When to switch doctors? Anyone take this step?

Do you live in the United States? The answers are very different for people who do not live here.

A surgeon who does prostatectomies is not the person to guide your future cancer care with a Gleason nine (Or any recent score when you have a recurrence). Your having an appointment with someone else may actually be the right answer. If they are setting you up with an oncologist to handle your treatment from now on, that would be the best thing to do.

Getting a second opinion from another doctor is critical when you are unsure of your treatment. Going to a center of excellence or finding a Genito Urinary Oncologist is extremely important, GU Oncologists are the ones that specializing in prostate cancer, unlike medical oncologist, who work with all different types of cancers. If you’re being set up with a medical oncologist, you may want to find another place For treatment. I’ve had a GU oncologist for eight years, As soon as I went on Lupron I was switched from my urologist/surgeon To the oncologist. She knows so much about prostate cancer, as much as I know, she was able to answer my questions every time I ask about Something I heard that might help my treatment.

You have some serious problems, cribriform Can be very hard to treat and can cause recurrence sooner than one would hope. Definitely find a second opinion you can depend on.

anosmic1, I always switch when shifted to an NP. Collect your records, you should anyway, I would request the surgical report and CDs of any scans. It is fairly usual for a medical urologist to follow-up either radiation or surgery. I suspect you want careful follow-up and sometime the division of care results in better attention.
I would want the same medical oncologist following me, but not an NP. You might address the concern for consistency of care in a complicated case with office management. I wouldn't like to lose the contact with the original surgeon, that might be the only downside. But I don't see your move as terribly significant for the assembly line directors.

Helpful - thanks. I live in Arizona. I had a conversation this week with someone I met through the Prostate Cancer Coalition who works in radiation. That office has oncologists so I might see about going there. The issues I saw in the post-op notes, some of which I mentioned in the first post, make me feel more urgent than the urologist/surgeon is acting. I'm worried about aggressive growth - I was Gleason 4+3 at the biopsy on 7/25/24 and 4+5 at surgery on 11/11/24. I understand that a PSA of 0.02 is lower than what would normally cause concern, but for it to be detectable at all just 7 months after surgery also concerns me. I thought I had an easier cancer - my parents both died from pancreatic - but apparently that was unwarranted optimism.

If my PSA was as low as yours, I would just see that it’s < .1. I’ve not been getting the extra sensitive tests. I don’t want to have to worry if mine goes up just a little bit like yours has. At .02 it is time to wait for the next test. It really might be just an insignificant blip. Did you ride a bike before you had the PSA test??

When to switch? Here's what I do. I like having two oncologist. One at a teaching, research cancer institute, NCI connected (National Cancer Institute). The other at my local hospital. Either way I am guided in my decision making based on treatments they offer and quality of staff/services. My cancer team includes two oncologist, one radiation oncologist, two hospitals. I also volunteer at the largest NCI Cancer Institute in my region. In others word I keep my options open. There is lots to learn about prostate cancer. My strategy is never stop learning.

here is my two cents ... IF you asked to speak to your surgeon , they should not substitute another person for this meeting. However , when you are under ADT treatment usually an Oncologist is your main point of contact I am told. IF you wanted a talk with your surgeon , that still should be granted . Maybe there was a mix-up on who you actually wanted to talk to . I think you need to talk to your entire team . Get a VERY SOLID understanding on who is looking after you case now , and why , and when the next change would happen and why , etc . This will stop the guess work for you . Hope this help Sir .

my two cents
I went to a urologist I really liked for years very nice private practice, however they got bought out merged with a big chain.
I could still see 'my guy' however I had a kidney stone and someone else was assigned. I got very poor treatment ( another story in itself) but I was/am so dissatisfied that I left)
i next went to a very big well known teaching hospital (one of the top five in the US) and met the chief of urology, He went over many options and pointed to focal treatment. however a month later with new biopsies he recommended RARP and another surgeon (part of the University) however this surgeon had very bad ratings ( I know good surgeons can get bad ratings but this surgeons rating included very specific details regarding surgical errors and very bad patient care./

In the meantime my son and daughter in law recommended a local urologist who has excellent patient care and is the chief of surgery at our local hopsital had done over 500 robotic surgeries so i went with him
I think he did a very good surgical job so in the end I got good diagnostic confirmation from three different sources which I value and surgery from a good surgeon.

I however now am 'shopping' for yet another urologist. My surgeon despite being a great surgeon is not so good with patients and is running a very overloaded private practice.

In terms of cancer and life and death , I want the best clinical information and recommendations I can find. For follow up and ongoing care I want someone that will really be attentive and work with me.
Some surgeons (I know I am stereotyping) can be very egotistical and talk a great game. Some really know their business and I want someone like that for the diagnosis and when important clinical decisions need to be made.

Get a second, third or even fourth opinion. It is your body, your life, get as good as possible medical opinions you can and do not tolerate poor treatment. Some of the teaching hospitals will only want one physical appointment and then can follow you via video sessions.
I really wish you good luck

.02 by many standards is considered indictable. What kind of doctor did they set the next appointment with? You kind of left us hanging by not clarifying that. I would think the surgery pathology would have mentioned most of the items you have a concern about. If the pathology didn't show any of those items more than likely you are now in the watchful waiting protocol. .02 isn't going to get anyone excited and could eventually go to .01 or slowly climb over a couple of years. I had 1/10 of one pin with Crib and the GU I had my second opinion couldn't get excited about it. Over treatment is a thing too. Future radiation with ADT seems somewhat frequent in RP patients. I enjoyed my life even while I was in the process of heading towards BCR. Kind of pointless and ruins your current day.

After my post-op PSA tests I saw an NP. I asked to see someone to talk about treatment plans, given that I am Gleason 9 (up from G7 3 months before surgery) and have a number of things that indicate a likely bad outcome. They assigned me to a PA. I called back and said no to that, and I now have an appointment with the surgeon//urologist. I also scheduled a consult with Mayo Clinic so I could get a second perspective. One of the first things the urologist told me after surgery was that my tumor could have been fatal. I know 0.02 is low, but it's also detectable after just 7 months. With all the negative indications I'm not going to sit back and follow protocol just because that's standard.

Sorry to hear that you have only met your surgeon once! How long of a time frame is this, from the biopsy until now?