Urologists Vs Prostate Oncologists

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John T
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Date Joined Nov 2008
Total Posts : 4203
   Posted 1/31/2009 2:48 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.
JohnT
 
 

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.

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/31/2009 4:52 PM (GMT -6)   
Technically, neither urologists nor oncologists diagnose cancer, but rather pathologists do. And some urologists are specific to prostate cancer in their work. But I do see the reason to ask and get an oncologists opinion. Don't be surprised when he sends you to a urologist for surgery as oncologists don't always make the best surgeons but will admit surgery or radiation, or other ablation is a good option. In fact few of the top oncologists in prostate cancer do surgery, and that's a good thing I think. But you can find that all oncologists will find a good use of surgery and refer you when it is best to do in their practice. Be it RP's or Lymphandectomies, or a debulking procedure, there are times when the knife is a good practice. My urologist at the time of Dx was as you said, practicing any form of urology. He recommended some top surgeons and I selected one of them. His title was Director of Urological Oncology for the City of Hope. He was also a master surgeon and oncologist. I was pleased with his work.

Second opinions are great, and a good oncologist is well qualified to give it. Thing is, not all oncologists agree on how to treat prostate cancer and if you select an oncologists treatment for primary care,,,,,get a second oncologists opinion...But remember some countries, and insurance companies will not let you keep getting opinions. Use the time wisely.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 1/31/2009 5:01 PM (GMT -6)   
Tony, you bring up a good point. Not everyone has the time, financial options, insurance options, to secure every possible consultation and opinion, I wish it were that way. Also, even here in the US, your geographic location can make a difference, you may be in a very rural area with limited choices and doctors, and don't have the resources or other reasons that you can't travel far. And if you are one of the unfortanate few with an agressive cancer, i.e. high psa and gleason and perhaps other tests, then you as the patient, and your doctor, really don't know with any extreme accuracy how much time you have to spare awaiting treatment, that part is always a bit of a gamble. It can go either way.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/31/2009 6:41 PM (GMT -6)   
I think I need to revise my thought a little. Clearly, any urologic surgeon removing a tumor is a practicing oncologist. But not all oncologists are surgeons.

Oncology is the branch of medicine that studies tumors (cancer). A medical professional who practices oncology is an oncologist. The term originates from the Greek onkos (ονκος), meaning bulk, mass, or tumor and the suffix -logy, meaning "study of". The oncologist organizes the care of cancer patients, which may involve various treatments of different disciplines such as physiotherapy, counseling, clinical genetics. Oncologists often consults with pathologists on the exact biological nature of a tumor that is being treated.

Oncology is concerned with:
The diagnosis of cancer
Therapy (e.g., surgery, chemotherapy, radiotherapy and other modalities)
Follow-up of cancer patients after successful treatment
Palliative care of patients with terminal malignancies
Ethical questions surrounding cancer care
Screening efforts:
of populations, or
of the relatives of patients (in types of cancer that are thought to have a hereditary basis, such as breast cancer).

Just a thought.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 1/31/2009 7:26 PM (GMT -6)   
Tony, that's a really good definition of an oncologist. A good and well experienced one covers the scope that you lay out. When I had my other cancers prior to PC, my oncologist, Dr. Larry Gluck, was responsible for my care before and after surgery, and with the radiation that followed. He was with me every step of the way. At that time, I was one of only 38 known cases of that cancer type in US medical history, and he had a total of 2 patients, including me, with it. So by default, he became the "expert" on it. I still think the world of him, even though I have been clear for 9 full years of that cancer. I contribute it mostly to Dr. Glucks intense knowledge and extreme patient care.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 2/1/2009 3:04 PM (GMT -6)   
After being diagnosed with pc, my urologist provided me all the options. He said he was a surgeon and wanted me to visit an oncologist before I made my decision. The urologist said since he was a surgeon he was somewhat biased toward surgery. I met with an oncologist and ended up making the decision to have surgery. I agree everyone should get a second opinion if able. I met with 2 surgeons and an oncologist. I learned a lot about patience during the my waiting for office visits. You can never get enough information.
 
Age 48
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
surgery may 9, 2008 - houston, tx
pathology report -gleason 8
margins clear
4 week and 6 week PSA >.04 (undetectible)
6 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is an issue


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 2/1/2009 3:28 PM (GMT -6)   
rob, it was good that your urologist suggested and encouraged you to visit the oncologist, that is the way it should be. Sounds like you did the right steps toward your treatment choice.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 

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