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Role of Medical Oncologist in Prostate Cancer Therapy?

Posted by rick137 @rick137, May 8 12:24pm

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?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

ecurb | @ecurb | May 11 9:30am

Mayo told me- I should see a urologist only if my PSA is >0.4 : otherwise they don’t want ya. In order to see Dr. Cwon, you need a PSA > 4. This was via phone call to Mayo- urology. Hence I don’t qualify so far. Mine is 0.01 less than.

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1 reply
rick137 | @rick137 | May 11 9:33am
In reply to @dirtdancer "Thank you for your response; I have been battling stage four since 2008 and have gone..." + (show)
@dirtdancer

Thank you for your response; I have been battling stage four since 2008 and have gone through most all treatment options. I’ve now begun to make my decisions based on one or two or three doctors opinions. I know I am getting jaded. Out of the seven doctors, I see in a semi regular timeframe. I am lucky if two have the same opinion. A couple years ago I started seeking treatment options that held out hope for a cure instead of just treatment.
I think you much for your response and your insight.

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@dirtdancer

Someway, somehow you have made it 16 years so far. All the best for another 16, Bro.

Rick

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lag | @lag | May 11 12:23pm
In reply to @dirtdancer "A question for you? Several years ago, three, I started on abireterone and prednisone. About six..." + (show)
@dirtdancer

A question for you? Several years ago, three, I started on abireterone and prednisone. About six months after that, my urologist switched me to Erleada which she provides through his own pharmacy. And now my number have run up to a PSA in the mid 20s he still does not want me to switch from Erleada and I am beginning to think it is because he sells it to me at $20,000 per month, I am thinking of going back to abireterone as my numbers were better then. Just curious if you took the one pill with food or you took the four pills on an empty stomach? Or is it possible to take two pills with food in the morning and two pills with food in the evening and get more positive results? My medical oncologist, hemmed, and hawed on that question.

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Both his Mayo urologist and both of his Simon Cancer Center medical oncologists told my husband to take all four Abiraterone tablets in the morning on an empty stomach and refrain from eating or drinking except water for an hour afterward. The price has gone down a lot, at least with Original Medicare and a Part D drug plan.

As for paying the doctor so much for Erleada, that sounds like an unethical plan by the doctor to enrich himself at your expense. Get rid of him if you can, or tell him you require to return to Abiraterone asap.

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lag | @lag | May 11 12:25pm
In reply to @ecurb "Mayo told me- I should see a urologist only if my PSA is >0.4 : otherwise..." + (show)
@ecurb

Mayo told me- I should see a urologist only if my PSA is >0.4 : otherwise they don’t want ya. In order to see Dr. Cwon, you need a PSA > 4. This was via phone call to Mayo- urology. Hence I don’t qualify so far. Mine is 0.01 less than.

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It is true that Dr. Kwon only sees advanced prostate cancer patients, especially those with a major recurrence. BUT you can be seen by another Mayo Rochester urologist if at or above .4 and then transfer care to Dr. Kwon later if necessary. We all hope you never qualify for either, of course!

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northoftheborder | @northoftheborder | May 11 2:11pm
In reply to @rick137 "@retireddoc Definitions: MO:=Medical Oncologist SOC:=Standard of Care COE:=Center of Excellence GU:=??? CET:=Cutting Edge Treatment TS:=Treatment Safari..." + (show)
@rick137

@retireddoc

Definitions:
MO:=Medical Oncologist
SOC:=Standard of Care
COE:=Center of Excellence
GU:=???
CET:=Cutting Edge Treatment
TS:=Treatment Safari
PCa:=Prostate Cancer

Many thanks for the details of your TS.

I agree completely with your desires and choices. "The most aggressive treatment that will give me the most time with a reasonable risk/reward ratio." "Curative intent." CET.

I wonder if you were given multiple options whereas the care team for non-physician patients consider multiple options but only present the one they consider optimal to the patients. For myself, if there are multiple options I would like to know them along with the one considered optimal. Second opinions are standard for other aspects of PCa, why not for the most important aspect, your PCa TS?

By the way I am also a retired doc but my specialty, solid-earth geophysics, is somewhat less relevant to PCa than yours.

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I'm also a "doctor", but I think medieval English and Latin manuscripts are even less relevant than solid-earth geophysics. 🙂

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retireddoc | @retireddoc | May 11 7:55pm
In reply to @rick137 "@retireddoc Definitions: MO:=Medical Oncologist SOC:=Standard of Care COE:=Center of Excellence GU:=??? CET:=Cutting Edge Treatment TS:=Treatment Safari..." + (show)
@rick137

@retireddoc

Definitions:
MO:=Medical Oncologist
SOC:=Standard of Care
COE:=Center of Excellence
GU:=???
CET:=Cutting Edge Treatment
TS:=Treatment Safari
PCa:=Prostate Cancer

Many thanks for the details of your TS.

I agree completely with your desires and choices. "The most aggressive treatment that will give me the most time with a reasonable risk/reward ratio." "Curative intent." CET.

I wonder if you were given multiple options whereas the care team for non-physician patients consider multiple options but only present the one they consider optimal to the patients. For myself, if there are multiple options I would like to know them along with the one considered optimal. Second opinions are standard for other aspects of PCa, why not for the most important aspect, your PCa TS?

By the way I am also a retired doc but my specialty, solid-earth geophysics, is somewhat less relevant to PCa than yours.

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GU=Genitourinary

I don't believe my MO gave me options different than he does for any other patient. They included whether to have the pelvic radiation. To continue Lupron indefinitely or discontinue after a year if my PSA remained undetectable. The discontinuation of Darolutamide after 3 months vs continuation indefinitely. I can't remember everything he said but he seemed pretty definite about what course of treatment he believed to be best.

I believe you know more about prostate cancer than I know about solid-earth geophysics. I'll have to Google it.

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