On January 4, Leah wrote, in pertinent part:

Bingo!

I'm glad to see this support for my oft-repeated rant that PCa patients
should consult a real live honest-to-God *cancer specialist* when
considering tx
options. Unless a uro is one of those few who are thoroughly trained in
*cancer* treatment, he will almost always urge surgery. That's how he
pays for his lifestyle.

Unfortunately, we all too often see pts here who have proceeded with a
surgery which was not (as advertised) curative. IIRC, Strum has written
(on P2P) that med oncs frequently are consulted by pts whose clinical
situations have deteriorated significantly because they were not
properly txd by urologists. So med oncs find themselves confronted by
pts who present with awful clinical records and who hope that the med oncs
are able to help them.

We also often see pts who are receiving ADT from uros who have no idea
what they are doing, but are mindlessly following a recipe. It's called
(by medics) "cookbook medicine." It bears little or no resemblance to
science. Especially the science of learning about the individual pt's
unique clinical record. Too much labor, not enough time.

Yes, it's true that I go on and on about consulting an onc when/if the
uro's surgery fails to cure (AIUI, about 30% of the cases). That's
because folks who post here are too often post-RP and wondering what to do.

No one should conclude that I am against RP of whatever type. Not that
my opinion should control anyone's tx selection. It can be curative but
it is all too often not.

Exactly.

Regards,

Steve J

"We must tailor the treatment to the nature of the disease. We must
listen to the biology."
—Stephen B. Strum, MD

You're right that the med onc has broad cancer tx expertise, and thus
often directs a pt's tx. But since her primary hammer is medicine --
i.e., drugs, aka ADT in our case -- we need to closely examine her
impartiality if she recommends . . . ta daaaa . . . treatment by
medicine. I considered, justifiably I believe, the published research/
teaching/ practicing med onc I consulted before deciding about ADT to be
just another leg of my treatment stool, along with the rad onc and the
uro (surg) onc.

I.P.

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