When I was initially diagnosed with prostate cancer by biopsy in 2021, the Urologist was the only bus driver. I did my due diligence and consulted multiple Urologists and Radiation Oncologists prior to deciding on RP, as the Imaging at that time revealed no spread outside the prostate gland. Unfortunately, 6 months later after a post op rising PSA (0.16 to 0.37) a PSMA PET revealed a solitary T8 met. Now the Radiation Oncologist took the wheel and did SBRT with curative intent to T8. Again, unfortunately, 4 months late my PSA had doubled, doubled, doubled and was now 4.6. Time for systemic therapy. My lead physician is now a MO at Johns Hopkins. He is heavily involved in prostate cancer research and has 30 years experience treating that disease. He directs my treatment (triplet therapy last Q 2022). I have received additional whole pelvic radiation on the advice of my MO. The RO was essentially following directions.

Yes, I suppose I am the ultimate driver in all of this. Despite having an MD and practicing Radiology for 40 years (most of the time at major medical centers) I feel inadequate to direct my care. I am very familiar with the Imaging of prostate cancer and even did US guided prostate biopsies in the day. I can't imagine a lay person deciding to direct their own care. The treatment of prostate cancer has become very complicated with numerous options depending on G score, Stage, response to prior treatment, patient age and co morbidities etc etc. I feel my role is to find the most competent specialists I can and pretty much follow his/her advice. Of course, I listen to the options presented and make a choice. But, I have told my MO that I want the most aggressive treatment that will give me the most time with a reasonable risk/reward ratio. He understands that. It's his job. I trust him. After my 3 months of triplet therapy he gave me 5 options. I said which one would you choose to give me the best chance? I chose that one.

I have extensively read the prostate cancer literature. I am used to reading medical journals and understand the language. It is still daunting to me. I don't necessarily want Standard of Care treatment. I want cutting edge treatment designed to obliterate as much of the cancer as possible. SOC usually lags cutting edge by several years. But you have to have an up to date, experienced MO at a COE who only treats GU cancer to get that cutting edge treatment.

At least that is my opinion. Good luck to everyone on this journey.