AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Novartis, Telix & Blue Earth Diagnostics.
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime!
Editor’s Pick: Counseling hope to a sports hero who fears the worst (bn)
Topics Discussed
High-profile British cyclist Chris Hoy fears the worst — Rick wants him to know there’s hope; ADT doesn’t just give you reasons to be sad, it physically causes depression — and if you don’t treat it, everything else gets worse; jury’s been out a long time on ADT and dementia; ADT side effects don’t wear off, as with other drugs — they get worse; on a drug holiday, his PSA has stayed undetectable — but not so fast: it only counts if testosterone is going up; drug holidays can’t come right away — they have to be earned; PSA rises, rises, rises, after he’s taken off Lupron, but Kaiser doc hasn’t acted; VA may be his way out of the Kaiser trap; after hating it twice before, darolutamide now suits him well; that lead box is a clue he’s not about to get the FDG PET he needs for his non-avid lesions; whirlwind of confusion over the new Part D rules and the magic $2,000 number; now that radiation treatments are over, when should he get a PSMA PET scan?; off Lupron and on darolutamide monotherapy, he feels about the same — does that make sense?; he’s already doing what his intraductal diagnosis suggests he do; doc who says no to everything should be saying yes to PSMA PET
Chat Log
Jim Marshall, Alexandria, VA · 6:29 PM
On ADT & Abiraterone for 5 years,stayed active, volunteering, bike rides even when fatigued, keepig my mind active doing research on PC and Veterans Affairs. No time to feel sorry for myself. Jim Marshall, USAF(Ret)
Steve L · 6:37 PM
I was classified low volume metastatic even with 12 of 12 cores positive because I have only 2 bone mets. Does the seem right?
AnCan – rick · 6:47 PM
$@Steve L-ID-400003$… low volume Mx is different from low volume Biopsy. Very different kettles of fish
Jim Marshall, Alexandria, VA · 6:48 PM
Been on Monthly PSA & testosterone blood tests since the beginning. Jim Marshall
Steve L · 6:49 PM
No Decipher. Gleason of 4 plus 5.
Steve L · 6:51 PM
Great that Bruce has had extended non-detectable PSA
AnCan – rick · 6:55 PM
I would disagree with @Jeff M. A Deicpher test at this point is not going to tell you much. It is designed to predict recurrence. 4+5 tells you all you and your med onc need to know.
Steve L · 6:59 PM
My treatment is ADT(lupron), Abi (now with Dexamethasone}. Also had Provenge in June/July.
Steve L · 7:12 PM
Jeff, After 2 years of undetectable, PSA started increasing in January and I was classified castrate resistant. No radiation nor surgery except turp. Denovo Mets. Most recent PSA 0.59
Doug D · 7:34 PM
Unfortunately, I need to leave early for an appointment. I will be attending these sessions regularly. I really appreciate your help, guidance, and time. Thank you very much.
Steve L · 7:51 PM
I recently proposed circulating tumor DNA test,
PSMA scan, and radiation to primary and mets with negative response. Any recommendations for a second opinion? Perhaps MD Anderson or ????? I am in Seattle area.
AnCan – rick · 7:55 PM
Steve – this a big question that should be posed to the group. Too much to handle via Chat window.
Steve L · 8:01 PM
Okay, I will try next meeting if no time today.
Thomas M · 8:04 PM
Good night , Gents,,,,,,,Thomas
dan: alexandria, virginia · 8:12 PM
I have to leave… thanks for advice, Gents. Night, dan
Low/Intermediate Prostate Cancer Video Support Group, Oct 21, 2024
Low/Intermediate Prostate Cancer Support Video Support Group, Oct 21, 2024
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Novartis, Telix & Blue Earth Diagnostics.
WELCOME all to our newly recorded Low/Intermediate Prostate Cancer Group. To receive notice when new recordings are posted, either follow us on this YouTube Channel or sign up to our Blog via https://ancan.org/contact-us/ – check New Blog box.
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime!
Editor’s Pick: A second opinion from a creditable source is a good way to verify an initial diagnosis. (bj)
Topics Discussed
New diagnosis researching HiFu and TulsaPro; PROMISE Study for genetic testing; focal treatment limitation; Interpreting nomogram results to choose between surgery or radiation; importance of getting a second opinion; dealing with anxiety as part of the decision process; helpful tip — build a list of questions before seeing your doctor(s); understanding radiation treatment options — SBRT, Cyber Knife, etc.; Are rectum spacers still needed for radiation treatments; overcoming analysis paralysis; nadir outcomes for radiation treatment; decision regret following prostatectomy; transitioning from active surveillance to a definitive treatment; SBRT experience update; Prostox (cheek swab) for DNA/genetic testing; Decipher testing for DNA/genetic testing; low dose brachytherapy.
Chat Log
AnCan – rick
Promise study https://www.prostatecancerpromise.org/?utm_campaign=ANCAN&utm_medium=link&utm_source=Webinar
With Open Enrollment starting on October 15, two AnCan’rs asked for advice this week on Medicare plans – and yes it’s complicated. AnCan recommends you watch the webinar we held last October to help understand the difference between traditional Medicare and Medicare Advantage. The dollar details are different for 2025 but not the principles.
