Sorry for you lost, I hope foe your fast recovery my dad and one of my causin died with this shit cancer. Now its my turn to battle it. I live in Sweden and we have good treatment here too.

Just tried to get an appointment. They would take me because it hasn't metastasized. Exactly what you said, if he's so great why can they try and stop this before it spreads instead of waiting for more serious problems and then hitting you with all these drugs and radiation. May be he's a genius but looks like is after the big money as most these doctors are instead of truly trying to help people and save lives. So very disappointing

@@jeffdwier5590 I’ve talked to a few guys who have gone to him. He often takes the worst cases; those who have run out of options. Anyone can handle the early and easier cases. (As he indicates in one of his presentations, he takes the recurrent/advanced cases.) I take some of the concepts that I pick up from what he says, and then go over it with my RO (and maybe incorporate it).

I do not have the expertise to agree or disagree with Dr. Kwon, but I think I can help clarify what he meant. His chief complaints about second-generation anti-androgens have to do with how they are sometimes sequenced rather than the drugs themselves. For example, it is common for a patient to be prescribed a second-generation anti-androgen when their PSA starts rising on standard hormone therapy (e.g. Lupron). The patient will continue on standard hormone therapy and the second-generation anti-androgen until the PSA starts to rise again, and then he will be offered chemotherapy. One of the most common justifications for this sequence is that second-generation anti-androgens have fewer side effects than chemotherapy, and so it is best to give a patient the best quality of life for as long as possible. Dr. Kwon's problems with this are: 1. The side effects of second-generation anti-androgens are not necessarily more tolerable than those of chemotherapy, and so that is not always a good justification. 2. PSA is not always a good indicator of whether the second-generation anti-androgen is working. He claims that in 20%-40% of patients, he has seen progression of disease on scans while the PSA is declining. Therefore, if a doctor and patient are only using PSA to monitor disease, it is possible for them to feel a false sense of security, believing that the patient does not need stronger therapy when he, in fact, does. 3. By forgoing chemotherapy until a second-generation anti-androgen starts to fail, it is possible that cancer cells in a patient that are resistant to all forms of hormone therapy will grow and mutate. These cells could have been susceptible to earlier use of chemotherapy, but can become resistant to it through replications and mutations which have been allowed to occur by not using more aggressive treatment earlier. Dr. Kwon provides preliminary evidence that patient survival is better when chemotherapy is used earlier in the disease course. So, the problem he has with second-generation anti-androgens is that some doctors rely on them to manage the disease, when he believes that combining it with other treatments gives you a better shot of eradicating (or mostly eradicating) the disease to give a better chance of longer remissions. When he talks about using the second-generation anti-androgen in combination with chemotherapy, this is in the context of newly diagnosed metastatic disease (that is, no prior treatment). This has been suggested as the ideal course of treatment based on a phase III trial in France which we actually discuss in this video (kzfaq.info/get/bejne/a52Vm62cu7vVfYk.html at 0:42-3:07). Dr. Kwon's opinions on previously treated disease, in theory, seem to be very similar to newly diagnosed disease (that is, to go as aggressive as you need to as early as possible rather than waiting for one treatment to fail before starting another one); however, since the particulars have not been confirmed by a clinical phase III trial, doctors have an obligation to not express their opinions on those matters as facts. I hope that helps clarify things. If you need a better explanation, give our office a call at 310-743-2116.

I endorse the PCRI response to this question. BTW...The chemo they're talking about is Taxotere which is pretty tolerable.

Thank you very much! I understand this now, I appreciate your great response in clarifying this issue.

Perhaps a bit more info will prompt a reply. My situation is complicated, advanced, diffuse (per Dr Kwon's categories) with Zoladex holding the PSA below detectable. Thanks.

This video is discussing advanced metastatic prostate cancer. Check out our playlist on "Teal" that is, intermediate-risk prostate cancer. The cure rate is generally very high.

He discusses this at 16:10. He recommends hormone therapy and six cycles of chemotherapy at the same time. If there is any detectable PSA after the chemotherapy, he suggests adding a 2nd generation hormone therapy to the standard hormone therapy. Then, he suggests considering Consolidative radiotherapy or surgery, but does not specify when or under what conditions. We also have a video about the latest Phase III prospective trial about patients with newly diagnosed metastatic disease here: kzfaq.info/get/bejne/a52Vm62cu7vVfYk.html We have a helpline staffed by a patient advocate that may be able to answer any other questions or provide some more clarify. Our contact info is here: pcri.org/helpline

And psa of 3

Hello Jeff, We are so sorry to hear this. Please reach out to our Helpline team so they can help you: pcri.org/helpline

This is a video for educating patients in general about the staging and treatment of advanced prostate cancer, and not a video exclusively about lutetium-177. We have about four or five other short videos about lutetium-177, its approval, and who qualifies (that is, patients with hormone-resistant prostate cancer who have been administered chemotherapy at least once) and your can find that by searching "PCRI lutetium-177." Currently, lutetium-177 is not available anywhere in the United States because of an issue with production, and we will be releasing a video about that imminently. It was estimated to be back in production in June or July, but there has not been much follow up by the company that manufactures it, Novartis. Once it is available, there should be insurance coverage for anyone who qualifies. Dr. Kwon explains that he does not like to deal with the insurance companies because it is time consuming and does not produce fruitful results. If a doctor has prescribed something, like a PSMA PET scan, then the insurance company is already aware that the doctor thinks the patient should have it, and having the doctor or staff member speak with the insurance company is unlikely to make any more of a difference than having anyone else appeal their decision, and would increase the cost of health care without providing any value. He also gives advice regarding the number of times that a patient should appeal in order to have the best chance of having a procedure like the PSMA PET approved. We are very grateful that Dr. Kwon took so much time out of his day to give patients a survey of all the different considerations in the staging and treatment of advanced disease. You are free to criticize our speakers, but obviously, not every single video will fulfill every person's specific needs, and we have several other shorter videos that address what you want to know.

Your timely and informative response is appreciated. Sadly, the resource that my family was referred to for dealing with the insurance company and accessing this medication were these 3 videos, not the ones you are directing us to watch. It’s nice these have been produced but patients need their physician to at least take the time to direct them to the right resource. Additionally, insurance authorization is most often done by the physicians office. Peer to peer is usually the final standard for approval when there is disagreement and these calls are highly efficient with direct calls to the physician at the insurance company. Most of the time it does not come to this and physicians are not the people calling but their health system has people trained to make these calls. We spent two hours on the phone last night with insurance bc they claimed the order was not received. They were shocked we were asked to make these calls and they indicated that they have a direct provider line that is far more efficient. They indicated this was the way to move things forward. At present, weeks of potential treatment have been lost.

It could be that the production halt could be the source of the issue since the insurance company said it was never ordered. It is surprising that the doctor's office would not keep you updated on that. Here is an article at the beginning of the halt, and the most recent update: www.fiercepharma.com/manufacturing/novartis-halts-us-production-radioligand-cancer-therapies-citing-manufacturing#:~:text=Thanks%20to%20the%20abrupt%20manufacturing,%2Dpositive%2C%20metastatic%20castration%2Dresistant www.fiercepharma.com/pharma/novartis-surprise-radiotherapy-production-halt-could-be-drawing-close