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My day with Duke Bahn

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Posted 3/31/2019 8:22 PM (GMT 0)
Last Tuesday I had a color Doppler ultrasound with Dr. Duke Bahn in Ventura, CA. The executive summary is that in Dr. Bahn's opinion my 3 positive Gleason 6 lesions should enable me to stay on AS for the forseeable future. He took blood for a PSA and called me personally two days later to tell me the result: 1.8. This was up from 1.4 last August but he didn't feel the fluctuation was important.

Dr. Bahn suggested another CDUS in 6 months and PSA readings every 3 months.

This of course is in stark contrast with my Kaiser urologist, who after my UroNAV biopsy in January recommended treatment - likely within the year.

So we're at a bit of an impasse. Right now I'm thinking that I'll get a second opinion from another Kaiser urologist, mainly because I can do so at virtually no cost, so why not. My other thought would be to go to someone good outside the Kaiser system for a consult - Dr. Leonard Marks at UCLA is one I've been considering - but that would run me around a thou. I've also been considering Dr. Mark Scholz or one of his associates. That's $1100 for an hour or so of his time.

Nobody said this would be easy....

On another note, my wife and I attended the mid-year Prostate Cancer Research Institute conference at the Los Angeles Int'l Airport Marriott yesterday. Four world-class physicians spoke and it was a bargain at 30 bucks. They even threw in a free boxed lunch (all of which paid for no doubt, ahem, by the Pharma companies hawking their wares in the lobby...).

I recommend this event to anyone able to get there. In September their yearly conference is held at the same venue on the first weekend after Labor Day. I understand up to 3K people attend, and in addition to Drs. Scholz and Mark Moyad, the organizers, they've scheduled Dr. Lawrence Klotz this year. Among many other top docs I'm sure. If you register now it's only 50 bucks. PCRI.org.
Posted 3/31/2019 11:12 PM (GMT 0)
Is Bahn the only doctor in the country who does CDUS? I only see his name when the topic comes up.

Most of the studies I have found that support CDUS are from 12 or more years ago.

IMHO, I would question a technology that pre-dated modern MRIs.
Posted 4/1/2019 6:57 PM (GMT 0)
CD-US is an excellent choice for your situation of "monitoring." (It is also the imaging selection of choice for patients with metallic implants, such as pacemakers, who may not be candidates for MRI due to the interaction of the magnetic field with the metal in their bodies. Same is true for patients with kidney disorders due to problems flushing the contrast agent.)

Both CD-US and mpMRI require highly trained expertise to properly interpret results; Dr Bahn is one of the very best in the world at CD-US.

HERE is a link to a video of Dr Scholz talking about CD-US. HERE's another where he talks about mpMRI. Both serve important functions.
Posted 4/2/2019 12:34 AM (GMT 0)
Thanks for your input, guys. I always appreciate the well-considered opinions on this forum.

ASA - I believe there's another doctor in the Midwest (Michigan?) who does this as well but can't quite bring the name up.

BJ - thanks for the reinforcement. I'll look forward to hearing what Dr. Scholz has to say about it.

I think the notion of having strong interpretive expertise is a wise consideration for any of the diagnostic approaches. I'd read a lot about Dr. Bahn before I went to see him, and had to do so out of my own pocket. So I clearly felt that his advice would be valuable, and hope I'm right.

One wants to, and should, avoid confirmation bias when dealing with any serious illness, all the more importantly when there are great differences of opinion as regards dealing with what might otherwise be a straight-forward course of action. When I was diagnosed 10 years ago with head and neck cancer the treatment options were basically zero: surgery and radiation and don't hesitate (chemo is also used but luckily I didn't need it, and I'm alive today to prove my MO right).

As we know, PCa is devilishly complicated both to recognize and treat... even to the extent that there is no one solution but rather many that we must decide on individually. I'm trying to avail myself of any and all expertise (that I can afford), and feel that Dr. Bahn's is one good avenue among many.

My best to both of you!
Posted 4/3/2019 3:34 AM (GMT 0)
2019 guy,
No need to get another opinion as Bhan is the best around in what he does, find cancer. Having dealt with both Bahn and Scholz in my 10 year journey, Scholz will take Bahn's opinion as the gold standard and you will pay a thousand bucks. Scholz sends his difficult patients to Bahn. Save your money, you can take Bahn's opinion to the bank.
Posted 8/25/2019 8:22 PM (GMT 0)
I'm adding to this older thread for 2 reasons. The first is that I got a letter yesterday informing me that Dr. Bahn is soon retiring and giving the practice over to Dr. William Klope, "a longtime associate".

