): 5:47 PM: Food added to full-dose Zytiga: PMID 25777155; DOI: 10.1038/pcan.2015.7 — Bill Lewis
Steve Barber (to Everyone): 5:47 PM: Thanks to all! At this time I must get off the meeting. I look forward to another visit and appreciate all the input today. Steve
AnCan – rick (to Bill Lewis): 5:49 PM: Tx Bill – we will definitely take a look at the refernce. I am sure Len and Herb are on it.
Len Sierra (to Organizer(s) Only): 5:51 PM: I just did. 2015 study with 41 patients. They claim 16% better response on food with full dose. No increase in tox. Hard to believe.
Len Sierra (to Organizer(s) Only): 5:53 PM: I’d need to read the full paper. And see if anyone was citing this study.
Herb Geller (Private): 5:53 PM: IT is a small retrospective study from 2015, They say that abi with food lowered T, so there must have been an issue with their initial therapy.
AnCan – rick (to Organizer(s) Only): 5:53 PM: Maybe you can look closer ….. But even so, changing dose like that must inc. medical advice. Did these men fail abi then up the dose.
Herb Geller (to Organizer(s) Only): 5:54 PM: T is a small retrospective study from 2015, They say that abi with food lowered T, so there must have been an issue with their initial therapy. It is totally flawed
Peter Kafka (to Everyone): 5:55 PM: Don’t forget the water quality at Fort Bragg
Jake Hannam (to Everyone): 5:57 PM: Military water quality is notoriously bad and still being EPA-remediated across the country
Herb Geller (to Everyone): 5:59 PM: I looked at the abstract of the study. Thay say that abi with food caused a decline in T levels as well as PSA in a small percent of men. The fact that T declined suggests they were undertreated before switching to food. T should be undetectable with any effective dose of abi
Joe Gallo (to Everyone): 6:01 PM: Veterans Population ~19,000,000
Veterans in VHA System ~9,000,000
Veterans in VHA with Prostate Cancer 488,984
Veterans in VHA with Metastatic Prostate Cancer 16,282
Veterans diagnosed with Prostate Cancer each year ~15,000
Cumulative (10year) Cost of High Risk PCa Patient2
~$200,000
Total Economic Burden for High-Risk Patients in VHA ~$3,256,400,000
Vic (to Everyone): 6:02 PM: Is a vet rep needed for St. Louis, MO.? If so, who should be contacted?
Joe Gallo (to Everyone): 6:03 PM: Vic and anyone interested let me know and I will forward the info. joeg@ancan.org
Vic (to Everyone): 6:04 PM: please do Joe, thanks
Vic (to Everyone): 6:14 PM: the nasa astronauts used a penis prosthesis for urinating, perhaps that would be available and helpful for you Jake
Erwin Zoch (to Everyone): 6:15 PM: Thanks to all of you for this amazing information! Thanks to Jay for encouraging me to join this group. I hope to be with you again soon.
Jay Mills (to Everyone): 6:16 PM: Best of luck tomorrow Erwin with your appointment.
Peter Monaco (to Organizer(s) Only): 6:18 PM: Need to sign off gents! I will handle all recordings this week. Best regards and Happy New Year!
Jake Hannam (to Organizer(s) Only): 6:19 PM: you too peter and thanks for your help
We also learned recently that in 2021 almost 15,000 visitors have watched 258,000 minutes in viewing time on our YouTube Channel – THANK YOU!
All AnCan’s groups are free and drop-in – join us in person sometime! You can find out more about this and our other 10 monthly prostate cancer groups at https://ancan.org/prostate-cancer/
Editor’s Pick:This week, it’s a theme – men who are clearly their own best advocate and men who just ain’t….. and don’t let a handful of difficult customers deter you (rd)
Topics Discussed
Foundation Medicine’s Next Generation Sequencing liquid biopsy ; ‘Be You Own Best Advocate; looking to bike like Dad for another 30 yrs ….at 59 ; get best information to make intial treatment decision; everone else responsible for this man’s PCa except him; when to intorduce 2nd line anti-androgen and which one; and more … abi vs enz; finishing salvage RT; let’s talk about soy; explaining RT ligands/radionuclides; yup – that pain in the neck is PCa; cabazitaxel – hopefully the plateau before the drop; holding the course with pembro despite no result; blood pressure issues; Lu177 PSMA’s a winner for this v. grateful man; palliative care, hospice or what?
Chat Log
Joe Gallo (Private): 6:08 PM: What about SelectMDx?
