Hi sandg,
Your local oncologist has a lot of information given the tests you have listed. You have asked him to refer you to Mayo. Mayo has certainly reviewed your case given the information from your local oncologist. They don't have to do a deep dive or see you immediately if you are stage 4 to get you started.

It would not be unusual for your doctor and the Mayo physician to confer on the best course for you given your advanced stage. Time is of the essence in getting you started on treatment. There are things that can be done independent of the information you get from a PSMA Pet scan.

After discussing your case, and given the resource constraints of both treatment centers, they might likely agree on a reasonable course of immediate action. It would be highly unusual for an Oncologist from Mayo to tell your doctor what to do.

Starting a course of chemo would not be an unusual place to start and I know it is sometimes recommended by at least one Oncologist at mayo. It's aggressive, but you are stage 4. After consultation, the doctors could certainly agree to a course of action that would precede your appointments at Mayo. And, it would be reasonable to do so.

Mayo is one of the top centers for PSMA Pet Scanning and demand for time on the machines is very high. But, you don't need to go to Mayo for chemo or ADT or other broad spectrum treatments for metastasized cancer. The scan will help guide the type and order of treatment that your physicians recommend. Hormone therapy (ADT) is part of the standard of care. Chemo is becoming more prevalent.

You've had a nasty surprise and people don't often get an initial diagnosis of stage 4. At age 65 you have a choice between aggressive treatment and palliative care. If Mayo has agreed to take you as a patient and you have elected to follow aggressive treatment, what you have experienced is reasonable. It would be nice if you had better communication with your local physicians and you need the answers to Colleen's recommended questions. Prostate cancer treatments are numerous and complicated. Be pro-active and educate yourself as fast as you can.

Mayo: After reviewing your test results including the PSMA Pet scan your team at Mayo may recommend further testing, re-examine past testing and help you decide on a course of treatment. They will recommend a treatment plan. This may be done on a remote video consultation.

You can give yourself a head start by learning about the different treatments. The prostate cancer videos done by the Prostate Cancer Research Institute on Youtube were helpful to me to begin to get a handle on all the choices available. You need to educate yourself as quickly as you can because things will happen fast once you start at Mayo.

Since you were diagnosed in January, I'm sure you've begun. And you may not need these suggestions. They may be helpful for others who have similar questions.

Use the Mayo website in your research. There is a lot there. If you have been accepted as a patient at Mayo, learn to use the Mayo Patient Portal.

You will not be disappointed in the care you get at Mayo and I've found communication to be quite good usually. You have a tough row to hoe, but you will get state of the art care at Mayo. I hope this has been helpful.

Good luck on your journey and may God bless you ...