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my takeaways from Prostate conference

SubDenis's picture
SubDenis
Posts: 130
Joined: Jul 2017

Here are my thoughts and feelings on the PCRI conference. 

 

I attended the PCRI conference for the first time.  I was struck by the number of men with advanced disease and pleasantly surprised by the number of men on AS and many with G3+4.  

The keynote folks had one theme and that is seeking docs with high expertise.  Caution on using someone who is a part time prostate doc, or said differently more focused on all urologic issues.  The point was made there are 2000 published papers on prostate annually and there is no way a doc can keep up with all the literature unless they focus. 

I was also surprised by the facts that pathologists have a 30% intra and inter-rater reliability error rate, including Epstein.  Epstein was asked does he look at all slides that come into JH. He had a tentative answer that if his signature was on it “I should have looked at it” That did not give me a warm fuzzy.  One statement, by one of the lead docs, was made that if your trust your Uro and he trusts the pathologist you should also. 

One interesting study was done in the UK, protect study, recently reported no sig diff in the 10-year survival rate of a purely random assignment of 1500 men to AS, Surgery, and radiation.  They also reported that 40 % of the AS group had intervention within 10 years.  That also means 60% of the AS men had no intervention and 60% of the other two groups had an unnecessary intervention. 

The presenters were critical of their field from a patient focus perspective and a bias towards their specialty for intervention.  Many of the men I met had poor experiences with at least one doctor, some a few.  Also, the danger of biopsy was discussed at length. Sepsis is a real threat and I met at least four guys who had it and were gravely ill.  Many of the docs were discussing the overuse of biopsy. 

Many of the sessions and vendors were more about advanced stage cancer.  Not one presentation or vendor or breakout group on surgery.  Genomics was discussed a lot and many felt it and gene therapies are the future. 

I attended three AS sessions and the theme I gathered from most of the guys was a tug of war between acting too soon and not acting soon enough. However, there were many long term AS guys who said this feeling will pass. Virtually every guy who is new at this had genomic testing like Polaris, Oncotype or decipher.  Most of the seasoned guys do 3-month PSA and periodic Doppler ultrasound or t3 MRI. Annual biopsy is on the decline. 

PSA doubling time seems to be the big warning sign. There was very little reference to Dr. Klotz’s work in Canada.  Bias seems to be the big threat to managing this disease. Bias by docs and patients.  We need to be educated on our disease, be assertive in talking with our docs and at some point, trust our docs or if we can’t get another doc.  

There was much discussion on diet and exercise.  Common themes on diet were plant based, many guys went vegetarian, and low carb and eliminate dairy.  Everyone seemed to agree that meat is out.  

I found the conference informative and supportive.  I am glad I went.  I am not sure anything dramatic happened for me.  I am more confident in my current state and current thinking.  I do believe many men on AS will have an intervention.  There was one guy who shared after 7years he had a successful intervention and that intervention was not available when he was first diagnosed, so the AS delay worked in his favor.

It was great to be around a bunch of guys in the same boat (800 attendees) and to have a variety of docs there to explain aspects of this disease.  There were about 1/3 of guys with their spouses.  It was a good investment and I may go back next year.  

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Thanks for reporting. I believe that you did understand well the matters in discussion for your knowledge from much reading and researching. I wonder if Dr. Myers announced his retirement. Can you list the main speakers?

 

SubDenis's picture
SubDenis
Posts: 130
Joined: Jul 2017

Dr. Meyers did announce his retirement.  It was sad to see him, as he seemed frail to me.  He was loved and honored by many at the conference.  You can see speakers at the PCRI site. www.pcri.org

Denis

hopeful and opt...
Posts: 2226
Joined: Apr 2009

please note that a t3 MRI is superior to a doppler ultrasound, since the capability exists to go back to any area under suspection in a future biopsy, as well as determining suspect lesions, and ranking them. The doppler ultrasound may be used for men who are not able to have mri's

In the southern ca area where you attended the conference, many have been going for a color-doppler by a radiolgist, duke bahn, so there is  bias toward this method from those in so. ca. I believe that he presented at the conference.

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Thanks for mentioning this conference.

While it would have been interesting, I don't think I would have traveled to LA to attend.  However, there are a variety of very informative articles on the conference website that others may find interesting.

See: http://pcri.org/insights/#blog

They also have an online "Helpline Resource Center" with relevant links on active surveillance, clinical trials, education videos, prostate imaging, recommend books and other prostate related matters:

See: http://pcri.org/helpline-resource-center/#helpline-resource-center-home

Check it out.

 

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