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urologist and radiation oncologist aren't on the same page

Posted by bluegill @bluegill, Jan 23, 2025

Urologist: There's a bit of cancer still there in the prostate, but all I need to do is to stay on ADT for the rest of my life, and I'll be fine. Maybe even for 20 years!

Radiation oncologist: (based on same PSMA results) my cancer is back, and we need to deal with it aggressively and soon! I need an MRI and then seed implants. For people like me, ADT would work for only a year or two, then the cancer would come roaring back.

(1st diagnosed 4 years ago, Gleason 9, PSA of 28. Radiation + 3 years ADT. Went off ADT last year and PSA shot up. Now back on Eligard.)

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

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docwatson | @docwatson | Jan 28, 2025
In reply to @nikolai57 "Definitely get a third opinion. My particulars were different to yours, but my situation was similar..." + (show)
Profile picture for nikolai57 @nikolai57

Definitely get a third opinion. My particulars were different to yours, but my situation was similar in that my urosurgeon disagreed with my RO and MO. I got a third opinion at MSKCC, and felt confident going with the recommendation I got there, which was a tweak of the MO’s recommendation. I recently finished my therapy, and so far so good. Although my treatments have been local, my doc at MSKCC has also been following me, and I feel better knowing that if there is a recurrence, I already have a doc there who knows the whole history.

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If you can find one, get a third opinion from a prostate oncologist (hard to find) who is agnostic to treatment options.

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broderbund1 | @broderbund1 | Apr 2 9:55am
In reply to @bens1 "Hi Heavyphil Small world. Dr Nagar went from using the Mridian, which is still available to..." + (show)
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Hi Heavyphil
Small world. Dr Nagar went from using the Mridian, which is still available to hospitals who want to pay $1 million a year for service updates, to another MRI based radiation machine, Elekta, at Memorial Sloane Kettering.

I wonder how long it will take other hospitals to move to MRI based radiation machines from non-MRI based machines, ROI notwithstanding.

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@bens1

Had a consult with Dr Nagar yesterday….very personable and he seems extremely confident (almost overconfident in some ways) that with SBRT any my profile this can be a one and done treatment (less 10% chance recurrence). Interested to know if he treated you and your overall thoughts…..?

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bens1 | @bens1 | Apr 2 10:47am
In reply to @broderbund1 "@bens1 Had a consult with Dr Nagar yesterday….very personable and he seems extremely confident (almost overconfident..." + (show)
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@bens1

Had a consult with Dr Nagar yesterday….very personable and he seems extremely confident (almost overconfident in some ways) that with SBRT any my profile this can be a one and done treatment (less 10% chance recurrence). Interested to know if he treated you and your overall thoughts…..?

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@broderbund1

Dr. Nagar did not treat me, but he did do one of my 5 consults when I had Prostate Cancer. I was actually sent to him by the president of Mridian Viewray at that time, in 2022. He was very helpful with me both in terms of the consult and when I had other consults as well, he was able to give me some insight. He has experience with both the Mridian Machine and the Electa Unity.

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