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.

begreat99 | @begreat99 | Sep 6 7:02am

In reply to @biggalew "@jeffmarc Any direction down here in the Tampa Bay area of Florida?" + (show)

@biggalew
Dr. Pow-Sang at Moffitt is Tampas best prostrate surgeon expert. Industry leader.

dan06 | @dan06 | Sep 6 7:32am

In reply to @biggalew "@jeffmarc Any direction down here in the Tampa Bay area of Florida?" + (show)

@biggalew Dr Pow-Song at Moffit in Tampa did my biopsy. For this area, he is touted as one of the best.

jim18 | @jim18 | Sep 6 8:29am

In reply to @gonzaler84 "Question: did any of you send your questions in advance to the team prior to your..." + (show)

@gonzaler84 The treatment recommended will be vastly different for a PSMA PET that is clean vs. one with a few bone spots vs. one that lights up all over. That could make a lot of your questions moot. I do not know these doctors, but many will not review before appointment. They will be looking at biopsy & PET results. It is useful to write out what you want answered so that you can make sure you ask all of the questions. For a first-time appointment there will be very little that they have not seen or heard before. Make sure you voice your wishes about quality vs. quantity of life.

gonzaler84 | @gonzaler84 | Sep 6 11:22am

In reply to @jim18 "@gonzaler84 The treatment recommended will be vastly different for a PSMA PET that is clean vs...." + (show)

@jim18 Jim, ty for your message. Agree that treatment will absolutely be influenced heavily by PET results. If I'm able to get scan done before visit on 08 Oct then I can review results online prior to appt and discuss w urologist how to best prep for the conversation.

Understand that they may not review q's in advance but the way the initial visit works is 3 of them meet together to review data, results and then I meet w each one of them individually. Perhaps when all 3 meet they can take a quick look at q's if sent in advance and get a sense of how to structure the conversation when we meet. Just one more piece of info for them to review...

Thx

Jeff Marchi | @jeffmarc | Sep 6 11:39am

You have a Gleason nine with what appears to be a lot of cores with problems, 6 of 7 is high. To really know what Risks you are at, a couple of things are necessary to know. Sorry I didn’t bring this up earlier.

What was your T level staging? T1 T2b or T2a T3a or T3b. Whatever you are is a factor in your treatment. I know someone with a Gleason nine that was a T1 so only ADT and radiation was recommended

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

As I explore the available options:
1. Alternative 1: Advanced Radiation + Hormone Therapy (ADT)

You can definitely have radiation, SBRT is useful hormone therapy is almost mandatory with a Gleason nine. If there is spread outside the prostate, they might want to use IMRT, VMAT Or one of the other options.

Before picking the next option, you need to know what the PSMA PET scan shows. If there’s no spread outside the prostate, then surgery may work, If there is spread, they usually want to do radiation. In either case with the Gleason nine, you probably need ADT.
2. Alternative 2: Alternative 2: Robotic Radical Prostatectomy (Surgery)

If your T level staging is higher than T1 And you have any of the aggressive issues than they would recommend you have an ARPI. I’ve been working closely with someone who has a Gleason nine but he is a T1 and no aggressive issues so the ARPI is not really called for.

You definitely have more to find out before you can make a decision. Hopefully you have a good doctor or a team of doctors that can work with you. With a Gleason nine if you have aggressive issues, you wanna have a GU oncologist working with you.