Does an oncologist only have to do prostate cancer to be an excellent PCa oncologist?

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 10/14/2009 12:10 PM (GMT -6)   
Uh...No.
Quite to the contrary it is a plus when their study of cancer is not limited to prostate cancer. In another thread John T posted:

Tony,
Try to do a search for Prostate Oncologists; they are very difficult to find. The PCRI use to have a list, but discontinued it. The only list I have found is on USTOO and contains less than 20 names.
I have bee treated by Urological Oncologists and they definately are not prostate specialists. Many medical oncologists treat prostate cancer, but don't specialize it in. I'm talking about oncologists that have prostate cancer as their speciality and only treat prostate cancer. I'm talking about oncologists that see hundreds of prostate cancer cases every year from diagnosis to treatment of advanced PC.
There are hundreds if not thousand of surgeons doing prostate cancer and any post from a city asking about surgeons wll result in 4 or 5 recommendations. Maybe you wll get 4 or 5 recommendations for a prostate oncologist across the entire US.
The Director of the PCRI told me that there were about 20 oncologists in the US specializing in PC. I spent 10 years seeing various doctors and only heard about prostate oncologists last year, and that was from my wife's oncologist, not from anyone in the PC industry.
JohnT

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/14/2009 12:29 PM (GMT -6)   
There are many points that are very assumptive in this post. Are we to assume that we can only see a Leibowitz, Strum, Myers, Sholz, to get great oncology? How about Walsh, Catalona, Dattoli, Menon, Kawachi, Carrol, Crawford, Scardino? If you search "prostate cancer oncology" you will find many that are qualified for the job. PCRI discontinued that list for a reason and it wasn't at the request of those on the list I am sure. There are some Uro Onc's that are not up to the task and there are many uro onc's that are fantastic prostate cancer oncologists. I named a few above. I do not see the need for a prostate cancer oncologist to only narrow his field in prostate cancer. I believe that of all the cases of prostate cancer, having one of the "dedicated" oncologists will benefit less than 1% of the population of survivors if at all.

There are many famous prostate cancer oncologists. Myers and Lebowitz are two such examples. Lebowitz came out with triple blockade in his practice, and he did it 13 years ago. Myers became famous after documenting his own personal case with stage 4 prostate cancer and writing a book. His tenure? Just went over 10 years. One could easily argue that the head of genitourinary cancer at MD Anderson has more experience than both of these guys with prostate cancer.

My point is that there are many excellent prostate cancer oncologists. And some are great surgeons as well.

Please also note: US TOO has removed references to specific oncologists and now when you search for prostate cancer oncologists, you are referred to the ASCO database search engine.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 10/14/2009 12:37:42 PM (GMT-6)


John T
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Date Joined Nov 2008
Total Posts : 4229
   Posted 10/14/2009 1:26 PM (GMT -6)   
Tony,
I guess that we will have to agree to disagree. If you read Walsh's and Scardino's books and then read Myers' and Strum's books you wll see a vastly different philosphy in diagonosing and treating PC.
This I believe is a result of their training in completely different fields, even though they all specialize in PC.
The biggest differences I see are that the 1st choice of Walsh and Scardino are surgery wheras Strum and Myers look at surgery as only one option and usually not the 1st option of choice.
Diet and supplements are a large part of an oncologist's treatment recommendatons.
More emphasis is placed on treating the whole body, not just the PC part of it.
More emphasis on using imaging to stage the cancer. Myers and Strum routinely send their patients to get color doppler ultrasound and Combidex if there are any questionable stats. I know of no urologists or surgeons that have recommended their patients for these tests.
Myer's and Strum place more emphasis on PSA kenetics to see how the cancer is manifesting itself than Scardino and Walsh.
Oncologists are more familiar with the results of various treatments and their affects as a very large part of their practice is dealing with failed local treatments of all types. Failed surgeries are usually passed on to someone other than the surgeon who did the 1st treatment.
I would suggest that everyone read all four books and come to their own conclusions.
By the way, the current head of urological cancer at Anderson was the one who mis diagonosed me during the three years I was his patient.
I agree with you that many patients don't need an oncologist as their PC is fairly straighforward, but it's way more than 1%. If one is seeking a 2nd opinion for anything relating to PC, I would strongly recommend putting a prostate oncologist on your list as they will look at your PC differently and from a different angle than a surgeon or a radiologist. If we look at the PC stats and see that nearly 1,000,000 men have been over treated and 25% to 30% of all treatments result in reoccurrances then we have to admit that our current system is not very effective.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 10/14/2009 1:43 PM (GMT -6)   
Tony,
Having an oncologist that specializes on only one cancer is absolutley a plus. I learned this 5 years ago while my wife was going through 2 rounds of chemo for breast ca from a well noted oncologist that only specialized in Breast Ca. 60% of the patients in the infusion room had been treated before by regular medical oncologists, not ones specialzing in Bca and the horror stories were unbelievable; the vast majority were given inapproiate treatment for their particular form of Bca. Specializing in one area brings much more skill and knowledge to the treatment of that specific disease.
Why would I ever bring my diesel to a general mechanic when there is a diesel expert just down the street.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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