Trust my doctor

Sorry you had to find your way here. It can be overwhelming but I'll give you my take and I'm relatively new here too (diagnosed May 2025). I trust my medical team explicitly, however, they had to earn it. I thoroughly researched every decision they made in the first few visits. They did not deviate from accepted standards of care once and actually fought with my insurance to cover a little more. I guess I'm saying trust but verify. Best wishes.

BTW, I've had 2 transrectal procedures done, biopsy and fiducials. No issues with infection with either but I followed prep to the letter.

IMO, doing a biopsy before an MRI is shooting blind. The purpose of the MRI is to identify areas of concern so that those specific areas can be biopsied.

Much of this has to do with how one handles decision-making with major life choices. With me, I dived headlong into investigative mode, using my doctors’ inputs as another source of prostate cancer information. In the end, it was up to me to wrap it all up into a nice little package that I could use to make a treatment decision.

I always keep in mind that doctors are human beings, not gods; they’re just people like you and me. They are working in an occupation they have an aptitude and passion for; but, they’re not perfect; they’re human, with human frailties; they sometimes make errors. (No different than you or I who were very good in our respective careers, but we weren’t perfect.) They have lives to live, spouses, and vacations to take, student loans to pay off, and on and on and on…… And, they’re not always right; no one doctor knows everything; they only know as much as they’ve learned and experienced. Whatever they tell you, accept it with some cautious and informed skepticism (and optimism).

It’s always the time to ask the questions you should be asking. But, it greatly helps if they’re informed questions. Do your homework; ask questions; get referrals; become a “student of prostate cancer.” Whatever your process is for making major life decisions, put that into full gear.

With my numbers, my urologist (and my wife, too) wanted me to have surgery. But, the data I had read indicated that active surveillance was the preferred path. I chose active surveillance; in time I chose a treatment path. The doctors’ job is to simply provide advice and recommendations. This was my choice, not my urologists.

Ultimately, the final treatment decisions are yours to make, not the doctor’s. After all, it’s you that has to live with the outcome of treatment, not your doctor.
===================

I know a lot of people that trusted their doctors and ended up with very aggressive prostate cancer as a result. I know other people that trusted their doctors and had prostatectomy when their Gleason Score was only six and they had a low PSA. The medical community decided not to do PSA exams at all because of this, about 12 or13 years ago, Today we have a lot of people with very advanced prostate cancer as a result.

You have given no information about your initial diagnosis. How high was your PSA? Have you had any side effects that could be related to prostate cancer, Something that is unusual actually.

The current opinion is that an MRI should be done first to see if there are tumors in the prostate. Those could definitely show whether or not you needed a biopsy. Unfortunately, in some cases, even though there are no tumors, there is advanced prostate cancer.

Did the doctor do a digital rectal exam and find he felt something in your prostate? That can be a cause for wanting to do a biopsy.

Welcome to the club that nobody wants to join, everyone wants to leave and all hate being a part of!

Nobody, and I mean nobody, is right 100% of the time. Your goal is to get a quorum. This is more accessible to us now than it was 20-30 years ago and it's much more common - and part of that is because people took the advice of, say, their GP, and got into trouble.

But you are also dealing with a disease that's not just within one practice realm. Urologist, medical oncologist and radiation oncologists are the primary doctors, but there are others as well. Also, remember that this isn't broken wrist, this is a potentially life threatening cancer and it's worth asking multiple people what they think.

When is the last time you had a serious repair job on your house or car and took one persons advice? Someone knocks on your door and say "you need a new roof and it'll be $75,000" - do you just say "yea, I thought it was getting old, here's a check"? No, you call up five other roofers and have it evaluated, then you call. your insurance company and see if it's covered and, if not, what the deductible is. The moral of the story being that if you don't trust a single roofing expert to fix your roof, something far easier to do than prostate surgery/radiation, why would you trust a single doctor for the far more complex thing?

Agree with scottbeammeup about shooting blind. I had little knowledge initially and trusted my provider. They did the right thing with an MRI first and then a fusion biopsy. All my cancer cores came out of the area the MRI targeted.

I also started all of this in early 2025. As others have said, I trusted by doc, but did my own research to inform my decisions. His approach was in line with current practices. I had the high PSA reading, the physical exam, MRI, a fusion MRI biopsy, a PMSA PET scan, and the robot assisted radical prostatectomy between February and October. If you are uncertain, get a second opinion from another doc, preferably at a well-established center of excellence, like Mayo or another. Some, like Mayo, have easy online procedures to start the process and you can upload your medical records for a review prior to them finalizing an appointment. Best.

Like a U.S. president once said, "Trust, but verify."

I won't try to second-guess any of your doctor's specific suggestions — even if I were a doctor, I wouldn't do that — but be aware of a few general points:

1. Doctors will gravitate towards what they're most familiar with, quite naturally (for example, if they or their facility haven't done many trans-perinial biopsies, they're not likely to recommend one; if they're never done nerve-sparing surgery, they won't recommend it; etc).

2. Doctors have to think about all the patients, not just you. Time and resources are limited. If machine A is sitting idle, and (newer, better) machine B is overbooked, they might nudge you towards machine A not because it's the best for you, but because they don't think it will make as big a difference for you as for other patients who are waiting, and they want to reduce wait times.

3. All other things, like need, being equal, patients who express a preference will be first in line for anything new or unusual. If you don't express a preference, you're more likely to get whatever the default is (see item #2).

4. While this doesn't apply in most countries, in the U.S. (sadly) doctors also have to consider the financial side. Will your insurance cover it? Will the doctor have to take time away from other patients to get in a long debate with your insurer? Are you likely to end up in financial distress?

5. Information doesn't disseminate instantly. Older doctors will sometimes be unaware or wary of recent innovations (though some others will embrace them eagerly, of course). Prostate cancer treatment and best practices have been changing very rapidly over the past few years, so it's understandable that a busy doctor might be content sticking with what they were doing in 2022, especially if they're chief of something and have that administrative overhead as well.

Best of luck!