When is Medical Oncologist Appropriate?

[B_Sprout]

I had RARP in December of 2018, Gleason 5+4=9, negative margins, pT3N0. Post op PSA 0.009 which has risen to 0.063 over the past 18 months. Have been followed at Univ of Penn by my surgeon/urologist with consults with Radiation Oncologist. The plan is to monitor PSA quarterly and intervene with ADT and radiation therapy if my PSA gets closer to 0.2. This seems to be the standard approach here. Given my Gleason 9 and upward PSA trajectory, my concern is that there is little emphasis on other systemic factors that might be affecting my PC. I am seeing an Integrative Health MD for nutrition support to ensure optimal overall health, but he is not a cancer specialist. I am curious, is there a role for a Medical Oncologist at my stage of PC? Or is MO typically not utilized unless one is involved in hormone or chemotherapy? Any thoughts are appreciated.

[Hidden]

We are very similar in many ways. My RO will not RT me if I don't issue a signed statement that it was my own will to skip HT. Her (old) book reads: High risk -> two years of HT. I have already got a 3 month's supply of Casodex and Triptoreline. They will stay into their wraps as long as my PSA hovers bellow 0.1 (last monthly test 0.05). On such an occurrence I am tempted to take the Casodex as a PSMA PET/CT is sine qua non and a 1-2 months of ADT will make this test a bit more sensitive. On Triptoreline not decided yet.

[B_Sprout in reply to Hidden]

Thanks for your reply.

[Tall_Allen]

I agree with your assessment that an MO is inappropriate for you just now. If you have 3 consecutive rises in your uPSA or if it hits 0.1, you can switch your care to an RO, who will develop a salvage whole-pelvic radiation plan for you, possibly with ADT.

[B_Sprout in reply to Tall_Allen]

Thanks for your reply, TA.

[B_Sprout]

Thanks for replying but I am not clear what you mean by your response “yesterday, asap”.

[EdBar]

In my opinion, once the urologist diagnoses you with PCa it’s time to find an MO who specializes in PCa. Especially with a Gleason 9. The MO should be leading your team.

Ed

[B_Sprout in reply to EdBar]

Thanks, Ed.

[MateoBeach]

Now. Yes in my opinion an MO should be central in the overall management of cancer care. One with a particular interest in prostate cancer if possible. I’m sure there are great exceptions but the Urologists in my community are not as razor focused on treatment strategies after surgery has not been curative. Just standard ADT.

[B_Sprout in reply to MateoBeach]

Thanks for your response. My urologist/surgeon specializes in PC but I have had consults with both RO and MO. They are all at University of Pennsylvania.

[Fairwind]

One more uptick in your PSA and it's safe to say the surgery did not cure your cancer. At that point the Urologist's job is done. At that point, an MO takes over with help from an RO.. 5+4=9 is a whole different ballgame than the less aggressive varieties of PC..G-9 calls for the most aggressive treatment..

[B_Sprout in reply to Fairwind]

Thanks

I have had consults with both RO and MO at Univ. of Penn where I had my surgery.

[j-o-h-n]

When you can afford one.............

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 06/30/2020 2:42 PM DST

[Hidden in reply to j-o-h-n]

How about he can’t afford not to?

[B_Sprout]

Thanks for the clarification. I have had consults with a MO at University of Penn which is a center of excellence that does research/clinical trials and where my urologist/surgeon and RO are as well.

[petercraig2]

I had a RP and PSA was rising after surgery.

The surgeon held onto my case file and insisted that ADT was the only option and also stated that "I should get really fit as I will probably die from heart failure" due to adverse effects of ADT.

That was my cue to move to another Cancer Care Centre and find a Clinical/Medical Oncologist. I was fortunate and found one who could talk and listen on therapy options from radiation to a multitude of alternative hormones.

I feel I got best information and advice and received the best therapy option for me and now three years later PSA is sub .008 and holding steady.

My conclusion is surgeons and radiation oncologists may be very proficient in their area of technical specialization but not so much in regards to current hormone therapy options.

[B_Sprout in reply to petercraig2]

Thanks for your reply. Much appreciated.

[RonnyBaby]

Urologists (qualified ones) can perform surgery and act in their own areas of expertise.

IF the RP worked 100% (no further signs of progression / successful elimination of the threat(s)) - you watch and wait and monitor - hoping you are 'cured'.

Once the PCa basic (RP) front-line treatment is 'off the table', is the time to move PAST the urologist and into the more 'advanced' aspects of treatment - AND the professionals who perform those roles.

Oncologists are the next step ....

[B_Sprout in reply to RonnyBaby]

Thanks for your reply. Much appreciated.