1. Is he/she smart enough to order a % free PSA test and a PCA3 test (or to tell you why it is not necessary)?
They are smart enough but most won't. Neither will a prostate oncologist in most cases unless there was an initial negative biopsy. Since we are talking pre-diagnosis here, the urologists must adhere to protocol that will allow further investigation. The fact is that PCA3 is only a few months old as an approved protocol, and that % free is 50% accurate in detecting prostate cancer.
2. Is he/she smart enough to know that biopsies sometimes cause pain and offer you sedation or at least some sort of pain relief?
Virtually all urologists use local anesthetic. I can't name one who does not. Sometimes pain is extensive. But it is unpredictable from patient to patient. In such cases for extensive biopsies (saturation and such) general anesthetic is used.
3. Is he/she smart enough to send your biopsy to an expert in PCa pathology (e.g. Epstein at Hopkins or Bostwick Labs)?
Your list is subjective. Are you saying MSK, Mayo, Harvard or Stanford pathologists, as examples, are incompetent? It is a patients CHOICE to have their labs sent to these guys, I shouldn't be an expectation of their urologist.
4. Is he/she smart enough to understand that this is a “big deal” to you and clear time on his/her calendar ASAP after the biopsy comes back positive so that you can ask questions and get some understanding of the disease?
Does anyone think that being diagnosed with cancer is easy? The problem here is that no one person ever has all the right questions after diagnosis. Certainly not after immediately being told they have cancer. There is no easy way to say "you have cancer" . As a person who runs a live prostate cancer forum, it sometimes takes months for a person to digest this information. You have to tell them several times that they can do well before they believe it. So the "Big Deal" thing requires education beyond the urologists. Or the radiation oncologists or the medical oncologists for that matter?
5. Is he/she smart enough to recommend a color doppler ultrasound (or at least to explain why you don’t need one)?
This has not proven to prolong life or to even change treatment options. I expect it will but the actual number of changed decisions will surprise those who believe in this technology. I see it as an aid. But I also see limitations. if we can add a test that can tell the difference between indolent prostate cancer and aggressive disease, this will supersede detecting where it is located. Of course that requires such a test to not require direct tissue samples. But remember. prostate cancer is typically multi-focal...and any part of it can be aggressive.
6. Is he/she smart enough to tell you that a bone scan and/or CT scan for a low PSA situation is a waste of time and money? Or, if he/she recommends it anyway do they tell you why?
Says who? Certainly a high risk case that shows invasion to the ribs with low PSA is more valuable information that a color doppler finding...
7. Is he/she smart enough to refer you to some excellent books about
prostate cancer so that you have some basics (e.g. books from Walsh and Strum)?
Or Myers or Vogelzang? Or Catalona or whoever? The key is that they inform you to take your time and do your research...
8. Is he/she smart enough to suggest that you speak with multiple disciplines and doctors so that you understand your options for treatment?
Mine did but not all do. Whether you talk to a urologists or a radiation oncologist, not all understand the others competencies. I found all radiation oncologists to be committed to their profession and urologists committed to theirs.
9. Is he/she smart enough to show you the nomograms for your case so that you understand the likelihood of cure?
Not one Radiation oncologist suggested I refer to nomograms...I rest my case...
10. Is he/she smart enough to discuss ALL of the potential side effects of the different treatment options, e.g. shorter penis and urine ejaculation for surgery?
Nope. Neither was my radiologists able to tell me about
the perineal pains. Or the potential for radiation induced bi-cancers. The jury is out.
11. Is he/she smart enough to discuss the quality-of-life issues with you in an
open, honest way and tell you the comparisons among the various treatments?
None of them were. All said they had the best approach. My favorite doctor had me on two and a half years of hormone therapy. It sucked. but in the end, I am treatment free and winning my battle...
12. Is he/she smart enough to tell you what the options and percentages are for salvage treatment if your primary treatment fails?
My radiation oncologists was my backup plan. His backup plan was my hormone therapy or chemotherapy.
13. Is he/she smart enough to share his/her personal statistics with you re cure rates and quality-of-life issues?
I hope so, but this is again very subjective. Regardless of profession...My radiaologists cited general information from studies he did not partake in.
14. Is he/she smart enough to carefully explain your chosen procedure to you in a very detailed manner…including the before, during and after?
Is anyone? This is a compiled question from all above. Does a radiation oncologists explaing these thing? Nope...Mine said what we'll do will work. I asked if it doesn't he said see my medical oncologist...
15. Is he/she smart enough to tell you to use a physician who has done 250+ procedures?
I say 1000 procedures...lol...I agree with you on this...
16. Is he/she smart enough to tell you that there is an epidemic of overtreatment for early stage PCa and to recommend active surveillance to you if you qualify? Is he/she smart enough to refer you to a physician who is experienced is handling active surveillance patients if he/she does not have the experience?
Epidemic is an inappropriate term. According to the Epstein criteria only 15% of patients qualify for active surveillance. Thus referring you to a "qualified specialist" in active surveillance is unheard of.
17. Is he/she smart enough to tell you that the cure rates for surgery and radiation treatments are the same?
18. Is he/she smart enough to tell you the specifics of your post procedure sexual rehab?
Mine did and he hit it. But I refer to asking did you ask?
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas
Blog : www.caringbridge.org/visit/tonycrispino
Post Edited (TC-LasVegas) : 5/21/2010 4:10:48 AM (GMT-6)