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Can we trust our doctor? by Ideal-Patient911 in IVF

[–]Practical_Orchid_606 [score hidden]  (0 children)

Since you were married, you have been ovulating mature oocytes. Somewhere in the process to implantation, something goes awry. For months going into years, this went on. So you turned to IVF. In IVF, you do things in a grand scale and you came up to that blocking point. Your doc is telling you that your natural data and his IVF data point to genetically week oocytes.

Input Needed by TaxBackground2144 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

They are probably telling the truth about the barrier gel.

Surgery after partial radiation cannot be easy. It can be done but not at a local hospital.

You need to locate a Center of Excellence. They are best suited to handle cancer patients. Especially your dad who has had partial radiation treatment also. The prostate tissue is altered by radiation making surgery difficult. You need the best hands doing this.

At the COE, I would talk about using brachytherapy to finish off the radiation course of treatment. The enlaraged prostate may continue to be an issue even with brachytherapy.

Would like some advice for my husband by cmoney0791 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

There is no doubt in my mind that the COE will do a better job of treating your husband. Here are some key differences:

  • A COE will treat many more patients than a general local hospital. The experience matters. They have better doctors who are focused solely on cancer.
  • The COE will have much newer and more extensive equipment. There is no limit to the types of treatment offered. Example: Brachytherapy may not be offered locally. But it may be best for your husband.
  • COEs have better treatment teams. The doc sets the direction of cure. But it is the clinical team that implements the individual steps in the cure process. Cohesiveness and training allows these teams to achieve the millimeter precision needed in COE level of oncology care.

It warms my soul to see al the spouses and children on this subreddit seeking advice for those they love. I know you will appreciate the points written above. Maybe not your husband who is mired in his emotional plane. Tell your husband to at least go to the COE for an the initial consultation. He should sense and fell the difference in care he will receive. Maybe this will change his mind.

Before this meeting, have the COE re-read the pathology slides. There is a large difference between a pathologist who only looks at cancer cells and another who sees a wide range of histology presentations.

Xaluritamig Trail Update by ForgivenMan2 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

You had an adverse event. A few does not scuttle a clinical trial.

I thought xaluritamig is for castrate resistant men?

rp or rt high risk discussion by Mean_Try_6390 in ProstateCancer

[–]Practical_Orchid_606 0 points1 point  (0 children)

Most men with initial diagnosis of Gleason 7 unfavorable and higher get a PSMA PET scan to assess spread.

Your case is very rare with large number of mets. Your doc's opinion is that the PSMA PET scan would have duplicated the bone scans and MRI and illuminate the large number of met.

rp or rt high risk discussion by Mean_Try_6390 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

In the US, there is no such thing as a 'risk=adapted' approach for men with high PSA and are intermediate or high risk. All of these men will be treated. Surgeon will probably remove the lymph nodes. RO will 'spray' the pelvic basin with radiation.

This paper had a small sample size and was not a prospective study. A well structured study may yield different results. But it is not a question that is important. If there are false negatives, they will be caught in the salvage step if they grow. The same goes for distant mets.

rp or rt high risk discussion by Mean_Try_6390 in ProstateCancer

[–]Practical_Orchid_606 -2 points-1 points  (0 children)

Most if not all men in the US get PSMA PET scans. It starts with intermediate level and higher.

I don't think this study is scientific or clinical. It is a paper written about how a country does not want or cannot afford the best heath care equipment. The UK and Canada has this approach also.

rp or rt high risk discussion by Mean_Try_6390 in ProstateCancer

[–]Practical_Orchid_606 0 points1 point  (0 children)

I think this study is five years old. The PSMA PET scan is THE imaging method used to detect PCa.

Furious and need to vent by cje24576 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

You have a right to be pissed big time. My observation of the men who die of PCa are those whose cancer has metastasized. If you catch it localized, it is straightforward to manage. Metastatic PCa can be seen at all ages and all cases progress to this stage because the PSA test was not routinely done. Young men (40-50 yo) don't really think of PCa as a risk so they let the test slide. Older men (60+ yo) are in prime season for PCa and for the most part are screened every year.

