Newsletters from Dr. Charles K. Metzger, MD, MBA (retired)
Our goal is simple: help patients and families understand how better detection and smarter treatments can save lives and prevent further harm. These newsletters offer clear, up-to-date summaries of current research, with links for those who want to dig deeper.
February 28, 2026
Testosterone’s Paradoxical Effects in Prostate Cancer
Those of you who participate in our support and information groups and/or our monthly presentations have heard questions about what factors turn prostate cancer “on” and are responsible for prostate cancer cell spread and increased severity. Of course, we are looking to prevention over detection and treatment. Researchers may be one step closer to answering this question.
February 7, 2026
5T Prostate MRI Study Reveals Enhanced Image Quality and Detection
An interesting and largely patient friendly article reporting a small study comparing prostate cancer detection results between patients who got 3T MRI versus those receiving 5T MRI. Researchers say there’s no need for contrast thus making the MRI’s faster, safer, less expensive, less stressful. They produce a more accurate image and better identification of benign findings.
January 24, 2026
New Therapy Delays Progression of Recurrent Prostate Cancer (Radioligand + SBRT)
Here are two short and easy to read articles, both from our friends at UCLA Health. If you do either or both
therapies, we would like your feedback.
And, we have several short presentations by Dr’s. Kishan, Calais, and other UCLA top doctors on our website at ProstateForum.org/presentations.
January 17, 2026
Will Genetics help predict who will benefit long term from Focal Therapy
Urology Times just published a summary of a September 2025 study of 108 focal therapy patients. The study wanted to find out if there was a way to predict prostate cancer recurrence in the treatment field both 6 and 18 months after treatment.
January 10, 2026
Preparing for SBRT
This patient-friendly article is about a small Canadian study comparing the oral use of PEG 80 laxative you might know as Mira Lax against the effectiveness of the “Fleet” enema containing sodium biphosphate / sodium phosphate. Spoiler alert. Prepackaged enemas outperformed oral PEG 80 where bowel and rectal cleansing was needed prior to SBRT.
December 13, 2025
Emerging Standard of Care for Castration Sensitive Metastatic Prostate Cancer
Combination treatment is the way to go. Fighting cancer with androgen deprivation therapy with androgen
receptor pathway inhibitors is replacing solo ADT use. The use of the two drugs together and early in the cycle produces dramatically better results.
November 29, 2025
Impact of Initial Prostate-Specific Membrane Antigen PET/CT Staging and Prostate-Specific Membrane Antigen–Targeted Biopsy on Treatment Decisions in Prostate Cancer
Here's a short patient friendly article that again shows that PSMA-PET scans help patients make better treatment decisions. And, Ira and I will say it again. The bone scan is history. Insist on a PSMA-PET scan.
November 22, 2025
The new malpractice frontier: Who’s liable when AI gets it wrong?
AI integration in healthcare is outpacing legal frameworks, creating liability challenges for physicians, health systems, and manufacturers. The standard of care may evolve to include AI, affecting what is considered "reasonable" practice in medicine.
November 15, 2025
Twenty-Three Year Long European Study of Screening For Prostate Cancer Shows Reduced Mortality and Reduced Risks
Matthew Cooperberg, MD, speaks with Monique Roobol, PhD, lead author of the NEJM publication “European Study of Prostate Cancer Screening - 23-Year Follow-up.” Dr. Roobol reviews the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial’s 23-year findings showing a sustained reduction in prostate cancer mortality and an improved harm–benefit ratio with PSA-based screening.
November 1, 2025
Genetically Modified Herpes Virus + Herpes Treatment Drug + External Radiation suggests Future Prostate Cancer Cure
Disease free survival. The goal every cancer patient wants to hear is elusive. A recent clinical trial may get us to disease-free survival with newly diagnosed patients with moderate to high-risk disease still in the gland.
October 25, 2025
Can PROSTOX ultra finally make radiation therapy safer for prostate cancer patients?
