At what point do I bail on my uro and seek oncologist?

Foretexas,
I think you should have been referred to a Radiation Oncologist quite some time back when it became clear that your PSA was trending upwards. Radiation therapy could potentially offer a cure. I would act sooner than later.

Even if your Uro subscribes to the 0.2 PSA threshold for further treatment, you are past it.

I don’t really know what your Uro’s strategy is. I think it’s time for you to move on.

Do you have your post surgery pathology report? It would be helpful to see that.

2015 would have been the best time. what was your uro telling you?

I fired my Uro and went to an Onco when Uro said, I shouldn't worry about the rise in my PSA.

When you should talk to a radiation oncologist, a medical oncologist, or both? I vote for three to five years ago -- once it became clear that your PSA was detectable and rising after your surgery.

Your urologist is right about one thing: with your post-op pathology report showing non-aggressive disease, and with the slow rate at which your PSA is rising, there is no need to panic... but... because you are so young you can expect to be around long enough for even a slow-moving problem to catch up to you eventually. If you were 25 years older than you are your urologist's plan would make a lot of sense.

You might look for a consultation at a cancer center where the initial evaluation of new patients is done by a team of doctors drawn from a number of specialties. At least you want to consult a radiation oncologist because, if you do decide to seek further treatment, that's the sort of doctor who would probably provide it, but the insights of a medical onclolgist, or even a different urologist, would probably allow you to make your decisions secure that all options have been considered.

Fore, nothing mother add, except that I wholeheartedly agree with the others. Your urologist/surgeons job was long ago done. Water under the bridge, but from this point on, be your own advocate , get a good RO, that you trust, with PC experience, and follow his/her lead

Timely query, foretexas (is that from your golf game - like this drive may go anywhere in the state??)

Agree with above that good time to move on from urologist, and I for one would consider carefully the chemical castration route with your relatively slow moving disease and so few years removed from high school compared to most here (meaning young!)

RO, yes. And if you go for SRT, only the best facility. Minimize risk.

Best to you -
Wilderness

Hello,

In my case, adding a medical oncologist was a GODSEND.

In my particular case, adding an oncologist opened new doors and treatment ideas.

My original urologist was more "old school" --- with his eyes focused on nothing but the next LUPRON shot.

My oncologist thought of many different angles that I needed --- taking a bone density scan, and he got me started on PROLIA to build back bone density from the ADT shots.

From there, he noticed my testosterone was spiking up and down, which led to fluctuations in PSA --- he suggested other forms of ADT shots, and we found ZOLADEX worked better for me than Lupron.

He then got me started on the "early chemo" plan when it first became available. He got me started on ZYTIGA. He offered me the chance to participate in genetic tests to see if new medications would be helpful to me.

This summer, he has a new angle that he wants me to pursue --- another form of genetic testing. My grandfather, father, and I have all had prostate cancer, and this oncologist is constantly looking for new, proactive, and innovative ways to help me maintain my health goals.

It was an important day when I told my original urologist that I was adding an oncologist. It's another set of eyes and additional expertise, added to one's case. Best decision I ever made, adding an oncologist, early after my diagnosis.

With my best,
CYCLONE ~ Iowa State University

Foretexas,

Since you are a youngster I will tell you something that we older guys will already have noticed.

Once you reach a certain age you no longer usually "switch" doctors when you need a different doctor, you just add specialists to your team. Younger guys, whose medical needs are minor, only need one doctor at a time. You've reached the age where they start to accumulate. There's no reason to "bail" on your uro just because you consult with an oncologist or two. Your urologist should see the sense of your talking to oncologists at this point. If (s)he acts like a dick about it then (s)he can be ditched.

One other thing: Cyclone's situation is a bit different than yours. He was diagnosed with already-established metastases so he needed to talk to a medical oncologist (an expert on treating cancer with drugs) because disease like his is usually treated with drugs. You, on the other hand, with your slow-moving recurrence after surgery, will probably be looking at radiation as your next step so you need to make sure you talk to a radiation oncologist.

So had a visit with a uro oncologist from OU cancer center yesterday. He is going to present my case to the tumor board at Stephenson OU cancer center Monday. I am going to have an 3T MRI and a bone scan before any treatment. Doesn't expect anything on the bone scan but have to do that for insurance to pay for PET scan in the future.

Edit for grammar.

Post Edited (foretexas) : 5/3/2019 7:59:00 AM (GMT-6)

You will need a basic uro for the rest of your life, and if you have one that accepts your insurance / will transition you to Medicare, keep him as a uro.

Mine sent me to the RO for that journey, then sent me to the MO when treatments started needing bigger drugs. I still see the uro once a year to keep my "place". Finding even a decent uro in my area that takes medicare assignment is virtually impossible. Up that to good uro, and you are looking for the holy grail.