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  2. Charles (Chuck) Maack

    New Diagnosis - Our story

    Dear Pinks, I suggest you get an appointment (probably will be at your expense) with Dr. Manish Kohli at the Mayo Clinic in Rochester, MN. Here is info regarding this Medical Oncologist wherein Prostate Cancer is among his specialties. If/when making an appointment, and if you have the opportunity, explain that you are seeking the advice of Dr. Kohli regarding your father in Orissa, India who has been diagnosed with advanced, Gleason 9, prostate cancer, and it is paramount to have as early appointment with him as possible. When you open the following, you can click on “Request an Appointment” in the upper right hand corner. https://www.mayoclinic.org/biographies/kohli-manish-m-d/bio-20055166 You could save the following for your visit with Dr. Kohli: Dear Dr. Manish Kohli, I have made this appointment with you regarding my father recently diagnosed with advanced, Gleason 9, prostate cancer and who lives in Orissa, India. He just received an orchiectomy and has been prescribed bicalutamide pending further imaging results and determining what to do next; possibly chemotherapy. With this distance between us and my wanting to do all in my power to make sure the treatment protocol determined for him is reasonable, my hope was with a review of his diagnostics, biopsy results, and imaging to date, you would help me with your review and advice as to whether his current and planned treatment is considered by you as reasonable protocol for my father, or have other suggestions to pass on to my sister and brother-in-law in Orissa to discuss with my father’s treating physician. With your review and suggestions in this matter, you would help set my concern at ease.
  3. Great Barry - count Judy and me in! Alan
  4. Pinks

    New Diagnosis - Our story

    Thanks again Chuck. I will save your email address. I would like to thank you for providing guidance and support to people like me and others. I have not reached out to Mayo yet. I heard Dr Kwon (?) is pretty good doctor here. I hope we could get in touch with him. Will do that next week. At this point we are still thinking whether to go for chemo or not. More to be discussed with Oncologist next week. I will further update soon. Take care.
  5. seafriend40

    Merv ALLAN. My Story.

    Have spoken to my GP and requested a PET SCAN, was informed it could only be requested by a Specialist, contacted Oncologist, who had told me that with PSA at 61,"most likely I was riddled with cancer", wife was most upset when I told her!1Oncologist apparently is"upset" at my attitude, but am seeing him again next Monday, all i'm wanting is referral for PET SCAN!! Can't understand his attitude!!
  6. Charles (Chuck) Maack

    New Diagnosis - Our story

    Hah! Pinky, you had me fooled all this time in thinking I was exchanging information with a man! Good for you in taking up the challenge to help your Dad despite the distance between you. During my 22 years as a mentor to prostate cancer patients and their caregivers, I have worked with a multitude of women who were the caregivers and researchers on behalf of their spouses, fathers, brothers; I commend all of you and have found you are not only diligent, you have become very well informed in your pursuit of knowledge and understanding to help your loved ones! You are proceeding on a good move to see if a Medical Oncologist at Mayo Clinic in Rochester, MN will be so kind as to review your Dad's diagnostics and treatments administered to date and hopefully offer suggestions to enhance his treatment in helping to control and manage his prostate cancer. My email address is maack1@cox.net
  7. Pinks

    New Diagnosis - Our story

    Thanks so much Chuck. You are so wonderful in proving me the details. Appreciate it. Mumbai is far from our place. But we will travel if needed. Bhubaneswar is the big city in Orissa where there are many doctors and hospitals. The urologist who did my dad's surgery seems to be pretty up to date. He is treating lot of PCa patients as well. We do have a good Oncologist whom we will meet again. BTW, I am a woman and I live with my husband in MN. Been in states for a very long time and we are settled here. Here is an update on my dad - He is feeling better post surgery. No pains. They have given him few antibiotics and bicalutamide (Casodex). Next follow up in 12 days. Hoping for the best. He is a wonderful dad. In the mean time, I am trying to get at appointment at Mayo clinic for review and 2nd opinion. I hope they will meet us without my dad being here right now. Working on creating a full report on his diagnosis and medications etc.
  8. Charles (Chuck) Maack

