MO or Urologist for ADT management

I have had a RALP and I am halfway through ART. I know that ADT is, unfortunately, almost certain to be a part of my future. I realize ADT is often given with RT but my Urologist and RO decided to test my PSA towards the end of RT to see if it rises above the 0.2 post RALP score (my margins were positive) and then go from there concerning ADT.

My RO told me my Uro would supervise the ADT, but he is leaving to practice with a different group. I am wondering if I should go to a MO rather than have another Uro to supervise ADT. Are there strong opinions on MO vs Uro?

Our risk factors are similar but my PSA was much higher. I used my urologist for ADT, though I consult with an oncologist to keep him informed. If you are comfortable with your urologist and he has experience with high risk patients, then stay with him for now. If not, then see an oncologist that has a lot of advanced PCa experience.

I am having the same dilemma. Uro did the first shot (Eligard), but now I regularly see an MO who gives me denosumab shots monthly and could just as easily add the ADT shot. He uses Lupron. I know they are chemically the same, essentially, but the shot location is different and could be somewhat different for me I guess in the way I react to that. I've done pretty well in terms of the side effects being pretty minimal, so I am a little reluctant to switch, but the MO is the "rockstar" of the two doctors. In fact, he was my Uro's mentor going through med school.

FWIW, I am leaning towards having the MO do it. The Uro has been excellent in communication and personalized care and the TURP he did on me has made life so much better. But the MO is who I see more often and has me in the TAK-700 trial. As a stage 4 guy, I will eventually be moving into chemo treatments, and the MO seems like the right choice to go forward with.

Tall Allen,

The original thinking was that RALP followed by adjuvant IMRT had the potential for cure since there was no evidence of mets. I think that the idea of cure is still there, but less so, considering the path report. I think my RO WAS leaning towards ADT during RT. I have voiced my great desire to avoid ADT. The studies I have seen suggest a few percentage points of improvement for doing RALP/RT/ADT over RALP/RT. That may be rolling the dice but I think qol is going to suck with ADT and I don't want it unless absolutely necessary.

The RO said that the effects of RT will likely raise my PSA as the cancer cells die (as you mentioned) but not until sometime after I am finished with RT. In the meantime, any PSA rise at the end of RT would be attributable to cancer elsewhere. At least that's the way I understood it.

Due to my diagnosis (cT3a, G9 5+4) I selected primary RT with ADT2 (Lupron and Casodex). Approaching 2 1/2 years on ADT, and over two years since RT finished. All of those thrills, chills, and excitement were at Vanderbilt University Health System in Nashville. (For me, ADT side effects are burdensome. I've been blessed to have essentially no side effects from my aggressive radiation treatment).

My uro onc there started my ADT2, the RO was on board with that. They were both in the same hospital system and shared info/consultations. The MO there said she was ok with it too, but thought the uro could continue the ADT2 plan. Those three were my "team", and I made sure they all agreed before we started anything.

We moved to another state subsequently. Since I had no uro here, RT is history, and all of my future treatments are in the MO realm anyway, I now have a University of Michigan MO managing my treatment plan. That makes sense for me.

The only thing with MOs, is they're generally involved in the recurrence/resistant/metastatic phase and have that long term permanent/progressive orientation. I'm still in primary treatment, so it's that perspective that I need to keep on the front burner. As in, I want OFF of ADT!

It depends probably upon where one is in the whole spectrum of treatment plans.

Jerry

It's called "Market Sharing"....The Urologists, Radiation Oncologists and Medical Oncologists have some sort of backstage agreement as to who gets to administer the very profitable Lupron shots...Ask your Medical Oncologist about it..He will squirm around and tell you to "continue seeing your Urologist for the shots"..If you say you find this inconvenient and you would rather HE would administer the injections, his response might be very interesting and enlightening..

To gain maximum effectiveness from the radiation treatment, it is commonplace to combine it with Hormone Treatment. The HT is started a few weeks before the Radiation and usually continues for a year or two...While it's the RO who prescribes the HT, he will nothing to do with administering it...

Best of luck to you....

Hello !

I've been on ADT for two full years now. At first, it was administered through my urologist's office. I always had to sit and WAIT for quite a while for a nurse to come over from the oncology department who was certified to give the ADT shot. Sit and wait, sit and wait ...

After a time, I added an oncologist to my medical team. Since then, I decided to have the shot administered right there in the oncology department, since that's where the certified nurses are located, anyway. Much more convenient ! This was my experience at my hospital, anyway.

I discovered that my oncologist is more detail-oriented in watching the shot's effectiveness. He was also willing to try FIRMAGON and also ZOLODEX in addition to LUPRON, whereas my urologist would only consent to giving LUPRON.

My oncologist was also the first one to start ordering testosterone tests for my lab work before each shot. My urologist had NEVER checked the testosterone level !?!! Many urologists don't monitor the testosterone level when ordering lab work. Knowing the testosterone level can be an important component in finding out whether the ADT shot is reaching its full effect. This is OFTEN overlooked. Patients can request a testosterone test from their doctor before doing lab work. If your testosterone is not being suppressed to a low level, then some changes need to be considered in your ADT shots. That's why my oncologist also orders a testosterone test in addition to PSA tests along with the lab work.

I hope my experiences will be helpful to a reader studying this thread.

Sent with my best,
Cyclone