Consult urologist or medical oncologist ?

[Tinkudi]

My dad , 83 , was detected with prostate cancer with mets to bones and psa 18.

Is it better to take treatment through a medical oncologist or a urologist ?

[MJCA]

I am NO medical professional. I would say if there are mets to his bones, a medical oncologist would be his best bet.

[Tall_Allen]

In the US, it would be the medical oncologist. I don’t know if it’s the same in India.

[Tinkudi in reply to Tall_Allen]

Thanks Allen.

[God_Loves_Me]

I would do both at the same time. It is essential to understand each perspective. Many users in the group have more than one medical oncologist.

[lgutman]

My dad was the same--stage 4 at diagnosis and a urologist would not touch or see him. He was sent to an oncologist. We never had a biopsy, or other of the initial tests up front. Straight to treatment.

[Tinkudi in reply to lgutman]

I thought in usa insurance would not pay unless a biopsy confirmed it ?

[lgutman in reply to Tinkudi]

I don't think that is the case when diagnosed at stage 4. We had requested to see a urologist, but they all declined his case saying the oncologist would need to treat. We never got a gleason score.

[Tinkudi in reply to lgutman]

Would getting that score make any difference to the treatment you think

[lgutman in reply to Tinkudi]

No. It would still be the three rounds of hormone blockers. I totally know where you are at emotionally trying to find answers, figuring out how much time your dad has. The most important thing our palliative care doctor told us at the start of this is controlling pain. Bone mets can be extremely painful. It can cause a patient to give up. In addition to having a good oncologist you need a very good palliative care doctor. When the hormone blockers would stop working my dad's pain would escalate and in fact he had to be hospitalized at one point. When you are diagnosed at stage 4 speed to treatment is extremely important. The goal is to keep it from hitting an organ.

[RS265]

My urologist was clear.

Over 80yo and he would send you home with no treatment as the side effects were not a reasonable trade off for any life extension given the myriad of other death causes when you reach this age.

If you wish to persevere then a medical oncologist is the starting point.

[groundhogy]

I would say an MO.

My experience is extensive with urologists in the usa. I find them not fully reliable.

[HikerWife]

Urologists tend to treat more localized PCa (i.e. surgery). Medical oncologists treat systemically - which is what is needed once you are metastatic.

[4tunate1]

In the US, I would say an MO, for sure. Not sure how it works where you live.

[cfhny]

I recently discussed this very question with my treating (3 years) urologist. He said that as long as I was responding well to ADT (Eligard) he would be able to treat me. Once I become hormone resistant, I would be beyond his expertise and my treatment would be relegated to my oncologist. With that said, we agreed that I would immediately and completely transfer my treatment to my oncologist, who had been acting only as a consultant.

[SteveTheJ]

Oncologist without a doubt

[j-o-h-n]

M.O. based on responses. An M.O. by far (if your dear Dad was in the U.S.) is the answer to your question, if in India is another question.

Good Luck, Good Health and Humor.

j-o-h-n

[Tommyj2]

not blaming….but how was this missed all these years? No one suggested a biopsy along the way?…….would think a MO is the way to go at this point.

[larry_dammit]

at this point the cancer has left the prostate. My oncologist told me that there was no use removing the host. Forget the urologist he needs a cancer doctor. At 83 the decision is totally up to him. When I was diagnosed they gave me a 50/50 chance of 5 years. August the 6 th this year will make 8 years . I’m so blessed to get to see my grand and great grandkids grow up. Not to mention the extra time with my wife. I’ll be 74 in August and would love to see the 80s. Time will tell. Keep fighting warrior 🙏🙏

[TJGuy in reply to larry_dammit]

This is not in response to a 83 year old patient which by age alone usually leads to a different treatment or no treatment.

But for young patients, such as myself my top surgeon at top US cancer hospital said he would take out my prostate regardless if lymph nodes were found to contain cancer, and he was certain that I had micro metastatic PC in my pelvic bones. Which has never been seen by the way. and by removing it that stopped any new seeding of new cancer cells.

So far that seems to have made a world of difference in my life and my cancers progression, and my prognosis. My PSA started at around 60 and today 7 years later is 0.6 and I haven't been on ADT in 3 years. And have only been on ADT for 2.4 years.

[Sagewiz]

Urologists tend to say: surgery or no surgery. To get a full treatment, and explore all options ,work with an oncologist

[Professorgary]

I have both. My oncologist, who will soon be fired, seems to think that monitoring testosterone is unnessary. My urologist says it is so he monitors my T numbers until I find a new oncologist. You need to be careful. If you can find an oncologist who specializes in prostate cancer that seems to work the best.

[Don_1213 in reply to Professorgary]

Funny - I've fired two urologists for doing PSA tests without corresponding T tests.. any testing my medical oncologist does includes both, and he asked what the purpose of the PSA test was if you didn't know what the T was up to.

And more importantly perhaps - he is comfortable with me getting T supplementation for my dropping T number (now down to 180 from around 320 a year ago) since my PSA has remained steady over a wide range of T (from nothing under ADT to 320 last year..)

The plan is - bi-weekly PSA/T tests for X months, then monthly, then bi-monthly, etc..