    New Diagnosis - Our story

    Thank you for the "location" information. Found this as to Medical Oncology in Orissa: https://www.hospitalkhoj.com/hospitals/cancer/orissa - I had provided you info as regards Mumbai, but that is over 800 miles from Orissa. I have a nephew who was nick-named Pinky during his youth; actual name John, and that is what he goes by now. I don't know "your" age, but if 35 or over, make sure you have annual of at least both PSA and DRE checks so that if - because of family history - you should end up with prostate cancer cell development, it is caught early enough to eradicate it. Keep in touch.
  9. Pinks

    New Diagnosis - Our story

    Hi Chuck, My nick name is Pinky. Thanks for being so understanding. I am very thankful to get all the information and guidance here. I have sent the links to my sister, I think she checks time to time as well. These are very helpful information. At least we can ask questions to the doctors on the treatment plan. I got a crash course on this right away although still so much to learn. Definitely fortunate that my sister and BIL are in India and they are taking care of everything. Thankful to them. They all live in Orissa. I live in MN. Its getting cold here! Thank you for the link. I will take a look.
  10. Charles (Chuck) Maack

    New Diagnosis - Our story

    Hello again, Pinks (where did that name come from?). You can never give too much information, so no apologies needed. If anything, we are provided too little information making it difficult to determine how to reply since it is important to hopefully get as much of "all the information" as possible. You have been doing that quite well considering you are in the USA and your Dad is in India! Fortunate for sure is you have a brother and sister there in India; are they in the same location as your Dad - and by the way, where does your Dad reside? Have they supported the information you have provided them suggested by we on this forum? Was not aware that your Dad was experiencing urine flow problems so good to hear he has a catheter for now to release the urine flow from the bladder; not a comfortable situation! Since you mention "the urologist has cleared that up" we would hope once decided the catheter can be removed his urine flow will not be impeded by any blockage. By the way, where in the U.S. do you reside? I live in Wichita, Kansas. Please review www.theprostateadvocate.com.
  11. Walter

    Merv ALLAN. My Story.

    Hi Merv, i am the same age and situation as you, 3 years ago I had a psa of 9, 3 months later it was 21, and my urologist diagnosed me with prostate cancer. By the time I had a biopsy my psa had gone to 52. The biopsy was positive and was put on Lucrin Depot 4, which was a 4 monthly injection. By 6 months my psa was below 1. Unfortunately after a pet/ct scan it was found that the cancer had metastasided into my spine and bones. After chemotherapy and radiation I am under control and it has been controlled for the last 3 years. I am now doing some exercise classes which hopefully will improve my condition. My only suggestion is, don’t have chemo unless it is essential because there are many side effects and I still have them after 3 years. Good luck
  12. Colin Glover

    Merv ALLAN. My Story.

    Hi Merv I'm same age, a year ago my psa was 34. I went on to Lucrin 3 monthly within a fortnight my psa was 10 then dropped to 4.6 and has been steadily dropping to 3.6 a couple of months ago. All with little and manageable side effects. However I took up the exercise challenge of the Man PLan by Lucrin and have benefited significantly. I do it at home but it can be done in a gym. Best of luck.
  13. seafriend40

    Merv ALLAN. My Story.

    Thanx to all who replied. Forgot to mention I am 78 years of age, am married, and retired, have the tired part, still looking for re!!Had a long phone conversation with Jim, and that is how I come to be on this site!! Have just seen Oncologist, he has put me on Hormone Therapy, LUCRIN DEPO, I think, writing hard to read, initial 1 month injection then PSA test to see ifit has dropped from 61 where it is now. If everything OK will follow up with 6 month injection, fingers crossed!!!
  14. Pinks

