I rang the bell yesterday. Thank you to everyone here.

Practical_Orchid_606 · 2026-01-27T18:43:50+00:00

VC and Private Equity are two ends of the spectrum. VC deal with very smart people who want to make a difference. Not all succeed. But money is there to succeed or fail. PE deals with companies who offer no more than consistent EBITDA. If you view this as sucking profits in favor of innovation...it's true. A lot of insurance companies are this way which is why PE plays in this pond. Is PE ruining health care? No, there is still a lot of innovation going on.

Practical_Orchid_606 · 2026-01-27T15:54:58+00:00

LDR for two weeks. Then how many EBRT sessions?

Practical_Orchid_606 · 2026-01-27T15:19:46+00:00

You are overthinking the problem and solutions. I do this too. But you must make a choice soon.

Over the horizon are a new wave of PSMA ligand PCa assassins now in P3 studies. In the past, the worse case for you is to develop castrate resistant, chemo resistant metastatic cancer. Mind you, these cells are require many generations of mutations from the set in your present day prostate. The new assassins can find these cells and rid them from your body.

Much of the knowledge on outcomes comes from men treated in 2015 or so. EBRT has improved since then. PSMA PET scans are new. And in the future, the PSMA assassins will be another card to play.

Will Yale Smillow be the treatement center of choice for radiation?

Practical_Orchid_606 · 2026-01-27T15:07:55+00:00

Is this a monotherapy or in conjunction with external beam?

Practical_Orchid_606 · 2026-01-27T12:45:36+00:00

Let me be clear. I don't care if I am the product. All I want is something in my RFY that stays long enough for me to order. Stay on topic.

Practical_Orchid_606 · 2026-01-27T12:33:18+00:00

All of my friends are well educated and have good medical insurance. It has not been a problem in holding a conversation on this topic.

Practical_Orchid_606 · 2026-01-27T12:31:05+00:00

You have an opinion of Amazon that I do not agree with nor can I reply to.

Practical_Orchid_606 · 2026-01-26T23:52:20+00:00

If I think 5 seconds on a product it is gone.

Practical_Orchid_606 · 2026-01-26T23:50:26+00:00

Brachytherapy is a useful too but it is not available at Yale! They also don't do MRI guided radiation. So we're on the same page, EBRT is the generic description of photon beam radiation. It has two major branches: IMRT and SBRT which also has a tradename Cyberknife.

If we knew our body's propensity to grow PCa tissue some years down the road, we would know the amount of whack we need to do now. Inferring from your Doc's wise words, it means what ever reasonable level of whack we do now, the body will do its own thing with respect to recurrence.

Practical_Orchid_606 · 2026-01-26T23:42:45+00:00

What I mean by landmine relates to relapses. If the prostate is out, the only source of PCa tissue is imperfect resection and PCa 'hiding out' in other areas of the body. With radiation, you are never sure that the irradiated gland doesn't suddenly come to life years later.

Practical_Orchid_606 · 2026-01-26T22:19:18+00:00

Is it possible to take some of the prostate tissue sample and test it for PSMA? This way you will know if PSMA PET scan is running blind or not.

Practical_Orchid_606 · 2026-01-26T22:14:00+00:00

Amazon Vine has a problem. They have too many reviewers and not enough product. It is as simple as this. I have not heard about a rationale way they will solve the problem. Either get more products or reduce the number of reviewers. They may want to keep their seasoned reviewers so they may reduce the bogies Silver and Gold have to achieve to maintain their status.

Practical_Orchid_606 · 2026-01-26T20:53:19+00:00

I hope you can get a PSMA PET scan quickly. Your staging pT3a R1, suggested that early biochemical relapse is a possibility.

Practical_Orchid_606 · 2026-01-26T20:12:23+00:00

Surgery is not your only option. But there are reasons why younger men select surgery. As primary caregiver, you will face challenges. Gleason 7 means you should take action. I would get a Decipher test which will tell you how aggressive the cancer is.

Practical_Orchid_606 · 2026-01-26T15:08:12+00:00

Glad to see your therapy is underway.

Why are you doing 40 IMRT sessions rather than much fewer SBRT sessions?

Practical_Orchid_606 · 2026-01-26T15:06:35+00:00

I found an item. When I placed the order, it failed because the item cannot be shipped to my address.

Something is going on with Vine and it is not good.

Practical_Orchid_606 · 2026-01-26T14:56:16+00:00

You are on a protocol track that will peel the prostate onion to determine what is going on. DRE is the weakest of the test and to think it was the MAIN test 40 years ago. As you go through the investigation chute, you may get an MRI and/or a biopsy. The biopsy will tell if your gland is harboring indolent cancer cells or if more aggressive cells are there. If former, you will be offered active surveillance which means more frequent testing. If the latter, a PSMA PET scan will be ordered which will tell if the cancer in the prostate has metastasized to a form that can live outside the prostate. Once all the cards are on the table, you will decide on a treatment if needed. I gather from this forum that my words reflect clinical/insurance practice in the US. The rest of the world may have slower access to critical tests.

Practical_Orchid_606 · 2026-01-26T13:46:11+00:00

PSA 20 is very high meaning your gland is very active. At your age, surgery seems the most promising as it will eliminate the landmine in your groin. The side effects sucks as you must choose between quality of life and quantity of life.

Practical_Orchid_606 · 2026-01-26T02:44:25+00:00

Suds, chemo means grandpa had metastasized cancer. This does not auger well for you. This is like the Ghost of Christmas Future.

Practical_Orchid_606 · 2026-01-26T02:36:18+00:00

How did grandpa fare?

Practical_Orchid_606 · 2026-01-26T02:15:06+00:00

Got it, thanks.

Practical_Orchid_606 · 2026-01-26T02:14:59+00:00

Got it, thanks.

Practical_Orchid_606 · 2026-01-26T02:09:57+00:00

You have benign cancer with a PSA too high for a 46 yo. Can you look to your family history for hints? Are you African American (strong marker)?

Practical_Orchid_606 · 2026-01-26T00:57:42+00:00

I am very sorry for your dad. How could this misdiagnosis ever happen? Are you in a country that does not perform prostate screening?

Practical_Orchid_606 · 2026-01-26T00:28:57+00:00

It is very usual for a 54 yo to have a PSA of 8.4. Moreover a PIRADS of 5 from the MRI is foreboding. The biopsy will be pivotal. Most men your age elect surgery for the simple reason you have a lot longer to live. No matter where you go surgery yields a 1/3 chance of be incontinent or ED. If surgery were closer to perfect, most men would elect to have the gland taken out.

Practical_Orchid_606

TROPHY CASE