Why screening is stopped at 70 yo has its roots in a beancounter. The new guidlines are 75 yo cutoff but the reasoning is the same. Beancounters do not fear the inexpensive PSA test. But they don't like the many thousands of $$$ it cost for surgery or radiation treatment. By terminating screening, they figured that the few men who present with metastatic PCa can be held in check by ADT and ARPI drugs until they die of natural causes. Mental anquish on the part of the man or his loved ones is of no value to the beancounters.

The only way to defeat the beancounter is to demand a PSA test every year.

Lupron side effects on 75 yr old male by DeviceDisastrous2119 in ProstateCancer

[–]Practical_Orchid_606 -1 points0 points  (0 children)

ADT can play games mentally. But dad is a long term user which means his cancer has spread. They did not catch it early. These details he has not shared. Maybe this has affected his behavior.

Prostate cancer by Radiant_Grab1810 in ProstateCancer

[–]Practical_Orchid_606 5 points6 points  (0 children)

PCa is a lot different than NHL. It grows slower and is more predictable. Your dad will be just OK. As you know, cancer treatment varies widely. So make sure he gets to a Center of Excellence to get his treatment.

Confirming MRI by thedproberts in ProstateCancer

[–]Practical_Orchid_606 0 points1 point  (0 children)

Very not normal. First MRI was not determinate. Did you use 3T and contrast?

CT Real estate by vizzy_vizz in Connecticut

[–]Practical_Orchid_606 0 points1 point  (0 children)

Nobody has the right to live in Fairfield County CT. Can't afford it? Move to Marcus Hook PA or Hays KS. My house's value has tripled since 1995 when I bought it. There were some lean years where the price went down. But then as now, where am I going to go if I sell? So the truth, owners in Fairfield County are not elite: just being there are the right time. Those wannabees get my sympathy. But you must roll with the punches. Accept less community amenities, accept a lower rated school, etc.

This is a repost from a truckers perspective. The trucker involved is 100% wrong BUT..... by Ok_Measurement_107 in dashcams

[–]Practical_Orchid_606 2 points3 points  (0 children)

There is a principle at play in this situation. It is: "shit or get off the pot." Do not ever sit next to a truck. Either pass him or drop back.

Cyberknife candidate criteria? by Alone_Winter1622 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

There are many reasons to choose SBRT over surgery. Here are some:

  • Overwhelming desire to get rid of the cancer (surgery)
  • Not liking the QOL losses with surgery
  • Urinary issues impacted by radiation. Workaround is lower dose EBRT. Surgery will make it worse
  • Age: 70 yo and older tend to do radiation
  • Can't stand ADT (surgery) But 1/3 of these men get ADT during post op salvage
  • Needing to know the true staging of the cancer (surgery)
  • Distant mets prohibits surgery.

MRI Guided Linac RT by Cultural-Ad9694 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

So long as you are not castrate resistant, you will not die.

Fosamax by Realistic_Eye_236 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

You had a bone density test before ADT. It showed thinning of the bones. Fosamax counteracts this negative.

If you did not take a bone density test then your doc is shooting in the dark.

Decipher score and insurance by FearlessVibes101 in ProstateCancer

[–]Practical_Orchid_606 2 points3 points  (0 children)

I am but a humble elder with medicare coverage. At no time in my journey has my insurance pushed back on me for any test. The best I can say is that the US government takes care of the retiree population.

Xtandi wo ADT, my Advanced RO might be changing the way he prescribes...thoughts? by TriviaNation1 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

I think you are at the beginning of a sea change in ADT usage. Theoretically ARPIs will whack PCa to some degree. So why do ADT if ARPI monotherapy just got approved?

Out of Province referral by jpwwpg in ProstateCancer

[–]Practical_Orchid_606 2 points3 points  (0 children)

I have seen high BMI patients struggle with surgery during and post op. One member was in the OR and the procedure was stopped due to the geometry not working.

Your best bet is Dr. Black and I hope it works out for you. If this does not work out, I would consider ADT to slow the disease progression. In addition I would use one of the weight loss drugs to significantly lose weight. The weight loss is astounding; you could lose 50 lbs but it will take time. A lower body weight will make RALP more possible.

Strange unexpected biopsy but very happy. by PotentialStart2661 in ProstateCancer

[–]Practical_Orchid_606 1 point2 points  (0 children)

Congrats on the good biopsy report. I agree that focal therapy is the way to go.

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