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News Updates in Prostate Cancer 

Newsletters from Dr. Charles K. Metzger, MD, MBA

One of the most important things we do at the Forum is educate patients and others about detection and treatments that have powerful potential to save their lives and/or prevent further damage to their bodies. Better detection leads to important, lifesaving changes in treatment. These newsletters provide up-to-date summaries of current research and links to detailed articles.

The tumor-seeking radiopharmaceuticals are charting a new course in oncology, with promise for targeted treatments with fewer side effects.

July 6, 2024


The advantages of ultrasound (US) over MRI pushed researchers towards developing an US that can create images that are 3 to 4 times higher resolution than traditional US and at least as clear as MRI
images. The result of their labor is Micro-Ultrasound (MUS). And not too far away, Artificial
Intelligence enhanced Micro-Ultrasound (AIMUS). The latter will lead to more accurate and
complete reading of the sound generated image.

June 1, 2024


Remarkable article about a study done on men after radical prostatectomy that had Gleason 8,9, 0r 10. The biochemical recurrence rate was zero at 24 months using mostly Erleada and Relugolix.

May 18, 2024


Metastasis Directed Therapy is used with all kinds of cancers. It can be done with surgery and /
or radiation delivered by external beam (IMRT, SBRT) or via Theranostics. Sometimes chemotherapy or hormone blockers are added. The objective is to stop cancer from spreading by either taking out what is “feeding” the cancer and / or preventing the Mets from creating more Mets. Hormone therapies have side effects that vary depending on the patient and the drug. Chemotherapy has side effects too.

May 4, 2024


New treatment option for prostate cancer shows successful outcomes. MRI Guided Transurethral Ultrasound Ablation has a high success rate without side effects associated with surgery.

April 27, 2024


Something old is new again. Years ago, men with Mets. were treated with estrogen instead of ADTs to deprive prostate cancer of testosterone. The study says patients who opted for treatment with estradiol skin patch had fewer side effects such as hot flashes, mood swings, blood pressure, blood sugar and cholesterol issues, reduced bone density and so forth than those who got ADTs.

April 20, 2024


Targeted radiation therapy via MRI guided SBRT can be an effective control of various oligometastatic cancers even without chemotherapy and / or ADTs. That’s a quick summary of some of the exciting discoveries discussed in the above article.

April13, 2024


The clinical trial scene is evolving and changing, and we are in an exciting time for such treatments. I want to share a list of contacts you can ask about clinical trials.

April 6, 2024


Click on the link in the newsletter to find out more about NEW clinical trials going on around the nation See if you qualify.

March 30, 2024


Genetic screening panels can alert patients to their potentially higher cancer risks. While they are not yet 100% reliable they can communicate the need for increased watchfulness going forward.

March 23, 2024


I wanted to share a study that correlates lower Alzheimer’s Disease risk in men with specific risk

factors with the use of Viagra or Cialis. The connection between these drugs and Alzheimer’s is

particularly interesting to P Ca patients as many of you are using them for ED and / or

controlling urinary incontinence. Thus the question: are there unintended benefits to using

these meds and if so, what dosages are needed to obtain benefits in men and maybe women

with an increased risk of Azheimer’s?

March 9, 2024


Here’s a link to a quick, patient friendly video discussing research that suggests your prostate

cancer fight will be more successful with moderate exercise and good nutrition. Moderate wine

intake is also good, and I am glad to hear that.

March 2, 2024


I found a ten yearlong study of 2455 men with cancer in the prostate only that underwent

surgery or external beam radiation treatment or active surveillance in 2011 to 2012 here in the USA. 

The research team wanted to know about side effects of treatment (or maybe no treatment in active

surveillance) and compare post treatment risks side by side. Here's what they found.

February 17, 2024


Black men are at greater risk for serious prostate cancer and at greater risk for discovering it later and experiencing it earlier in their lives. That’s consensus among prostate cancer researchers and practitioners.

February 10, 2024


Giving the finger to the finger?

In this study, the Digital Rectal Exam (DRE - the finger) is found to be less effective that some more recent diagnostic techniques.

February 3, 2024


Medicare/Medicaid sets pay schedule for artificial intelligence assistance to P Ca testing, and that's just a start...

January 20, 2024


While not a holiday present, assistance with medication cost is welcome this time of year and

throughout the year. I see many drug companies offering help with patient drug costs and for a

wide variety of illnesses. So, ask your pharmacist or heath care provider about financial relief for the Meds you and your loved ones take.

December 16, 2023


We may be as close as five years to having an injection for most if not all genetically based

diseases according to F. Perry Wilson M.D., M.S.C.E., of Yale Medical School.

November 25, 2023


Scanxiety is the stress you may feel around your cancer tests. There are several things that you can do to manage scanxiety.

November 4, 2023


PSMA-PET scans are more selective and more sensitive than conventional imaging. Here, four expert physicians discuss how these scans are changing the way they practice medicine, criteria for ordering PSMA-PET scans and how PSMA-PET scans can better serve patients and doctors.

