I'm in the process of trying to work through my options on treatment.
I've seen Dr Parsons (URO) at UCSD who thought RP was a good choice but supported my checking out RT as it offered similar outcomes.
So, I then saw Dr Einck (RO) who suggested the triple play (IMRT, 25 treatments, ADT, and LDR brachy) but wanted the urinary flow rate test done to make sure brachy was not contraindicated due to some urinary symptoms (low flow, slow starting, and a feeling of not fully empty).
RO told me to go back to URO to get flow and retention tests done, but URO did not want to schedule tests right now. After a few messages it turns out that URO wanted me to start Flomax (which did it's thing within the first six hours of taking it -- after 10 days now of Flomax I don't feel as if I have any urinary issues now), and between the two of them (URO and RO) they thought 2 to 3 months of ADT would shrink the prostate and would be useful whether I went with RP or RT, so they set me up with MO appt for next Friday.
But reading another thread here (started by Stray), TA stated "Medical oncologists have no more knowledge of curative treatment options than any well-prepared patient would have. Why would they? They treat incurable cases. They can only get in the way by offering their unqualified opinion, when what you need are opinions from specialists who are qualified."
So, is it right or wrong to be seeing an MO about
ADT in conjunction with either a RP or RT treatment subsequently? Is the MO the person who selects and manages the ADT, or can or is that done by a URO or RO? I do know that UCSD, they use an interdisciplinary approach where the URO and RO and work together -- so perhaps its URO + RO + MO all working together.
Incidentally, I have taken TA's suggestion and scheduled a consult with Dr King of UCLA in regards to the current trial of SBRT for high risk patients. This appointment will be next Wed, two days before the UCSD MO appt. Incidentally, this SBRT trial also uses ADT at the discretion of RO.
I'm trying to both take my time with making a treatment decision exploring all my options -- but I do wish to make a decision here sooner rather than later to both stop this "which way do I go" feeling and start attacking the cancer.
PS. I haven't set biopsy slides to Epstein as I don't see that changing what I am going to be doing. My target #1 (from mpMRI) was 95% involved Gleason 4, grade group 4 -- so a second opinion is not going to be taking that down and I've got 5 Gleason 4+3 with 50% to 90% involvement. On the good side, URO and RP still say based on mpMRI it's still localized and contained in the prostate.
PSA 4.1 11/2017 (age 63)
DRE 1/2018, nodule one side
mpMRI 2/2018, PIRAD 5
Biopsy 2/2018, 12 core + 2 target cores
DX 3/2018 (age 63)
8/12 cores PCa (7 4+3, 1 4+4)
2/2 target cores PCa (4+4 and 4+3)
Post Edited (CAdogsRus) : 4/11/2018 4:08:18 PM (GMT-6)