Second: My 12/18 MRI has now been read by 3 radiologists; the third was not something I requested but was rather initiated on his own by one of the uros I saw for a second opinion. I sought this as I was unhappy with the first results. Well, unhappy with a PI-RADs 5 is a given. But in my case I was very glad to go for the "first" second reading as that radiologist told me there was nothing there. As did this most recent volunteer radiologist.

Which leads me to wonder what the estimable Dr. Bahn found when he color Dopplerized me back in March. Like radiologist #1 he identified 2 areas in my prostate but found both quite suspicious, albeit low-risk, and thought I should be classified T2c.

By contrast, the most recent radiologist wrote: "I don't think the area on MRI is particularly suspicious."

As my mother used to say, "That's what makes horse racing."
Posted 8/25/2019 10:23 PM (GMT 0)
2019Guy,
I saw some familiar names in your posts and wanted to add my comments, for what they might be worth to you going forward.

Klope is a contract urologist that Kaiser (Ventura) uses. I saw him regularly for several years for blood work and DRE before I was diagnosed. Although my PSA was increasing Klope felt a biopsy was unnecessary. I finally went to Bahn on my own for CDUS and Bx of G3+3.

Began seeing Scholz next, and as John T said, Scholz has great respect for Bahn, but he added nothing to what I already knew.

I had the good fortune to learn of Dr Leonard Marks at UCLA from Tall Allen. Dr Marks treated me like a new patient, MRI guided biopsy + random biopsy, and we discovered I was G4+5, not the G3+4 we had been monitoring all this time. That led to a so far successful SBRT treatment with Dr King at UCLA.

In hindsight, I should have gone straight to Bahn to Marks to King, but that's not how these things evolve.
PM me if I can provide anymore details or info. I do not recommend Klope.
Posted 8/25/2019 10:31 PM (GMT 0)
Many of the best oncologists offer advise gratis. Author Dr. Scholz charges $1,200 to have one of his associates call for a consultation. That's more than Johns Hopkins, Mayo or MD Anderson, and what he has is far from a Center of Excellence. Big business, for sure.

Caveat Emptor.
Posted 8/26/2019 8:53 PM (GMT 0)
Thank you, Max and Gary.

Max, I'm glad you found your way at UCLA (rhyme not intended). I did indeed see Dr. Marks and had his radiologist review my MRI. Undoubtedly they are tops in the area. And if/when I ever need treatment I will strongly consider SBRT with Dr. King; several of the guys in my support group have had very successful experiences with him. I went to Dr. Bahn purely for an opinion. I have no need nor desire to go back - not that I didn't find him excellent, just that I'm well covered otherwise. But thanks for the tip on his successor and I'm sorry you had to go through that with him.

Gary, yeah, true that. The RO who treated my head and neck cancer years ago has given me some good advice and wouldn't dream of charging me for it. I have yet to find any others however. As far as what the Scholz practice charges.... well, I paid nearly that for my time with Duke Bahn (including a PSA test) and a bit more to see Dr. Marks. The latter though is because my Medicare goes through Kaiser. So caveat emptor indeed!
Posted 8/26/2019 11:45 PM (GMT 0)
I had active surveillance for 9 years, things started to go off a bit and I was advised to get treatment by January, this was August. I checked a lot of stuff and final said screw it, take it out, I'm tired of dealing with it, end of November I had it done at USC......surprise! the cancer came out of the prostate less then 7 weeks after an MRI that indicated all was well, it wasn't. I'm a T3a, stage 3 cancer, now, 9 months later......its baaaaack, Here comes radiation. If I had it to do over again I would have gone surgery or protons years ago when it was tiny, Gleason 6 and 'no big deal'. Small sample, but the guys I know who did what I didn't do are better off for it, just sayin'
Posted 8/27/2019 2:28 PM (GMT 0)

Vistacal said...
....If I had it to do over again I would have gone surgery or protons years ago when it was tiny, Gleason 6 and 'no big deal'. Small sample, but the guys I know who did what I didn't do are better off for it, just sayin'

Vistacal....your story is a common one I hear too often from guys in my circles, if not on this forum. The potential stress, admitted or not; the continual vigil; and all those biopsy holes over time, make extended AS unfathomable to me. We have a select, and far from average PCa group here.

Hope your status stays in quiet lifetime remission.
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