October 28, 2023


Dr. Spratt, author of this article, will join us on Thursday, October 26th at 5:00 p.m. Pacific Time on zoom to address the role of artificial intelligence in treating prostate cancer.

October 7, 2023


The title says it all. OTC alternative to ED drugs will be available soon in the US.

Added 10/10/2023: check for availability in the US.

September 30, 2023


Medicare can be a confusing business. Dr. Metzger presents an article that describes a tool that helps you choose a Part D plan that meets your needs, and follows up with some further advice for navigating Part D.

September 23, 2023


Links to a podcast and discussion of the effectiveness of flotufolastat F 18.

August 12, 2023


Report in the Orange County Register tells how top quality medical care is growing rapidly in Orange County.

July 29 2023


Tonight, we will look at the Mark Cuban Cost Plus Drug Company (“Cost Plus”) and other options for holding down drug costs. Cost Plus is a mail order pharmaceutical house that manufacturers one hundred prescription drugs. Its business model saves money and passes savings onto consumers.

July 8, 2023


Dr. Calais of UCLA reports on a study that suggests we are getting closer to real time evidence that PSMA Guided (precision) radiation is the real deal and will make treatment of early metastatic disease more accurate and ready for prime time!!

July 1, 2023


“Would a heart healthy, vegan or vegetarian diet improve my P Ca outcome?” This question gets asked a lot at our meetings. This article answers that some of the cancer or drug related side effects may be improved, but since it was not controlled for pure vegan vs vegetarian, it is still not known what a true vegan diet may do for prostate cancer patients. Heart healthy diet still remains the diet of choice since men are usually in the heart risk age when prostate cancer is diagnosed.

June 17, 2023


Tonight, Dr. Metzger shares a list of current clinical trials with you. The clinical trial scene is evolving and changing and we are in an exciting time for such treatments. He also shares a list of contacts in Orange County that you can ask about clinical trials.

June 10, 2023


Here’s strong evidence that the medical community is looking at standardizing detection and treatment modalities for low grade prostate cancer and is moving towards international consensus. This is exciting news for AS patients who hear so many different things about detection and treatment of Gleason 3+3 and low grade 3+4 P Ca.

May 27, 2023


Here’s some good news. In a promising US study, patients who got both intermittent hormone therapy and radiation saw a 75 % reduction of P Ca progression or death over their counterparts who only got intermittent hormone therapy.

May 20, 2023


The ProtecT trial was a UK-based study where 1600 men were randomized to either active monitoring, prostatectomy, or radiotherapy. The trial followed up on these men for 15 years and found that there were no significant differences in mortality between the groups.

May 13, 2023


Several United Kingdom researchers demonstrated that prostate cancer treated or not has low mortality. Keep in mind we are primarily discussing mortality.

May 6, 2023


In tonight's newsletter, Dr. Metzger looks at a study of 55,432 European men who were followed for 16 years to determine if the quantity of PSA in a first routine draw can predict the likelihood of developing a Gleason 7 or more serious cancer. The results are encouraging.

April 29, 2023


A recent Canadian study demonstrates how well a Prostate Specific Membrane Antigen called “Piflufolastat F 18” or “Pylarify” used with PET / CT scan can locate metastatic prostate cancer in post treatment patients with low PSA levels.

April 15, 2023


Summary and analysis of a study called Patient Reported Outcomes 12 Years After Localized Prostate Cancer Treatment ."

April 1, 2023


Patients with prostate cancer whose diets included the highest amounts of plants had a lower risk of disease progression and recurrence, according to findings shared during the 2023 ASCO Genitourinary Cancers Symposium.

March 25, 2023


This paper discusses the results from the PACE-A trial, comparing quality of life outcomes from surgery vs stereotactic body radiotherapy (SBRT) among patients with intermediate-risk localized and low-risk prostate cancer.

March 18, 2023


Sign up for the PROMISE Registry. Help yourself. Help your family. Help other P Ca fighters.

To learn more, visit 

March 4, 2023


This non-invasive means of determining presence of high risk Prostate Cancer will become easier to get via Iso-PSA Blood Test and may eliminate the need for some biopsies.

February 16, 2023


MRI-guided SBRT reduced both acute toxicity effects and decrements in quality-of-life measures when compared with CT-guided SBRT, according to findings published in JAMA Oncology

February 4, 2023


A little change of pace. Here's the Fall 2022 UCLA Urology Newsletter featuring our Nov. presenter Professor Leonard S. Marks, M.D. and his coworkers. We hope it will help you prepare for the Nov. presentation.

October 29, 2022


Just a brief glimpse of the literature regarding MRI before a biopsy. Not all studies agree but the consensus is in favor of the pre biopsy MRI fused to the ultrasound. Standard of care, to be sure.

