Questions for first meeting with oncologist

oldspice

For all you fighters out there. I am new to this network and to this board and I have my initial meeting on Dec 20th with my oncologist and urologist together. I have plenty of my own questions and have been working hard to educate myself but my question for all of you is looking back, what are the 3 best questions to ask the doctors in your opinion? I will post their conclusions here shortly there after. Thank you all and keep fighting!

Doug age 73 PIRAD5, Gleason 4+3 grade group 3 right mid lateral SUV 3.6 tumor 9mm (pattern 4 is 65% of one core tissue) Grades 1 and 2 nearby as well as internal iliac lymph node SUVmax 9.1. Unfortunately the beast found it way outside of the prostate to a lymph node but PSMA scan shows no other spread at this time.

Clevelandguy

Hi,

Once the cancer has progressed outside of the Prostate, radiation in my non medical opinion is a better solution. But you should check with your medical team to see what they have to say.

Dave 3+4

Old Salt

One question that I don't know the answer to is whether it is possible to (safely) remove the cancerous lymph node along with the prostate during surgery. You can also ask whether hormone therapy will be recommended directly after surgery, or later in case the PSA rises from (essentially) zero.

The above doesn't imply that I recommend surgery...

oldspice

if they mention surgery I will definitely ask but I heard since their is a lymph node involved they would most likely choose radiation. We’ll see. Thanks

Steve1961

https://csn.cancer.org/discussion/comment/1711473#Comment_1711473

Yes they can remove all infected lymphnodes I believe it clled radioactive surgery I believe or radio something surgery they fill you with dye the night before or early that morning of surgery and I believe they use an ultraviolet light during surgeryand any infected lymph node or any bit of cancer will glow and they can remove it they do the surgery at UCLA, Dr. Robert Reiter I believe I posted it earlier the video showing how this is done.

Steve1961

https://csn.cancer.org/home/leaving?allowTrusted=1&target=https%3A%2F%2Fyoutu.be%2F-ZXDohxylg0 Copy and paste radioguided surgery amazing what they can do now they can see which lymph nodes are involved, rather than just take a bunch out and guess

centralPA

Some questions for you, @oldspice

What is the size of your prostate? Is it bigger than normal?

Do you have any urinary issues? BPH symptoms?

Any prior prostate surgeries? TURP or similar?

If you have an oversized prostate, or have urinary issues, that can constrain some radiotherapy treatments.

oldspice

https://csn.cancer.org/discussion/comment/1711479#Comment_1711479

My prostate is larger than normal therefore some BPH issues which is why I have been on Tamsulosin for a long time. Had a biopsy in 2008(negative) because PSA doubled from 2ng to 4ng. Developed chronic prostatitis due to biopsy IMO since 2008. . Have already been told by Urologist that Brachytherapy is out because of enlarged prostate. But really no symptoms maybe more frequent urination during the day but not too noticeable. 73 years of age.

oldspice

https://csn.cancer.org/discussion/comment/1711478#Comment_1711478

That’s very interesting Steve1961. Watched it 3 times. Only place in country being done is at UCLA. Thanks for insight. It’s been approved but I think it’s still in clinical trial stage.

oldspice

https://csn.cancer.org/discussion/comment/1711462#Comment_1711462

I tend to agree and never really thought much about removal but good input concerning trials on radio guided surgery. Will find out soon what they are thinking

oldspice

https://csn.cancer.org/discussion/comment/1711473#Comment_1711473

That’s another good question

centralPA

@oldspice , have you seen the NCCN info on prostate cancer? They have a fairly thorough algorithm for selecting treatment, and you could print out the pertinent pages, highlight key parts, and be ready to ask questions to help them to help you to understand it. On this page there are guidelines (written for doctors) and guidelines for patients. You want to read both. Requires a free account.

https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459

It is also worth asking about ongoing clinical trials that might apply to you. At your hospital or other.

Finally, three questions: which treatment method has

1. the highest probability of cure (or longest time in remission)
2. lowest probability of bad side effects
3. a reasonable blend of the two

oldspice

https://csn.cancer.org/discussion/comment/1711501#Comment_1711501

No I haven’t seen it yet, info from all directions now which is good. I plan to check it out for sure. Thanks for input, good questions too.

Steve1961

https://csn.cancer.org/discussion/comment/1711491#Comment_1711491

Well, I would think they’re good trials I mean what is there really to trial it’s not like a pill or a type of radiation. It actually is pinpointing cancer. It makes it glow don’t think there’s much to trial.

Josephg

Oldspice,

The first question that I suggest that you ask is to ask the Oncologist for a commitment for the development of a relationship that focuses on brutal facts and candidness and not feel-good platitudes, assuming that is what you want. (Not all are willing to do this for a variety of reasons). In other words, tell the Oncologist that you want the cold hard reality of your situation at all times, so that you can make the best decision on future treatment options.

This is the relationship that I requested of my Oncologist 13 years ago, and I believe that relationship has helped me immensely on my PCa journey.