Radiation has been made safer with the development of a genetic test called PROSTOX that in early trials looks like it can predict who will suffer late-stage side effects and who is likely good to go with MRI guided or PSMA guided SBRT and spacing methods to protect the rectum.
October 25, 2025
An Ancillary Study of the STAMPEDE Docetaxel Trials
We discuss genetic testing’s value in creating a personalized treatment plan resulting in metastasis - free survival without additional side effects and costs. The above article discusses the value of using androgen deprivation therapy (hormone therapy) with an androgen receptor inhibitor. Let’s understand how Metastatic P Ca grows.
September 13, 2025
Micro ultrasound vs MRI-Guided Biopsy for Prostate Cancer Diagnosis
Here's a patient friendly article discussing how micro-ultrasound will someday soon improve the ability to find cancer in the gland thus making more correct biopsies. Add the benefits of costing hospitals and doctors less than the purchase of an MRI machine and getting patients to diagnose faster and more often because they don’t have to join an extensive line for MRI appointments and we get real benefits from this innovative technology.
August 30, 2025
A Real Patient's Recent HIFU Experience
The purpose of the Saturday post is to educate our men and their families about prostate cancer. What better experience than to have our fearless leader recount his experience with one of the much talked about whole gland and focal HIFU therapy. Let's hear it from Neal
Berke for this interesting real-world account of HIFU.
August 23, 2025
The latest research: Xandi and PSMA-PET CT Scan results
Uro-Today sent me links to several patient friendly videos and articles concerning PSMA-PET CT scans. Simply, PSMA-PET CT scans can advance diagnostic accuracy and precision treatment towards lowering mortality, morbidity, treatment side effects and perhaps treatment hassle and cost.
August 9, 2025
Advanced Imaging for Focal Therapy in Intermediate Risk Prostate Cancer
Here’s the link to a patient friendly and exciting article and video discussing some of the past, present and future of High Intensity Focused Ultrasound ablation, the role HIFU plays in active surveillance, and Focal One Robotic HIFU.
August 2, 2025
Will Teraium 161 start a new theragnostics era?
How about some news about a new theragnostic agent that looks like it will be a promising weapon against metastatic castration resistant prostate cancer? The first in vivo clinical trial of terbium-161 produced few side effects and a good result towards reducing both metastatic cells and micro-metastatic single cells thus outperforming Lutetium 177.
July 26, 2025
Pluvicto™ Expands to Pre-Chemotherapy Space for PSMA-Positive Prostate Cancer
One of our group members wanted to know about theranostic treatment without chemotherapy. Dr. Finkelstein was the first to use Pluvicto without chemotherapy. This is an interesting discussion of the recent interest and excitement in theranostic medicine.
June 21, 2025
FDA approves expanded label for 177Lu-PSMA-617 in mCRP
A patient friendly article about Pluvicto for the treatment of some forms of metastatic castration resistant prostate cancer. Good news: Increased progression free survival. Now the theranostics can be used before the chemotherapy. Hopefully this will avoid some of the exposure to the side effects of the Taxene chemotherapy.
June 14, 2025
Depression, Suicidal Thoughts, Anxiety and More reported bysome Proscar and Propecia Patients
This month I found an article about Proscar and side effects that was surprising. I practiced for 30 years plus and never have my patient’s reported depression, suicidal thoughts, anxiety or any other psychological consequence from the use of Proscar or similar medications.
May 17, 2025
Largest-Ever Genetic Study of Prostate Cancer in Men of African Descent Finds New Risk Factors for the Disease (encore report)
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.
May 3, 2025
Long-term study compares adverse events from prostate cancer treatments (encore report)
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.
April 26, 2025
Treament Decisions for Older Prostate Cancer Patients
I want to share a short, patient friendly article that you will find important, especially if you are over 70 years old or so. If you’ve regularly attended our Support & Information groups, you’ve heard fellow prostate cancer patients discuss how their treatments are affected by other medical conditions. Good medicine strives to cure or reduce the impact of ailments without creating bigger problems. “First, do no harm."
