Re: Oncologists v Urologists

[Guest guest]

In my case, the urologist told me that they treat prostate cancer until it metasizes and then refer to an oncologist. Was he wrong, should I have already been seeing an oncologist? I dont know. Supposedly the urolologist that I have been seeing is supposed to be one of the best in Seattle.

Anyway, now that it has gone into the bone, I will be seeing an oncologist next week.

Dave

To: ProstateCancerSupport Sent: Sun, September 5, 2010 5:28:24 PMSubject: Oncologists v Urologists

In a recent post on another List, in response to a man looking for a recommendation for an oncologist in the New York area, I said:

<snip> In his recently published book Dr Mark Scholz makes the point again, as others have before him that oncologists, rather than urologists should head up any prostate cancer team - and if at all possible men should consult oncologists with a special interest in prostate cancer. <snip>

This generated a couple of Off List e-mails from people whose opinions I normally value. These mails suggested (one in fairly strong terms) that my views might not be of much use, since there were many oncologists who had no idea about prostate cancer, especially early stage disease. (Thus apparently ignoring what I had said about trying to find oncologists with a special interest in prostate cancer, which I would expect to include all stages of the disease, in my apparent naivety.)

But be that as it may, it made me think about the issue a little more and relate these comments to my own experience and to wonder if I was the only person who had found it extremely useful to consult oncologists, along with the urologists who were my first port of call. This is a brief summary of these experiences:

The first oncologist I saw was not long after I was diagnosed and when I was living in South Africa . I was about to head off to the US for scans that were not available in South Africa and second opinions from specialist doctors (radiologists, surgeons, oncologists). I was still being pressured by my urologist not to wait any longer for my surgery. The oncologist agreed that it might be better to gather more information and we agreed that I would see him on my return. He asked me to let him know ahead of my appointment what issues I’d particularly like to discuss with him and he also asked me to send in my scans before the appointment so that he could have time to study them. We did all this, there was no time pressure on the appointment, which lasted a little over an hour and at the end of which I was undoubtedly better informed about

cancer and had some support for what was then termed Watchful Waiting as my choice.

The second oncologist I saw was at a well known prostate cancer institution in the US on my exploratory visit. By then I had my scans (described as works of art by this good doctor) which he had studied with interest. In his view the ‘gold standard’ as he termed surgery was my best option, but he acknowledged that there might be other options that might suit me. He did not go so far as to recommend or support Watchful Waiting however. Incidentally this was in complete contrast to the specialist surgeon I saw on the same visit, who was shocked that I had not had surgery and offered to carry out the procedure the following week!

The third oncologist I saw was here in Melbourne when we returned to Australia five years ago. Again a very pleasant man who was prepared to discuss the issues I raised without any apparent judgement about my foolishness in waiting almost 10 years to make a treatment decision. He was ambivalent about waiting any longer, in the face of a consistently rising PSA, citing my ‘youth’ – I was only 63 at the time – as his main objection and saying that if I was ten years older he would support a continuance of my current Active Surveillance regimen. Since he was a radiation oncologist, he naturally suggested EBRT (External Beam Radiation Treatment) with neo adjuvant ADT (Androgen Deprivation Therapy) as my best option.

The fourth and (so far) final oncologist was here in Melbourne . I consulted him when my PSA finally hit 40.0 ng/ml and the radiographer report said that there was evidence of a lesion that was indicative of metastasis. Again, he gave us all the time we needed to discuss my options (including why orchidectomy or DES might not be my best choices!). He was prepared to support a further delay in starting Intermittent ADT (Androgen Deprivation Therapy) Lite – Zoladex implants, which we both agreed might be the best course, saying that he had successfully managed men with PSA counts in the 100s successfully for many years.

So, that’s my experience with oncologists. All good, all positive. Maybe I was just lucky and beat the odds, but I would be very interested if anyone who has had experiences with oncologists, good or bad) would respond to this post setting out the brief summary of how this was for them. Mail me off line if you want to, and it may be best not to identify the oncologist by name, especially if you are critical, but it would help me focus on the issue because I have consistently advices men to include an oncologist in their ‘team’ and I would hate to think that this advice is as misdirected as has been suggested. .

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

[Guest guest]

The old saying goes “If the only

tool you have is a hammer then everything looks like a nail”. Usually a

Urologist is a surgeon their for he may have a tendency to approach problems

as surgeon would. By the same token a Radiation Oncologist my recommend

radiation as his primary tool. This is why it is important to assemble a “team”

of doctors to monitor your case. Your job is to take their input and make

decisions for the best therapy for you. As part of my team I have a urologist a

radiation oncologist, and medical oncologist that are actively monitoring my

condition. I also have a Chief of Urology at a research hospital and a couple

of other doctors that I refer to for advice or questions. I top that off with

staying current with the PCa trends by monitoring these forums and other

locations on the internet. I lined these up when I was diagnosed

and have kept the relationships going throughout my treatments. Never

have I felt any one doctor as my “main” doctor until a specific “event”

occurred. I did spend more time with one doctor or the other at different

times but I did confer with the other doctors via email, phone or visits from

time to time. From the beginning I was also up front with all of my doctors

that I was talking with the others and got their opinions of treatment

suggestions. Often treatments were based on recommendations from all of

them.

