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PSMA scan for PSA of 0.023?

User
Posted 04 January 2018 19:15:38(UTC)
Prostatectomy in December 2016 - T3bN0M0 Gleason 9 Positive margins. Age 46.

January 2017 - PSA 0.014 January 2018 PSA 0.023

Oncologist looking to start salvage radiotherapy. She said she wanted a scan to see if it would give a more complete picture. She said I can definitely have another Choline PET scan but said a PSMA scan had a better chance of picking things up. She said she had never had a PSMA scan approved by the NHS but was going to ask again.

Is my PSA too low for a PSMA scan to be truly worthwhile? Her view was a choline PET scan might not pick anything up and that there was a greater chance of detecting something with a PSMA scan. But no guarantees.

If the NHS won't fund it, I might consider doing it privately. Where in the UK can I get it done privately and does anyone know the total cost? What about Germany?

Ulsterman
User
Posted 06 January 2018 23:19:39(UTC)

We could all go - John has a 7 seater car x

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 21 February 2018 13:56:17(UTC)
I'm off to the Lake District for a few days, but Gambia is still on the radar screen, along with an awful lot of other places.

Ulsterman
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User
Posted 22 February 2018 09:57:49(UTC)
Chris

They will blast the whole prostate bed and the lymph nodes. I don't know if this is the standard treatment, but my oncologist does 32 days of radiotherapy to the prostate bed, or 37 if she wants to go further up the prostate bed to include lymph nodes. She doesn't like doing the 37 day treatment unless she knows for certain it is needed as there are more risks of later complications, I think in the bladder. At my January appointment, I told her I wanted the 37 days regardless and she said she would consider it. Now we have the evidence it is needed. Without the PSMA scan though, I might have had the 32 day treatment and left the cancer in the lymph nodes totally untouched. She said there's no way the Choline scan would have picked things up. Hope that all makes sense.

I had a few lymph nodes removed during surgery and so, inevitably, am wondering why they didn't remove these two. Maybe that's not standard practice. I'm not blaming my urologist, but just wonder what would have happened if he had removed them.

I'm so sorry they haven't found where your cancer is hiding and I hope the March scans finally find out what is going on.

Ulsterman

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User
Posted 04 January 2018 19:42:18(UTC)

I have had two PSMA PET Scans, both carried out privately at the London Clinic.

Best wishes

Dave

"Incurable cancer does not mean it is untreatable and does not mean it is terminal either"
User
Posted 04 January 2018 19:56:34(UTC)

Bear in mind that CJ has had fancy scans at a much higher PSA than yours without any success. Having said that, if I thought I could get J an FACBC I would pay.

I posted this in January 2017 on another thread

************************************************************************************************************************************

Posted Sunday, January 22, 2017 11:56:42 PM
It isn't a straightforward issue though, is it ChrisJ, and presumably the reason you are unlikely to be referred is that it is still in trial stage. Like John with the FACBC tracer, it seems you might not meet the narrow trial criteria :-(

 

This is a useful perspective from 'those that know'

http://www.birminghamprostateclinic.co.uk/prostate/assessments/pet-scans-for-prostate-cancer/

 

For anyone interested, this is the report on FACBC which has had great results in Italy and is now being trialled at a small number of hospitals in England (but again, with very narrow criteria)

http://www.europeanurology.com/article/S0302-2838(13)00905-6/fulltext/the-new-promise-of-facbc-position-emission-tomography-computed-tomography-in-the-localization-of-disease-relapse-after-radical-treatment-for-prostate-cancer-are-we-turning-to-the-right-radiotracer


*************************************************************************************************************************************

 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 04 January 2018 19:58:25(UTC)

Rough costs seem to be £1800 for choline PET scan in UK, and about £6000 for a Gallium 68 in Europe.

This thread has some useful discussion on the strengths / limitations of the different new tracers coming along

http://community.prostatecanceruk.org/posts/t12371-Psma-testing#post154275

 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 04 January 2018 22:01:46(UTC)

It is possible that from what your oncologist is suggesting, that your individual circumstances suggest that a 68 Gallium PSMA scan might reveal cancer in your case notwithstanding your lowish PSA. From what I have read a more usual starting point is 0.05 for this scan for patients with similar situations to yours but due to rarity and lack of experience of the scan oncologists are very much on a learning curve of just what it can show.