April 12, 2025
The Bone Scan is Dead
Medical history is full of obsolete treatments and some never worked. Next in line for the history books is using a bone scan to find prostate cancer in the skeleton according to Professor Daniel Spratt, M.D. a radiation oncologist with Case Western Reserve University Comprehensive Cancer Center in Cleveland, Ohio.
April 5, 2025
Trial and Experimental Therapies for Cancers other than Prostate Cancer
Let’s look at two pharmaceutical firms whose products may provide precision cancer therapy soon. There are two reasons we are looking in the neighbor’s yard tonight. Frist, variations of these drugs may someday fight prostate cancer. And many of us know someone close to us fighting blood or breast or other cancers and they are looking for answers beyond what has been presented
March 29, 2025
ADT with SBRT versus SBRT alone for hormone-sensitive oligorecurrent prostate cancer
Researchers wanted to know the effect of adding ADT’s to SBRT to treat oligometastatic disease. They found their patients receiving two therapies at once delays Mets for more than twice as long as the group treated with SBRT only.
March 22, 2025
Published data show noninferior treatment-free survival with HIFU vs Radical Prostatectomy
How does robotic HIFU stack up against radical prostatectomy? According to Pascal Rischmann, MD, PhD, a urologist and president of the Surgical Society of France, HIFU is at worst “noninferior” and at best superior to surgery as far as its ability to kill intermediate risk cancer in the gland without long term side effects of impotence, urinary leakage and damage to the rectum and other tissues surrounding the prostate.
March 15, 2025
HDR Brachytherapy Boost for Unfavorable Localized Prostate Cancer: A Single Center Experience from Inception to Standard of Care
A study at the Juravinski Cancer Centre in Canada indicated that patients with a simultaneous high dose brachytherapy with external beam radiation had a high enough rate of progression free survival and low enough rate of toxicity to make this treatment the new standard of care at the Centre.
March 8, 2025
Considering a Radiology Second Opinion? Practical Advice for Navigating the Process
Ira and I are keen on second opinions for prostate cancer biopsies. We are considering advocating second opinions on MRI’s as well. Pathology and radiology are the same as other skilled fields. Some know more than others and are better at picking up subtle differences. That difference in skill might make a huge difference in the quality of treatment you get. Here's a link to a simple and straightforward article.
February 22, 2025
Study shows urine test for prostate cancer could be used at home
What if a take-home urine test could quickly and inexpensively eliminate the need for prostate
biopsies in men with indolent cancer? The accuracy of the My Prostate Score test was validated once again in a clinical study of men with known grade cancers. This test detects biomarkers for serious cancers like the PROMISE saliva test we’ve been urging our support group members to take.
February 8, 2025
Another Study Shows Active Surveillance is Safe
Dr. G . Chiarelli and his team assessed mortality associated with active surveillance. They examined the medical records of 546 men, 75 years and younger who were diagnosed between 1995 and 2022. They decided on a criterion for compliance with active surveillance guidelines
January 25, 2025
MRI guided SBRT is living up to expectations
A study led by Dr. Amar Kishan of UCLA, a recent presenter to the Forum, found that MRI guided SBRT does in fact protect healthy tissues outside of the margins. Those treated with MRI radiation did significantly better with bladder and bowel toxicity and sexual function than with CT.
December 7, 2024
White button mushroom extract shrinks tumors and delays their growth
Recent City of Hope research on mice demonstrated that white button mushroom extract increased the number of T cells and natural killer cells in mice infected with prostate cancer tumor components and reduced the tumor’s ability to fight off T Cells.
