PROSTATE CANCER INFO SHEET — March 2022
Contains recommendations that have been found to be useful to support group members. Additions and modifications will be made to future editions as new information is acquired. Please advise if you find errors in the Info Sheet. While we are trying to make this succinct, please offer suggestions for additions and/or improvements.
———-SENSITIVITY & SPECIFICITY———-
When medical tests are done most are not 100% perfect. For a given condition there are false positives and false negatives. These are also categorized by the terms sensitivity and specificity, which are mentioned in some of the sections below. You can ask the doctor for these numbers when given a test.
SENSITIVITY – The probability that you have the condition if the test says you have it.
SPECIFICITY – The probability that you don’t have the condition if the test says you don’t have it.
COLOR DOPPLER — Dr. Duke Bahn, the original guru of Color Doppler in Ventura, CA has retired. But Prostate Oncology Specialists (www.prostateoncology.com) in Marina Del Rey, CA (310-827-7707) does an excellent job and is easy to reach. See PROSTATE MEDICAL ONCOLOGISTS below. Imaging with/without biopsy is available. Color Doppler prostate specialty is not available locally. Also note that Color Doppler only covers the gland itself and the seminal vesicles. The system uses a rectal ultrasound probe. The famous Dr. Scholz has a video about this: www.youtube.com/watch?v=nBfWS34CRD8
MRI — Of MRI’s, mpMRI (Multi-Parametric MRI) is prostate specific and gives the most information about high Gleason prostate cancer. If a doctor prescribes an MRI ask if it is an mpMRI. The mpMRI can be used with an ultrasound image to target suspicious spots on a biopsy, though the detection of low-grade prostate cancer is not as good. Unlike the Color Doppler, this mpMRI covers much of the pelvic area. A comprehensive description of mpMRI can be found in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832385/. NOTE: Since it requires a radiologist skilled in prostate readings to interpret, second opinions are recommended for MRI readings.
PET SCAN — PET scan modalities, for detecting where the cancer is when it recurs after some form of treatment or when metastatic cancer is suspected, are excellent at detecting the lesions. A PET scan covers the whole body so can detect metastasis if the lesions are large enough. One of these is Mayo Clinic’s C-11 Choline PET scan. See https://www.mayoclinic.org/tests-procedures/choline-c-11-pet-scan/care-at-mayo-clinic/pcc-20384630. Mayo has waived exclusivity so the scan is available elsewhere.
A new PET scan for recurrent and metastatic PC that targets the PSMA (Prostate Specific Membrane Antigen) will become the PET scan of choice for this type of prostate cancer. This scan currently has limited availability but is covered by Medicare. It is available at Anschutz. It appears to be very accurate and detects small lesions. One drawback is that only about 80% of prostate cancers exhibit the PSMA. Also, sensitivity is dependent on PSA level; for PSA of 0.2 – 0.5 sensitivity is 55-60%, for PSA 0.5 – 1.0 it’s 72-75%, PSA 1.0 – 2.0 it’s 93%, and PSA ≥ 2.0 it’s 97%. Furthermore, the radio-nuclide used has a very short half life and must be flown in to Colorado. But soon a Colorado lab will be producing it. You can find information on these scans appropriate to your current technical level about prostate cancer on the Internet. However, a favorite source for current information is the www.prostatecancerinfolink.net listed in the ‘Links’ section on this USTOO site. Simply bring it up and use the “search” field.
PSMA PET scans are clearly more precise at low PSA’s than other PET modalities but are not statistically more significant than the other modalities when the PSA is high.
Some PET scans are used almost exclusively to detect bone metastasis. The old one, available almost everywhere and almost universally prescribed, is the technetium-99m scan. The doctors just call it the “bone scan”. The sensitivity and specificity are not good. But the F18-sodium fluoride PET scan that was an alternative for this is no longer covered by Medicare. However, bone scans are considered useless with a PSA < 20.
Tests done on the genome structure of the cancer in your biopsy can be useful in determining how your cancer may progress. There are four or more companies offering tests. Each is different and has different uses. This is a complicated subject. A physician may recommend a test but the patient should be informed. One place to start is www.zerocancer.org/learn/newly-diagnosed/genomic-testing/.