As regards the cost of this scan privately, as I reported on another thread in November last, having enquired of UCLH, the figure they gave was £2,200. The Royal Marsden quoted £3,700 plus a fee for their interpreting if required. There are a number of facilities who could do the scan in Europe and prices will vary. £3,000 would not be far out for Germany. A member located in Australia on another forum said the scan could be had in Melbourn Australia for Aus$800 and for a little more or less in other parts of Australia. So, for the price of this scan in Europe you could have it, including the air fare and a few days in the sun! If you think the OZ figure is wrong, read this :- https://www.huffingtonpo...for-to-s_b_12807018.html

Barry
User
Posted 04 January 2018 22:05:33(UTC)

Hi mate
We all know I’m a bit weird but I wouldn’t even be dreaming of RT at 0.023. That measurement could have moved just because you sneezed the night before. The ideal psa for cholinePET is 3 or more. I showed nothing at psa approx 2.2.
PSMA PET is regarded as being far more accurate at much lower psa values, however at pda 2.7 it revealed zero spread as well — not even the known positive margins on my bladder neck. I stamped my feet and got the PSMA free on the NHS at UCLH. I was told privately it would be £1800 but not sure about follow up costs etc.
I don’t really know what to say as it is your cancer and your fears and logic. You need to know that salvage RT is only 50% successful and you are mikes away from the normal 0.2 start recommendation. I know you value QOL like myself and it’s a tough decision. But given your stats I wouldn’t even think of paying. On the NHS then why not ?? Remember every scan is giving you radiation poisoning in one form or another , and RT at 46 can increase the likelihood of later cancers in bowel and bladder. All my best my friend




If life gives you lemons , then make lemonade
User
Posted 04 January 2018 22:09:58(UTC)

My C/pet/ct  scan showed nothing at 1.50

but at 3.1 it showed three mets

 

User
Posted 04 January 2018 22:28:51(UTC)
My choline F18 PET scan showed cancer (moderate uptake) in seminal vesicle remnants and subtle uptake on the Prostate bed(which was already picked up by a Gadolinium enhanced MRI). My PSA was 0.7 on 30/11/16 and was increasing fast so would be above that on 21/12/16 when I had the scan.
Best wishes, Ian.
User
Posted 05 January 2018 20:21:18(UTC)

So, rightly or wrongly, I'm proceeding with a PSMA scan.  If the NHS won't pay, I will.  It may show nothing up, but my understanding is it has a better chance of picking something up than even the choline PET scan.  If anything, I may be contributing to the advancement of medical science.

On Dave's recommendation, I phoned The London Clinic today and they said they can do in at the end of January for £2588.  I prefer Old Barry's link to Australia, but I'd never be allowed the time off work.

Now Lyn, that FACBC tracer - is there anywhere we can get it?  I'm tempted!

And CJ - without you I would never have known about Invicorp 25 or PSMA scans - so thank you.

I'll keep you all posted.

And I still don't understand the graphs from the other post!!!!

Ulsterman

User
Posted 05 January 2018 20:51:32(UTC)

I would seriously do more research before paying privately for a PSMA at such a tiny tiny value. Yes I got one on the NHS , and that was partly because I was the first from Southampton General , but only on the grounds my PSA was rapidly rising and approaching 3 again. They won’t even give me another one now my psa is 12. Seriously your choice but I’d at least wait to see if your psa rises again in 3 months time. Personally I had 6 f**k -ups with PET scans with the tracer reliability and I’m not sure we’ve got that right in the UK yet. Best wishes whatever you choose , but choose wisely




If life gives you lemons , then make lemonade
User
Posted 05 January 2018 20:59:19(UTC)

“About the FALCON Trial

The FALCON trial, “Fluciclovine (18F) PET/CT in biochemicAL reCurrence Of prostate caNcer (FALCON),” is an open-label multi-center study in the U.K. designed to assess the clinical utility of fluciclovine (18F) PET imaging in the management of patients with prostate cancer with biochemical recurrence after initial treatment. The primary endpoint is to evaluate the clinical impact of fluciclovine (18F) in affecting treatment decision and is assessed by comparing records of the patient’s treatment plan after a fluciclovine (18F) PET scan with the treatment plan prior to the scan. Secondary endpoints include evaluation of the effect of treatment change in patients with positive fluciclovine (18F) PET imaging findings who had a treatment change involving radical salvage therapy; diagnostic performance; PSA threshold; safety assessment and comparison with choline PET (if performed).

