At what point do you see a medical oncologist

This has been an ongoing, interesting discussion on HW. I have been thinking about consulting with a medical oncologist who specializes in PC. But, right now, my situation has been pretty cut and dry. I've had the surgery and I'm doing the PSA monitoring. But I would prefer to be able to think things through and anticipate events with a plan in place. Right now, the plan is that is the PSA goes up (say 3 increases or above 1.0 confirmed with a subsequent PSA test) I do SRT (obviously I would consult with a radiation oncologist before that time).

 

But... is it really cut and dry. Is that for sure the next step.

 

I get the sense that I should consult the oncologist when and if SRT appears to be failed. But, it would seem an earlier meeting would be useful. For example, I am reading of studies advocating HT (perhaps) with SRT (or just before it). Or...whatever. My point is I think some expertise could be useful BEFORE deciding to do only srt.

 

Anyway, I hope that is not in the near future, but I come back to the subject question.

 

Mel

Mel, when I was diagnosed with cancer, my urologist (surgeon) wouldn't operate on me until I met with an oncologist. My uro said I needed all options and he was a surgeon and was biased toward surgery but I needed to have all the information needed to make a decision. Long story short, I ended up with surgery but was very impressed with the oncologist. If my cancer were to return, I would go straight back to the oncologist. I was very impressed with him and he scared the xxxx out of me. He told me to have surgery because with all the cancer I had I would need to "mop up" the rest with radiation. Well, two years out I am still <.04 and have not needed to pay him a visit. To answer your question, if you want to see an oncologist, you may be in a better frame of mind to talk one now. You do not have a recurrence at this point (and may never). As some have said on this site, knowledge is power.

Mel, I hope you don't take this the wrong way but this thread reminds me a little of when you first arrived at HW...in what looked to most of us as total panic mode...  I think you're just freaking a bit since your PSA test is due...maybe not and if this is offensive I apologize.

Specifically in answer to your question, I agree with JT.  The first time to visit an oncologist is BEFORE any treatment.  I didn't do that because I hadn't been educated properly by HW!  Hopefully I chose the right treatment plan but if I had it to do over again I would see a PROSTATE oncology specialist pre treatment, not just any medical oncologist.

Having said that I can see no reason for you to see an oncologist now.  If your PSA rises then that's another story but I just don't see the gain on a what-if basis when you're rolling out .01 readings...  But, if you see a significant rise, I would certainly agree that going to a PROSTATE oncologist is the best bet...before getting any additional treatment.

Best of luck and I'm guess you're gonna score another .01 so this will all be academic...LOL...

Tudpock (Jim)

Mel, I was hesitant too to answer this thread, but would have to say I feel along the lines of Tud above. You have only had a single post surgery psa, and your reading was good, you just had your second one, and of course, until you get the reading you have no idea. But even if it bumped up a tiny amount, you would still not be in a recurrance situation. I believe in researching, planning ahead, trying to stay a step ahead in the PC game, especially after all my difficulties, but on the other hand, I don't think seeing one now would prove a lot. You have no evidence of recurance, and if you are fortunate, you never will. And if you do, then you will have to deal with making a secondary treatment choice, which in most likely hood, have to be some form of radiation. Not quite sure where you are really going with this.

And no disrespect intended with my answer here. Been a rough and painful day for me, so a bit on edge. There's a time and place for proper worry in our journeys, in my opinion, I don't think right now you need to be thinking along these lines.

David in SC

Mel, as always, you ask good questions (albeit a bit early in the game for you). As John T stated, seeing a prostate oncologist at diagnosis - as well as a surgeon and radiation oncologist - should be part of the decision-making process for all PCa patients. Unfortunately, prostate oncologists are not all that easy to come by.

I guess no one can really answer your question since your situation does not warrant an oncologist. However, if you feel that there are questions you need answers to that could only come from a PCa oncologist, then make the appointment and go as long as you're willing to accept the possibilility that speaking with an oncologist might just create more anxiety (e.g., more questions than there are answers to).

You are still at the beginning of your journey ... PSA anxiety will be part of your life from now on. But, at least in my case, it gets easier to deal with with every "zero" that comes in. None of us is immune from the worry about what the next test might tell us.

I am a bit confused, you want to see an oncologist as a proactive step "in case" you need him/her in the future ?

I suppose you could ask them "what if" questions, but then again you can do that with any specialist for any part of ones body, not sure what peace of mind that gives you

I saw a Medical Onocologist yesterday and he really put my mind at ease regarding my chances for the future. I am of couse so far gone that I am on HT and was having a lot of pain over the weekend but he said that means the medicine is working and shrinking the bone mets and the prostate. Mentioned pain should go away soon and I do feel less today.

Funny thing is I still have to self-cath but going on my own some but last night at 4 am was surprised and woke up with an erection and tried to have sex but was unable to orgasm - thought maybe any kind of sex at all was impossible while on the Lupron treatment but thought I would try it anyways.

Well I woke up this morning having to pee real bad but just got dribbles sitting on the toilet (before I had an OK but not great stream). Had to self-cath then and already 4 times today. Did I mess something up by trying to have sex? Or will the Casodex & Lupron treatment help me get back to where I was?

I'm trying to have to aviod a Turp but the Uro says that still might be a possibilty down the road some....thanks guys!

Midi- I had total urinary blockage and drove to emergency room with it all caused by having a $H*#$& load of PCa and terrible stats, diagnosed right after that visit (2002-March), the pain of not be able to rid yourself, is unbearable pressure. Well I must say the FLOMAX worked very well in my case, I cut off the catheter thing myself at home about 8-9 days later even though doc wanted it in longer, I could see I had results. Been good ever since, coupled also with all my treatments and protocols. Don't know if it works that well on everyone, but if needed I would buy it in heart beat (Rx-needed). Oh I drove a stickshift car with this catheter thingy on too, I would say do that at your own risk...not fun. (LOL)

Best to you. Hey midi-aren't you the piano man, I talked to you before and caught the midi thing (midi synthesizer), I  love music and creativity with it. So, give me a little bass with those 88's  (88 keys-on std. piano)

Mel, do whatever makes you feel more comfortable right now.  You may do better than you guess.

May I just say to sit back and enjoy life. I made a news years resolution two years ago to STOP watching the news and reading the news paper. I started training for a marathon, reading positive books and listening to postive CD's and Mel I am loving life now more than ever. I still have PCa, it is still a gleason 9, but I refuse to give it any control what so ever over me.
Thanks for writing my friend and please know I care about you and your well being

peace and joy
dale