My First Appointment With My Urologist

[Arthro92]

my first appt. was this past wednesday. i met with dr. sanda at emory. but i also met with a dr. moghanaki, who's a radiation oncologist. VERY NICE guy. you know how much i value great bed side manner. well, dr. moghanaki came in first. he ask'd me a lot of questions about my health/family background. when i told him i have a history of colon cancer in my family, he recommended if i decide to choose radiation, i should first have a colonoscopy and a genetics test to see if i have that gene. what are your thoughts on that, PCa brothers?

anyhow, dr. moghanaki went on to tell me about the different types of radiation they offer and its pros/cons. then in comes dr. sanda. he tells me about the surgery and its pros/cons. it was about an hr. long session. overall, it was a good session. i go to see, dr. hershatter another radiation oncologist, to get his opinion about my diagnosis and treatment. what questions should i ask, dr. hershatter?

[Tall_Allen]

What kind of radiation does he specialize in? What is your diagnosis?

[Arthro92 in reply to Tall_Allen]

he specializes in external beam, high dose radiation and i believe low dose radiation. my diagnosis is G7 4+3

[Tall_Allen in reply to Arthro92]

I'm not sure what you mean by high or low dose radiation. Do you mean external beam hypofractionated or extreme hypofractionated radiation (SBRT)? Or do you mean high dose rate brachytherapy? At any rate, you should talk to a specialist in brachy boost therapy, like at Radiotherapy Clinics of Georgia.

[Arthro92 in reply to Tall_Allen]

high and low dose rate brachytherapy, external beam

[kayak212 in reply to Tall_Allen]

TALL..are you familiar with Dr.Phillip Shrake at Radiotherapy Clinics of Georgia..he is located in Lawrenceville,Ga 20 miles from me. I am looking for an experienced Rad Onc to meet with after my fusion biopsy on May 1st to get a new current evaluation of my case. I saw your recommendation to Arthro92 , thus my question about Shrake. I'm not familiar with Radiotherapy Clinics of Georgia at all. Thanks for your help.

[Tall_Allen in reply to kayak212]

I think that the therapy they offer is inappropriate for you - lots of extra side effects potentially.

[kayak212 in reply to Tall_Allen]

thanks for your feedback. i have been thinking about SBRT as form of Rad Ther if i agree to any treatment at all. Do your comments about side effects pertain to that particular form of therapy? I thought it was supposed to be minimal side effects, relative to other types?

[Tall_Allen in reply to kayak212]

No- I was commenting on the therapy that RCOG gives.

[Hidden]

I’ve actually seen both Sanda and Hershatter. During my consultation with Hershatter, he explained brachytherapy and broke that down between LDR and HDR. Also external beam alone with either 44 or 28 treatments. It was more a general explanation. He seems pretty knowledgeable. So far, I haven’t had to make a treatment option. Good luck.

[Classical6 in reply to Hidden]

Look up Dr Erik Randolph. He is a RDINC affiliated with Northside and/or St Joe in Atlanta. He is and expert in Brachytherapy. He comes highly recommended in the medical community. He handled my radiation treatment plan and performed the Brachytherapy procedure. My outcome is successful so far. Very minimal side effects. Keep in mind that everyone’s body is different. I just had my PSA checked last week for the first time since The beginning of my radiation therapy I am down to .08. My Uriligist was thrilled with my progress.

Be strong and always get a second opinion. In addition to pray and trust that God will work it out in your behalf.

[kayak212]

FYI..i was a patient of Sanda since Sept 2016...On AS all of that time .Recently he and i parted company due to my questioning his recommendation that i now begin EBRT based on my latest 3TMRI results and my PSA going over 10. He turned me over to Hershatter...the Rad Onc...very nice guy...went through my whole case history and recommended EBRT 28 sessions...i asked about SBRT which so far is my treatment of choice if any..I am 79...and he said he preferred the EBRT...no real reason ...but because that is what he does. In Dec 2017 Sanda had me meet with a Dr.Patel...Rad Onc...who recommended SBRT...5 sessions...only now Patel is over in the Proton Therapy Ctr so he doesnt work with Sanda anymore. My overall experience with Sanda is simple.

1.You will do fine as long as you agree with him and dont question his judgment.

2.If you want something done he hasnt mentioned try to get it to be his idea or he wont think it is worth doing...examples are genomic testing, second opinions of MRIs...he told me in February that a 2nd op i had from the Natl Cancer Inst disputing the findings of the Emory MRI in a key area of the results..."doesnt matter" because his reviewers are as capable as the NCI reviewers...that is a joke!

3.He told me that since i dont want surgery..and he doesnt recommend it either...and i have reached the point where i need radiation therapy..he wont see me anymore and i should work directly with Hershatter. That blew me away but was fine because i couldnt take anymore of his Napoleon approach....he never heard of shared decision making that i can see in my dealings with him.

4.Finally...i asked him if he thought i should have a fusion targeted biopsy since my only past biopsies were both the blind random type. He said yes that is a good idea!!!???? If so why didnt he raise it with me? I now have that biopsy scheduled for May 1st after which i will find a new Urol and get a comprehensive 2nd op of my case with an accurate up to date biopsy in hand.

I hope you do better with Sanda, but dont plan to ask a lot of questions. He once told me and i quote..."stop talking" when my wife and i tried to ask a question about my case.I think since he only sees patients one day a week he has so little time per patient there is only time to listen to him. After my most recent meeting with Sanda and Hershatter i sent both an email through the portal to list my current concerns and questions. That was about 3 weeks ago. I have not received any response from either...not really surprised. I guess the doctor who is doing my biopsy is now my only doctor at Emory...dont really know...Dr.Filson...i had to find that out through the clerical staff...when i asked Sanda if he would do my biopsy he said no...." I have people who do that"...wow...I guess anyone can do these biopsies...who knew?

I hope your experience is a lot better than mine was and my case is a garden variety PC case if such a thing exists. I wish you the best of luck. I really think that when i honestly completed a customer survey that Emory sends you after each visit..and it was not complimentary of Sanda...of course i signed my name ...i must have gone on his "list" if you know what i mean...actually if true it is the best thing that happened to me. I'm moving on.

[Arthro92 in reply to kayak212]

WOOOOOOOOOW!!!!!! first allow me to answer a concern. dr. hershatter is having hip surgery and won't be available 'til august 6th. i got inside information on that deal. i'm glad i found out before i went up that way for nothing. 2ndly, see if you can find a dr. james bennett. i think he's still with emory.

i hear he's pretty good. he's a uro who treated two of my best friends fathers. also, you are right about that a-- hole, dr. sanda. he seemed a bit perturbed when i ask'd him about a particular biopsy as supposed to the one he suggested. i'm leaning more towards radiation.

if you'd like a radio-oncologist, try dr. drew moghanaki. VERY NICE man. very thorough. if i choose radiation, he's the guy i'm going with.

[kayak212]

Thanks for the tips. I live about 60 miles from Emory so i am going to be looking for a Rad Onc closer to home...there are 4 good ones i plan to contact but not until after my biopsy on May 1st. I finally sent message via the portal to the doctor who will do my biopsy...Chris Filson...and to my surprise he responded within an hour, answered every one of my questions and just generally made me feel much better about the upcoming procedure and process he follows.I had no idea about Hershatter's surgery. I just figured that since i told him i wanted his recs for someone closer to my home for therapy he didnt bother to respond....like Sanda. I will check out Bennett and Moghanaki as just in case possibilities for after my biopsy.Thanks very much and good luck with your PC journey!

[Arthro92 in reply to kayak212]

glad i could help