The FALCON trial is jointly funded by Innovate UK and Blue Earth Diagnostics and is being conducted at six leading institutions in the UK: Oxford University Hospitals NHS Foundation Trust, University College London, Kings College London, The Royal Marsden NHS Foundation Trust, The Leeds Teaching Hospitals NHS Trust, Mount Vernon Cancer Centre and Greater Glasgow Health Board. Additional information about the FALCON trial is available at: www.clinicaltrials.gov (NCT02578940).”

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 05 January 2018 21:10:42(UTC)

Forget that - I built you up only to crush you! Recruitment is closed already :-(


https://www.clinicaltria...p;city=Leeds&dist=50


From what I can remember, John didn’t meet the criteria because his PSA was too low so you probably wouldn’t have got on it anyway. But as I said, if I could pay for it, I would .... our Mr B was very excited about the results it has had in Italy.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 05 January 2018 21:29:58(UTC)

Lyn

Can we not go to Italy and have it done?  Surely between the two of us we could find a way??!!

Ulsterman

User
Posted 05 January 2018 21:50:18(UTC)

Best proposition I have had in a long time :-)

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 05 January 2018 21:50:43(UTC)

It would have to wait until a school holiday though :-(

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 06 January 2018 01:47:30(UTC)

Because of advances in scans it is difficult to ascertain which is the best one for a particular man's situation. It may well be that scan A reveals more than scan B with low PSA and micro mets whereas scan B shows better say within the Prostate or elsewhere. Then there is the matter of finding where you can get the scan. Often these advanced scans are only available within a trial so you have to meet the criteria of the trial. Some you can have done at varying cost as a private patient but with a referral from your GP who probably knows less than you do about scans! This is another promising possibility for some but at an early stage as yet. https://www.kcl.ac.uk/ne...ncer-test-developed.aspx

As it happens, I have an appointment with my GP next week with a view to being referred back to the Royal Marsden in the hope that they will give me the 68 Gallium PSMA scan within the NHS. Should they not be prepared to do so, I will check whether UCLH will do the scan privately as they will not do so within the NHS. Other options would be Germany or Australia but my wife is now dependent on me and no longer really up to long distance travel.

Incidentally, my original RT treating hospital in Heidelberg suggested in my situation that I had the 68 Gallium PSMA test if my PSA reached 0.7 and it is already 0.99 (at last test). If the scan showed cancer they held out the possibility of further RT/HT.

I am most interested in how you get on at the London Clinic, this could be yet another option for me. Decisions decisions!

Barry
User
Posted 06 January 2018 09:13:34(UTC)

I’d ask to come too , but I think I’d be in the way 😁😁
I might get stroppy again though and ask for an 18F PET. We can but try !




If life gives you lemons , then make lemonade
User
Posted 06 January 2018 23:19:39(UTC)

We could all go - John has a 7 seater car x

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 31 January 2018 15:02:18(UTC)
To keep you updated. Miraculously, my NHS trust said it would refer me for the PSMA scan and pay for it. After a month of waiting, and a bit of chasing from me, they told me they just couldn't get it organised quickly at any of the NHS centres which can do it.


I told them to stop trying. The London Clinic will do it next Wednesday.


Ulsterman
User
Posted 31 January 2018 21:43:27(UTC)

That’s amazing news - fingers crossed it gets you the answers you want

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 31 January 2018 22:56:08(UTC)

I am sure many of us will be interested in learning how it works out for you.