    New Diagnosis - Our story

    Orchiectomy was done successfully today. They could not do the turp (channalization) because of the fear of rupture. The mass is spread there. They put a catherer (?) for now. His urine flow was blocked by something else, so the urologist cleared that up. Next - PSA check up in 14 days. Next steps on medicines and chemo etc - To be discussed further. Research on the drugs. Sorry if it’s too much information. But I am atleast happy that treatment got started after 1 month of diagnosis. It’s been a crazy day. 😰
  15. Earlier
  16. [PCFA have advised they are calling for nominations for the 2018 Max Gardner Award. I have attached below a copy of the call for nominations from PCFA, the Nomination Form, and a leaflet on Frequently Asked Questions about the strict conditions of the award. If you are aware of someone in this support group, or your local support group, that you think is worthy of nomination for this prestigious PCFA Award I urge you to consider nominating that person. Please note the strict closing date for nomination is 7 December 2018. Nev Black] Dear Network Members, We are excited to announce nominations are now open for the 2018 Max Gardner Awards. Max Gardner Award for Distinguished Service is a prestigious award presented by PCFA. It is awarded to an individual member of the Network that has made an outstanding and significant contribution to reducing the impact of prostate cancer on Australian men, their partners and families, recognising the diversity of the Australian community. This award is a peer-based form of recognition for PCFA Network members who are currently an official Ambassador, in a Support Group Leader role or an active member of an affiliated support group. We encourage you to share this message with your networks and look forward to receiving nominations, celebrating and recognising the fantastic work of Network Members across the country. For further information and convenience, we have attached the Max Gardner Award FAQ document and Nomination Forms. Nominations need to be submitted by Close Of Business Friday December 7th 2018 to supportnetwork@pcfa.org.au or Att: Network Support Prostate Cancer Foundation of Australia Level 5, 437 St Kilda Road Melbourne VIC 3004 If you have any further questions please feel free to contact myself via Network Helpline 1800 00 22 98. My best wishes, Support Network | Network Support Max Gardner Award - Frequently Asked Questions.pdf 4.1 Max Gardner Award - Nomination Form (Fillable) 2018.pdf
  17. Patrick Turner

    Lutetium177 Clinical Trial

    Well I hope we do. Not all is free, but for me that's OK. I have not followed through about asking exactly where Ra223 is made, but Bayer sell it, not sure from where. My finger / toe nails are fine so far, but could decide to leave me any time. Got to cycle a bit now, have lunch, then talk to Dr Lenzo at 2pm here, 11am in Perth, via Skype. Doc said I had 8 years at start of chemo, I said maybe 4, and when Psa went up so badly I thought maybe 2years or less. Once you get to bad bone pain, you are basically stuffed, life over, can't do much, and it only takes one or two bad bone lesions to cause enough pain. Bones are the castles of our bodies and if they are rotted out from within you have huge bothers. At another group HealthUnlocked, there are daughters posting about how their dad is getting along, and he isn't well enough to type anything. Keep well as you can mate, Patrick Turner.
  18. Pinks

    New Diagnosis - Our story

    Thanks so much Chuck. Appreciate your help. I learnt today that they met with the urologist and he is going to do orchiectomy and turp (channelization). It seems like he won’t remove the prostate as it is attached to bladder etc. Seems like Orchiectomy is become critical to be done right away. They are doing it tomorrow. He did suggest some other latest drugs and possible chemo as well. I am yet to get the full details on it but we are thinking to get the surgery done first as everyone has agreed on that. Then we we will decide on the drugs, chemo and radiations as needed. At this point, the hormones need to be shut off. Are there other options at this point? I think we don’t want to delay any further as it has spread to bones and lymph nodes. That’s why the urologist and Oncologist suggested to get it done right away.
  19. Chalkie

    Lutetium177 Clinical Trial

    I had 7 Docetaxel infusions from Feb to Aug last year - It brought my psa down from the 80s and stabilized at about 20. I could have gone on but was keen to get on to the Xtandi - which I am still using but it is running its race. My fingernails became infected one by one - perhaps I should have scrubbed them every night and bathed them in salty water early on. I gargled every night to keep my throat from getting infected and that worked. I admire your effort in riding your pushie to the hospital for your infusions 18kms that's a long way. I ride the bike at the gym for huff and puff and it certainly helps my cardio-etc and I continued through doing this when I was on the Chemo - it was harder but I pushed myself to do it as I hoped it would help with the effectiveness of the chemo. I now wonder whether I should have continued for longer and I am not sure if I can have it again if all else fails. I am off O/S for two weeks and hope that I have no real issues as no travel insurance was available for my medical situation and the Drs at PMCC say go for it. They gave me 5 years at best 14 years ago so I consider that I am on profit - and am making the most of it. So far my brain seems to be in tact and I am enjoying life - with lots of things happening around me. I guess you oar on the Denosumab to protect your bones My onco told me that the Radium 223 was only made in a nuclear power station in Norway! but that was a few years ago when a trial was about to happen but one of the vials was found to have a hair in it and the batch had to be destroyed Hearsay perhaps Anyway we are in a lucky country where many meds are free and available and lots of stuff happening in the future. Cheers
  20. Chalkie

