Posted 1/31/2009 3:48 PM (GMT -6)
I know this thread is going to generate a lot of controversy, but we can also learn through controversy.
The prostate cancer world is very different from the rest of the cancer world in one improtant area: The oncolgisist in most other cancers get involved up front. They are usually the 1st doctors that a patient is referred to after a diagnosis or suspicion. The oncologist confims the DX, stages the cancer and recommends treatments. Surgeons, Radiolgists and other specialists are brought on board to support the treatment and the oncologist follows up afterwards with regular appointments to monitor any reoccurances.
In the prostate cancer world the urlologist is usually the 1st doctor a patient sees when PC is suspected. He does the DX, makes the recommendation and sometimes even performs the treatment. An oncologist only gets involved when the cancer has reached the stage where it can no longer be cured by a local treatment.
A urologist is not an expert in PC as he also works with bladders,, SDS, women's problems, ED and many other issues. If a patient is lucky he is referred to a urological surgeon who devotes a major portion of his practice to PC and has a much better knowledge of it. If the treatment is beyound his control he may refer one to a radiologist or an oncologist, but the oncologist is always the last on the list, not the first as in other cancers.
My own experience and my research supports that oncologists generally do a much better job in diagonosis, staging, and recommending the most effective treatment options. They use more tools, tests and imaging, and are more aware of the latest technologies and methods.
I know there are always exceptions to any rule and this thread will generate a lot of exceptions. I have had 5 urologists in my quest, one the head of the cancer department of a major hospital, one trained at Slone Kettering; another is now head of urology at a major cancer center that we would all recognize as one of the best.
In a 45 minute consult with an oncologist I learned more about my cancer, heard about 3 additional tests I should have been given and told about several probabilities that I never considered and were never discussed with me.
I'm convinced that a prostate oncologist should be on the list of everyone for a 2nd opinion after a diagnosis.
I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%
I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.
in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.
2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.
Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.
Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.