Specialty to start with?

[Billyeff]

Originally joined group because 55 yr son diagnosed with stage 4 PCa. Been tracking my own PSA for a few years and it is now 18.5. Due to this group and other reading I am pretty well versed in treatment alternatives. I am 77 and if I do any treatments I would lean toward proton therapy. I had an appointment with urologist at Penn Medicine, because my PCP suggested starting there. She recommended getting a biopsy. I can't have an MRI due to pacemaker.

I saw TA's comment the other day about having a CT-scan/bone scan before a biopsy and it got me to thinking that maybe I should have started off with a RO from the very beginning. What are people's thoughts on having a urologist involved at all, particularly if radiation is my preferred treatment choice?

Thanks for indulging someone not as far along with the disease as you all are.

[Tall_Allen]

You need a urologist to do the biopsy - transperineal, ideally.

[Billyeff in reply to Tall_Allen]

Can transperineal be done without an MRI? Due to pacemaker, I can't have an MRI.

[Tall_Allen in reply to Billyeff]

Yes.

[fireandice123]

My urologist, referred by my PCP, performed the biopsy and when that showed PCa he ordered the bone and CT scans. When that showed metastatic PCa he referred me to my MO. My MO immediately brought in my RO to get his view of potential RT options. My MO and RO work very close together.

I still see my urologist annually for more general urological health follow ups. He prescribes my tamsulosin and sildenafil but he is not directly involved in the treatment of my PCa. All three of my docs, and also my PCP, are part of the same health network and all my records are automatically available to them so, in theory, they are working together. It’s worked well for me.

[MarkBC in reply to fireandice123]

This has been my experience exactly.

[HopingForTheBest1]

You both need to have genetic testing, which can determine effective course of treatment.

[GAdrummer]

Urologist did biopsy of prostate and periaortic lymph node in 2009. Administered Lupron until the shortage during Covid. He was needed to clear blockages of ureters at one point. See him once a year now to monitor stone formation.

[Muffin2019]

My urologist did my biopsy then referred me to an oncologist which both did well by me. The great urologist is now teaching but the oncologist is really great he has my back.

[MBOY1]

no uro needed so you’re on correct track with an RO. After extensive research I chose proton therapy in San Diego . I’m 4 years out and had positive experience. PSA was around 7.5 at dx and now .04. Good luck.

[AlanLawrenson]

Hi Billyeff

I have been invited to comment on your diagnosis and possible treatment. I went to the National Cancer Centre in Seoul S. Korea in 2013 for PBT. Excellent result. I would do it again if I had to make a decision now.

I am a little out of touch with US PBT pricing as I live in Sydney, Australia. If you want more info on PBT, read my book "An ABC of Prostate cancer-3rd Edition" . Available from Amazon.

Best wishes.

Alan L.

[groundhogy]

My ranking of who seems competent..

1. The plumber

2. The handyman

3. The mechanic

4. wife

10. MO

15. RO

99. Uros

[groundhogy]

oh, forgot number 5...

5. Anybody you find on craigslist