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Posted 8/27/2014 10:09 PM (GMT 0)
Just got my results from Epstein. Received 9 slides. Confirmed original path at G6 on same 3 of them. Waiting for the Oncotype Dx. Have 2 questions:

1. I have an appointment with Dr. Ukimura USC/Keck regarding Color Doppler US that he was trained by Dr Bahn to do. Chose him due to taking insurance. Wondering if overkill at this point.

2. One core from area of interest on MRI is at 70%. Thought AS qualification was for less % core. See sig for tumor size.

Gonna stay on AS regardless until Focal is well established at UCLA, then may consider.

Best
Posted 8/27/2014 11:36 PM (GMT 0)
Hi Jdad,

I'm sort of on the same track as you. I had my original Color Doppler US and biopsy with Dr Bahn, and now I'm scheduled for a 1 year surveillance biopsy at UCLA (Targeted Fusion). I had the Prolaris test which is similar to Oncotype I believe. I've been seeing Scholz and Lam for AS.

In my case I was told that the MRI, US, and Prolaris test results are "consistent" and none added any new information to the mix. The biopsy seems to be the most important of all for remaining on AS.

Interestingly Scholz and Lam don't place any significance on free PSA and don't even test me for it.

I would suggest getting the US now so that you have a baseline established for your AS going forward. Scholz and Bahn use the US to watch for progression in the tumor. You might also want to estimate the size of the tumor as 1.5cc used to be an upper limit for AS, although Dr Turner now says that isn't always the limit.

Hope this helps. I'd like to remain on AS as long as I'm G6.
Posted 8/28/2014 12:02 AM (GMT 0)

Jdad said...
1. I have an appointment with Dr. Ukimura USC/Keck regarding Color Doppler US that he was trained by Dr Bahn to do. Chose him due to taking insurance. Wondering if overkill at this point.

I think so, especially after your targeted mpMRI/US fusion biopsy at UCLA. That's about as good as it gets, and CDUS doesn't seem to be quite as accurate. Ukimura is good at it by now; Scholz is a relative neophyte, so it would be no contest to me. It seems to me that the critical thing is how you will monitor progression on your AS program.

Jdad said...
2. One core from area of interest on MRI is at 70%. Thought AS qualification was for less % core. See sig for tumor size.

There are old criteria, known as the "Epstein criteria" that included <50% in any core (also, <3 cores and PSAD≤.15). Now that AS has matured and with the advent of tools like mpMRI, many programs, including NCCN, have moved away from that. Now they consider it a good option for anyone who is low risk. Even that is getting liberalized, allowing men on who have small amounts of GS 3+4.

- Allen
Posted 8/28/2014 3:13 AM (GMT 0)
Just a consideration -
Color doppler scans the entire prostate. Biopsies hit what they hit in a limited area.

I'm not sure of the comparison MRI vs CD.

It would have been a pointless test for me (I had 9 of 12 cores positive 4+3 or higher), but I have seen some good presentations on the value of a well-done CD.
Posted 8/28/2014 5:45 AM (GMT 0)
As usual great feedback. Given that the CDUS shouldn't cost much think I'll go through with it. Interesting to see what it sees. Really last thing anyway. Next step, if any, focal treatment which I'd only do if they can assure won't rule out future removal if necessary. Great new world ahead in this arena!! Truly.
Posted 8/28/2014 5:59 AM (GMT 0)
Thermal ablation causes scar tissue which might make salvage surgery difficult. It's a good question though - would it interfere with, say, SBRT? Increase probability of hypoxic areas? Did you attend Dr. Marks' dinner on focal laser?
Posted 8/28/2014 4:12 PM (GMT 0)
Dinner is in 3 weeks.
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