Recommendations for top RO in CA, Mayo-Rochester please.

Salvage radiation is fairly straight forward so I would direct you to UCSF and UCLA who have respected radiation departments. Most of the well known names specialize in certain types of treatments or conditions and are scattered across the country. If you were able to see Dr Kwon, he would just turn you over to the RT department at Mayo for SRT.

Also consider that typical SRT is a couple of months of daily treatments (maybe less nowadays) so it is helpful if treatment center is not too far away. Don’t know any MO’s so cannot help much there.

You have to differentiate between radiation as a primary treatment vs. a salvage treatment. There has been a lot of work done on speeding up primary radiation such as SBRT at 5 sessions and hypofractionated IMRT where they get the duration down to approx. 25 sessions. The balance is between higher dosage at less cycles while limiting side effects. Slowly but surely, men are doing less sessions nowadays as studies have been favorable.

Salvage radiation is a bit of a different strategy since there is no prostate to aim at and is more of a general mop-up operation of a larger volume where the prostate used to be. There are studies trying to speed this up also but most men have gone through 7-8 weeks at lower dosage. Some of the studies are also looking ADT or not with SRT.

The good thing about UCLA and other major cancer institutions is that they will usually be up on all the current studies, probably are involved in some, and be able to fully discuss options with you and your husband.

Dr. Kishan is one of the SBRT guys you read about, there are others scattered around. Like I said, it is good to find a RT center (they are at many hospitals) that is not too far away. Most use the same equipment and the RO’s come from major universities. There are some men here that got treated in Southern Cal that may chime in.

@Mumbo, Thanks so much for your detailed information, you are a wealth of information with PC. Thanks Mumbo.
@JNF, Thanks for your response. My husband had his surgery 2 years ago and his PSAs are inching up since Sept 2023. He has not yet offered any scans and an insurance advocate is currently working/pushing it for him. He has neither an oncologist or medical oncologist currently and we wanted to get them added to his care team. Someone else told about dr. Mark Scholz but I thought he is RO and he is not affiliated with any Center of Excellence i have not yet checked him out. Thanks JNF.

Thanks Mumbo. Someone has mentioned the same thing to me yesterday that we need to get a MO and they will directing us to treatments when needed. I have so much to learn from everyone in this forum to navigating through this disease, thanks for your help Mumbo.

Thanks JNF. We would love to find one that practices independently like yours. In California, or at least where we are, it’s very hard to find these independent doctors. Most, if not almost all, doctors are joining the big medical groups, i.e. Sutter Health, Physician Medical Group, and we are forced to see doctors in one of those groups. Even so, finding Internal Medicine doctors in these groups are so difficult as many of them don’t accepting new patients. When my husband’s long time doctor who was independently practiced, retired 6 years ago he couldn’t find a new Internal Medicine doctor so he ended up with a Family doctor. We went through the same situation again last year when he wanted to leave that doctor. After many phone calls for 10 months, he has founded no one. Finally, he got one last December when he accompanied me to my appointment and because we like that doctor so much we asked him to be my husband’s doctor. I will check Dr. Scholz out as I have read his book when my husband was first diagnosed. I am praying that my husband’s will be just an easy situation but it’s so scary when dealing with cancers.

His PSA was 0.106 two weeks ago. He had another test last Friday but his results are not yet in. I am hoping and praying that it will be either lower or at least staying the same as his last one. The RO that my husband has talked to will not doing anything until his PSA reached 0.2. We have just founded out last week that his surgeon is still on his care teams during our tele call with a NP and we don’t understand it as his jobs are done. The NP later relayed his message that my husband needed to talk to the RO. Currently my husband does not have either an oncologist or a MO on this care team so no ones are overseeing his care. Therefore he can’t get any scans even though the insurance will be paying for it. It’s so frustrating, our experiences with UCSF are not good and that’s why I am here asking for recommendations of RO and MO to support my dear husband.

Post Edited (ConfW) : 8/4/2024 11:30:55 AM (GMT-8)

ConfW. According to ASCO (the professional society for clinical oncologists) the PSA threshold for effective PSMA scans is 0.20, following surgery. That is probably why none of the docs have ordered it as his PSA just isn’t high enough and no one wants to order one when it is unlikely to show anything. Just be a waste of resources and your insurance company probably uses that generally accepted threshold for reimbursement consideration.

Regarding docs, the call to Scholz is easy. My understanding is that he doesn’t practice within Medicare or commercial insurance networks. So you pay his fee and then apply to your insurance for some reimbursement.

He is also the co-founder of the Prostate Cancer Research Institute. It has a great deal of information that is aimed at patients and caregivers. The national conference for patients and caregivers is in LA the first week of September. I encourage you to register and attend. It is always well regarded and will feature many leading PCa specialists. An amazing bargain at only $30.00 for two days of presentations and workshops. Check their website for details and registration. You can see and meet the docs that participate as possible doctors for you. These are also excellent sources to get provider referrals in your area to investigate.