Treatment Decision

So I have now seen 5 doctors to help review my case and come up with a treatment plan.  The one item to remember with every doctor is that they will recommend a treatment plan that is based on their specialty.  A Urologist is a surgeon.  They will tell you that surgery is the best curative approach.  A Radiologist does radiation therapy so they will tell you that radiation is the best curative approach. So after those somewhat biased discussions, I threw in a Medical Oncologist.  They are not biased to any one treatment approach but look at what they think is the best curative outcome based on your diagnosis.

So here is how I see the options:

Kaiser Doctors:

The first two appoints I had was with the Kaiser doctors.  I know I wasn’t going to stay with Kaiser for my treatments, but the appointments were made and I had to go.  Looking at the treatment options and which doctors they gave me, it is indicative of why I need to go somewhere else.   The first Kaiser doctor, Dr. Lodin only recommended one treatment option, a long course of IGRT with a 6 month course of Hormone Therapy. That is it.  He did not offer anything else. Kaiser does not offer any other tests to ensure that the cancer has not spread unless your PSA is over 20! That is not in line with guidance by the American Urology Association or other published studies for Gleason scores over 8. Another red flag was that there are no studies that show a 6 month HT treatment is effective for Gleason 9s.  The 2nd doctor, Dr. Faber, was the Urologist/Surgeon.  He recommended Robotic Assisted Radical Prostatectomy.  Experience of the surgeon is the single most important factor when it comes to prostate surgery.  Successful surgery without long term erectile dysfunction or incontinence is based on the skill of the surgeon.    Dr. Faber just finished medical school.  We noticed he didn’t have his name on the hospital directory yet and Marcy asked the receptionist if he was new.  He said he was.  During our discussions with Dr Faber, I asked him if he was doing the surgery.  He said possibly, as he didn’t have his privileges yet at the hospital, but he might have them soon.  If not, one of the other surgeons will do it.  Oh brother.  They gave me the new guy to mess with my prostate.  No thank you.

UCLA Doctors:

It was night and day going to UCLA.  Their facilities were spotless and the professionalism felt with everyone you come in contact with.  Dr Chamie is one of the most experienced surgeons in the Urologic Oncology department. Obviously I am getting the teacher and not the student if I choose surgery as the treatment option at UCLA.  Dr King was also very knowledgeable and made a lot of sense with the radiation treatment options.  Dr King also stated that guidelines suggest I get a bone scan to be on the safe side to insure the cancer has not spread.  He offered all the treatments that would work with my Gleason 9 cancer.  Single course, also known as Mono-therapy, is not suggested for high risk cancer.  I felt great being at UCLA and had good conversations with the doctors.

Prostate Oncology Specialist:

It is very apparent that Dr. Lam is one of the best.  He doesn’t just talk about a treatment plan, he discusses all health related issues that I have and that could occur with treatment.  He also emphasized diet, exercise and supplements to support the best treatment approach.  With my diagnosis, it is clear that I not only need a surgeon or radiologist for the actual treatment, but I need a doctor who will be my primary doctor for potentially the rest of my life. With that in mind, I am going to have Dr. Lam be my primary doctor.

My Treatment Choice:   I have chosen the HDR Brachytherpy, with the short course of IMRT (4 weeks) and Hormone Therapy.  The good news is that my HDR Brachytherpy will be with Dr. Kamrava at UCLA.  I can have my short course of IMRT at CMH in Ventura which will make it much easier on me and continuing work for the 4 weeks of that treatment.   Dr. Lam feels this is the best strategy to handle my cancer and to help stop the cancer from spreading. Dr. Lam will coordinate it all.   Mentally I am in a better place knowing my treatment plan, however I still have to continue to wrap my head around the next year and half.  It is still a lot to take in.