AnCan – rick (to Joe Gallo): 6:09 PM: ???? – explain Joe
Joe Gallo (Private): 6:11 PM: Urine based test that confirmed the probability that I had greater than Gleason 7. Proceeded to TP. A favorite of E David Crawford
ALFRED LATIMER (Private): 6:12 PM: Rick. I forget. Who does the liquid biosy?
Jake Hannam (to Everyone): 6:13 PM: ty carl – i do have a brief update but no news
Joe Gallo (Private): 6:13 PM: Measures 2 mRNA cancer related biomarkers
AnCan – rick (to ALFRED LATIMER): 6:14 PM: Foundation Medicine
AnCan – rick (to Organizer(s) Only): 6:19 PM: He is high risk with PSA 22 but borderline
Jimmy Greenfield (Private): 6:19 PM: Thirty years! I like his optimism
Len Sierra (to Everyone): 6:19 PM: Crude incidence of individual secondary cancers ranged from 0.2% to 2.3% for patients treated with external beam radiotherapy, 0.1% to 2.1% for patients treated with brachytherapy, 0.2% to 1.7% for patients treated with brachytherapy and external beam boost, and 0.3% to 2.3% for patients not exposed to radiotherapy BMJ. 2016; 352: i851. Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis
Warren in Edmonton (to Everyone): 6:24 PM: If Len would like to chat with me after the meeting please let me know, I can offer a great deal of information on his question
Peter Kafka (to Organizer(s) Only): 6:24 PM: He should get a second opinion on his biopsy with this one
Joe Gallo (to Everyone): 6:26 PM: Epstein Consult https://hopkinsconsults.org Eric. Just ask you urologist to send. You don’t have to track down your slides
Eric Madison, WI. (to Everyone): 6:35 PM: Have a great night, guys!
Joe Gallo (to Organizer(s) Only): 6:35 PM: He will get a good discussion when he chats with Epstein
Pat Martin (to Everyone): 6:36 PM: I was dxed and had at least 6 weeks before sugery. They gave me casodex and Lupron
Warren in Edmonton (to Everyone): 7:24 PM: I have a small emergency at home and I must leave the meeting. Merry Christmas to all.
Len Sierra (to Everyone): 7:45 PM: Soy might lower the risk of other cancers
Studies among prostate cancer survivors indicate that eating soy foods may lower PSA levels. Among men in various stages of prostate cancer, those who consumed soy milk or isolated soy isoflavones saw their PSA levels rise at a slower rate. Source for my post: www.nutritionfacts.org
Alan Moskowitz (to Everyone): 7:48 PM: Regarding Enza vs Abi – my MO at MSK said “As for abi vs enzalutamide, as we discussed, never been compared head to head though my feeling is enzalutamide is a bit more active. Though they work differently, both have very high response rates up front but much lower when the other has already been used. In “switching” trials, enza has higher response rate after abi than abi after enza. To me, this doesn’t mean starting with abi is better. It’s just consistent with enza being the more active drug (easier to become abi resistant than enza resistant). But overall, it’s a tossup and I give abi to more elderly and frail and enza to younger and healthier. Essentially no difference between enzalutamide and apalutamide.”
Alan Moskowitz (to Everyone): 7:49 PM: I have to leave, thanks for the guidance.
AnCan – rick (to Everyone): 7:49 PM: Alan – this NOT about head-to-head; it’s about sequencing
John Antonucci (to Everyone): 8:02 PM: will they give a 2nd booster?
Len Sierra (to Everyone): 8:04 PM: They will give a second booster to immunocompromised folks.
Cal Van Zee (to Everyone): 8:12 PM: My blood pressure peaked at 200/100 on prednisone on 50mg Losartan w/o diruetic. After changing to dexamethasone, BP dropped to normal and I stopped Losartan.
Cal Van Zee (to Everyone): 8:17 PM: 120/80 or below: for me it was the Prednisone, not the AbiI’m still on Abi now but my PSA is rising now at 19. Most likely starting chemo first week of Jan
Jerry Pelfrey (to Everyone): 8:19 PM: Sorry I have to leave. Have a Great Christmas!
Julian Morales-Houston (to Everyone): 8:24 PM: Merry Christmas to all!
Stan Friedman (to Everyone): 8:24 PM: Merry Christmas!
We also learned this week that in 2021 almost 15,000 visitors have watched 258,000 minutes in viewing time – THANK YOU!