Barry
User
Posted 01 February 2018 07:42:58(UTC)

Well no-one more interested than me. I really have my doubts about this as you know. Not the scan technology but the seemingly terrible difficulty getting the tracer produced right at exactly the right time. I’ve had two PET scans but four last minute cancellations. My psa was 3 for the PSMA PET scan and it didn’t even pick up my known margins at the bladder neck .... work that one out. I’ve just been given my dates mid March for two more scans. My psa will be 24. They would not offer PET , but merely Bone and full body CT. He reckons that will be enough GULP
Best luck my friend




If life gives you lemons , then make lemonade
User
Posted 01 February 2018 16:37:21(UTC)
I could have had a choline pet scan or try for this PSMA scan. It's funny, though. Either way, I don't win. If the scan is clear, there's always the doubt that it missed something. If it finds something, that's hardly brilliant news. Nonetheless, I've made the decision to proceed. Maybe I'll be making a small contribution to medical science.

Ulsterman
User
Posted 01 February 2018 18:11:00(UTC)
Good luck Ulsterman,

My experience of the PSMA Pet scan at the London Clinic is that they are very efficient and professional. You will be in good hands.

Regards

Dave
"Incurable cancer does not mean it is untreatable and does not mean it is terminal either"
User
Posted 01 February 2018 21:57:57(UTC)
Dave

Glad you told me about the London Clinic - my oncologist hasn't ever referred anyone there before.

Ulsterman
User
Posted 01 February 2018 22:23:57(UTC)

Chris,

The quality of the tracer for the Choline scan is very hit or miss. It is produced on a cyclotron elsewhere and delivered in double quick time to the treating hospital as it has a very short half life. As was the experience of some other members, the first batch delivered for me did not meet the standard required and a further batch had to be made.  The ligand for the 68 Gallium PSMA scan can be produced with a generator and hopefully will result in fewer rejections for unsatisfactory quality.  Hope Ulsterman does not have a problem with his scan.

Barry
User
Posted 01 February 2018 23:32:35(UTC)

Thanks Barry. I know you are ultimately much more well informed than I , but the PSMA was cancelled twice also due to “ production reasons “ which cost me significantly in transport and hotels ( but I’m not complaining ) !!! I wouldn’t put it past 3 failures for a company to supply a tracer that wasn’t quite perfect to keep their status. You know the score in any business. If you can’t provide the goods .... I’ve seen far too many failures. Yes I may have very micro mets but it’s taken me six attempts to get two PETS which were both undetailed to such an extent that they won’t give me another at PSA 24 post op. That surely shows lack of faith in Southampton NHS of this technology ?? Scan fine — but tracer very unreliable ?




If life gives you lemons , then make lemonade
User
Posted 02 February 2018 00:28:32(UTC)

The flip side of that is that some men present initially with PSA of 4 or 6 or 10 or whatever and the tumour areas show up on a normal run-of-the-mill scan so it could be your cancer that is odd rather than the tracer being faulty?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 02 February 2018 07:50:10(UTC)

Yes I am odd. It’s always been said. I think the data PCUK sent me says it cannot “ pick up “ on 8% of subjects. I always knew I’d be good at something :-)




If life gives you lemons , then make lemonade
User
Posted 07 February 2018 20:30:35(UTC)
Had my Ga68 PSMA scan today at the London Clinic - thanks Dave for the recommendation. It cost me £2588. The reports will be with my oncologist on Friday. I'll keep you all posted.

Ulsterman
User
Posted 07 February 2018 21:54:17(UTC)

Good news and no c**k-ups ! As you say you’re not sure what a good result is. But I hope it’s a negative as ideally that’s what you want. I can’t imagine what it may see at psa 0.02 , but you never know. Everyone’s PCa is different as you know by now. But not sure you should have had to pay for it - prob because psa was so low ?? Anyway here is hoping you get the answers you need




If life gives you lemons , then make lemonade
User
Posted 08 February 2018 08:14:18(UTC)
Chris - the NHS was willing to pay but just couldn't get it organised quickly enough so I decided not to wait and go private. I was the first from my nhs hospital to be offered the scan on the NHS - because I'm young and high risk

Ulsterman
User
Posted 08 February 2018 08:31:21(UTC)
Originally Posted by: Online Community Member
Had my Ga68 PSMA scan today at the London Clinic - thanks Dave for the recommendation. It cost me £2588. The reports will be with my oncologist on Friday. I'll keep you all posted.

