My friend, late 60s, just Dx with Gleason 7 (4+3)11 of 12 biopsy cores positive. Lives in Dallas Fort Worth. PSA in May was 5.1. Due for PSA this week, and consult with Uro. Doesn't know his staging. Uro wants him to have DaVinci procedure ASAP. I suggested he get busy and seek second opinion (s) from the best centers and specialists (PCa specialized ROs and MOs) in Dallas-Fort Worth ASAP. He has Medicare, probably Medicaid. Not a lot of savings, but ? I'd appreciate hearing from members about best rated resources in his location. Also about second opinions on his biopsy pathology. He has had Parkinson's for 10 years, and wonders if this will limit his options. I did advise him to join this forum. He's not his old self, and is really starting from scratch on this. Many thanks in advance.
A Long Time Friend and Colleague Just... - Advanced Prostate...
A Long Time Friend and Colleague Just Dx with Gleason 7 (4+3) in Dallas-Fort Worth. Info on Best PCa Centers and Specialists There Please.
Dr. Brian Chapin at MD Anderson Cancer Center Houston...When I was dx about 4 months ago before they found out I had metastasized .....my uro in Georgia told me that I had to have my prostate and bladder removed...he said this guy was the best
Thank you.
One option that I have over 100 patients on is single agent casodex (bicalutamide) as “bridging therapy” to delay safely the time to going to surgery or radiation. The longest patient has been on for over six years. Its cheap ~$5.00-10.00 per month . 1 pill per day. Doesnt affect erections or cause urine leakage. As long as psa declining or stable no risk of cancer progression. Side effect can be gynecomastia ( tender breasts) in around half the men. Surgery and radiation are better today then they were 3-5 years ago and there will be better treatments and techniques in the next 3-5 years. I wouldnt consider this for Gleason 8-10 cancers but safely have dozens of 7 4+3 patients on it today. Summary: cheap with few side effects but safe for delaying definitive treatment with surgery and radiation.
Thank you. That seems a good option to potentially provide more non-progression time to make important decisions.
Yes not a permanent replace just a bridge but can last several years. Any questions I would be happy to talk to u or him.
Thank you again
OK, but gynecomastia closer to 70%. With me, on eligard (supposed to be less of a gynecomastia factor), it was 100%.
Remember eligard shuts down production of testosterone and casodex doesnt shut down testosterone just blocks the testosterone from binding to the cancer. The incidence of gynecomastia is different when given in conjunction with eligard vs casodex given alone. In my own series that we are getting ready to publish in over 100 patients on casodex alone: ~ 50% had gynecomastia that required a dosage change (every other day) holding or discontinuing the casodex.
After he sends his slides to Epstein's lab at Johns Hopkins for a second opinion, and has a bone scan (which will probably be negative at his low PSA), he should talk to Robert Timmerman at UTSW. I know he can get SBRT there and I think brachy boost therapy too. Jeffrey Cadeddu has been recommended as a surgeon by some patients.
Thanks for that.
Dallas has a number of great options starting with UT Southwestern, Texas Oncology, and Baylor. I am not as familiar with Ft Worth. With so many options there is little reason to travel for treatment. I cannot imagine getting treatments or surgery and not being close to home unless so had no other option.
I have used Dr. Joshua Fine at Baylor for many years and have been very happy with him. His father Dr. Miron Fine is a very well known urologist. Are you sure he has "Medicare" at 60?
I've been pleased with UANT at USMD in Arlington (I-20 @ Matlock) They gave many options for me and am now 2 1/2 years down the road with 1/2 year more of Lupron after 40 Radiations. But he has plenty of options in Fort Worth, Dallas, Arlington, and Irving (for Proton).
Dr LaNasa and Dr Bevan-Thomas.
A 74 year-old friend had Gleason 9s in five or six quadrants. He went to Texas Proton Therapy Center in Irving. He had 40 treatments combined with Lupron for a year and has been cancer free for over two years. I had Gleeson 9s in four quadrants at age 65 and had robotic surgery at USMD in Arlington by Dr. Scott Thurman. I was diagnosed at UT Southwestern in Dallas, but opted for Dr. Thurman since UTSW is a teaching hospital and I would have met the resident surgeon the morning of surgery. Proton was not available in the area then. Dr. Thurman was the most experienced robotic surgeon I could find at that time seven years ago.
Since my surgery, HIFU has also been approved. Dr. Jim Cochran at Presbyterian in Dallas has been doing HIFU for years by taking his patients overseas where it had been approved long before it was approved here. It is a day patient procedure. But, I don't know if it is recommended for Gleason 9s. Dr Cochran was part of the study that was done to gain US approval. He also is head of clinical trials at Presbyterian, so I would recommend visiting him to learn what trials they might have to offer.
Update on my friend.: He met with his urologist and decided to go ahead with surgery, scheduled for today. He feels confident that he is in good hands. Having Parkinson's for 10 years, his memory can be lacking at times, but he does not recall having an MRI on his prostate/pelvis, just bone and CT scans. Hoping for a good outcome for him.
Thanks to all who have responded with info and advice.
My brother has advanced Prostate Cancer
PSMA - how is this?
Very slow start getting treatment and diagnosis 
Bone scan. Thoughts?
