RE: Who should be the primary doctor now?

[Guest guest]

Larry,

Until now I would have said that an

oncologist should ‘head up the team’, but in a demonstration that

there is always something to learn about this disease, I have been assured that

this is a mistaken view. The reasons advanced – by people whose opinions

I trust – is that the majority of oncologists do not have a detailed

knowledge of prostate cancer and that a good urologist would have better

knowledge. What these people DO suggest is that, if you can find an oncologist

who specializes in prostate cancer, then it might be an idea to have them as a

leader, but otherwise, by all means consult an oncologist, but choose as the ‘leader’

someone whose judgment you have come to value, be that your MD, urologist or …..

In the recent book Invaders of The

Prostate Snatchers, Dr Scholz, himself an oncologist, makes a very similar

point and he lists in an appendix to the book, oncologists who have published

or studied prostate cancer, suggesting that they might be suitable candidates

as prostate cancer specialist oncologists.

As I say, I always thought that consulting

an oncologist was important and the three that I have consulted – one in

South Africa, one in the US and one in Australia have been very pleasant to

deal with, seemingly well balanced and, best of all from my point of view, did

not insist that their views were paramount. I am told, by people in the US that this may not be the case in the US.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Larry Helber

Sent: Tuesday, 14 September 2010

3:44 PM

To:

ProstateCancerSupport

Subject:

Who should be the primary doctor now?

Ok, we all

know that are urologists are surgeons. When going to the next step we

need to switch to an oncologist, either radiation or medical. My question

to the group is who should be my primary doctor leading the way now? Some

background Dx’d just about a year ago with an aggressive Gleason 9

cancer. 6 months of neo-adjunct hormone therapy was recommended before

surgery. Pathology from the surgery (RALP) resulted in lots of positive

margins. Every doctor I conferred with agreed that radiation would be

next as soon as I had healed from surgery. Now that I have completed my

IMRT, my radiation oncologist wants to keep me on hormones (Lupron) for another

year or two to give the radiation treatments a chance to do their thing.

I am not crazy about it but if that is what I need to do I can live with

it. I have been on hormones for a year already. Any way at

the moment my urologist is administering my Lupron at the recommendation of the

radiation oncologist. Who should I consider to be the point person

now? Should I touch base with the medical oncologist I talked with

earlier? Should I keep ping ponging between the radiation oncologist and

the urologist? Maybe just consider the radiation oncologist my primary

since he was the last one to work on me and he will be doing follow ups.

Just a little confused about the next steps.

[Guest guest]

After I completed radiation at the MD Proton Center, I consulted with

my family physician, an internist, for advice on setting up a team of doctors

who could oversee my general well-being in addition to the specialist at MDA who

had direct oversight of my treatment protocol. Since I had a Gleason 9 with a

PSa of 12.2 preceding treatment, I was put on a regimen of ADT with Lupron for

an indefinite period. I had particular concern about ADT having been diagnosed

previously with osteopenia as wsll as the potential for other ill-effects from

hormone therapy and advanced prostate cancer. With my family physician in the

loop for general health considerations and referral to other specialists as

needed, I now have a medical oncologist on the team who works in coordination

with my radiation oncologist at MDA who I consider to be the lead specialist on

all matters related to the prostate. I currently see each oncologist on a three

month rotation which may be extended to six months once I am confident that my

condition is under control. In regard to bone density, my physician has

prescribed an annual infusion of Reclast. So far so good, except for the heat

flashes, but that's a small price to pay to keep the monster at bey.

[Guest guest]

On 9/14/10, GeneA wrote, in pertinent part:

>

> In regard to

> bone density, my physician has prescribed an annual infusion of

> Reclast. So far so good, except for the heat flashes, but that's

> a small price to pay to keep the monster at bey.

How is the bone density checked? I'd recommend a yearly test via

dual-energy absorption x-ray (DEXA) or quantitative CAT scan

(qCT) methods.

So far as hot flashes and other side effects of ADT are

concerned, all too often medics either don't know or don't care

about them. Here are links to two excellent and helpful articles

on coping:

http://www.prostate-cancer.org/education/andind/Guess_TestosteroneSideEffects.ht\

ml

or

http://tinyurl.com/2ymb8f

http://www.prostate-cancer.org/education/sidefx/Strum_ADS.html

or

http://tinyurl.com/g6fzp

Regards,

Steve J