Do I need a medical oncologist?

watertender

My husband has just been diagnosed with Gleason 9 PC. Met with the radiation oncologist who laid out the plan, standard ebrt and bracy starting Casodex & Lupron 2 mo. prior to radiation. I would like to explore the first mo on Firmagon due to the Lupron flare, I mentioned this to him & he was a bit defensive. Since then I called the sister medical oncology arm of the practice to inquire about meeting with one the doctors there but was told the radiation oncologist could handle the hormone needs. Looks like he is following the NCCN guide for high risk PCa but what happens down the road or if added drugs are needed? They told me not all cancers need a medical oncologist so there we sit.

Is a med oncologist necessary? Given the prognosis my husband will be on these drugs for quite awhile. Getting a MRI tomorrow.

Thanks to all.

Old Salt

1. Casodex is supposed to prevent the Lupron flare.
2. A urologist can handle hormone therapy; they love that because it's a nice financial incentive.

Without scan data, it seems premature to engage a medical oncologist at this point. However, if metastases are found (or are likely), I would certainly add a medical oncologist to my team. Gleason 9 prostate cancer is serious business, but let's hope the cancer is still contained.

I had multiple Gleason 9 cancers within my prostate and decided on radiation therapy similar to what you described. I never saw (or had to see) a medical oncologist. However, the radiation oncologist who treated me did tell me that with a recurrence, I should be consulting a medical oncologist.

watertender

https://csn.cancer.org/discussion/comment/1693084#Comment_1693084

Thank you, that makes me feel better. The journey we are headed down looks daunting.

I appreciate the reply and let's hope the MRI looks good.

VascodaGama

I agree with oldsalt's comment. In any case, the radiologist at this moment may be just suggesting the protocol (as recommended by NCCN guidelines). He will reconfirm his recommendation once image studies are added to the investigation.

You have to realize that if metastases are found at far places then radiation may be substituted by a protocol that can include chemotherapy. It will be wise to add also a bone scan (BS) to complete the investigation.

I also would recommend a colonoscopy to check for ulcerative colitis that could prohibit radiotherapy at some areas and also a DEXA scan to check for bone health if the hormonal treatment is planned for a long period.

Best wishes and luck in this journey.

VG