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Experience with Dr Dan Lin - UW Fred Hutch Cancer Center in Seattle

Posted by gonzaler84 @gonzaler84, Sep 4 7:41pm

Hi all,
First time participant. Great forum for ramping fast on prostate cancer. Ty all for your contributions.

Curious if anyone has been treated by Dr Dan Lin at UW - Fred Hutch Cancer Center in Seattle. I am sched to have my first consult w him and two other specialists.

About me: 64, excellent health and no other health issues and no meds currently other than Tamsulosin. I work out 7 days a week and maintain a pretty strict diet: Meditteranean and pescatarian. Occaisionally consume chicken and rarely eat meat.

Current PSA reading: 6

Biopsy came back with following:
Left side: Gleason 9 with tumor involves six of seven cores
Right side: Gleason 7 with tumor involves 4 of 7 cores

I am planning to start treatment pretty quickly. First step is to get the PET scan done which is currently ordered by urologist.

As I explore the available options:
1. Alternative 1: Advanced Radiation + Hormone Therapy (ADT)
2. Alternative 2: Alternative 2: Robotic Radical Prostatectomy (Surgery)

I also want to discuss the SpaceOAR option as it appears this is done together with Alternative 1.

Appreciate if anyone can share feedback on Dr Dan Lin. If not then I welcome what other alternative treatments to consider. I do not qualify (based on criteria) for Tulsa procedure.

Thx

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | Sep 5 11:27am
In reply to @biggalew "@jeffmarc Any direction down here in the Tampa Bay area of Florida?" + (show)
Profile picture for biggalew @biggalew

@jeffmarc Any direction down here in the Tampa Bay area of Florida?

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@biggalew
Best I have isn’t too far

Sarasota, Florida
MO is Elizabeth Guancial.
One of the moderators on Ancan.Org Advanced prostate cancer meeting Says the following
I think she is top tier and several other ancan members see her and agree.

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Profile picture for gonzaler84
gonzaler84 | @gonzaler84 | Sep 5 12:35pm
In reply to @brianjarvis "ADT (androgen deprivation therapy) can be one of: Lupron, Eligard, Prostap, Lucrin, Camcevi, Zoladex, Trelstar, Pamorelin,..." + (show)
Profile picture for brianjarvis @brianjarvis

ADT (androgen deprivation therapy) can be one of: Lupron, Eligard, Prostap, Lucrin, Camcevi, Zoladex, Trelstar, Pamorelin, Decapeptyl, Firmagon, or Orgovyx.

Advanced radiation usually refers to IMRT (photon) or proton. But it could also refer to VMAT, IGRT, SBRT, MR-Linac, and others,…..

ARPI (androgen receptor pathway inhibitor) can be one of: Zytiga (abiraterone), Erleada (apalutimide), Xtandi (enzalutimide), or Nubeqa (darolutamide).

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@brianjarvis Ty Brian for the addl detail w the visuals and insights...

Cheers

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climateguy | @climateguy | Sep 5 2:26pm

The Dr. Michael Schweizer at Fred Hutch recommended by Jeff is conducting research into Transdermal Estradiol, a.k.a. tE2, as an alternate to Lupron and Orgovyx, or any of the drugs you might be prescribed as ADT if the therapy you choose includes ADT. Apparently he can prescribe and monitor patients who take it.

tE2 can be 1/100 to 1/400 cheaper than drugs traditionally prescribed for ADT, and it does not come with the side effects most commonly objected to by patients on ADT. Take a look at the website https://estradiolinitiative.org/

tE2 is becoming increasingly recognized as equivalent in efficacy with less side effects after the recent publication of the highest standard of evidence in one of the best medical journals, i.e. https://www.nejm.org/doi/10.1056/NEJMoa2511781

If the PET scan doesn't show that you are ineligible for radiation or surgery, a radiation treatment you might want to consider is Brachytherapy. In your case this would probably be prescribed as in addition to some sort of external beam, either protons or photons.

Dr. Michael Folkert is the chief of brachytherapy at Fred Hutch. I highly recommend him. When it comes to brachytherapy it is essential to get the treatment from a highly experienced group. This is who Folkert is, and what he leads at Fred Hutch. They have the ability deliver high dose brachytherapy, a.k.a. HDR, which can be used even if the cancer has spread outside the prostate into the seminal vesicles.

