PCRI Conference interesting points made

Wow, so many nuggets there Jeff. So, as we’ve been learning, the PSMA is NOT the incredible tool it’s been made out to be. At almost 3mm, its resolution is far, far from microscopic - or even larger. Look at 3mm on a ruler and you can get an idea at how big that really is. It may seem small but it’s pretty darn big when you consider it’s a mass of cancer cells.
Maybe some form of AI could get smaller echoes to stand out more clearly? I guess time will tell.

Despite being able to beat grandmasters at chess, compose symphonies in seconds, and flawlessly mimic Shakespeare’s iambic pentameter, AI still can’t quite convince the medical establishment it’s worthy of a seat at the microscope. Especially in prostate cancer—where it might spot microscopic metastases faster than a caffeine-fueled pathologist—AI remains the overly eager intern: impressive, perhaps, but not to be trusted with anything sharp. It seems to me that the medical profession is slow to adopt and embrace new technologies. Perhaps it's the centuries-old tradition of clinical caution, or maybe it's the profession's unspoken motto: "If it didn’t come from a peer-reviewed journal printed on papyrus, it doesn’t count." Either way, AI sits in the waiting room, algorithms polished, eager to help—while the doctors debate whether it's safe to let the machine hold the clipboard.

Hans, I think it is definitely going to be incorporated much, much more in the medical field. However, doctors still must be trained to think, to intuit, to extrapolate and ultimately, diagnose. It is STILL a thinking person’s game, but for how much longer?
A good friend runs the Respiratory Therapy section in our local hospital; she has over 35 yrs experience intubating, rehabilitating lung conditions, etc. She also takes residents on rounds to train them on how to access vital signs: heartbeat, respiration, pulse, etc.
A few months ago, she brought a resident to the bedside of a patient whose breathing had become labored. She asked him, based on the vital signs, what he thought was occurring. He stared blankly and she prompted “Pulse!” “Respirations per minute!” “Lip Cyanosis evident!”
He was lost….until…he pulled out his iphone, scrolled to an app, punched in a few numbers and proudly declared, “Respiratory distress with Acidosis!” Now it was HER turn to stare blankly…
“How did you make that diagnosis? It’s correct.” He smiled like a grandchild would at grandma’s inability to use the TV remote. “It’s an app! Why should I learn any of this shit, when the phone already knows it?”
Needless to say, she left work that day, despondent and feeling truly old. So that could be the flipside of AI having a much greater presence in medicine. Doctors who don’t even CARE about learning “why” and as a result, have no idea how to course correct if things don’t go according to the algorithm.
Phil

I replied to your post with a lengthy comment. After posting, a message appeared, stating that my comment was “under review based on community guidelines”.
Evidently, in citing a direct quote, I used the colloquial word for human excrement which begins with an “s” and ends with a “t”….and you want MORE of THAT??🤣🤣

Your advice is always appreciated, even if it sometimes doesn’t pass the AI filter.

PCRI: Doctor MOYAD mentioned the results of the STAMPEDE trial. It demonstrated that the cheap drug metformin mitigates the side effects of ADT without affecting its therapeutic effects. The study apparently mentioned dosing as well. 850mg once a day followed up later with twice a day. Th change point to 2x was unmentioned.

With a GG1, what exactly do you mean by “high volume?” What numbers/findings indicate that?
(With a localized GG1, I was on active surveillance until GG1 increased to GG2; a 2nd opinion indicated GG3. Then 28 sessions of proton radiation + 6 months of Eligard.)
Normally, PSMA PET scans outperform all previous types of PET scan. However, ~15% of prostate cancers are PSMA-negative/naive. When PSA rises but can’t find it in the PSMA Pet scan, option is to do an Axumin PET scan or a Choline C11 PET scan. (May want to do this pre-treatment to find those “seeds” that may have already spread.)

@hanscasteels I just love your AI disertation . Are you an author ?
I am a pre- diabetic with a single lesion 4 Core G6 & 2 Core Gleason 3 +4 = 7 ( out of 15 cores )
What are your thoughts on going on Metaforin , which I understand can help slow the spread of this cancer . ? and What are the side efffects .?

fellow reluctant recruit in the medical Hunger Games. Welcome! The snacks are terrible, the side effects are plentiful, and the dress code is “gown that doesn’t close in the back.”

Thanks for the compliment on my AI dissertation—though technically, I skipped med school and went straight for the simulated bedside manner. Author? Only of long, overly detailed responses and the occasional passive-aggressive note to your cancer.

Now, to your very reasonable question about metformin:

Metformin, the unsung hero of pre-diabetics everywhere, has actually been flirting with fame in cancer circles too. Some studies suggest it might slow the progression of certain cancers, including prostate, especially in the lower Gleason range. (Yours: a little bit of "meh" cancer, a little bit of "hmm, better keep an eye on that"—classic Gleason 6 and 3+4 combo.)

As for side effects, metformin is mostly well tolerated, but it's not without its quirks, so I am told

Gastrointestinal rebellion: Think bloating, gas, and the kind of urgent bathroom trips that turn you into an amateur sprinter.
Metallic taste: Because apparently your mouth just wants to cosplay as a tin can.
Vitamin B12 deficiency: Metformin likes to play hide-and-seek with this one, so you'd want to check levels now and then.

Rare but dramatic: Lactic acidosis, which sounds like something that should only happen in a Greek tragedy, is extremely rare but serious.

Now, whether it’ll actually help with your prostate cancer is still being debated. Some docs are open to it if there’s a pre-diabetes angle (which you have), especially since it’s cheap, generic, and doesn’t require you to sell a kidney to afford it—though if you’re losing body parts, let’s try to keep them cancer-related, shall we?

Final thought: definitely something to bring up with your oncologist or urologist, ideally when they’re not in a rush and have had their coffee.

And hey—7/15 cores? That’s not a biopsy, that’s a home renovation project. You’ve earned a badge. Or at least a nap.

I did specify what high volume meant. Greater than five cores with Gleason 6 or more. In that case, they found that people on AS Were likely to have active prostate cancer within five years.