Was a good meeting today, I really like this doctor and his attitude about cancer and health issues in general. He has never been a surgeon, or a radiation doctor, only an oncologist. His big thing is "treating the whole patient, not the numbers". He said a lot of bad advice and treatments are done on just a PSA number by itself. Probably in his early 40s, I am not a good judge of age.
The entire visit was 2 1/2 hours, but I timed it, we spent a full 90 minutes one on one, and not once did he fool around with his cell phone or get interupted by staff.
Some of his general views, and please, let's not shoot the messenger (me) or start trashing the doctor, I am just repeating:
AS - He thinks that most all low positive cover, low percent Gleason 6 cases should be made to do AS, until there is evidence of the cancer becoming aggressive. If someone has like 1 core, 5-10% cancer, that treatment is overkill in most cases.
RT as primary treatment - best served by Gleason 6 cases, but not in favor at Gleason 7 or above. Same with 'seeds'
Recurrance - any 3 rises above .10 from surgery, any consecutive rise at all post-SRT
Surgery - feels its best treatment for most Gleason 7 cases. While he is not anti-robotic, he respects the quality of a good open surgery with the tactile quality to it. Among his patients, he has seen a rise in incontinence issues and ED issues, despite nerve sparing operations, among men that went Robotic. He said the best robotic surgeons, are the doctors that have a lot of experience with open Surgery, that switch to Robotic. The surgeons that start with Robotic, have a long learning curve.
HT - He doesn't like mixing treatments. Like doing HT before surgery, or during ART or SRT, likes to see each treatment stand on its own. He's not in favor of using HT too soon after a secondary treatment failure, as its best to save the HT for when you really need it, and since its not curative, you have to time the use of the HT card to the needs of the patient. If you go refractory too soon, you are screwed sooner.
Diet - He's big on dietary issues in a balanced way, not the excess that some express here. Doesn't believe in the elimination of entire food groups, i.e dairy, meat. He is very anti-excessive sugar consumption. Big on Mederteranian Diet or any sensible Heart Healthy Diet. The subject of POM got a good snickle out of him. If you are thirsty and like the taste, drink it.
Supplements - Not for people mega dosing or self-dosing without doctor's approval. Big on Vit D levels, again under doctor's supervision. Most people don't even need multi-vitamins.
He's big into the science of PC, not just the treatment. Most of his patients are PC guys, and with women, of course, BC.
If you love studies and research, you would love this guy, he's on top of every possible study past, present, and future.
As far as my situation goes, this is his current thinking:
He does not reccomend HT at this time, despite a climbing post-SRT psa. Doesn't want me to jump the gun at this time.
Wants to change my PSA tests from 3 months apart, after this next reading, to 6 months apart.
Wants to talk some dietary tweeking with me on the next visit.
Wants to deal with my major faituge and pain issues, and has actually increased my pain management program, to include more regular doses, instead of me waiting all day for the pain to build up to higher levels.
Wants to get x-rays of my hips, to see if he can see anything. With the bone scan, only going to show mets once they are larger.
Doesn't feel there are any other tests that can be run right now, that would show anything about where the cancer may or may not need. Did feel that PNI is a good escape mechinism for cancer cells to leave the barn even way before dx.
I need to stay in the Oncology Rehab that I am in, best way for me to get safely conducted exercise.
Wants to see me in 4 weeks, to see if I can get a handle on the pain, and if so, it may reduce some of the fatigue. Kind of the chicken and the egg syndrome.
Very sharp guy, he knows my former Oncologist very well, but understands with the litigation in place, I can't see him.
Said I was a very intelligent and informed patient, loved that I gave him some a detailed chronology on my PC and previous cancer episodes in such precise detail. He asked about support groups, and I gave a huge plug for HW, so I won't be surprised if he doesnt lurk.
All in all, he had a very balanced view, on me as a person, not a number, and no generic fix with HT, without a reason or a purpose. Wants to preserve as much quality of life for me as possible.
David in SC
I will add more comments as I remember, this is all from memory, don't have my notes nearby