Dr. John Sylvester is one of the most experienced brachytherapists in the world. His presentation at a 2024 symposium "Brachytherapy: The Historical Evolution, Techniques, and Efficacy in Prostate Cancer Management" is worth seeing if you do consider brachy.
https://grandroundsinurology.com/brachytherapy-the-historical-evolution-techniques-and-efficacy-in-prostate-cancer-management/
Dr. Nelson Stone is another of the most experienced practitioners of brachy. In his presentation "Radiation Dose and Hormone Therapy: How Much is Enough?" he discusses why shorter periods of ADT are required when brachytherapy is used. Basically, it is not possible to administer the highest possible safe dose of radiation to the prostate unless brachy is used, and the data shows that the higher the dose, the better the outcome of the treatment is.
https://grandroundsinurology.com/radiation-dose-and-hormone-therapy-how-much-is-enough/

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1 reply
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gonzaler84 | @gonzaler84 | Sep 5 5:54pm
In reply to @climateguy "The Dr. Michael Schweizer at Fred Hutch recommended by Jeff is conducting research into Transdermal Estradiol,..." + (show)
Profile picture for climateguy @climateguy

The Dr. Michael Schweizer at Fred Hutch recommended by Jeff is conducting research into Transdermal Estradiol, a.k.a. tE2, as an alternate to Lupron and Orgovyx, or any of the drugs you might be prescribed as ADT if the therapy you choose includes ADT. Apparently he can prescribe and monitor patients who take it.

tE2 can be 1/100 to 1/400 cheaper than drugs traditionally prescribed for ADT, and it does not come with the side effects most commonly objected to by patients on ADT. Take a look at the website https://estradiolinitiative.org/

tE2 is becoming increasingly recognized as equivalent in efficacy with less side effects after the recent publication of the highest standard of evidence in one of the best medical journals, i.e. https://www.nejm.org/doi/10.1056/NEJMoa2511781

If the PET scan doesn't show that you are ineligible for radiation or surgery, a radiation treatment you might want to consider is Brachytherapy. In your case this would probably be prescribed as in addition to some sort of external beam, either protons or photons.

Dr. Michael Folkert is the chief of brachytherapy at Fred Hutch. I highly recommend him. When it comes to brachytherapy it is essential to get the treatment from a highly experienced group. This is who Folkert is, and what he leads at Fred Hutch. They have the ability deliver high dose brachytherapy, a.k.a. HDR, which can be used even if the cancer has spread outside the prostate into the seminal vesicles.

Dr. John Sylvester is one of the most experienced brachytherapists in the world. His presentation at a 2024 symposium "Brachytherapy: The Historical Evolution, Techniques, and Efficacy in Prostate Cancer Management" is worth seeing if you do consider brachy.
https://grandroundsinurology.com/brachytherapy-the-historical-evolution-techniques-and-efficacy-in-prostate-cancer-management/
Dr. Nelson Stone is another of the most experienced practitioners of brachy. In his presentation "Radiation Dose and Hormone Therapy: How Much is Enough?" he discusses why shorter periods of ADT are required when brachytherapy is used. Basically, it is not possible to administer the highest possible safe dose of radiation to the prostate unless brachy is used, and the data shows that the higher the dose, the better the outcome of the treatment is.
https://grandroundsinurology.com/radiation-dose-and-hormone-therapy-how-much-is-enough/

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@climateguy This is fantastic! Ty @climateguy for your insights and detail for the specialists you've cited. More to read eh? But that's why I've joined the forum - to prepare myself as much as I can...

Ty again...

Cheers...

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gonzaler84 | @gonzaler84 | Sep 5 5:58pm

Question: did any of you send your questions in advance to the team prior to your initial visit? Reason for asking is that the more heads up provided to the specialists, perhaps they are better prepared to address the questions with data, research or experiences with other patients...I should clarify that given the available potential treatments available based on the current situation this allows the patient time to prepare thoughtful and specific questions. In turn, the specialists having these q's in advance hopefully gives them some time to prep...

Was thinking of this as I'm reading the responses and given the breadth of info available, the discussion could go in lots of directions. Hence focusing the discussion could help ensure a more thoughtful and valuable experience for me...

Appreciate any thoughts you may have on this idea...

Cheers...

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1 reply
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dailyeffort | @dailyeffort | Sep 5 8:24pm
In reply to @gonzaler84 "@dailyeffort Bill, many, many thx for your guidance. I truly appreciate your feedback on Lin together..." + (show)
Profile picture for gonzaler84 @gonzaler84

@dailyeffort Bill, many, many thx for your guidance. I truly appreciate your feedback on Lin together with your other insights. How you describe the initial visit is what is currently planned with me. Lin is one of the 3 that I will meet with on the initial visit.

Did you have your PET scan done before you met with the team for your first visit? The urologist has put an order in but he came back and said it takes a while to secure a date. Current order is to have the scan done at Overlake Hospital. That said, I really want to get it done before initial meeting with Lin and others on Oct 8 so that I can have a more thorough and relevant discussion based on the scan, biopsy and other lab work. I am planning to call Overlake on Tue and also Fred Hutch to see which one can do the test before the first visit.

Lastly, Bill would you be open to a brief chat by phone or email to chat further about your experience at Hutch? If not no worries - I understand.

Ty

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@gonzaler84 I was able to have the PSMA PET done prior to my initial meetings. If, after checking with Overlake (and UW as well) you are unable to get the scan scheduled ahead of your Oct 8 meeting, I would probably request the initial meeting be rescheduled in the event that they are unable to "pull some strings" to get it scheduled ahead of time.

