Do I need find a medical oncologist following proton therapy?

Posted by lifutang @lifutang, May 19 1:14pm

I was diagnosed with two Gleason score 8 prostate adenocarcinomas and one with a score of 7, measuring 7 mm, 4 mm, and 1 mm respectively. All tumors were confined within the prostate and had not spread to other organs or lymph nodes. However, a PET/CT PSMA scan suggested possible metastasis to two ribs.

After consulting with a doctor, she explained that in order to confirm bone metastasis, a bone biopsy would be needed. However, since rib bones contain few cells, even a biopsy may not definitively confirm metastasis. Therefore, the bone biopsy was not pursued.

After careful consideration, I decided to proceed with treatment as if it were metastatic prostate cancer and chose proton radiation therapy. On March 18, I received an Eligard injection, and this month I am scheduled for 32 proton therapy sessions.

I noticed that many of you consulted with medical oncologists, surgical oncologists, and radiation oncologists before making your treatment decisions. After I chose proton therapy, my radiation oncologist later mentioned that the rib lesions may not actually be cancerous. During the discussion of my proton therapy plan, the possibility of including rib proton therapy was also considered.

Since I have not yet seen a medical oncologist, I am wondering whether I should consult one after completing the 32 proton therapy sessions, or if I should find a medical oncologist at the proton therapy center to serve as my follow-up doctor for post-treatment care.
Your comments and suggestions are appreciated.

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

jeff Marchi | @jeffmarc | May 19 2:03pm

You don’t just want a medical oncologist, you want a Genito urinary oncologist, They specialize in prostate cancer and have much more information than medical oncologist who work with all different types of cancer. With a Gleeson eight and what looks like metastasis spread speaking to a GU oncologist would make a lot of sense before radiation.

If you have one core that is Gleason eight, you are a Gleeson eight the seven is irrelevant. The question is, did they find anything else in the biopsy? Cribriform, seminal Vesicle invasion and intraductal can be a problem, and in some cases brachytherapy is used at the end to make sure everything has been treated.

A PSMA PET scan Can only see metastasis that are larger than 2.7 mm, And even up to 5 mm they are questionable and that’s pretty big. You could have those bone mets zapped with SBRT, but you do need to treat the underlying cancer which would include treating the prostate.

lifutang | @lifutang | May 19 6:24pm

In reply to @jeffmarc "You don’t just want a medical oncologist, you want a Genito urinary oncologist, They specialize in..." + (show)

In my biopsy report, No Intraductal carcinoma of prostate (IDC-P), No Perineural invasion, and no Extraprostatic extension). No lymph invasion. My PSA is 5.8. I check the PSA level every year,but last year, the value suddenly raised to 6.8. My other healthy conditions are well. Due to the gleason score is 8, so I make decision to do proton treatment. I will talk with my radiation oncologist regarding find a GU oncologist. I also think it has no help for continuing my urologist after proton treament.

jeff Marchi | @jeffmarc | May 20 10:12am

You are correct, Your urologist is not trained to help an advanced prostate cancer case. That’s where a GU oncologist comes in most useful, They know how to handle advanced cases.

You might wanna check other centers of excellence near you to see if you can get a second opinion from somebody that works with prostate cancer patients.