All AnCan’s groups are free and drop-in – join us in person sometime! You can find out more about this and our other 10 monthly prostate cancer groups at https://ancan.org/prostate-cancer. To sign up to receive a weekly Reminder/Newsletter for this Group or others, go to https://ancan.org/contact-us/
Editor’s Pick: Is palliative care the right call or should it be hospice? We also pick apart the abi steroid recommendations. (rd)
Topics Discussed
Abi fails for denovo Mx Newbie; setting up a medical team away from home; best steroid protocol for abi; Pylarify is widely available – advocate for it; palliative vs hospice care and when to switch; abi fails for denovo Mx Oldie!; high risk man needs to watch the urologist pushing surgery; is a new ‘bone drug’ right for PCa?; cabzitaxel maintains stability – no significant results yet; Novartis/AAA helps our guy get into 2nd Lu177 trial; Ac225/pembro trial not producing results.
Chat Log
Mark Perloe, MD Atlanta (Private): 4:22 PM: If the tissue is negative shouldn’t germline be negative as well?
AnCan – rick (to Mark Perloe, MD Atlanta): 4:24 PM: Yup – exactly; but there may be a lot more in his somatic test
Mark Perloe, MD Atlanta (Private): 4:25 PM: too many different companies offering different tests.
Jim Marshall – Alexandria, VA (to Everyone): 4:57 PM: was just switched from 10 to 5mg per day because the current recommendaition from Janssen for CSPC is 5mg and CRPC is 10 mg
James Barnes (to Everyone): 5:01 PM: Thanks Jim. Just checked and my dosage is 5mg as well.
Herb Geller (to Organizer(s) Only): 5:04 PM: Based on Jim’s comment should I take 10 mg of prednisone
Len Sierra (to Organizer(s) Only): 5:07 PM: I would, Herb.
AnCan – rick (to Organizer(s) Only): 5:09 PM: I have never heard that difference …. 5mg vs10 mg. That said – my advice would be to discuss with your doc, Herb
Herb Geller (to Organizer(s) Only): 5:15 PM: The package insert for CRPC says 5 mg twice a day.
Len Sierra (to Organizer(s) Only): 5:17 PM: Herb, Jim said Janssen says this is the current recommendation (10mg). Why not call them?
AnCan – rick (to Organizer(s) Only): 5:17 PM: That was the original approval; since then 5 mg seems acceptable as you saw. Only one person takes 10 mg
Len Sierra (to Organizer(s) Only): 5:25 PM: Did Larry Fish say Hospice will not “allow” any care, even pain relief?? That doesn’t sound right.
Herb Geller (to Organizer(s) Only): 5:26 PM: They will do pain relief but not continue survival meds
Peter Kafka (to Everyone): 5:26 PM: All hospice care is different
Pat Martin (to Everyone): 5:28 PM: External catheter worked for me so I could get out and about. External hocked to tubes and a leg bag.
Cal Van Zee (to Everyone): 5:36 PM: Herb: My counselor taught me the future doesn’t exist, only now. FEAR stands for future events appear real. I choose every day to be grateful that I’m here today.
Stephen Saft (to Everyone): 5:39 PM: Eckhart Tolle writes on this. Book called the Power of Now is fantastic.
Len Sierra (to Everyone): 5:40 PM: Yes, I read that book and it is excellent.
Stephen Saft (to Everyone): 5:42 PM: To a man with a hammer everything looks like a nail. Urologist is not the only one to listen to in this situation.
Pat Martin (to Everyone): 5:54 PM: What I did is contact the practice I was transferring to and they contacted my local urologist. And it happened without my involvement
Julian Morales – Houston (to Everyone): 5:54 PM: Got another meeting to go to. always good meetings. thank you
Stephen Saft (to Everyone): 5:55 PM: I got in the habit of taking a disk copy with me whenever I get a scan.
Jake Hannam (to Everyone): 6:00 PM: I love all you guys. Just saying …
Jim Ward (to Everyone): 6:00 PM: Evenity (romosozumab)
Pat Martin (to Everyone): 6:02 PM: gotta run. Catch everyone next week
Peter Monaco (to Everyone): 6:02 PM: Right back at ya Jake!
Herb Geller (to Everyone): 6:05 PM: Romosozumab causes ONJ equivalent to others
Jim Ward (to Everyone): 6:07 PM: Thanks, Herb.
Paul Freda Florida (to Everyone): 6:17 PM: Have an online Calculus lesson to do. See y’all next week.
Jake Hannam (to Everyone): 6:20 PM: take care Paul!
