A cautionary tale

[Purple-Bike]

An MO abroad urged me to get SBRT rapidly to two suspected mets shown on a scan.

A second MO, based in my home town, urged me to wait and to get new scans without great hurry. The new scans, taken three months later, show there is no cancer. He had access to scans way back in time for comparison that the first MO didn´t have. But when I check the reports from all the scans the first MO had access to, there were signs that at least one the spots shown on his new scans was seen on earlier scans and appeared not to be growing.

The first MO did not bother to check this, or, worse, chose to disregard it in his urge to get me to pay for the expensive SBRT. AFAIK he is (part) owner of his clinic, which gets it´s income from radiation and testing. They do this very well, he is highly regarded.

Scared at what he told me I suggested a PARP inhibitor + abiraterone besides the SBRT, since I am BRCA2+. He said no, since that is highly toxic and the SBRT will be just fine (he just wanted me to have 7 months of ADT). "You will get a few more good years and then we can SBRT any new mets again". His consultation and prescription fees combined amount to less than 3% of the cost of the radiation he wanted me to do.

The second MO gets his only income from his government salary. At the first consultation he told me that if mets are confirmed he would want to put me on PARP inhibitor olabparib + abiraterone. All treatments are paid by our government in our single-payer system.

First lesson I learned: All that is shown on scans is not cancer. It could be several other things. In my case, it could be bone islands: benign tissue that attaches to adjoining bone.

Second lesson: When an expensive treatment is suggested, think over if that MO may have financial interests in offering that specific treatment. If so, wait to act and go for a second opinion.

[Regulator]

I'm sure some doctors are over zealous with treatment for financial reasons as well as liability reasons (don't want to get sued for missing something - especially true in USA). Whether your MO was or wasn't, I don't know. But second opinions are very important before doing any treatment and while some doctors are over zealous, I've found some who are too complacent (if I'd listened to them, I'd be dead by now). [15 year survivor with lots of experience on my way to the present [progressing metastatic castrate resistant prostate cancer.]

[Cooolone]

Selection bias is real, and the motivating factor can be borderline criminal as well.

You did your diligence, sought and received a 2nd opinion. I would offer even a 3rd if you haven't been receiving care at a Major Cancer Center and one rated in Excellence! Just sayin'...

As for Olaparib, it's no joke, check the drug makers site and see for yourself the toxicity probability... I've been on it almost 18 months and I'm approaching the witching hour (2yrs)... Slowly some of my blood numbers have edged "Danger" territory. Keeping a close eye. But my PSA and recent scans all indicate things are stable, PSA undetectable, etc. So good stuff apparently. Again, PARP inhibitors are no joke, use it when needed, ie, secondary treatment failure and resistance as it is a hammer and IMO best reserved for when a hammer is needed! Keeping tools in the box for use later rather than earlier is one of the most difficult decisions to make on this journey!

Good Luck!

[Purple-Bike in reply to Cooolone]

Thanks, Cooolone.Is it your red blood cells that is the issue? The white?

[Cooolone in reply to Purple-Bike]

Both... But White Cells lately more so. So we shall see. Keeping fingers crossed!

[Purple-Bike in reply to Cooolone]

I wish you the best!

[Justfor_ in reply to Cooolone]

There are tiny hammers silversmiths use and sledgehammers. Use the one that fits the job. Just saying.