Urologist vs Oncologist - who's right????

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Regular Member

Date Joined May 2011
Total Posts : 23
   Posted 5/13/2011 6:03 AM (GMT -6)   
Hello all, I've been diagnosed with prostate cancer last month.
I've consulted with multiple urologists and oncologists which gave me different treatments.

Urologists recommends radical surgery to remove all prostate and lymph nodes.
They say there is a chance of curing the disease. They said that after surgery, according to the prostate examination, I might need radiation (but they think that I won't need).

Oncologists deny surgery saying it won't cure me (GS8), and recommends radiation+hormons. They say that the tumor is probably spread because the Gleason 8 high grade.

My medical info:
- Gleason 8(4+4) - 1 out of 12 cores has cancer (0.5 cm) (replaces 10% of this core and less than 5% of entire cores)
- PSA rising for the last 5 years, now it is 9 (started with 5 at 2005)
- Prostate volume is very large - 90 (measured in US)
- Had CT, Bone mapping, ultrasound - nothing found
- clinical stage T1C (stated by my urologist (not an expert))
- 63 years old.

I really don't know what to do. Scheduled a surgery 2 months after the biopsy, and now I need to decide what to do: Surgery or Radiation+Hormons.

I really don't know how to consider these two options. I don't know the chances...
Read a lot in the net, forums, etc but I really don't know...

Is there anyone here that had the same medical info like me and can share the treatment and results he had?

Thanks a lot ! Please advise

Post Edited (Perineum) : 5/13/2011 6:06:31 AM (GMT-6)

Regular Member

Date Joined Aug 2010
Total Posts : 486
   Posted 5/13/2011 6:46 AM (GMT -6)   
First, welcome to the forum. I'm about five years younger than you, and my stats were very similar to yours at the time of biopsy. My Gleason is a whopping 4+5=9' with a psa of 3. Your higher psa is a troubling factor. I had visited with my uro, a well known prostate oncologist, and a local surgeon who has PCa. All of them suggested surgery, but all said to not be surprised if my cancer had spread. They all wanted to save the radiation bullet for when/if it's needed in the future.
I was blessesd at surgery since my cancer was organ confined, with no discernible metastasis.
But, due to my high Gleason, my uro has me doing Lupron for two years. Since my surgery, my psa has been non-detect.

Good luck with your journey, and please keep us informed.

Age 57 at Dx
5/09 PSA 2.26
6/2010 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes neg, Ves neg
tumor contained, still 4+5=9
pni ext.
9/3, 2010 PSA - 0.04
9/3/2010, I'm 99% continent
10/14/10, PSA still 0.04, and lupron #1, now 99.9% continent
Total ED, 3 caverject failed
10/20/10 OD'd .5cc trimix, after 3hrs, neo synephrine shot
tried .15 & .17 cc neg, next .2

Veteran Member

Date Joined Sep 2009
Total Posts : 5462
   Posted 5/13/2011 10:35 AM (GMT -6)   
Put your stats in the partin nomagram. That sounds like a hunch from oncologist, I would go with the urologist, from the angle of a cure, could be surgery, could be radiation. Urologists are the ones who set the clinical stage. The experts, we talk about here are the pathologist who read the biopsy slides. Most urologists are " experts " in setting stage from the pathologist's subjective interpretation of the slides, which is why you want a pathologist who read beaucoup PCA slides. By the way There are urologists who are also urological oncologists, my surgeon is. The psa is not that high based on the size of prostate. Mine was 8.1 with a prostate a third of your size. It does indeed matter. Surgery is defietly an option. the oncologist has no idea if yours is contained or not. Unless he is saying the radiation/HT can cure you, which I don,t think he is saying. I think he is saying without any facts other than his knowlwdge/ experience that it is out of the barn and no chance of cure. Not nessacarily so,IMO
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Regular Member

Date Joined Jun 2010
Total Posts : 118
   Posted 5/13/2011 10:46 AM (GMT -6)   
I was also diagnosed as a 4+4 in one core out of 10 also less than 5%. I made my decisions based on that. What I should have done was sent my slides to another pathologist and he might have told me actually I was a 3+4 (80% 3) and I would have made totally different decisions. There are good pathologists who specialize in prostate pathology. I would recommend you find one before making a decision.
PSA 2.1 on Avodart
Biopsy: 1 of 12 cores positive >5%, Gleason 8
open RP: 05/10/2010 Dr. Gary Steinhoff, Victoria BC
Pathology: pT2c Gleason 3 (80%) 4(20%)=7, no lymph invasion, no extraprostatic extension, negative margins, tumor 5% of tissue.
Nerve bundles removed (based on original Gleason 8 biopsy)
PSA 06/22/10 >.01 09/22/10 >.01 01/06/11 >.01 04/04/11 >.01

Veteran Member

Date Joined Jul 2010
Total Posts : 3596
   Posted 5/13/2011 10:47 AM (GMT -6)   
Perineum (that's a good one) read my history...All my docs agreed that surgery only had a 40-50% chance of curing me (see Partin tables and Johns-Hopkins Nomograms) but I figured 50% was better than NOTHING! so I began with surgery..The surgery failed. Now, with 20-20 perfect vision hindsight, seeds plus IGRT might have been a better treatment choice for me, even though I would have had to travel to receive that treatment which triggered major insurance issues..

So now, less than 6 months out from diagnosis, I have endured and am enduring all three therapies..At the moment, my PSA is undetectable and the total side-effect load is manageable and has not changed my lifestyle too much although having sex is a thing of the past...

During my research concerning treatment, I talked to several experts and they pretty much agreed that for 'high-risk" guys like us, surgery, radiation and hormones together results in the highest possible cure rate. To them "cure" means you are still alive 10 years out...But the playing field is changing rapidly and surgery is becoming less and less prevalent as the techniques and equipment used to administer radiation improve..

Plus, cancer treatment is BIG Business and they all try and sell whatever it is they do....
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Veteran Member

Date Joined Nov 2009
Total Posts : 1095
   Posted 5/13/2011 11:05 AM (GMT -6)   
P: typical situation you face -- the surgeon recommends surgery; the radiation oncologist recommends radiation. You can read all the books and websites you want -- that will make you a lot smarter about prostate cancer and more able to ask good questions. But you won't find a definitive answer to this question because, unfortunately, there isn't one. But here's one thing you can do to get an "independent" opinion: find a really good "medical oncologist" who has deep experience with prostate cancer. A medical oncologist is a different kind of doctor than the "radiation oncologists" you appear to have been talking with. Medical oncologists tend to deal with more advanced prostate cancers. But one benefit of talking with such a person now is that they don't do surgery and they don't do radiation, so they are typically not wedded to either of those two approaches. Thus, you might get a "less biased" and "more independent" view of how you should proceed. For these purposes, in my opinion it is important that you consult a medical oncologist who is really experienced in prostate cancer. Most medical oncologists are not. If you tell us where you live, someone here can probably recommend a medical oncologist. Best wishes, medved.
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