All AnCan’s groups are free and drop-in – join us in person sometime! You can find out more about this and our other 10 monthly prostate cancer groups at https://ancan.org/prostate-cancer/
Editor’s Pick: Some docs are holding off starting HT – others are jumping in quickly. We hear from both sides in this session. (rd)
Topics Discussed
Responding to a high risk PCa Dx; responding to a recurrence; treating abdominal lymph mets; EMBR discussion; PSA fluctuates on abi; pushing the envelope on starting HT; scans or no scans before starting RT; Lu177 Managed Access Trial discussed; Dr. E
Chat Log
Joe Gallo (to Everyone): 6:31 PM: www.mskcc.org/nomograms
Len Sierra (to Everyone): 6:40 PM: Pylarify
George (to Everyone): 6:40 PM: pylarify psma scan
Joe Gallo (to Everyone): 6:40 PM: PSMA PET Pylarify
Joe Gallo (to Everyone): 6:44 PM: GU Medical Oncologist
Joe Gallo (to Everyone): 6:46 PM: Ask to take a Lupron holiday
George (to Everyone): 6:52 PM: Mike, My case was like yours. My urologist surgeon sent me to interview radiation oncologists. The surgeon told me he would not do surgery, because if I had a prostatectomy there would surely be positive margins.requiring salvage radiation. He also told me that after surgery there would be incontinence, which might in time resolve. However, he said, radiation will lock in the incontinence at the state it is at the start of radiation.
Paul Freda , Lake Worth FL (to Everyone): 6:57 PM: Have to give an online Physics lesson at 9pm. See you all next week. 🙂
Peter Sherman (to Everyone): 7:01 PM: I’m pleased with my care at MSK Cal Van Zee (to Everyone): 7:05 PM: Anyone here in a PSMA Lu-617 trial?
Herb Geller (to Everyone): 7:05 PM: Yes, several guys
Peter Kafka (to Everyone): 7:07 PM: Sylvester has the record.
Jake Hannam (to Organizer(s) Only): 7:10 PM: Why do they still do bone scans these days – so old tech!
Cal Van Zee (to Everyone): 7:10 PM: For those in Lu-617 trial, would appreciate any offline feedback/side effects. I’m waiting/hoping to get into a trial.
Joe Gallo (to Organizer(s) Only): 7:11 PM: PSMA PET replaces CT and Bone scans. Assume they are trained to read them.
Pat Martin (to Everyone): 7:18 PM: Somatic gene testing
Peter Sherman (to Everyone): 7:21 PM: what is the difference between the types of genetic testing?
Pat Martin (to Everyone): 7:23 PM: Germline is what your Mom and Dad gave you. Somatic shows the mutations that your tumor has created.
Peter Sherman (to Everyone): 7:23 PM: thanks Pat
Pat Martin (to Everyone): 7:27 PM: They ran Somatic on the tumor they removed 5 year prior and determined that I might be eligible for Keytruda after ADT fails.
George (to Everyone): 7:28 PM: T3a: The tumor has extended outside of the prostate on one side. T3b: The tumor has extended outside of the prostate on both sides. T3c: The tumor has invaded one or both of the seminal vesicles, which are small bag-like organs near the bladder.
Henry (and Staci) Cornelius (Private): 7:30 PM: Rick, I have to step away for 5 minutes to tuck my daughter in. I’ll be right back.
Joe Gallo (to Everyone): 7:33 PM: https://embrlabs.com/products/embr-wave-2
Joe Gallo (to Everyone): 7:33 PM: for basic info
Peter Monaco (to Everyone): 7:35 PM: Signing off gents! See you next week!
Jeff Marchi (to Everyone): 7:39 PM: thanks George
George (to Everyone): 7:41 PM: You’re welcome Jeff.
Pat Martin (to Everyone): 7:53 PM: Does he have a quarterback?
AnCan – rick (to Everyone): 7:54 PM: Pomerantz at Dana Farber
Frank Fabish (to Everyone): 7:59 PM: got to sign off
Peter Sherman (to Everyone): 8:03 PM: got to go. Getting up early for work
Stan Friedman (to Everyone): 8:21 PM: see everyone next time.
Julian Morales-Houston (to Everyone): 8:21 PM: Dr E is my medical oncologist.
AnCan – rick (to Everyone): 8:24 PM: Eleni Efstathiuou
eric (to Everyone): 8:32 PM: Thanks for you time and good luck everyone. bye
Julian Morales-Houston (to Everyone): 8:32 PM: Thanks again – see you next week!
George (to Everyone): 8:32 PM: Thank you all. George
