Do I need a Urologist?

I would say to follow the recommendations of your primary doctor. If he/she believes a referral to a urologist is needed, then go. Blessings to you on your journey..,

@sicernon3 - I appreciate that. Unfortunately, my "Primary" is an overworked underpaid Family Practice Doctor at an Insurance Company owned Clinic. So pretty much get "the book" primary care.

Been with the guy for most of 30 years and mean no disrespect to the Doctor.

The urologist is definitely out of the picture. Mine did surgery for me, but once I had salvage radiation, I really didn’t need to work with him any longer, Except when I had a problem that a urologist works with.

I started working with a Genito Urinary oncologist, The ones that specialize in prostate cancer. Medical oncologist work on almost all types of cancer so they can’t specialize and keep up with everything going on in prostate cancer.

Having your PSA rising after salvage radiation usually means you need to get on ADT plus an ARSI. That would get your PSA back down to undetectable in almost all cases. You can also wait until metastasis show up in the PSMA PET scan as your PSA rises, Some doctors do that. I had salvage radiation and 2 1/2 years later my PSA started rising again. I was put on Lupron, but without the ARPI. My cancer became castrate resistant after 2 1/2 years, something everyone wants to avoid.. At that point, I was put on an ARPI, Zytiga.

When my urologist got test results back last June, indicating that my metastatic cancer was not operable, he immediately stepped aside and referred me to a Genito-Urinary Oncologist. The GUO has been driving the boat since. Even after referral to Radiation Oncology, once IMRT was completed, the RO referred me back to GUO for follow-up and there I stay. Keep us in the loop with what your new oncologist has to say and best wishes. 👍

@jeffmarc
Thanks Jeff - I appreciate it. Pretty much as I thought on the Urologist.

Salvage was a decade ago. As far as metastasis it is already occurring. Both iliac nodes (treated with single-shot Photon SBRT at Mayo), got back to undetectable. Rising still and again.

Latest PSMA PET showed foci on spine L2, but MRI didn't show. Next PSA next week, yes as much as I hate to even imagine going back on ADT, I am sure some sort is in my future.

@briang1958
My PSMA PET scan showed a metastasis on my L4, 9 years after SRT. Before doing radiation, the RO wanted me to do an MRI and that enabled them to see exactly where the radiation would be done. Apparently the metastasis was wrapped around my L4. It seemed to be successful because two months later I became undetectable, though I am on ADT and an ASRI so that is a factor as well.

I noticed you did get SBRT and it worked. Must be very annoying that the PET scan shows something but the MRI doesn’t. Makes it difficult to exactly target the spot. I suppose they want to do another MRI in a few months. Depends on what happens with your PSA. Maybe a Tesla 3.0 MRI will show more. Do you know if the one they used was a 1.5?

Your PSA is pretty low, as I mentioned, so maybe it will go down, Definitely keep us up with what’s happening.

@mjp0512 Excellent, thanks for this.
My new Oncologist specializes in PCa, I will be meeting again with him after the next PSA. I will ask about a GUO.

@jeffmarc - I do not know if it was a 3.0 or 1.5, it was at Mayo at the request of the RO.

PSA has been rising over the last 3 PSAs. Went from .01, to 0.3 to .7 to 1 monthly tests.

Hoping that we don't see my L3 glowing, happy and sorry to have you as a reference should we go there.

The "nothing left to cut" comment must have been meant as a joke. If you still have a bladder and/or a penis, you might still sometimes need help from a urologist (they treat the urinary tract, not just the male reproductive system).

I had a urology oncologist treating me for a while because of minor complications from radiation. He didn't stay as a permanent member of my team, but I can go back to him if any additional issues develop.

I had my prostate cancer treated with proton radiation (with ADT) during April-May 2021. After making my proton decision in December 2020, I haven’t seen a urologist since.

My medical oncologist coordinated my hormone therapy during treatment, as well as my regular bloodwork to this day. When/if the time comes when her services are no longer needed, my primary care physician will manage my PSA-tracking (along with all the other bloodwork she does annually).

I don’t see the need for a urologist unless there’s a reason.