Hello - can anyone recommend a medical oncologist in the Philadelphia area? I am looking for someone to look at my tests, scans, current medical history, etc. and give unbiased advice on a treatment plan (i.e. not a surgeon or radiologist with a bias towards their area . of training and expertise).
Thanks!
Everyone has biases. Medical oncologists are inappropriate for men with localized PC to see - they are biased towards what they see in their patients - managing incurable disease. You can make this decision without surrendering your power to someone else. Here are some questions to ask yourself:
To say everyone has biases might be an overgeneralisation, but you might find it difficult to find someone . I'm not sure what "oncologist" means in the U.S., but in the UK, the first specialist to consult is a urologist if the cancer is localised I.e confined to the gland. An oncologist will be consulted if it has "advanced", I.e. spread outside the gland.
If your test results show that it has advanced, I'm sorry to hear this. If the cancer has only advanced locally an oncologist can treat it.
Although generally speaking, oncologists CAN cure some cancers, in the case of prostate cancer, if it's advanced more than just locally, it can't be totally cured and I hope you already knew this.
If your test results show the cancer is NOT advanced then there are several treatment options available to you which may cure the cancer.
I agree that in order to stay empowered to make the decision yourself, you need to be as informed as possible about the pros and cons of each option. The questions referred to give an incomplete picture. A urologist may be able to give some information, however biased, you don't have to go along with their recommendations.
There's a national organisation for prostate cancer in the U.S. that can give you information. I'm sorry I forget what it's called. Perhaps someone else on this forum will say.
In the UK there are several organisations, one for all cancers, one for prostate only. The Prostate one has a team of specialist nurses you can contact who are unbiased. Perhaps the American equivalent has the same facility.
If you wouldn't mind posting your test results on here, there are lots of guys who may have had similar results who can tell you their experiences which might help you.
Coping with prostate cancer is not just about dealing with information and you may find some guys on here can be quite supportive.
I hope this helps you.
Here are results of recent whole body bone scan:
CLINICAL HISTORY: Prostate cancer
COMMENT: Following the IV administration of 26.6 mCi technetium 99m MDP images
of the whole body were performed in the anterior and posterior projections.
COMPARISON: This examination was correlated with the concurrently obtained CT of
the abdomen and pelvis.
Findings: There is physiologic distribution of the radiotracer throughout the
osseous structures. Both kidneys are visualized. A focus of asymmetric
radiotracer uptake is noted in the left iliac bone, which corresponds to a
sclerotic lesion on the accompanying CT. There are also foci radiotracer noted
in the left posterolateral ninth and 10th ribs. These correlate to the vague
areas of sclerosis on the 6/10/2018 CT. Left knee arthroplasty is noted.
IMPRESSION:
Foci of radiotracer uptake in the left iliac bone and left posterolateral 9th
and 10th ribs. Benign uptake is most likely favored given the recently obtained
PSA of less than 1.0 ng/mL. A 3 month follow up is recommended to ensure
==========================================================
biopsy took 12 samples from a 34 cc size prostate. One core had 11% volume cancer. Last two annual PSA readings were .7 in 2017 and .8 in 2018. Getting scheduled to have a Free PSA test, MRI of left hip bone, a multi-parametric MRI with endorectal coil done of the prostate.
Thanks for your advice!
I have been seeing Dr. Naomi B. Haas, at Penn. She has seemed very open to my questions about options, listens well, and now that I’ve moved to Vermont, I’ve still been making the drive down to see her. I may not be the best person to ask, since my treatment options were limited by my medical history (crowns disease, liver transplant—radiation wasn’t an option). But I have been very impressed with her so far.
Great - thanks. I was going through Penn's website yesterday and had already identified her as someone I might contact.
I see auto correct turned crohns into crowns—it should have been crohns.
Looks as though there are a variety of opinions and advice which makes sense given how personal everyone's experience is. As others have noted, the takeaway is that you should gather as much information as they can and then make a personal decision. If a med onc can help with this, so much the better. Although I cannot recommend a med onc near Philly, I will share my own experience - my med onc (I am fortunate that he is a PCa expert, which is somewhat rare) was very helpful in providing additional information for me to make a decision. This doctor also has extensive experience with additional PCa treatments if the first one is not fully effective, which may be useful in the future. As you noted, they typically do not have a bias towards a particular treatment and they have dedicated their work to understanding and treating cancer. What can make this difficult is finding one who understands the complexity of PCa. In my case, the med onc recommended mpMRI as well as Decipher test, and has supported the rationale I used to decide on RALP, while recognizing that every case is unique and that the decision is up to me. He also provided me with a second surgical referral. Good luck and I wish you the best of health.
As you've read your bone scan results shows some "hot spots" in your ribs and pelvis. The opinion given is that these areas of greater absorption of the radio-isotope are benign lesions. The MRI will hopefully confirm this and additionally that th
ere is no localised spread. You have very low PSA and only one core positive. Looks promising.
Not sure why you're having the free PSA test, as you've already had a biopsy, but will do no harm.
I see you've got a good suggestion for an oncologist, great.
All treatments have their merits and drawbacks, the physical consequences vary and what you have to deal with whilst actually having treatment needs to be considered.
Treatments are improving and such things as Erectile Dysfunction aren't necessarily inevitable, (and can be a consequence of radiation as well as surgery). There is also lots of info about how to reduce the risk of this and restore function.
I understand you didn't ask to have cancer, it's scary, but so far, it seems you are on track.
You are a good man - thanks Tim2131! Keep in touch and I will update you after the next test results.
We have been very happy with Foxchase- we see Dr. Geynesman. But we also really liked Penn and Jefferson- we "interviewed" pca oncologists at all three and really liked them all. They all recommended the same course of treatment. We chose Foxchase because it's easier for us to get to. All of the oncologists we saw specialize in Prostate cancer. All three also are friendly and we know all ask each other's advice on treatments so we felt comfortable with all. All of them were also open to listening to my ideas for some holistic and nutrition ideas- not as treatment but for quality of life.
We looked at docs that were involved in research and willing to think a little out of the box and knew about current studies.
Radiation Oncologist
Information requested - Perineural invasion (PNI) in needle biopsy
How medical diagnostics giant Abbott flooded the market with faulty machinery
Met with Radiation Oncologist
today’s appointment with the oncologist 
