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Role of Medical Oncologist in Prostate Cancer Therapy?
My care team at Mayo PHX includes both an Urologist and a Radiation Oncologist.
I was surprised to receive a telephone call from Department of Hematology and Medical Oncology saying my request for a consultation was rejected. I never made such a request.
I presume that the Radiation Oncologist will be responsible for the Directed Therapy aspects of my treatment while the Urologist will be responsible for the Systemic Therapy.
If the Medical Oncologist is suppose to handle the Systemic, then a very strange situation. Or does the left hand know what the right hand is doing?
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Different country (Canada), so maybe different practices, but I was handed off to a radiation oncologist as soon as I recovered from the surgery to debulk my spinal lesion.
My care team also includes an oncology urologist, an orthopedic surgeon, a weight-management physician, a hematologist, and (of course) a family doctor, but the radiation oncologist is in the lead for my cancer treatment, while the others are helping with specific issues (or general care, in the case of my family doctor).
I saw a medical oncologist very early on when I was still hospitalised, but she didn't stick around as part of my team. She might have been just assessing something specific (I was paralysed and unable to eat at the time, so I don't remember every detail clearly) or perhaps giving a second opinion to support the radiation oncology team. Perhaps that's the kind of consultation that someone else on your care team requested for you.
@rick137, that does sound like a miscommunication that will likely be sorted out. I would ask about this at your next appointment or through the patient portal. I think I read elsewhere that your current treatment plan includes hormone therapy (ADT) and proton beam therapy. It was unclear whether you were getting chemotherapy or not. Is chemotherapy part of your treatment plan? With whom is your next appointment - urology or radiation oncologist?
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1 ReactionWell, a urologist may or may not may be able to"handle" your systemic therapy.
I think from a technical perspective they can prescribe ADT to include ARIs.
The dividing line may be chemotherapy.
Still, I read an article recently which discussed data showing urologists were less likely to employ the full suite of drugs for systemic therapy, ARIs, PARP inhibitors, radio isotopes, genomic testing....
Both my urologists were great surgeons, after that well, limited thinkers. The first retired and at our last appointment told me how much he had learned from me...what, it's supposed to be the other way around. The second let his ego get in the way of providing me the best possible care, yes, I fired him!. There was a 3rd, went for a 2nd opinion and he dismissed my reasons for wanting to do triplet therapy and said he would put me on continuous ADT mono therapy, Lupron...I fired him too.
I have an oncologist now, he is very comfortable with a wide array of treatment for systemic therapy.
Would I see a urologist again, sure for urinary issues..
I'm not saying there aren't urologists who are well versed in the myriad of systemic treatment for advanced PCa.
For me, I'm more comfortable using a medical oncologist for advanced PCa.
Then again, I'm a study of one and my choices have worked best for me.
Kevin
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7 Reactions@colleenyoung
Colleen:
You are correct that my current treatment path is Eligard, which I started on 2024-04-25, and Proton which will start about 2024-06-01. I consider this Phase 1 of my treatment path.
I do not know who is on my care team other than my Radiation Oncologist and two Urologists, one of whom I have seen and one I will see on Monday. Perhaps that is the standard/default care team for prostate cancer together with specialists like pathologists. The Radiation Oncologist deals with Directed Therapies and the Urologist with Systemic Therapies. A Medical Oncologist, if present at all, is a supernumerary.
I will commute from from home in Eugene OR to Phoenix on Sunday for two appointments on Monday and four on Tuesday, all preparatory for Proton. One of the appointments on Monday will be with a Urologist and two on Tuesday with my Radiation Oncologist. I will certainly ask about Phase 2 if there is time since I presume the focus of these appointments are the procedures, carbon marker implantation on Monday and CT Simulation Therapy followed MR Prostate Imaging on Tuesday.
The PCRI videos by Dr. Eugene Kwon and Dr. Mark Scholz have greatly influenced my desired Path 2 treatment path. I have advanced prostate cancer and Dr. Kwon's overall message is advanced prostate cancer requires aggressive treatment, such as 2nd line hormone therapy and 6 cycles of chemotherapy in addition to continuing Eligard. The other message is the absolute need for at PSA testing and PET/CT imaging at regular intervals to asses the effectiveness of the therapy and, if possible, genetic testing. If genetic testing is not part of the Mayo protocol I will self-finance it. Since I am not a doctor of medicine, I am certainly open to alternative treatment paths by my care team at Mayo.
As a comment I have not read where anyone is simultaneously on radiation and chemo. This raises the question of sequencing. Should radiation proceed chemo or vice-versa? And if so, what are the factors in deciding which should be first. Perhaps the overriding factor is operational, the availability of slots for Proton. This decision could be conveyed to the patient in a few sentences or a few minutes with verbal communication. This is an added burden to the care team but an inevitable consequence of knowledge patients who want an optimal treatment path.
Being able to message your Doctors seems to be a privilege given to few at Mayo PHX. With regrets I called the PA of my Radiation Oncologist asking her to relay a question to the Doctor. With regrets because I know the medical personnel are going flat out and the question did not have telephone urgency. She gave me a number to call for requesting that my Radiation Oncologist be added to people I can message. The number was for Tech Support who said no can do. No big deal since the PA said all messages to the Doctor go through her anyway. Message triage I presume. I severely limit my communication because it is just one more task for the medical personnel. My observation is that, in general, at Mayo PHX for a patient to message someone he/she has first to be messaged by that person.
Finally, I like to think of my treatment path as my treatment safari. Safari has the connotation an adventure into the dangerous unknown. However, amusingly, safari is a Swahili word that simply means journey so you could take a safari to the grocery store.
KR, Rick
@kujhawk1978
I know prostate cancer is a serious business but I could not help thinking as I read your post is that you want a surgeon with superb eye-hand coordination. Intellectual acumen is definitely a secondary factor and perhaps perilous . No overthinking the situation with you on the table and a scalpel in his/her hand.
After PSA persistence of .19 post RP, with G 9 and EPE, I was referred in early 2023 to a Radiation Oncologist who recommended Radiation IMRT tx to the whole pelvic floor and to the pelvic lymph nodes together with short term ADT.
I asked about adding a consult with a Medical Oncologist and he responded that he was trained in both Radiation and Oncology.
My layman research indicated to me that his treatment prescription was in line with the SPPORT trial results.
And my first 2 post treatment PSA tests have reported undetectable < .02
If/when my PCa recurs, I will definitely add a consult with a Medical Oncologist, as it appears that there will then be a number of treatment paths potentially involving different medical "cocktails" to consider.
In summary, I was comfortable with the Radiation Oncologist designing my treatment course at that time.
Best wishes.
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1 ReactionSafari to the edge of a cliff, like in Jumanji- lol. I m in the same boat as you, I prefer my medical oncologist over the urologist. RT completed taking Arbiterone/Prednisone. PSA UNDETECTABLE. Gotta decide in 6 more months what to do? Goodbye ADT/ Trelstar or continue the path. I am on
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2 ReactionsA question for @collene. Does mayo Rochester have mri guided proton therapy equipment ?
@billfarm, to not take this discussion off topic, please my response and from other Mayo patients in this discussion:
- What does Mayo say about MRgRT (e.g. MRIdian)?
https://connect.mayoclinic.org/discussion/what-does-mayo-say-about-mrgrt-e-g-mridian/
My oncologist drives my cancer treatment bus. My urologist faded into the background of my treatment plan. My Oncologist, way groovy rock n roll historian, really runs the show. My radiation only saw during 28 treatments couple of years ago.
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