Should an Oncologist be involved?

An opinion from a radiation oncologist may help you weigh what decisions would be best for you. Although Dr’s are devoted to people who are suffering, there is an inherent bias towards suggesting a solution that they have had success with that may or may not be the best one for you.

Hmm..

With that kind of PSA test results, I have two questions?

The first, have you had any type of imaging, if so, which one(s) and what were the results? That's important since surgery is generally a treatment decision when the clinical data indicates it is confined to the prostate gland. Here are some links that may help inform any discussion and decisons with your medical team - https://www.urotoday.com/video-lectures/nccn-prostate-cancer-guidelines-review/video/2365-nccn-guidelines-staging-evaluation-and-imaging-approaches-in-prostate-cancer-christopher-wallis-and-zachary-klaassen.html

You say the biopsy was mainly GS 6 and some 7s, were the sevens 3+4 or 4+3?

I would consider bringing on board a radiologist and oncologist to discuss treatment considerations. A 2nd opinion from another urologist my be something you want to consider. If your current urologist has an issue with either of those, well, consider finding one who does not have a fragile ego, the cancer resides in you, not him and the choice of treatment is both important to the desired outcome - the "cure," as well as your quality of life.

If you have not already, read the NCCN guidelines, they are a starting point for your discussion with your medical team - https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459

Another piece of the clinical data puzzle may be the PSADT and PSAV, not sure that two data points is sufficient to calculate using the various online calculators such as MSKCC - https://www.mskcc.org/nomograms/prostate

Kevin

I would most definitely get a 2nd opinion from a radiation oncologist. I first went to the urologist that the hospital assigned me, and he was all too happy to cut my prostate out$$$ The minute I said I wanted to consult with a radiation oncologist he could not wait to get rid of me. At least that was my impression. Too many tales of urinary incontinence on here from prostate removals for my liking. I decided to go with the radiation.

Urologist experienced and current on research.. our urologist scheduled a meeting with the radiation oncologist. The radiation oncologist and urologist actually speak about every move.. the urologist manages the ADT, it’s the urologist that ordered the PSMA PET scan.. he has extensive education and experience with advanced Prostate Cancer.. ask him honest questions most are going to say you need an oncologist to manage your care..and even a major cancer center even better..

Your Gleason score, PSMA PET results, doubling Time and other issues all need reviewed along with the experience of medical personnel prior to any decision

Our first Urologist wanted to go straight to Radical Prostatectomy without any imaging alarm bells…

Knowing what I know now, a stage IV Prostate Cancer survivor, I'd consult with an oncologist. My Oncologist is helpful in explaining and educating me about treatments and prostate cancer strategies.

I first had an MRI, then a biopsy. MRI showed lesions in 2 locations. 12 or 13 samples taken in the biopsy. I do know, my Urologist is specializing in Prostate Cancer, he does a hundred or so of removals every year. I am assuming therefore more biopsies than that each year. He thoroughly discussed radiation be. Removal with us. This process (as slow as it seems to go) is very mind boggling quick for decisions that need to be made. I do trust my urologist, at the same time my future quality of life is at stake.

An MRI of the prostate a piece of the clinical dta, what is not is a PSMA scan which may show prostate cancer outside the prostate, lymph nodes, bones, organs. If you decide on surgery, you want clinical data which to the best of modern medical technology, can confirm or deny it is confined to the prostate.

It can help this group form their responses if you include the pathology report.

Hundreds or so may not be an indicator of "experienced."

It's great that he discussed radiation with you, would it hurt to consult with a radiologist to get their perspective?

Quick for decisions, hmmm, with 6s and 7s, not sure you need to rush to make a decision. Maybe if the pathology report indicated GS 9 and 10, then yes, but still, consults with a radiologist and oncologist along with a 2nd opinion from another urologist may lead to the same decision, surgery, but you may be more comfortable with that decision having gathered data from other specialists and other treatment options.

Miami62:as a reference, Dr. Patel in Celebration,fl has done 18,000 prostate removals in his lifetime.

If your tag name is any indication, one of the six radiation oncologists I spoke with(5 out of 6 had slightly different suggestions and they each had 20+ years of experience), and liked, was at the Miami cancer institute, Dr Fernandes. They also have the MRIdian radiation machine.

My urologist had suggested radiation OR prostate removal to me. For me, there were more questions regarding quality of life with prostate removal but many had it done successfully, without BCR but many had recurrence.

Regarding radiation, a “thorough discussion” regarding radiation changed for me as I researched. 2 mm vs 4-6 mm margins and real time vs image comparing. These can make a big difference in your quality of life and it varies from machine to machine…cyber knife,MRIdian photon, proton therapy…