What to ask with scan results? Urologist and radiation oncologist in Orlando?

Below are questions you may want to ask on a first visit with a Uro. You should not feel rushed to make a decision even with high risk PC - it just doesn't grow that fast. The one question you want to ask is the one question I would never ask - you cannot expect him to be an expert on all the different therapies. PC is not like other cancers where you see an oncologist who you expect to have all-around knowledge. In general, Urologists only know urologist stuff (although they will have opinions about all kinds of things outside of their area of expertise). You may also wish to look at the new AUA guidelines:

www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017)

Questions for surgeons

1. Am I a good candidate for surgery? What about anatomic abnormalities, previous hernia, effects of anesthesia, cardiovascular disease, diabetes or other comorbidities?
2. Do you think it’s a good idea for me to get a second opinion on my biopsy slides from Bostwick or Epstein? (Yes!)
3. What is my stage, and risk level? (You should know your Gleason score and PSA – if you don’t, ask). How big is my prostate, and what is my PSA density?
4. If stage is T3 or T4: How can surgery be a good option if only the prostate capsule is taken out, leaving the rest behind? Aren’t the side effects of adjuvant radiation worse than if I had radiation at the start? (he may not know this.)
5. How many of the surgery technique you practice (whether robotic, laparoscopic or open) have you performed? (1000+ would be a good answer)
6. Are you going to be doing all of the really important parts of my procedure yourself? (You need to be particularly careful about this at major training institutions where residents may be doing some parts of the surgery, or even the whole operation, while “your” surgeon is overseeing it.)
7. In the last year, what was your positive surgical margin rate? (Should be less than 10% among men with stage pT2)
8. What is your "trifecta" rate? (tricky because you don't want cherry-picked patients)
9. What is your estimate of my risk for lasting incontinence; i.e., a pad or more after a year?
10. What about lasting stress incontinence? climacturia? penile shrinkage? inguinal hernia? Peyronie’s? orgasmic pain or dysfunction?
11. What kind of anastomosis technique do you use? (total - not just anterior)
12. Will the bladder neck be spared? How will you maximize the urethral sparing?
13. If you have positive biopsy cores near the apex: How will you ensure that all cancerous tissue is removed there?
14. Will you take frozen sections and have a pathologist standing by to determine margins and how much of neurovascular bundles can be spared?
15. What measures will you take to assure the integrity of the neurovascular bundles?
16. What kind of penile rehab do you suggest?
17. What kind of imaging (Bone scan, CT or MRI) is necessary for men at my risk level?
18. Will you sample lymph nodes (PLND) or take extended lymph nodes (ePLND), or does it seem unnecessary for my risk level? If so, how will you find them (fluorescent dye)? How will you minimize risk of lymphocele and lymphedema?
19. What kind of aftercare (including sexual rehab) will you provide, and how will we monitor side effects, and for how long? Will you regularly monitor my urinary and erectile recovery progress with validated questionnaires like EPIC and IPSS?
20. How will I be monitored for recurrence? Will I get an ultrasensitive PSA test? How will you decide the point at which you would recommend I see a radiation oncologist? Do you use the Decipher test?

Questions not to ask:
1. What treatments should I consider and which is the best for me? (this would be asking your doctor to be an expert in treatments outside of his specialty, and also to know which benefits and risks are most important to you – he doesn’t have time or inclination to be expert in all therapies, and he’s not a mind reader.)
2. If I were your father, what would you recommend? (You don’t know how he feels about his father (lol), and more importantly, what he would feel most comfortable with is not necessarily what you would feel most comfortable with. This is your decision to make and live with – don’t give up your power!)

You've already received what I consider to be very good technical advice from TA and others will chime in soon. What I would add is an extra emphasis on the slow down suggestion. I was diagnosed as a G7 in January and am 69 years old. My urologist told me that at almost 70 years of age, that I was about the oldest one could be for the Da Vinci surgery. However, since I was in good physical condition and without other health issues of any kind, he said that I should tolerate the surgery well. So I scheduled the surgery for the end of the second week in March and honestly, I was delighted with the idea of "getting this thing out of me" ASAP!

I began to read books, internet articles from all the government agencies that have anything to do with cancer, pertinent information from hospitals and cancer treatment providers all over the US, and internet forums. It didn't take long when I joined this forum for me to realize there should be more involved in this treatment choice decision than "getting this thing out of me". I immediately began to see that the choice of treatment decision is clearly the most agonizing part of the whole process of dealing with this disease. And there is frequently no right or wrong, no clearly advantageous treatment that will work for all, no one path to treatment, whether for disease control or possible cure, that fits everyone. Each person should look at what is involved in the protocol leading up to the treatment, the actual treatment procedure, and the side effects, both short and long term, taking into consideration how each might affect you (quality of life as a man, husband, father, etc) immediately and in the future. Make no mistake, while things may work out quite well in general after treatment, your life will definitely be changed in numerous ways.

All specialists tend to know the most about (naturally)the treatment that they perform the most and it has been my experience that they also will nudge you (hopefully gently) in that direction. My URO did but to be fair, he also recommended that I see a radiation oncologist.

I just finished my treatment and I did it with Dr. Debra Freeman at the Cyberknife Center of Tampa Bay. My experience could not have been better and I am quite satisfied with everything associated with my treatment. There is also Moffitt in Tampa and Dr. Patel in Orlando if you should decide that surgery is the right path for you. You are actually in a fantastic area for treatment among the communities of Orlando, Tampa, and Sarasota. If you would like more details about my specific experience, you can search on this site for my postings or feel free to email me and I will be glad to provide any details you would like. I am one week out of treatment right now so it's all very fresh in my mind. Good luck to you both. I wish you well and you are in a very good place here. There are many, many compassionate and knowledgeable people here who will give you ideas along the way and provide support throughout your journey. Believe it or not, once ensconced in the details of all this together with learning the basics that you need to make informed decisions, you will begin to relax some and feel better about where you are and where this is all going.

Dattoli Cancer Center in Sarasota, at least call for free consult as part of your information gathering.