    Lutetium177 Clinical Trial

    Scary - I am being considered for the TheraP trial starting in Nov. My psa is on the rise 75 to 125 in the last month and I am hoping that I draw the long straw when the trial for me starts. When I was on chemo last year steroids kept me going but there was a lot of peripheral neuropathy which is still lingering. But lifestyle was not too debilitating and I am told that most tolerate cabazataxel better that taxatere or detoxatel or what ever it is called. Watch this space in November
  21. Patrick Turner

    Lutetium177 Clinical Trial

    Hi David W. I have to raise a salute to your courageous efforts to type your continuing story of your fight with Pca. I am had 5th Docetaxel last Thursday, and before that was done I had meeting with onco who told me Psa had declined from 45 to 36 in just a week, which equals a 3 week halving rate, so my faith in chemo has not fully evaporated. Meanwhile, my referral to Dr Lenzo given in previous week went through and I have a Skype talk tomorrow, Sunday at 2pm here, 11am in Perth. I have filled in 14 pages of questioinaires about history and a consent form. Theranostics has become a part of genesiscare.com.au, I guess because its better for Dr Lenzo not to have to run an admin office, allowing him to spend more time doctoring with rising demands in Oz where public hospitals are still in trial modes. I don't know if you had Docetaxel, but I get neuropathy and legs feel a bit slowed, and its like skin of feet is glued to plastic sheeting, but I walk fine and cycle even better, and my hands also suffer but get better in last week of 3 for ech chemo cycle. I think having Lu177 soon is critical to me preventing damage to bone structures which begin in the inner parts of bone with blood supply. Once the lesion formed reached through the hard outer shell of each bone you can get lumps of cancer pressing on nerves and cartlidge tissue causing pain and damage to any joint, while making the bone less strong, so the sooner anyone hits the bone cancer mets the better, and its a tradgedy to let Psa go high and have Pca break through into the outer surfaces of bone. Bones of the skull are prone to Pca mets, and a break through to brain through the thin bone means real trouble. So I'll go with Lenzo if he thinks it'll do me good, and because my bone mets are PsMa avid, I should be within 80% of men who get at least 50% reduction of Psa. The latest scans show Docetaxel has not been useless because there's no mentions in report of any visceral lymph node spread seen in earlier PsMa scans. I've had 4 so far. All my organs are clear, but that just means whatever might be there is below detectable size. But PG which could not be removed with RP back in 2010 has moderate uptake of PsMa in its central portion where all the shit first happened, and of course the mets seen now could have mostly began when PG Gleason score moved from whatever it was, say when Gleason was 5 with pea size tumour and low Psa in 2005 to the monster inoperable gleason 9 in diagnosis 2009. Most of those mets were suppressed while ADT worked. But mets could have slowly dribbled out of PG after ADT began, and with whatever continuing mutations which now could be very numerous, and not eventually be able to be stopped by anything. So the Lu177 plus docetaxel will kill whatever they can while applied, and if there are mutation Pca cells near Pca cells that are PsMa avid, all these can be killed, maybe, and so I might get good result with lower Psa, but with underlying low levels of mutants than nothing could kill, unless perhaps Radium 223 is brought in to gate crash the cancer parties going on in my bones. The radiation Registra doc has written to thr Thera-P trial P about Cabitaxel or Lu177. They are still accepting patients but are not filling numbers because there isn't any benefit seen by many thinking men who can't get what looks best, Lu177, and then lose lifetime when Cabitaxel does not work, leaving them having to fund Lu177 after Cabitaxel has left them with bigger bone mets. I could get Cabitaxel at Canberra Public Hospital if I wanted to, or could now have changed to it because Psa rise from 12 to 40 after 4 Doctet