Oncologists v Urologists

[Guest guest]

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