Ulsterman


Ulsterman,

I am delighted you were able to have the scan. In my case it picked up pin pricks of cancer cells which were unfortunately in places they should not have been and hence the aggressive treatment regimes that have followed for me in trying to flush them out. I do hope they pick up everything for you, it will be such a head start for you and your Onco to have in your armoury.

On a lighter note, I hope you didn't fall in the trap of tipping the doorman at The London Clinic. On many occasions he is decked out in all his regalia and it is difficult to sometimes remember you are at a hospital and not a hotel.

All my very best wishes to you

Dave
"Incurable cancer does not mean it is untreatable and does not mean it is terminal either"
User
Posted 08 February 2018 12:47:34(UTC)

Dave

The doorman and reception staff all did put me in mind of hotel concierges.  After paying as much as I did, I wasn't minded to tip anyone!  Call me miserable.

Ulsterman

User
Posted 21 February 2018 12:14:30(UTC)
Well, it worked and I didn't waste my money

With a PSA of 0.023, the PSMA scan picked up cancerous cells in two ymph nodes further up the prostate bed. It picked nothing up on the prostate bed itself and nothing in the bones.

The plan of action? I start bicalutimide today for six months and will have 37 sessions of radiotherapy.

Quite worried about the bicalutimide. Don't want boobs!

Off to pick up my prescription.

Ulsterman
User
Posted 21 February 2018 12:56:15(UTC)

Well in the world of poor outcomes that is a bloody marvellous outcome. So pleased for you that you have a plan and that there is a really good chance of the plan working.



You will make it to Gambia yet :-)
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 21 February 2018 13:56:17(UTC)
I'm off to the Lake District for a few days, but Gambia is still on the radar screen, along with an awful lot of other places.

Ulsterman
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User
Posted 21 February 2018 15:01:45(UTC)

Picking up cells with a PSA of 0.023 is amazing. I'm sure you would rather not be in this position but as Lyn has said there is a real chance to deal with this successfully now.

Hope it all goes well and you enjoy the Lake District plus many more holidays elsewhere.

 

Ian

User
Posted 21 February 2018 17:53:51(UTC)

Well worth getting the PSMA scan which has helped a decision on your further treatment but as Chris said not suitable for all men and in all situations. It was specifically designed for PCa and should provide a more definitive result than the Choline one which, as in my case resulted in different interpretation. According to an Australian Professor, they are going over to the PSMA scan now for PCa, which is becoming available at a number of centres in Australia as I posted elsewhere. He said they abandoned the Choline one after only about 6 months but it is still being used in the UK.

Barry
User
Posted 21 February 2018 18:46:17(UTC)
I'm delighted that they found the pin pricks of cancer cells for you.

I told you the London Clinic were good, they really are at the top of their game there.

My Oncologist has repeatedly told me that without these new high powered scanners they are blind to knowing where the cancer really has spread to until it is too late in some cases.

I am one to talk as my numbers are not the best by some way, but at least the Chemo is keeping some degree of control on it (infusion number 14 yesterday with 2 more to go in this session to bring it up 16 infusions)

My very best wishes for a full recovery Ulsterman.

Regards

Dave
"Incurable cancer does not mean it is untreatable and does not mean it is terminal either"
User
Posted 21 February 2018 21:31:40(UTC)

Wow I’m glad you’ve not wasted the money and have a plan ahead. Even though it’s just 2 lymph nodes are they going to blast the whole area ? Was targeted therapy offered or advised ? I’m simply baffled mate. Where the Hell is my cancer ?? My psa expected at roughly 20 now. Well we will soon find out as I have a full body CT and Bone scans end of March. Hopefully it’s all a mistake and I’m actually fine. I’m living , loving , working ..........
Best wishes as ever from our camp




If life gives you lemons , then make lemonade
User
Posted 22 February 2018 09:57:49(UTC)
Chris

They will blast the whole prostate bed and the lymph nodes. I don't know if this is the standard treatment, but my oncologist does 32 days of radiotherapy to the prostate bed, or 37 if she wants to go further up the prostate bed to include lymph nodes. She doesn't like doing the 37 day treatment unless she knows for certain it is needed as there are more risks of later complications, I think in the bladder. At my January appointment, I told her I wanted the 37 days regardless and she said she would consider it. Now we have the evidence it is needed. Without the PSMA scan though, I might have had the 32 day treatment and left the cancer in the lymph nodes totally untouched. She said there's no way the Choline scan would have picked things up. Hope that all makes sense.