injects sum up to a failure, and its just luck the Psa then went to 45 and then is now going down, but nobody knows exactly why, but I think its because visceral soft tissue mets have reduced Psa output, and the bone mets have maybe slowly risen. They must have, looking at the CT scans I have had, but bone met size and Psa levels become a bit non linear toeach other so Psa is less important. Bone mets can reduce in size, and a CT scan still shows them without size loss because radioactive scan isotope goes where calcium activity is happening and there is some where bones have had Pca. Bones where lesions occur fill with soft chalk like muck, or hard junk and both make bones more brittle and less able to take compressive force, or tension force where bones bend, and ribs are very susceptible. Maybe if your mets are avid for PsMa then more Lu177 may not do much harm although expect a drier mouth. I know a guy who has had a dry mouth for 10 years after IMRT to his throat area where he had a cancer hit him before he had Pca. He chews a special chewing gum and he copes, and is glad to be alive. His treating doc died of a similar neck cancer. I think Barry E has had 6 x Lu177, ask him how he fares with a dry mouth. Anyway, in my 4th Docet cycle I cycled each day except for 2 half way due to rain. My radiation doc said he's never seen anyone ride a bike right through the cycle. But it reduced all the side effects and nervous effects of restless legs and aches in muscles are less and I am doing stretch exercizes of leg muscles - big difference. Now I am expected to take 4 Dexamethazone tablets during day before Docet, on day of Docet, and day after Docet, and that occurs when I have recovered from previous 3 week chemo cycle, and I found it easy to do the to-from trip to hospital on bike of 38km, and on way home I ovwer took 11 ppl riding home from their dreary office jobs, some only 30. Well usually day 2 after chemo the body and mind gets the whamo from chemo, and youse jus don't feel like yourself. But today I tried one Dexa pill at breakfast, and felt so good, and rode 18km like yesterday without ills of bad legs dragging. Maybe a little Extra Dexa won't hurt, and allow me to pump the chemo round and round faster and faster while I ride, and getting it to mets again and again, amplifying the effects of chemo at mets. The same would happen with Lu177, round and round we go, and more Lu177 locates at mets than if I sit in a chair feeling morose. I am not a good walker, I have a bung ankle I broke at age 19, a bit lumpy, and I need to see a podiatrist about shoe mods, but manage without it. But I walk enough, and at hospital if I visit in car, I park far away in long stay zones and get a 2km walk rather than a short useless walk. So far, weight has not changed, resting HR is low, waist is < 100cm, BMI <25, and I am doing quite well to be able to continue most QOL stuff. Barry E said he saw a fella get 40 chemo injects. Wow, that is 120 weeks or 2.3 years. He didn't tell me if the dose was same but some cancer cases can lead to repeated doses at lower "maintenance levels" so cancer remains, but does not increase, ie, is under control. There is more QOL time with less side effect damage. but that's uncommon because cancer usually is not entirely indolent and either its all killed as I have seen or there's always some left after any treatment and that's what grows back again, maybe harder to treat especially if a man has got old and weaker from ageing, and unable to take side effects. Tomorrow wis a mystery day with unknown outcome when I talk to Dr Lenzo. I hope he can help me, and I'll just have to wait and see. My doc said Ra223, aka Zofigo, made at Lucas Heigts reactor, was available here, but I googled it and found nothing, but I may need it for bones. Maybe better than Lu177 which can work on bones if possible to, depending on PsMa avidity and mutations. Bone cancer is like a rats eating the walls of your house, hard to kill with a club, but in the rooms of your visceral soft tissue you can swing a club easier. I hope you get some good future treatment results, don't give up HOPE until you are really forced to. All the best mate, Patrick Turner.
  22. Chalkie