Dr. Glode has a nice intro in a blog article “Improving Our Focus” in www.prost8blog.com. Use the SEARCH section of this blog for genomics and other topics. You can get more current information by going to the www.prostatecancerinfolink.net and entering the string “genome test” in the search field.
Provenge (also known as sipuleucel-T) is the only immunotherapy that has been approved by the FDA for prostate cancer. It is usually only approved for the treatment of metastatic cancer that has failed all the standard treatments. There is a lot going on in immunotherapy research however. To keep up, access www.prostatecancerinfolink.net and enter “immunotherapy” in the search field.
Check out Nanoknife (irreversible electroporation). Available in Germany now; investigational at some locations in America. www.prostata-center.de/index.php/en/ and https://www.mskcc.org/videos/irreversible-electroporation-nanoknife-treat-prostate-tumors.
Most new treatments are for metastatic and castrate-resistant cancer (mCRPC). A treatment that has recent FDA approval is 177Lu-PSMA-617. Read about this at https://www.targetedonc.com/view/fda-grants-priority-review-to-177lu-psma-617-in-mcrpc or do a GOOGLE search.
Unless your biopsy was read by the local expert, Scott Lucia, or by Ameripath Labs, second opinions are always recommended for the biopsy pathology. Go to an expert. Locally, Scott Lucia at UCHealth (303-724-3470) or Jon Epstein at Johns-Hopkins www.pathology.jhu.edu is recommended.
——–PROSTATE MEDICAL ONCOLOGISTS———
It is hard to find one locally that specializes in the prostate. Drs. Scholz and Lam at www.prostateoncology.com in Marina Del Rey, CA, are visited by many of our support group members. They do Color Doppler, accept Medicare, and are easy to reach by bus from LAX. One day round trips are not uncommon. Dr. Charles Myers in Virginia, previously on the preferred list, has retired.
An oncologist preferred by many in the support group is Dr. Elizabeth Kessler, UCHealth at Anschutz, www.uchealth.org/provider/elizabeth-kessler/. There are prostate oncology specialists at local centers such as TUCC, 303-825-8822, and support group members have seen them. You can ask about them or other doctors at the monthly support group meetings.
The advantage of a prostate oncologist over a urologist, radiation oncologist, or other doctors who have a specialized prostate treatment is that they do not have a single treatment that they are trying to push and will recommend the best treatment option. In any case, 2nd or multiple opinions should always be sought.
———UCHEALTH 2nd OPINION CLINIC———
UCHealth (Colorado Med School) has a second opinion clinic in which your case is reviewed by a committee of prostate cancer specialists. The clinic has mixed reviews. Contact 720-848-0170.
A great site for summarizing and critiquing, in terms patients can understand, the most important recent papers on prostate cancer, is www.prostatecancerinfolink.net/.
Dr. Glode, a former oncologist at UCHealth, still posts in his excellent blog. You can also review all previous posts and sign up to get an e-mail when a new one comes out. www.prost8blog.com.
There is one main prostate conference everyone should attend once in their prostate cancer journey — the PCRI Conference held annually in early September in Los Angeles. For 2022 the projection is an “in person” conference but that could change to virtual. There is also an abbreviated early-spring PCRI conference. Go to www.PCRI.org and click on CONFERENCE. DVDs of previous conferences are available.
A newer addition to the conference scene is the ZERO PROSTATE CANCER SUMMIT. The March 2022 virtual conference is now history. To check for future conferences, ask to be put on the mailing list at firstname.lastname@example.org. USTOO and ZERO merged to form a unified organization to fight prostate cancer.
Books about prostate cancer seem to appear regularly and many are quickly out of date because of rapidly advancing progress in prostate cancer. An older one that is durable for those deciding between radiation and surgery is “Invasion of the Prostate Snatchers” by Mark Scholz, a top prostate oncologist. Recently published and a very readable overview by local urologist/oncologist Emilia Ripoll is “Prostate Cancer. A New Approach to Treatment and Healing.” Just announced and not yet reviewed by the support group is “The Key to Prostate Cancer”, edited by Mark Scholz, where 30 experts explain 15 stages of prostate cancer. See Amazon for these books.