November 30, 2024
Studies Of Transrectal Vs. Transperineal Prostate Biopsy
Data is now available from the PREVENT study from a research team headed by Jim C Hu, MD,
MPH, a professor of urology at Weill Cornell Medicine / New York-Presbyterian Hospital, in which the researchers want to know if trans perineal biopsies (TP) provide better cancer detection with fewer infections than traditional trans rectal biopsies (TR).
October 26, 2024
18F-flotufolastat demonstrates high detection rate in low PSA setting
We know that the sooner we spot Mets post-surgery, the better the chances of controlling its spread. Testing is the name of the cancer treatment and recovery game. Click on the link for good news coming from a small study of men with low PSAs after surgery.
October 12, 2024
Some PSMA-PET scan basics with a link to a 14-part video discussion by top medical professionals
Dr. Metzger talks about a detection process called a Prostate Specific Membrane Agent Positron Emission Tomography. It’s something he and Ira talk about at nearly every meeting for our visitors who have high Gleason scores, high prostate stimulating antigen labs, or who may be experiencing biochemical recurrence.
October 5, 2024
High Decipher score is predictive of docetaxel benefit in advanced prostate cancer
Decipher is a painless, no fuss means of detecting genetic aberrations that could lead to cancer spread and treatment challenges. Researchers discovered that patients with a high Decipher genetic test score did better with docetaxel than those with a low Decipher score.
June 8, 2024
Big Breakthrough': New Low-Field MRI Is Safer and Easier
Last week I told you about Micro-Ultrasound and how it may replace MP-MRI as a diagnostic
tool. Now, another exciting development suggests the medical community will have a smaller,
more portable, more affordable MRI machine to use on a variety of diagnostic tasks once it’s
approved by the United States Food and Drug Administration.
June 1, 2024
Developments in the use of Micro Ultrasound (MUS) as a Diagnostic
and Biopsy Tool
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.
May 18, 2024
Apalutamide Combo Hits High 2-year Recurrence Free Survival Rate for High-Risk Prostate Cancer Patients
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 4, 2024
The Efficacy and Safety of Metastasis-Directed Therapy in Patients with Prostate Cancer
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.
April 20, 2024
Impact of Relugolix Versus Leuprolide on the Quality of Life of Men with
Advanced Prostate Cancer
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
Impact of Relugolix Versus Leuprolide on the Quality of Life of Men with
Advanced Prostate Cancer
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 13, 2024
The Future of Prostate Cancer Treatment: An In-Depth Look at Emerging Personalized Strategies
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.
March 23, 2024
Hundreds of Genetic Variants That May Lead to Higher Cancer Risk Can Be Identified In Patients with the Invitae Common Hereditary Cancers Panel
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 9, 2024
Erectile Dysfunction Meds May Affect Alzheimer’s Risk
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?
October 28, 2023
Recent Advances and Key Updates in the Use of PSMA-PET scans
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.
September 23, 2023
Out-of-Pocket Costs for Prostate Cancer Medications Substantially Vary by Part D Plan: An Online Tool Presents an Opportunity to Mitigate Financial Toxicity
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.
July 8, 2023
Study of the cost of cancer medications purchased via the Mark Cuban Cost Plus Drug Company
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 1, 2023
PSMA PET Guided Salvage Radiotherapy - UCLA Study (Dr. Calais)
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!!
June 17, 2023
Plant-Based Diet and Prostate Cancer
“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 10, 2023
Updates on Clinical Trials in Prostate Cancer
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.
May 27, 2023
Best Current Practice and Research Priorities in Active Surveillance for Prostate Cancer
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 13, 2023
15-Year Follow-Up of the ProtecT Trial: Discussing Results and Changes in Prostate Cancer Management
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.
April 29, 2023
Relationship Between Baseline Prostate-specific Antigen on Cancer Detection and Prostate Cancer Death:
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 15, 2023
Analysis underscores value of piflufolastat F 18 in recurrent prostate cancer with low PSA levels
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.
March 25, 2023
Plant-based diets linked to lower risk of prostate cancer progression and recurrence
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.