    Lutetium177 Clinical Trial

    Scary - I am being considered for the TheraP trial starting in Nov. My psa is on the rise 75 to 125 in the last month and I am hoping that I draw the long straw when the trial for me starts. When I was on chemo last year steroids kept me going but there was a lot of peripheral neuropathy which is still lingering. But lifestyle was not too debilitating and I am told that most tolerate cabazataxel better that taxatere or detoxatel or what ever it is called. Watch this space in November
  23. DavidW

    Lutetium177 Clinical Trial

    I have posted my general story elsewhere here. 2017 was my Cabazitaxel year and 12 months on I have debilitating neuropathy in hands and feet. Typing this is a struggle. I am reduced to a wheelchair for longer trips and wheel a cart around the house. Oncologists don't tell you it can happen and certainly no one has a cure answer. Some of you correspondents did considerable exercise post treatment which seems to have helped. I exercise by physio routine and struggled walking. But the chemo is fading in its effect. PSA from <1 now to 8. So I now have started Lutetium at my own cost. Two doses have reduced the PSA to 2 and two more to go at around 6 weeks gap. I had two (free) doses at St Vincents in Sydney 2016 as part of a trial but when I returned the trial had "stopped" so two expected doses were not available. Hence the commencement on Cabazitaxel. We're all wise after the event and now I know the virulence of Cabazitaxel. I should have paid $20,000 for two more Lutetium. I have no side effect from Lutetium - maybe a little dry throat and I am not strong and lack endurance but I blame Cabazitaxel for that. My spirits are good and I have minimal pain except for neuropathy stabbing. It doesn't last.
  24. It is great to put faces to names at our local catch-up meetings. This is a reminder to men and their partners in SE Queensland or Northern NSW. Members from anywhere in world visiting the area are welcome to attend. Saturday 3 November 2018 at the Greenbank RSL. For numbers: RSVP secretary@jimjimjimjim.com or surferscentury@hotmail.com Greenbank RSL is at Hillcrest, near Browns Plains. We will meet in the Gardens Cafe from 11.00am. Lunch will be in Gardens Cafe after 12 noon at our leisure. How to get to the Greenbank RSL The address is: 54 Anzac Ave Hillcrest QLD 4118 Phone (07) 3800 7746 Many ways to get there. This is the simplest to describe. 1. Come along the Logan Motorway. 2. Take the Browns Plains exit on to the Mount Lindsay Highway (Beaudesert Road) 3. Take the Boronia Heights exit towards Middle Road. 4. Travel along Middle Road until the first roundabout. 5. Take the 4th exit so you are coming back along Middle Road. 6. At you approach the highway again, veer left to travel along Anzac Avenue. 7. RSL is 54 Anzac Avenue on your left, car park on your right. If you are coming from the South along Mount Lindsay Highway (Beaudesert Road) 3. Take exit Middle Road towards Boronia Heights So, in short: • Logan Motorway • Browns Plains exit (There will be some roadworks) • Boronia Heights exit • Middle Road • Back along Middle road to 54 Anzac Avenue. Call Nev on 0419 673 096 if you get lost.
  25. Charles (Chuck) Maack

    New Diagnosis - Our story

    I meant to add, likely the best place in India to seek most all medications prescribed in the treatment of Prostate Cancer is All Day Chemist, www.alldaychemist.com. Drugs from India are more than likely equal to those sold in the U.S. – primarily because those sold in the U.S.- and probably the U.K. - are more than likely out-sourced for manufacture in India as well as other countries. From my understanding, the government of India has decreed that as long as a drug is produced in the generic form of an otherwise trademarked brand name, and the ingredients are equal to but not precisely identical in all forms to the brand name drug, they are authorized by that government to be manufactured for their own pharmaceutical use. The foregoing remark and the following interesting comment were in a paper no longer available on the internet, but pretty much explains: “However, the major firms say their plants, like the one owned by the Bombay-based Cipla Company, are more than safe. Many, in fact, are inspected by the U.S. Food and Drug Administration, since Indian companies export billions of dollars each year in generic drugs to the American market.”
  26. Charles (Chuck) Maack

    New Diagnosis - Our story

    The Urologist/surgeon will provide the orchiectomy, but then your Dad should come under the supervision of a Medical Oncologist for subsequent medications. Radiation is pretty much out of the question since where do you radiate (other than possibly targeted radiation to the specific "mass" that has been noted). In addition to the orchiectomy your Dad's adrenal gland produced androgen (testosterone) needs to be blocked from access to the multitude of "androgen receptors" present on cancer cells and that can be done by prescribing the generic of the antiandrogen Casodex (in the U.S. that is bicalutamide). I am a proponent of also including the 5-Alpha Reductase/5AR inhibitor dutasteride/Avodart since when any androgen/testosterone has made its way to the cancer cells it is converted by 5AR to dihydrotestosterone/DHT which is five or more times more powerful a stimulant to cancer cell growth and proliferation (dividing/multiplying) - dutasteride/Avodart inhibits that conversion. What might even more be considered in addition to the orchiectomy and these androgen/testosterone reducing medications is early chemotherapy followed by a return of these medications. Here in the U.S. androgen/testosterone deprivation accompanied by chemotherapy with docetaxel/Taxotere, and possibly accompanied by carboplatin to synergize the effect of docetaxel has become a recommended initial protocol with men diagnosed with advanced/high grade prostate cancer. The medications mentioned should be available at significantly reduced expense there in India since India is known as the manufacturer for many of these drugs subequently sold in the United States at higher cost.
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