Oncologists vs. Urologists

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DanaA
Regular Member


Date Joined Jan 2009
Total Posts : 71
   Posted 4/19/2009 12:07 PM (GMT -6)   
Someone here suggested my boyfriend get an oncologist opinion and not just a urologist's. He got an opinion from the VA doctor who did the biopsy that it was T2c and Gleason 4+4. He went to a urologist at the Cleveland Clinic after that, who said he needs to look at the results, but said he couldn't feel anything in one side, whereas the VA said they felt a little something in the other side too. Can anyone come up with an argument I can make to him for getting another opinion? He seems pretty well set with the two opinions and both agreed he should get surgery. Will an different opinion matter if they all agree on surgery? In other words, will a difference in opinion make any difference in HOW, vs. whether, the surgery is performed? Thanks again for the help and sharing- it is greatly appreciated!
 
Dana

Post Edited (DanaA) : 4/19/2009 12:12:10 PM (GMT-6)


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 4/19/2009 12:16 PM (GMT -6)   
For one thing I would trust the Cleveland Clinic more than your local VA. Reason being I have a brother inlaw whose treatment at the VA Hospital there left a lot to be desired. No it wasn't PCA. I suggest he see an oncologist too.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 4/19/2009 3:07 PM (GMT -6)   
DanaA,
Urologists will always recommend surgery, except when a person is older or has health problems. Seeing two or 20 urologists will get you the same opinion.
It is important to get opinions from doctors in different fields as they have a different perspective. A surgeon, a radiologist and an oncologist.
A gleason 8 cancer is an agressive high risk cancer and oncologists have a better knowledge base of cancer than a urologist. Be sure you see an oncologist who specializes in Prostate cancer not other cancers.
The most important thing to determine right now with a gleason 8 is if the cancer has spread beyond the surgical margin. An oncologist is better at doing this.
Stay away from the VA if you possibly can.

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/19/2009 4:01 PM (GMT -6)   
Dana,
Whether he sees an oncologist or not, his treatment path isn't a bad one. But I would side with any suggestion that a visit with an oncologist would be a good proavtive move. Your boyfriend has high risk of capsular penetration and once the procedure is complete, he will likely need an oncologist anyway. But removing the prostate and examining it is still a good move.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 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!


DanaA
Regular Member


Date Joined Jan 2009
Total Posts : 71
   Posted 4/19/2009 9:38 PM (GMT -6)   

Thank you so much for the feedback. I'm very grateful for this site and all of the caring people here.

Dana

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