What was your most recent PSA? What other labs or tests are being done to provide you with additional data upon which you and your doctors can arrive at the best possible treatment decision?

Below are two links that will be of interest:
https://fox5sandiego.com/news/tv-travel-guide-rick-steves-on-road-to-recovery-after-cancer-diagnosis/
https://x.com/RickSteves/status/1893507918563340618
In a later post you mention submitting a list of questions in advance of your appointment. It is a very good idea and is something I always do.

Let me know if you have you been on Mayo Clinic Connecct long enough to send/receive private messages?

Bill

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2 replies
Profile picture for ddavid
ddavid | @ddavid | Sep 5 9:12pm

Hi:
I have been getting treatment at the Hutch since 2019. Dr. George Schade was my urologist and did my RALP. I know others who have seen Dr. Lin. They all speak very highly of him.
For GU oncologists, Dr. Schweitzer is recommended by many.
With regards to getting a scan ahead of time. You may try scheduling it at Harborview Medical Center or UW Medical Center if you can't get it done in time at the Hutch. Both are part of the UW Medicine network and closely tied with Fred Hutch. Medical records are visible throughout the network. Many of the Fred Hutch doctors are part of the UW Medicine system.

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1 reply
Profile picture for gonzaler84
gonzaler84 | @gonzaler84 | Sep 6 12:10am
In reply to @dailyeffort "@gonzaler84 I was able to have the PSMA PET done prior to my initial meetings. If,..." + (show)
Profile picture for dailyeffort @dailyeffort

@gonzaler84 I was able to have the PSMA PET done prior to my initial meetings. If, after checking with Overlake (and UW as well) you are unable to get the scan scheduled ahead of your Oct 8 meeting, I would probably request the initial meeting be rescheduled in the event that they are unable to "pull some strings" to get it scheduled ahead of time.

What was your most recent PSA? What other labs or tests are being done to provide you with additional data upon which you and your doctors can arrive at the best possible treatment decision?

Below are two links that will be of interest:
https://fox5sandiego.com/news/tv-travel-guide-rick-steves-on-road-to-recovery-after-cancer-diagnosis/
https://x.com/RickSteves/status/1893507918563340618
In a later post you mention submitting a list of questions in advance of your appointment. It is a very good idea and is something I always do.

Let me know if you have you been on Mayo Clinic Connecct long enough to send/receive private messages?

Bill

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@dailyeffort Thx for your update and addl links. My most recent PSA was 6. No other lab tests other than biopsy earlier this week.

I just joined this forum a few days ago. I have an Inbox so I should be able to receive PM. I can try to send you one and see if you receive it. I'll send one shortly...

Cheers

REPLY
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gonzaler84 | @gonzaler84 | Sep 6 12:12am
In reply to @ddavid "Hi: I have been getting treatment at the Hutch since 2019. Dr. George Schade was my..." + (show)
Profile picture for ddavid @ddavid

Hi:
I have been getting treatment at the Hutch since 2019. Dr. George Schade was my urologist and did my RALP. I know others who have seen Dr. Lin. They all speak very highly of him.
For GU oncologists, Dr. Schweitzer is recommended by many.
With regards to getting a scan ahead of time. You may try scheduling it at Harborview Medical Center or UW Medical Center if you can't get it done in time at the Hutch. Both are part of the UW Medicine network and closely tied with Fred Hutch. Medical records are visible throughout the network. Many of the Fred Hutch doctors are part of the UW Medicine system.

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@ddavid Ty for your update on Lin and Schweitzer...his name has come up several times now. Will def see if I can get time w him...

Good idea on Harborview or UW for the scan...

Cheers
Sergio

REPLY
Profile picture for gonzaler84
gonzaler84 | @gonzaler84 | Sep 6 12:15am
In reply to @dailyeffort "@gonzaler84 I was able to have the PSMA PET done prior to my initial meetings. If,..." + (show)
Profile picture for dailyeffort @dailyeffort

@gonzaler84 I was able to have the PSMA PET done prior to my initial meetings. If, after checking with Overlake (and UW as well) you are unable to get the scan scheduled ahead of your Oct 8 meeting, I would probably request the initial meeting be rescheduled in the event that they are unable to "pull some strings" to get it scheduled ahead of time.

What was your most recent PSA? What other labs or tests are being done to provide you with additional data upon which you and your doctors can arrive at the best possible treatment decision?

Below are two links that will be of interest:
https://fox5sandiego.com/news/tv-travel-guide-rick-steves-on-road-to-recovery-after-cancer-diagnosis/
https://x.com/RickSteves/status/1893507918563340618
In a later post you mention submitting a list of questions in advance of your appointment. It is a very good idea and is something I always do.

Let me know if you have you been on Mayo Clinic Connecct long enough to send/receive private messages?

Bill

Jump to this post

@dailyeffort Bill, just checked and am unable to send a message. You can try to send me one and I'll reply once I receive it.

Ty

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