I have seen the urologist and did a biopsy and PET/CT scan. Now that I have all the results, the urologist wants me to start treatments with his urology partner in the office. When I inquired about going to an oncologist and/or radiologist, he said his partner could handle the treatments.
I have prostate cancer with met pelvic lymph nodes and met bone cancer. His partner wants to do a multimodal therapy. He said it would consist of androgen deprivation therapy, medication for the bony metastases (Xgeva) and oncolytic treatment.
I guess my primary concern is whether to let another urologist handle the treatments OR SHOULD I seek out an oncologist and that doctor would be able to help with a radiologist if need be.
Any thoughts or help in deciding from anyone's personal experiences would be most helpful.
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PARKER3237
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Thanks. I'll read it over. I am just concerned the urologist I am using and suggesting his partner do the treatment might not be the right way to go. My research on the partner's background shows he is only a urologist too and not an oncologist.
If your cancer has metastasized and spread beyond the prostate gland to the bones (or beyond) then you definitely need an oncologist. Where I live Radiation Oncologists (ROs) handle the ADT drugs and any type of radiation. When you require the second tier ARPI (Androgen Receptor Pathway Inhibitor) drugs like Xtandi or Zytiga then you are referred to a Medical Oncologist (MO). They also look after chemotherapy and any recommendations for a clinical trial. Definitely not a urologist for bone mets.
Get all of the second and third opinions you can get. I saw 9 Dr's while putting my team together (Uro - MO - RO). After finding this site, reading up on all of SOC etc. I now realize that 2 of them were recommending the wrong treatments. YOU are your best advocate!
I had radiation therapy for a solitary bone met to T8 at a COE. Four months later my PSA increased and a repeat PSMA PET revealed another positive pelvic node. My very experienced Radiation Oncologist that specializes in Prostate cancer treatment said it was now necessary to involve a Medical Oncologist.
Although physicians vary as to their knowledge and expertise, I believe it is reasonable to state that treatment of metastatic prostate cancer is best managed by a Medical Oncologist.
Minor point but a Radiologist is totally different from a Radiation Oncologist (who performs radiation treatment for cancer). The specialities are totally different. I practiced Radiology for 40 years (as a Radiologist).
My urologist handed me off to a MO on diagnosis of cancer. My MO has always taken the lead. My RO was also very good at what he did but he deferred to my MO as lead. My second opinion at a center of excellence was with a MO as well.
Thank you. What I am gathering from the various experiences is that I should go directly to a MO and not spend anymore time with the urologist and his partner who is also a urologist.
Thats an important decision for you at this time. I would encourage you to keep learning about this disease yourself as well. This is a great place for that. Best of luck to you in all of your decisions.
Once the urologist did his work up and I decided that surgery was not an option for me I was done with him and asked for a referral to a RO and then set up an appointment with a MO. I find that I am in goods hands with having a RO and MO they work in the same facility and coordinate nicely.
I meet next week with a second MO who takes care of my wife’s blood cancer issues. Why? Well she had no idea I was under treatment for prostate cancer and I have been able to observe her work in dealing with my wife. I liked how she deals with issues and am comfortable with her. So she will be the second MO on the team and I will use her as a backup and second opinion if necessary.
I am having my caregiver call some up and see which one I should make an appointment with to discuss my treatments. I just do not want this going on so that it continues to spread or grow. I know something must be done but hard to get quick appointments these days.
The urologist's partner in the office wants to do androgen deprivation therapy, medication for the bomy met (Xgeva) and oncolytic treatment. I suppose I could get him to just do the ADT and skip the others while I get a MO scheduled.
my dad stayed with his urologist and radiation oncologist for years. They did not recommend regular scans despite his cancer being metastatic. I asked questions about their plan, and I was always brushed off. Based on our experience, I highly recommend establishing with a MO. We were always told by the urology office “we can manage this. A MO will not have a different plan.” While that’s true, a MO won’t have a special treatment per se, our experience has been that the MO is much more on top of things. We wish we would have switched over sooner. It’s also been known, at least in our town, the urologist waits until it’s too late to refer to a MO.
My caregiver has fielded the questions on many cancer sites and the same responses come back. All say to get a MO and proceed from there as they have the expert knowledge. My concern for staying with the urologist's office is the partner will do treatments but not look at it as seriously as a MO or RO. Every time in our meeting this week when my caregiver pressed about getting a MO and a RO, the urologist brushed it aside. Scheduled for blood work and a meeting with the partner for consultation of treatments in the next two weeks. I may do it to keep things going while getting a MO scheduled so I am not missing any time at moving forward.
Also, the radiation oncologist kept recommending treatments he could provide. Once we switched to a MO, we were informed the treatments he recommended are further down the line for my dad as options.
That is somewhat in the reading and research my caregiver has found. I think they need to shrink and contain the tumors and cancer, then zap them with radiation. We met a an online who is in the same situation but been treating for 2 years now and he started his radiation last month.
My urologist, upon confirming Gleason # via biopsy, referred me to the hospital's "Oncology Clinic", which is a team of RO's and MO's. Although the hospital is a fairly modest regional hospital, the oncologists are actually employed by Mass General Brigham and I can draw on its far richer resources and specialist doctors if need be. So far, no need. I was fortunate all around with this. At one point I did some calling around to see if there was such a thing as a urologist-oncologist. Ans: no. Just be warned that should you get handed off to an MO, they cover a lot of cancers of which prostate is only one category. MO's that specialize in PCa can be found but expect a lot of travel unless you happen to live near them already.
Thank you. My caregiver got a referral from my primary doctor. As soon as they get the referral, he will schedule me. We are in the Baylor system here in Dallas TX and have massive resources to the cancer center here.
M.O. is the way to go............. List your location and post a question if anyone can refer you to a good M.O. in your area. Best to choose rather than lose....
Good Luck, Good Health and Good Humor.
j-o-h-n
Time is of the essence... oncology is the way to go... if these guys fail to produce results, you are going to end up in the hands of an oncologist anyway....
Urologists are usually the first line of defense in uncovering prostate issues.
Mine expressed concern over my PSA. He did a biopsy, found cancer, scheduled a bone scan, no spread, then discussed surgical and oncological treatments...
Post RP surgery... he continued to monitor my PSA ... as it started to rise above <0.1 to 0.13 and then 0.25 he ordered a bone scan, no spread, then a PSMA scan which reveled lower lymph nodes affected.
It was now time to be handed off to Oncology.
Radiation was not recommended by Oncology based on the PSMA scan.
I underwent triplet therapy. that being Lupron and six Taxotere treatments in three week increments. I am still on Lupron and currently on Zytiga and prednisone, daily...
So far so good... 3 PSA tests thus far < 0.1
FYI... Oncology did the genetic test to rule out a predisposition for cancer
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Side effects of withdraw from prednisone and can a oncologist give Lupron/xgeva shots? 
MY dad was not accepted for Lutetium (177Lu) treatment since he's not had chemo. What is SPLASH? We live in Michigan. Other options?
Expiration date
Wait time for radiation is 6-8 weeks in BC Canada; will this cause an issue with triplet approach?
Xtandi failed suggested Zytiga
