Who is my primary PC doc now?

I had my annual checkup with my local urologist today. Everything looked great he thought. We discussed having my PSA every 12 months rather than 6 and he thought that would be fine. My RO at UFPTI recommends I have it tested every 6 months. The question is who is my primary doctor now for follow up? I see the local urologist every 12 months for DRE and discussion and he is the best. He has many patients who have had radiation as primary treatment for PC so is familiar with SE’s and treatment options for failure. I can call him at home if necessary. I haven’t seen my RO since treatment 4 years ago. He’s a robot, no bedside manner, and hates discussion. I just fax in my PSA results. I don’t know what his role would be if I had recurrence. I know if I had a couple of PSA increases he would prescribe an antibiotic probably and want retest in a month, but my local URO can do that. If PSA rose 2.0 above nadir the RO might arrange scans, but again my local guy could make those arrangements at one of a several great hospitals in the area. I suppose my RO would hand me off to an oncologist if it was determined that I had BCF or distant spread. I mean what can he do for me once I’ve had primary radiation that one of the local major hospitals in my area such as Duke or Wake Forest can’t do?

I met with my RO once a year for 5 years and then he released me. Mainly he was monitoring me for radiation side effects and was getting my PSA readings before each meeting. He released me but still gets my PSA from my urologist along with side effect questionnaire so they can keep their treatment statistics up to date.

I see my urologist quarterly and have a PSA draw. I have never had a DRE since treatment. Uro says no need that my prostate was so thoroughly zapped that he would be feeling mainly scar tissue. Plus in nearly 20 years he has not experienced a combination brachytherapy and IMRT local recurrence. Only times PSA has gone up have all been confirmed to be outside the readiation area.

Hi DaysBetween,

Welcome. There are many reports, retrospective studies and statistics from clinics that show the excellent results for combination therapy. I can get a few to share and I suggest you look into the archives for a poster named TallAllen. He posted many links over the past several years. Two premier brachytherapy clinics, one here that does seeds and one in California associated with UCLA that does High Dose Rate have published their results for many years. Try www.cetmc.com for Dr Jeffrey Demanes the HDR pioneer who started using HDR in 1981. Also the Radiation Group of Georgia, Dr Frank Critz that pioneered the combination of seeds and external beam radiation back in the 1970’s. Website is www.prostricsion.com. Both are well published and you can go to www.ncbi.nlm.nih.gov and click on PMC which is Pub Med Central.

Also google for studies of effectiveness for combined therapy of brachytherapy, external beam radiation and ADT for high risk PCa. Some call this ther “triple play” and some refer to it as “brachy boost”. You should find a lot of papers and reports .

I am hoping you are doing well and PSA is undetectable as I assume you are still on ADT given your risk factors. Where were you treated?

Sounds good. I was on ADT for three years. I am now more than eight years past radiation and am drawing all undetectable PSA tests, but my doc (Lewis Kriteman GA Urology) is keeping me on a tight leash for monitoring. I did my IMRT and HDR brachytherapy at Preston Ridge (Ga 400 exit 10) with Dr. Wilkerson and McCord.

I just added some info to my post with some direction to more information.

We have several men on the board that are VHR and their is a separate thread for G9&10 guys. I suggest you also follow that and get some of their experiences and contacts.

Best wishes,

Jack