I had a few lymph nodes removed during surgery and so, inevitably, am wondering why they didn't remove these two. Maybe that's not standard practice. I'm not blaming my urologist, but just wonder what would have happened if he had removed them.

I'm so sorry they haven't found where your cancer is hiding and I hope the March scans finally find out what is going on.

Ulsterman

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User
Posted 22 February 2018 10:37:49(UTC)

Not all urogists routinely remove lymph nodes but when they Do, they tend to only remove the ones immediately next to the prostate.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 22 February 2018 17:37:37(UTC)
Originally Posted by: Online Community Member


The plan of action? I start bicalutimide today for six months and will have 37 sessions of radiotherapy.

Quite worried about the bicalutimide. Don't want boobs!

Off to pick up my prescription.

Ulsterman


You should consider asking the Onco for Tamoxifen to try and counter the man boob growth/pain

Not certain to work by all accounts but for me it’s worth the try as I started getting growth and pains fairly quickly
User
Posted 22 February 2018 21:26:49(UTC)
She said no to tamoxifen and nearly took the head off my shoulders for suggesting a burst of radiotherapy to my breasts. I was taken aback as I have a really good relationship with both my oncologist and urologist, and some members of the forum have commented that I seem to have treatment more like a private patient than an NHS one. But on the radiotherapy to the breast, I was spoken to sternly. It shut me up, and, believe me, that isn't easy to do.

I'll see if I can get round my GP for tamoxifen.

Hope things are going a bit better for you, Kayaker Bill.

Ulsterman
User
Posted 22 February 2018 21:30:43(UTC)

It's odd isn't it that so many men get it but some oncos just refuse outright. I wonder if there are additional risks that they know and we don't? I shall ask Mr B when we next see him.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 22 February 2018 21:31:21(UTC)

My surgeon said he could remove all the lymph nodes as well as everything else. But one guarantee he could make was that he could not put them back. He said full removal of lymph nodes could lead to mobility problems as the legs could swell.

So he just took a smallish sample and removed 15

Bri

User
Posted 22 February 2018 23:28:02(UTC)
Originally Posted by: Online Community Member

It's odd isn't it that so many men get it but some oncos just refuse outright. I wonder if there are additional risks that they know and we don't? I shall ask Mr B when we next see him.



My Onco seemed reluctant and more worried about risk of DVT rather than anything cancer related

But she did prescribe 10mg weekly and will put up to 20mg next week when I’ve recovered fully from my chest infection
User
Posted 23 February 2018 07:26:30(UTC)

Yes , as I’ve said from the very start , it still seems wherever you are in the country you may be treated differently despite having an identical PCa and scores !! I had to fight and fight for Cialis !! But Tamoxifen 20mg offered on a plate. Offered RT but it was a no no no to 20 sessions instead of 35.
I was dry almost immediately after surgery and it was stated I was fifth in a row after Mr X had performed on me. Let’s hope his technique is widely shared around the country.
I guess also Walter that some Oncos hate the fact that we have informed ourselves via this site and google etc.




If life gives you lemons , then make lemonade
User
Posted 23 February 2018 10:35:01(UTC)
Chris

Do you take tamoxifen 20mg weekly or daily? I'm going to ask my gp.

My daughter who is training to be a doctor told me that doctors have a name for well-informed internet-searching patients. My oncologist laughed when I said that to her and said I definitely didn't fall into that camp and that she enjoyed our consultations! But there is no way on God's earth she is going to blast my breasts as a precaution!

Ulsterman
 
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