Sally Jones-oncologist??

[SallyJones]

Thank you again to all who have replied about my husband's Feb diagnosis of stage 3b prostate cancer, gleason score of 8 and PSA of 10.5. He is seeing his Urologist for the Lupron shots and Casodex and a Radiation Oncologist for his Radiation treatments (5x/wk for 9 wks). Just wondering your opinion on if he needs to see an Oncologist or if the Radiation Oncologist is it for the time being?

[TylexGP]

Hi Sally, I think an medical oncologist is an important part of the cancer care team. My MO handles all my ADT treatments and will be my go to guy if I have progression of my pca. Better to have them involved early on. FYI regarding my Hx G9 T3b with PNI and SVI and epe with suspected N1. PSA 10.1. On ADT(Lupron)+ Zytiga since last May. 7.5 months post HDR Brachytherapy and 6.5 months post EBRT. PSA 0.11 with nothing detectable on NaP bone scan or CT in February. My MO or his PA is who I see on a monthly basis post blood draws. I see my RO every 6 month now. I know adding another physician can be daunting especially when the diagnosis is new. I wish you and your husband well and feel free to continue to ask questions. This is a great group.

[SallyJones in reply to TylexGP]

thank you, and I agree that this is a great forum.

[Tall_Allen]

No medical oncologist (MO) is necessary because he knows a lot less than the radiation Oncologist (RO) about his treatment. You are asking this question on a forum for advanced prostate cancer (which your husband does not have) so you will probably get a lot of people praising what their MO does for them.

In my experience "too many cooks spoil the broth." If his RO needs the services of an MO (say, if more advanced hormone therapy is required), he will refer your husband to one and they will work together. Your bringing in your own MO will only complicate whatever cooperation is required.

However, from what you wrote here, your RO may not be the best because that many radiation treatments is rarely given anymore. Insurance/medicare reimbursement is based on the number of treatments, so ROs who are still recommending that many treatments are more concerned with the money than the patient.

The kind of radiation with the best record of curing "high risk" patients is called "brachy BOOST therapy. This usually involves 1-2 years of ADT+external beam radiation+ a boost to the prostate itself using brachytherapy. The ASCENDE-RT trial proved that it is much better than just external beam radiation:

prostatecancer.news/2017/03...

I also would suggest you consider the following randomized clinical trial. In the "Locations" section, find a site near you. The ROs listed are all top quality:

clinicaltrials.gov/ct2/show...

[SallyJones in reply to Tall_Allen]

thank you for your response. However. we have been told that it is advanced as it is in the seminal vessicles, with Gleason score of 8 and PSA of 10.5. the radiation Oncologist stated that Brachytherapy would not be right for him. I appreciate your thoughts about insurance and the medical profession etc. That's why I am trying to gather as much info as possible. Thanks again for your input.

[Tall_Allen in reply to SallyJones]

What you were told is incorrect. Cancer in the seminal vesicles is stage T3B. Stage T3 is part of the definition of "high risk"and is "localized," not advanced. A Gleason score of 8 is also a "high risk" feature. To be classified as advanced it must be in surrounding organs (like the bladder or rectum- Stage T4) or metastasized outside of the prostate to pelvic lymph nodes (stage N1) or to other lymph nodes (Stage M1a), bones (Stage M1b), or visceral organs (Stage M1c).

The radiation oncologist was talking about brachytherapy as a monotherapy, which would indeed be inappropriate for a high risk patient. Brachy BOOST therapy is another thing entirely. But you will have to talk to an expert in brachytherapy to find out about it. As I said, your RO, does not seem to be adequate to your needs. Where are you located? Maybe I can suggest someone.

I know there is a LOT of medical terminology to take in, but it is important you understand these distinctions and see the right kinds of ROs before making a decision. As a start, here's a good guide from NCCN:

nccn.org/patients/guideline...

Because any kind of radiation therapy will entail androgen deprivation therapy (ADT) starting at least 2 months before radiation begins, it may be a good idea to get a Lupron shot now. This will prevent any cancer growth from occurring, and will provide peace of mind. It will also give you plenty of time to find and talk to several ROs before deciding on which kind of radiation is most appropriate.

[SallyJones in reply to Tall_Allen]

Thank you again for your input. Perhaps I misunderstood their categorization. And, as I stated, he is already receiving ADT with Lupron and Casodex. And, if he is at high risk and not advanced, I will be sure not to take up any more of anyone's time and space on this forum.

[Tall_Allen in reply to SallyJones]

Try this forum:

healthunlocked.com/prostate...

(I reply there too)

Brachy BOOST means external beam radiation+ADT+brachytherapy to the prostate. It is normally given with at least a year of ADT.

[Lee70]

Dear Sally,my husband was diagnosed in 2005 with Gleason 8, then had Prostate removed, in 2008 his PSA started to go up, and Bob’s Urologist immediately referred him to an MO.

2009/2010 Bob had 33 radiation treatments (without ADT) which didn’t work, the PSA went higher, then started on 1 year of ADT.

2012 PSA started to rise Bob did ADT for 1 year.

2014 Bob had serious back pain, had a PSMA which revealed 5 Lesions on his spine with possible Lymph Node involvement, started on ADT for 1 year.

2017 PSA started to rise, PSMA Scan revealed the PC had spread to the Lymph Nodes and one lesion on the Sternum.

Bob started on Lucrin, Casodex and Avodart has been on them continuously, tolerates them well, PSA is undetectable,, and is living a very healthy and active life.

So I hope this information is helpful, and also gives you hope.

God bless you both.

Leonie

[SallyJones in reply to Lee70]

I can't thank you enough for your reply. Your words are very encouraging and I thank you again for such a detailed response. I will keep you and your husband in my prayers.

[Lee70 in reply to SallyJones]

Thank so much Sally. God Bless,

Leonie