Lastly, my own health insurance broker, Kim Umphres, is licensed to write in 15 States. He offered his help to all in last year’s webinar, so take him up umphres100@yahoo.com
Since the same questions are likely in the mind of many others, I have written this Blog Post. I am no expert but this may illustrate how I think about my own health insurance. Sadly, I cannot help you all individually – consult with your own Medicare health insurance for the best advice.
Onward & upwards, rick
Many of us on Medicare are faced with renewing our plans – or buying a plan for the first time. If you choose not to buy a plan to supplement Medicare, it leaves you exposed to roughly 20% of your medical costs. That can amount to very big bucks!
The main choice is whether to opt for Traditional Medicare + a Supplement (Medigap) Plan + a Drug Plan. Alternatively, a Medicare Advantage Plan can look attractive but comes with warts.
If you are low income and cannot afford the available plans, there are Medicaid alternatives for Medicare supplements.
Advantage Plans (Plan C) restrict your choice of Health Care Providers since they are based on Provider Networks. If you need a particular type of specialist, for example a genitourinary medical oncologist, or a neurologist who specializes in MS, this can be a problem with Advantage. Community Standard of Care is often the byword. If you choose an Advantage Plan, be sure it covers HCPs who practice at a Center of Excellence.
Advantage Plans usually have small monthly premiums, sometimes zero. They also include co-pays when you visit a Provider. Co-pays can be anywhere from Zero dollars to several hundred for fancy scans like PSMA, so you have to look carefully at the coverage. The more you use the plan, the more you pay. Some may include coinsurance – avoid those altogether. It’s a nuance we won’t get into here.
You can also go out of network to a Provider of your choice, but copays will be significantly higher. For example, you may pay $50 for a visit to a specialist in-network. Out-of-network, the cost can be significantly higher – often 40% of the approved Medicare fee for the service sought.
Advantage Plans often have a Gatekeeper who must approve any referral. You may not be able to self refer. Also there can be stricter intervention by the Plan to pre-approve procedures.
Drugs are included, however there is also a co-pay for some generic and all branded drugs that depends on the tier in which they are classified in the Plan’s drug formulary. List the drugs you use and find the cost. That said, the good news in 2025 is that drug out-of-pocket costs cannot exceed $2,000.
Traditional Medicare with a Supplement (Plans F,G,K,L,M,N) may not restrict your choice of HCPs – you can go anywhere in or out of state provided the Provider accepts Medicare.
Traditional Medicare Supplement Plans cover the 20% not covered by Medicare A and B. You pay a monthly premium that varies according to the plan chosen. The different supplement plans have different features. The more you pay in monthly premium, the less the restrictions and the lower the deductibles.
In addition you will need drug coverage (Plan D). Again that includes a monthly premium, plus a charge for each drug, so you have to shop plans against your Rx. For 2025, drug out-of-pocket costs cannot exceed $2,000.
As long as your chosen Provider accepts self-referrals, there may be no Gatekeeper. Procedures and protocols may still be subject to pre-approval.
Since Advantage Plans can be more profitable for the Payer, they offer lots of bells and whistles to sell the plan – for example subsidies for OTC products. One plan I was offered recently, actually pays the Holder $5/month!
I’m trained as an economist so I look at risk reward. I compare the annual maximum out-of-pocket cost between the Advantage Plan and the Traditional Medicare Plans (inc. the drug plan).
For traditional Medicare There is a required monthly premium for both the Supplement and the Drug Plan. Add those together and multiply by 12. In addition you can have out-of-pocket drug costs, especially if you are using expensive cancer drugs, but that cannot exceed $2,000 in 2025. Btw, the $2000 will decrease in subsequent years.
Each Advantage Plan has a stipulated maximum out-of-pocket cost for in-network and out-of-network Providers. In-network will be less. I look at the out-of-network max, and add to that any monthly premiums that are usually minimal. Drugs are included with a co-pay, but that co-pay cannot exceed $2,000 in 2025.
Now that I know what I HAVE to pay with Traditional + Supplement vs what I could pay with Advantage depending on my usage, I can compare whether I want to roll the dice to save money.
If the Traditional route costs me $500 in monthly premiums, I know I am out-of-pocket $6,000 plus my drug copay costs capped at $2,000.
Say my Advantage Plan has a monthly premium of $25, then for sure I am out of pocket $300. The rest depends on how much medical care I use. Assume ( the economist’s favorite word) the out-of-pocket for out-of-network in my plan is $8,000, that is my max. I still have to consider up to $2,000 for drugs.
Let’s compare!
IN THE WORST CASE I am spending $6,000 (+ drugs) for Traditional Supplement versus $8,300 (+ drugs) for Advantage. The Advantage could be $2,300 more pricey.
IN THE BEST CASE, I am out-of-pocket $300 (+ drugs) for Advantage vs $6,000 (+ drugs) for Traditional Supplement, so I could save $5,700 with Advantage.
Risk-Reward… do I want to roll the dice to save up to $5,700 that could cost me an extra $2,300??