This is my approach to my disease, and

makes me feel better about moving forward. Blindly following a doctors recommendations

may get you healed I just prefer to be more proactive.

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of dave halvorsen

Sent: Sunday, September 05, 2010

8:36 PM

To: ProstateCancerSupport

Subject: Re:

Oncologists v Urologists

In my case, the urologist told me that they treat prostate cancer until it

metasizes and then refer to an oncologist. Was he wrong, should I have already

been seeing an oncologist? I dont know. Supposedly the urolologist that I have

been seeing is supposed to be one of the best in Seattle.

Anyway, now that it

has gone into the bone, I will be seeing an oncologist next week.

Dave

From: Terry Herbert

To: ProstateCancerSupport

Sent: Sun, September 5, 2010

5:28:24 PM

Subject:

Oncologists v Urologists

In

a recent post on another List, in response to a man looking for a

recommendation for an oncologist in the New

York area, I said:

<snip>

In his recently published book Dr Mark Scholz makes the point again, as others

have before him that oncologists, rather than urologists should head up any

prostate cancer team - and if at all possible men should consult oncologists

with a special interest in prostate cancer. <snip>

This

generated a couple of Off List e-mails from people whose opinions I normally

value. These mails suggested (one in fairly strong terms) that my views might

not be of much use, since there were many oncologists who had no idea about

prostate cancer, especially early stage disease. (Thus apparently ignoring what

I had said about trying to find oncologists with a special interest in prostate

cancer, which I would expect to include all stages of the disease, in my

apparent naivety.)

But

be that as it may, it made me think about the issue a little more and relate

these comments to my own experience and to wonder if I was the only person who

had found it extremely useful to consult oncologists, along with the urologists

who were my first port of call. This is a brief summary of these experiences:

The

first oncologist I saw was not long after I was diagnosed and when I was living

in South Africa

.. I was about to head off to the US

for scans that were not available in South Africa and second opinions

from specialist doctors (radiologists, surgeons, oncologists). I was still

being pressured by my urologist not to wait any longer for my surgery. The

oncologist agreed that it might be better to gather more information and we

agreed that I would see him on my return. He asked me to let him know ahead of

my appointment what issues I’d particularly like to discuss with

him and he also asked me to send in my scans before the appointment so that he

could have time to study them. We did all this, there was no time

pressure on the appointment, which lasted a little over an hour and at the end

of which I was undoubtedly better informed about cancer and had some support

for what was then termed Watchful Waiting as my choice.

The

second oncologist I saw was at a well known prostate cancer institution in the US on my

exploratory visit. By then I had my scans (described as works of art by this

good doctor) which he had studied with interest. In his view the ‘gold

standard’ as he termed surgery was my best option, but he acknowledged

that there might be other options that might suit me. He did not go so far as

to recommend or support Watchful Waiting however. Incidentally this was in

complete contrast to the specialist surgeon I saw on the same visit, who was

shocked that I had not had surgery and offered to carry out the procedure the

following week!

The

third oncologist I saw was here in Melbourne

when we returned to Australia

five years ago. Again a very pleasant man who was prepared to discuss the

issues I raised without any apparent judgement about my foolishness in waiting

almost 10 years to make a treatment decision. He was ambivalent about waiting

any longer, in the face of a consistently rising PSA, citing my

‘youth’ – I was only 63 at the time – as his main

objection and saying that if I was ten years older he would support a

continuance of my current Active Surveillance regimen. Since he was a radiation

oncologist, he naturally suggested EBRT (External Beam Radiation Treatment)

with neo adjuvant ADT (Androgen Deprivation Therapy) as my best option.

The

fourth and (so far) final oncologist was here in Melbourne . I consulted him when my PSA

finally hit 40.0 ng/ml and the radiographer report said that there was evidence

of a lesion that was indicative of metastasis. Again, he gave us all the time

we needed to discuss my options (including why orchidectomy or DES might not be

my best choices!). He was prepared to support a further delay in starting

Intermittent ADT (Androgen Deprivation Therapy) Lite – Zoladex

implants, which we both agreed might be the best course, saying that he had

successfully managed men with PSA counts in the 100s successfully for

many years.

So,

that’s my experience with oncologists. All good, all positive. Maybe I

was just lucky and beat the odds, but I would be very interested if anyone who

has had experiences with oncologists, good or bad) would respond to this post

setting out the brief summary of how this was for them. Mail me off line if you

want to, and it may be best not to identify the oncologist by name, especially

if you are critical, but it would help me focus on the issue because I have

consistently advices men to include an oncologist in their ‘team’

and I would hate to think that this advice is as misdirected as has been

suggested. .

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