August 12, 2022


This is a big step toward treatment intensification for men with both oligometastatic disease as well as more advanced metastatic disease.

August 6, 2022


This keeps coming up at our meetings, Dr Fuller endorses this as does UCLA.  Makes a lot of sense to prevent rectal issues with radiation.

June 24, 2022


This is a good reminder that androgen deprivation after salvage radiotherapy is the way to go, especially if the new drug is used (relugolix). Here are two articles for review.

June 18, 2022


An example of how modern technology is helping surgeons do a better job of finding proper anatomic margins to know they have resected all of the cancerous prostate.

June 3, 2022


This is the nail in the coffin for the mri vs ultrasound debate. Not only will it get the process back into the urologist office, away from the radiologist there will be less reluctance to do guided biopsies.

May 14, 2022


Here is a current update from Johns Hopkins to their 2011 original article regarding active surveillance for prostate cancer. 

May 7, 2022


The FDA officially approved these agents which will be discussed in our next talk, on Thursday, April 24, 2022 at 7 pm. Please attend and find out how all this fits together.

April 22, 2022


An extensive review of the literature about pre treatment of advanced disease with different therapies (neoadjuvant) prior to surgery or radiation

April 9, 2022


Here are two exciting new developments for the prostate cancer world. The first is treatment for men with metastatic prostate cancer that is hormone sensitive. Really impressive results. The second is the use of LU PSMA for treatment of end stage disease and its approval for use by the FDA in castrate resistant prostate cancer.

March 26, 2022


This very informative video presentation by Dr. Eric A. Klein, MD is another example of progress in the decision about how to use PSA and who needs more testing.

March 13, 2022


This is a very interesting review of the history of PSA.  Lots of twists and turns in its life as a screening tool.  Using it wisely is really the key to its existence.

March 5, 2022


Although controversial, the trend is to treat the main tumor even if there is oligometastasis (less than five sites).

February 26, 2022


This is the near future of prostate imaging.

January 29, 2022


German hospitals are offering a 3-4 day inpatient treatment called Lutetium 177. 

January 10, 2022


The FDA has approved piflufolastat F 18 injection, a prostate-specific membrane antigen–targeted positron emission tomography imaging agent to identify suspected metastasis or recurrence of prostate cancer- it is finally official.

January 4, 2022


The Exablate system, which uses high intensity ultrasound to control locally-confined prostate cancer,  is very precise for the treatment of focal prostate cancer.

November 13, 2021


This is another step forward in the theranostics arena.

November 13, 2021


This is a succinct look at the field of immunotherapy as it relates to prostate cancer. It’s a great overview of current and future treatment options.

November 1, 2021


This article answers a question at the advance meeting of the value of pre op multi parametric MRI (this was pre PSMA work) in determining if surgery is the way to go. 

October 11, 2021


The PSMA-PET imaging agents Piflufolastat F 18 and Gallium 68 PSMA-11 are approved by the FDA for managing patients with prostate cancer

September 26, 2021


This very long article really is the answer to where MRI fits into the diagnostic scheme of elevated PSA.

September 11, 2021


It was just a matter of time before another promising agent was added to the PSMA.

Sept 3, 2021


The following articles help put to rest the value of MRI fused biopsy and compares it to the regular ultrasound guided biopsy

July 31, 2021


These articles show the amazing advances in the treatment of advanced prostate cancer.

July 17, 2021


Experts in prostate cancer discuss considerations for initiating ADT therapy after definitive treatment in patients with prostate cancer in the context of biochemical recurrence.

April 27, 2021


ORGOVYX, the drug that will eventually replace Lupron or Zoladex for the treatment of advanced prostate cancer, is now readily available. This is the only androgen deprivation therapy (ADT) medicine that is not given in the form of an injection.

April 10, 2021


The use of MRI guided transurethral approach to just treat a solitary lesion is now gaining traction as a way to do a more directed minimally invasive treatment.

April 3, 2021


A really good review of the use of active surveillance in all age groups. Emphasis on clinical guidelines and non-medical factors, like Vitamin D, low-dose statin, and frequent biomarkers for disease status.

March 18, 2021


Scientists are making great strides when it comes to the gene editing technique known as CRISPR. Scientists are confident that the treatment and prevention of prostate cancer using CRISPR technique holds tremendous potential.

March11, 2021


Scientists are making great strides when it comes to the gene editing technique known as CRISPR. Scientists are confident that the treatment and prevention of prostate cancer using CRISPR technique holds tremendous potential.

February 25, 2021


The incidence of prostate cancers that have spread to the bone at diagnosis has increased since the PSA test was taken off the guidelines of the U.S. Preventative Services Task Force (USPSTF). Some modification of this recommendation needs to be considered on a case-by-case basis.

February 25, 2021


A shorter course of stereotatic body radiotherapy (SBRT) has been shown to be effective in high-risk prostate cancer. The toxicity has been favorable and the cost is competitive.

February 16, 2021


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