Each person has to make that decision.
There’s more to it than this. For example HMO’s like Kaiser Permanente may make it even harder to go out of network. And with KP, you are guarantied to only get community Standard of Care medicine . As I often say, KP is great as long as you don’t get seriously ill.
AnCan strongly suggests finding a local Medicare Health Insurance Agent to help you sort through this morass. Plans change by State, so your agent must be licensed in your State.
And one last thing. The first time you enter Medicare there is NO underwriting. No matter your preconditions, you are accepted to any Traditional supplement or Advantage Plan. In subsequent years, you may be subject to underwriting should you choose to switch plans. You can be restricted from changing between an Advantage and Traditional Supplement Plan.
AnCan recommends watching our webinar from last October to help understand the difference between traditional Medicare and Medicare Advantage. 2025 details are different but not the principles.
We also recommend you visit the Triage website and attend its free webinars. Many of their Medicare resources can be found at https://triagecancer.org/medicare-cancer
For differences between the Traditional Supplement Plans, consult with a specialized Medicare Health Insurance agent. F and G are the best options. There are also high deductible options. An agent can also help you compare Advantage plans by various criteria, like maximum out-of-pocket for out-of-network care.
Low/intermediate Prostate Cancer Video Support Group, Oct 7, 2024
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Novartis, Telix & Blue Earth Diagnostics.
WELCOME all to our newly recorded Low/Intermediate Prostate Cancer Group. To receive notice when new recordings are posted, either follow us on this YouTube Channel or sign up to our Blog via https://ancan.org/contact-us/ – check New Blog box.
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime!
Editor’s Pick: A careful review of treatment options can help you avoid decision regret. (bj)
Topics Discussed
New prostate cancer diagnosis — how do I avoid decision regret?; prostate cancer treatment considerations — surgery vs radiation; using nomograms to predict likelihood of recurrence; PROMISE research study and germline DNA testing; decipher test; external beam radiation; cyber knife; somatic DNA testing; catheter; Gleason score; TULSA Pro; electroporation; kegel exercises; Prostate Cancer Research Institute (PCRI); RTIRE trial update; COVID and PSA spikes; High-Intensity Focused UltraSound (HIFU) and other focal treatment options; applying study results to your situation.
Chat Log
AnCan – rick
http://nomograms.mskcc.org/Prostate/index.aspx
George Toronto
I have a question for Michael
George Toronto
cancel my question please
Causley
Michael – this is Causley E. I’m in the group with you. I had surgery 2 years ago and can share my experiences with you when time permits.
Boykin Jordan (DC Metro)
PCRI – https://pcri.org/
Boykin Jordan (DC Metro)
PCRI (YouTube) – https://www.youtube.com/c/thepcri
AnCan – rick
PROMISE test – free trial by mail. https://www.prostatecancerpromise.org/?utm_campaign=ANCAN&utm_medium=link&utm_source=Webinar
AnCan – rick
Dr. Ming Zhou https://profiles.mountsinai.org/ming-zhou
Covered service for Vietnam era veterans means active service in:
The Republic of Vietnam from Jan. 9, 1962, to May 7, 1975.
Thailand at any U.S. or Royal Thai Base from Jan. 9, 1962, to June 30, 1976.
Laos from Dec. 14, 1965, to Sept. 30, 1969,
Cambodia at Mimot, Krek, or the Kampong Cham Province from April 16, 1962, to April 30, 1969.
Korean Demilitarized Zone (DMZ) from April 1, 1968, to Aug. 31, 1971.
Guam, American Samoa or territorial waters thereof from Jan. 9, 1962, to July 31, 1980.
Johnston Atoll or on a ship that called at Johnston Atoll from Jan. 1, 1972, to Sept. 30, 1977.
Air Force or Air Force Reserve veterans who regularly and repeatedly operated, maintained, or served aboard a C-123 aircraft know to have been used for spraying herbicides.
Qualifying service for Gulf War era veterans means you either:
Performed active military service in any of the following countries during or after the Gulf War (Aug. 2, 1990): Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia or the United Arab Emirates. Or;
Performed active military service in any of the following countries after the start of the Global War on Terrorism (Sept. 11, 2001): Afghanistan, Bahrain, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Somalia, Syria, United Arab Emirates, Uzbekistan or Yemen.
Nuclear and Radiation-Exposed Veterans
The PACT Act expanded veterans who are eligible for presumptive service connection for diseases which manifested as a result of radiation exposure by adding onsite participation in the following radiation-risk activities:
In one of the largest-ever expansions of Veteran health care, all Veterans exposed to toxins and other hazards during military service—at home or abroad—are now eligible for VA health care.
At the direction of President Biden, VA is expanding health care eligibility to millions of Veterans, including all Veterans who served in the Vietnam War, the Gulf War, Iraq, Afghanistan or any other combat zone after 9/11, years earlier than called for by the PACT Act. These Veterans will be eligible to enroll directly in VA health care without first applying for VA benefits.
Additionally, Veterans who never deployed but were exposed to toxins or hazards while training or on active duty in the United States will also be eligible to enroll.
Covered service for Vietnam era veterans means active service in: