Is Your Urologist Smarter Than a Fifth Grader?

Thanks for the post.

My Uro did pretty good too and didn't mention color doppler either. Or recommend books.

I wasn't shown nomograms of cure rates but was told my cure rate.

He didn't discuss active surveillance with me. Maybe because my Gleason was 3+4 instead of 3+3.

I did have to wait 8 days from the time the doctor called to tell me I had cancer to the time I had my consult with him.

My uro spend 40 minutes with me during the consult.

My Uro is a very experienced open surgeon but still discussed the + and - of Da Vinci and even recommended the best robotic guy in town (Kansas City) should I choose to go with robotic (which I did).

He also said that he still would be happy to have me as a patient for post surgery care even if I had my surgery done by the Da Vinci Uro surgeon, which I thought was pretty cool.

Tud,  Thanks for posting the questions.  My long time former uro would get a "no" on most of the questions.  I tried another local uro and he would get a "no" on all of the questions.  I feel a little sheepish mentioning this, but in desperation I was able to get a very good 3rd opinion from my dentist.  He did fairly well on the questions.  His advice: "get out of town fast".  You folks that live near reputable established treatment centers just don't know how diffiicult it is in small communities.  Living in our secret northwest Florida paradise has its draw backs.

Carlos

Perhaps this could be added to Alf's list?

Great test for all newcomers. My Uro scored only 55% the Yes side. He was a No on color doppler also. Reminds me of a picture I had hanging in my office at one point during my working life. It was a tired, grizzled, sweat soaked, cowboy who was squinting into the sun. The caption under the picture read: "There were a helluva lot of things they did'nt tell me when I hired on with this outfit".  

My uro/surgeon got 12 of your 18, and some of the other 6 didn't pertain to me.

This list may be useful on one hand, but find it still another stab and a bit condenscending towards doctors and surgeons in general, a theme here that some seem to be bent on. If one thinks they are so clever, treat and operate on yourself, and don't comply with your medical staff and the advice they are giving you. They have a name for patient's like that, and its not a good one.

David in SC

David:

I'm not sure why you reacted the way you did.  In no way was I attempting to insult physicians or to suggest that people should treat themselves.  Instead it was a light hearted attempt to help our newcomers understand what they should look for in a urologist.  After all, one of the purposes of our forum is to "help".  If there are specific mistakes that I made in my list by all means feel free to suggest changes.  Otherwise please explain what you feel that I did wrong by starting a thread that gave what I feel is pretty relevant advice to people who might be new to this process...

Tudpock (Jim)

Maybe David was referring to the "are you smarter than . . ." references. This might seem less condescending if it said something like: "As patients, these are some things we believe our urologists should do." But the list itself -- and the other list Hero started in a separate thread -- seem quite useful.

OK...this was intended as a knock-off of the popular TV show, "Are You Smarter Than a Fifth Grader".   But...geez, louise...now that I know the humor police are out I will henceforth limit my postings to medical terms and the Kings English.  Talk about the necessity to be politically correct...heaven forbid if one of our exalted medical professionals gets any hint of criticism...

Tudpock (Jim)

Darn, mine got 2 out of the 18.


I think that's about an F- isn't it? Oh well, he got fired about two months ago anyway.



Steve

For example...

1. Is he/she smart enough to order a % free PSA test and a PCA3 test (or to tell you why it is not necessary)?

They are smart enough but most won't. Neither will a prostate oncologist in most cases unless there was an initial negative biopsy. Since we are talking pre-diagnosis here, the urologists must adhere to protocol that will allow further investigation. The fact is that PCA3 is only a few months old as an approved protocol, and that % free is 50% accurate in detecting prostate cancer.

2. Is he/she smart enough to know that biopsies sometimes cause pain and offer you sedation or at least some sort of pain relief?

Virtually all urologists use local anesthetic. I can't name one who does not. Sometimes pain is extensive. But it is unpredictable from patient to patient. In such cases for extensive biopsies (saturation and such) general anesthetic is used.

3. Is he/she smart enough to send your biopsy to an expert in PCa pathology (e.g. Epstein at Hopkins or Bostwick Labs)?

Your list is subjective. Are you saying MSK, Mayo, Harvard or Stanford pathologists, as examples, are incompetent? It is a patients CHOICE to have their labs sent to these guys, I shouldn't be an expectation of their urologist.

4. Is he/she smart enough to understand that this is a “big deal” to you and clear time on his/her calendar ASAP after the biopsy comes back positive so that you can ask questions and get some understanding of the disease?

Does anyone think that being diagnosed with cancer is easy? The problem here is that no one person ever has all the right questions after diagnosis. Certainly not after immediately being told they have cancer. There is no easy way to say "you have cancer" . As a person who runs a live prostate cancer forum, it sometimes takes months for a person to digest this information. You have to tell them several times that they can do well before they believe it. So the "Big Deal" thing requires education beyond the urologists. Or the radiation oncologists or the medical oncologists for that matter?


5. Is he/she smart enough to recommend a color doppler ultrasound (or at least to explain why you don’t need one)?

This has not proven to prolong life or to even change treatment options. I expect it will but the actual number of changed decisions will surprise those who believe in this technology. I see it as an aid. But I also see limitations. if we can add a test that can tell the difference between indolent prostate cancer and aggressive disease, this will supersede detecting where it is located. Of course that requires such a test to not require direct tissue samples. But remember. prostate cancer is typically multi-focal...and any part of it can be aggressive.

6. Is he/she smart enough to tell you that a bone scan and/or CT scan for a low PSA situation is a waste of time and money? Or, if he/she recommends it anyway do they tell you why?

Says who? Certainly a high risk case that shows invasion to the ribs with low PSA is more valuable information that a color doppler finding...

7. Is he/she smart enough to refer you to some excellent books about prostate cancer so that you have some basics (e.g. books from Walsh and Strum)?

Or Myers or Vogelzang? Or Catalona or whoever? The key is that they inform you to take your time and do your research...

8. Is he/she smart enough to suggest that you speak with multiple disciplines and doctors so that you understand your options for treatment?

Mine did but not all do. Whether you talk to a urologists or a radiation oncologist, not all understand the others competencies. I found all radiation oncologists to be committed to their profession and urologists committed to theirs.

9. Is he/she smart enough to show you the nomograms for your case so that you understand the likelihood of cure?

Not one Radiation oncologist suggested I refer to nomograms...I rest my case...

10. Is he/she smart enough to discuss ALL of the potential side effects of the different treatment options, e.g. shorter penis and urine ejaculation for surgery?

Nope. Neither was my radiologists able to tell me about the perineal pains. Or the potential for radiation induced bi-cancers. The jury is out.

11. Is he/she smart enough to discuss the quality-of-life issues with you in an open, honest way and tell you the comparisons among the various treatments?

None of them were. All said they had the best approach. My favorite doctor had me on two and a half years of hormone therapy. It sucked. but in the end, I am treatment free and winning my battle...

12. Is he/she smart enough to tell you what the options and percentages are for salvage treatment if your primary treatment fails?

My radiation oncologists was my backup plan. His backup plan was my hormone therapy or chemotherapy.

13. Is he/she smart enough to share his/her personal statistics with you re cure rates and quality-of-life issues?

I hope so, but this is again very subjective. Regardless of profession...My radiaologists cited general information from studies he did not partake in.

14. Is he/she smart enough to carefully explain your chosen procedure to you in a very detailed manner…including the before, during and after?

Is anyone? This is a compiled question from all above. Does a radiation oncologists explaing these thing? Nope...Mine said what we'll do will work. I asked if it doesn't he said see my medical oncologist...

15. Is he/she smart enough to tell you to use a physician who has done 250+ procedures?

I say 1000 procedures...lol...I agree with you on this...

16. Is he/she smart enough to tell you that there is an epidemic of overtreatment for early stage PCa and to recommend active surveillance to you if you qualify? Is he/she smart enough to refer you to a physician who is experienced is handling active surveillance patients if he/she does not have the experience?

Epidemic is an inappropriate term. According to the Epstein criteria only 15% of patients qualify for active surveillance. Thus referring you to a "qualified specialist" in active surveillance is unheard of.

17. Is he/she smart enough to tell you that the cure rates for surgery and radiation treatments are the same?

Says who?

18. Is he/she smart enough to tell you the specifics of your post procedure sexual rehab?

Mine did and he hit it. But I refer to asking did you ask?

Below (revised from your Smarter Than list) is what I plan fax to our Urologist tomorrow.

Thank you -
Paella



1. Should I have a free PSA test and a PCA3 test?
Yes_________ No__________

Reasons why or why not?______________

2. Is a color Doppler only useful BEFORE a biopsy?
Yes_________ No__________

3. Should I have a color Doppler now?
Yes_________ No__________

4. What is the purpose of a bone scan?
_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________


5. Who do you consider the best robotic guy in the greater Los Angeles area?

_________________________________________________________________________


6. Who do you consider the best Prostate Oncologist in the greater Los Angeles area?

_________________________________________________________________________


7. What are your personal statistics regarding cure rates, impotence, incontinence?


8. Would you tell me again what is my prostate volume?
_______________________________


9. What is Saint B.’s “percentage of positive lymph nodes after prostatectomy? (% of patients
that have positive involvement after surgery)
_______________________________


10. What is my “total cancerous tissue length?
______________________________________

Tony, I disagree with many of your comments on a number of levels but won't take the time to debate this with you.  I will say that your understanding about "intentions" of the post and any implications about being disrespectful because of treatment choice are TOTALLY inaccurate and off the wall.  Obviously some of us have higher expectations of our physicians than you do but that's ok...each to his own.  Nevertheless if even one new forum member got something out of this, as Paella seems to have done, then it was worth the time to put the list together.

Tudpock (Jim)