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DUKE MEDICINE
Judd Moul, MD posted:
Hello. I am Judd W. Moul, MD, Professor and Chief of Urologic Surgery and Director of the Duke Prostate Center at Duke University Medical Center. My interest in medicine began when my father died suddenly as I was completing high school. Several years later, my father-in-law died of advanced prostate cancer, solidifying my desire to become a prostate cancer specialist and surgeon. My goal is to cure the cancer and ensure that the treatment does not hinder my patients' quality of life. I look forward to corresponding with you about your concerns.
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Caprice_WebMD_Staff responded:
It's great to have you here, Dr. Moul, and I really appreciate you sharing the background info, learning what motivated you to be a doctor in the first place and then to specialize in this field.
 
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DUKE MEDICINE
Judd Moul, MD replied to Caprice_WebMD_Staff's response:
Thank you.
 
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gwclinic responded:
Dr Moul
I am 51 could really use your advise diag 10 months ago psa 5.5 3 3=6 1 of 12 cores cancer. my psa keeps going down now 2.2
not sure if i should have biosay reread repeat it. get mri or just watch and wait. I have been eating better green tea pomagrante, lots veggies lean meats curry,ect...please give me wome ideas or imput what next?Rob
 
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DUKE MEDICINE
Judd Moul, MD replied to gwclinic's response:
Although I am not permitted to provide specific medical advice to you, I can provide some general information. The treatment of early stage localized prostate cancer must be individualized. Your options include nerve-sparing open or robotic prostatectomy, various radiation options or active surveillance. Although active surveillance is a reasonable short-term option, it may not be durable for most young men with a long life expectancy.

My own bias as a surgeon would be to have surgery. I am in a very similar age group and would likely choose an open, nerve-sparing radical prostatectomy by an experienced surgeon.

At Duke, we are currently doing a study of pomegranate supplements to learn if it helps to prevent prostate cancer progression.

You may want to get an opinion from a medical center that offers a multi-disciplinary (urologists, medical and radiation oncologists) prostate clinic.
 
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gwclinic replied to Judd Moul, MD's response:
Dear Dr moul
I also have cll fish was 13q my white blood 23,000 also found out 10 months ago. Do not know life expectancy is there a way to find out if my cells are aggressive they said i was t1.
Thanks so much rob
 
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gwclinic replied to Judd Moul, MD's response:
Dr Moul
Will a mri and spectroscope help me find out more where I am. I really just need to know aggressiveness of cells not to excited about do a biosay again but would you recommend that at a year or would the mri be more helpful.
Thanks Rob
 
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riverrat35 responded:
HELLO I WAS DIAG. WITH PROSTATE CANCER IN OCT. AND HAD SURGERY ( ROBOT ) ON NOV.2 2009. MY NUMBERS WERE STAGE 2 WITH SOME PERINAL INVASION AND CLEAR LYMPH NODES ALSO HAD A PSA OF 5.9 AND A GLEASON OF 9. NOW I AM STARTING RAD BECAUSE MY PSA NUMBERS ARE RISING FROM .025 TO .6 IN JUST TWO MONTHS. SHOULD I EXPECT THE RADITION TO TAKE CARE OF ANY CANCER THAT WAS LEFT AFTER MY SURGERY? DOES THIS HAVE A VERY GOOD CURE RATING? I FEEL FINE AT THIS TIME BUT WILL I BE ABLE TO WORK THOUGH 30 TREATMENTS OF RAD.? THE SURGEON SAID THAT HE TOOK AS MUCH OUT AS HE COULD, DID TAKE ALL THE NERVES AND HE RECOMMENDED THE RAD. TREATMENTS AFTER SURGERY.
 
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az4peaks2 replied to riverrat35's response:
Hi riverrat, - It will all depend on whether the PSA is coming from malignant cells that are "localized" or whether your disease has already become "systemic".

Radiation may well be effective IF the PSA stems from either tissue left behind in the Prostate bed or cells that have migrated to immediately adjoining tissue, which would qualify as "local or regional disease (locally extended).

However, if malignant cells, perhaps in a size too small to be detected by currently available technology, have already escaped into the blood/lymph circulatory systems, Radiation will not be able to cure your disease. Unfortunately, it is often unable to be determined which status exists and the only certain way to determine cure is to continue to monitor post-treatment PSA results until a man dies of some other fatal malady.

Most men are able to work through the time of their salvage radiation, although you MAY experience a greater sense of fatigue and some temporary urinary frequency/urgency as the treatments accumulate. These symptoms usually self-resolve as post-treatment time increases.

OVERALL, salvage radiation following failed surgery is about 50/50 in its permanent success at 5 years and 25 to 40 percent at 10 years, depending on a number of varying factors.
Realistically, with a Gleason 9 your risk of systemic disease is statistically greater than with a more moderate Score of 6. This, however, is perhaps even more reason to try for a local cure, while there is still a chance for cure, if it is still, POSSIBLY localized and potentially sensitive such treatment.

Good luck! - John@newPCa.org (aka) az4peaks
 
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riverrat35 replied to az4peaks2's response:
THANKS FOR YOUR IMFORMATION. I AM ONLY 49 YEARS OLD AND MY RADITLOGIST THINKS THAT THE CANCER CELLS ARE STILL IN MY PELVIC AREA. MY GLEASON SCORE OF 9 WAS ONE REASON FOR MY RADITION TO START AS SOON AS POSSILBE AFTER SURGERY. THEY SAID TO NOT LET THE CELLS HAVE A CHANCE TO MOVE TO OTHER AREAS. MY URLOGIST WAS GOING TO START WITH THE PENIAL SHOTS TO IMPROVE MY ERECTIONS BUT HE SAID I WOULD HAVE TO WAIT UNTILL RADITION WAS OVER. HAVE ANYONE BEEN TOLD THIS BEFORE? DOES RADITION INTERFER WITH THE PENIAL SHOTS? THANKS
 
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pjmck responded:
I have been recently diagnosed with prostrate cancer. And am considering the HIFU procedure. I understand that some research has been done at Duke. I would like to speak with someone that has been involved with the research. And receive information on the success with this procedure. Also would like to know when this procedure would be available in US. As I undestand it, this procedure is only approved Canada, Carribean locations. Do you have any experience with the HIFU procedure?
Thank you for your response.
 
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DUKE MEDICINE
Judd W Moul, MD replied to pjmck's response:
Dr. Cary Robertson, here at Duke, is currently conducting a clinical trial using the Ablatherm HIFU system on patients with low-risk, localized prostate cancer. For more information, please contact the trial coordinator, Ms. Jill Smith at 919.668.3613 or email: smith248@mc.duke.edu
 
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KSDAD2 responded:
I (we) are searching for answers--and are eager for any suggestion you may offer. Sounds like you are very motivated and caring we need more like you--so glad you are here!!

Currently for the 2 hours following a bowel movement, I pass sediment and occasionally bits of stuff in my urine---it stings as it moves thru the urethra. I have identified carrot, tomato skin, flax seed and a sesame seed. (I caught the sesame seed in a sample cup and had it sent for cytology) no one can find the hole--what can I do. who can help--this is getting miserable. been going on since Aug 09--I would be happy to fill you in on my efforts so far thanks, ksdad2
 
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pjmck replied to Judd W Moul, MD's response:
Thank you for the information. Ms Smith was very helpful and gave me information on contacts for the Ablatherm HIFU system in Canada.
Regards,
pjmck


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