Prostate cancer is often a multidisciplinary problem. At any stage, you may need some help beyond your family doctor, oncologist, or urologist. If your doctor doesn’t suggest this, it may be up to you to ask for it.
What’s the best initial treatment for you? The answer isn’t always obvious. For example:
Maybe you have been diagnosed with cancer that is localized to the prostate, but the pathology findings from the biopsy suggest it is high-risk. Should you undergo surgery by itself or with a course of hormonal therapy or radiation therapy? Or would you be better off with external-beam radiation, with or without hormonal therapy?
Maybe you have other health conditions to take into consideration in determining your treatment. Maybe there are practical concerns: maybe you don’t have reliable transportation and would have trouble getting to the hospital every day for radiation treatment. Maybe you have scar tissue or mesh from previous abdominal surgery that could make a robotic prostatectomy difficult. Or maybe you have been diagnosed with cancer that is within the prostate – but a PSMA-PET scan also showed cancer in one isolated location. Should you undergo surgery or external-beam radiation – and also stereotactic “spot” radiation?
These are just some of the scenarios where two (or more!) heads may be better than one. Many hospitals and medical centers have a multidisciplinary clinic where you as a patient might see a urologist, a radiation oncologist, and perhaps a medical oncologist on the same visit: medical one-stop shopping. These providers then meet regularly as a group “to come up with a comprehensive plan of care,” says Anne Calvaresi-Lizardi, DNP, a urology nurse practitioner at Jefferson Health-Thomas Jefferson University Hospitals in Philadelphia. “The benefit of a multidisciplinary approach is that it’s different, intelligent minds coming together with your best interests at heart.” At Jefferson Health, a typical multidisciplinary clinic meeting might also include a pathologist, nurse practitioner, social worker, and a radiologist.
What if your hospital doesn’t have a multidisciplinary clinic, or you weren’t given this option? Seek a second opinion. You could do this two ways: If you’re talking to a surgeon, for example, and want to know if radiation might be a better option for you, ask for a referral to a radiation oncologist. However, if you are talking to a doctor, have some doubts and want to talk to another doctor of the same specialty, you may want to pay out of pocket for a consultation (you can allow that doctor to see your biopsy and imaging results). It’s perfectly common and okay to get a second opinion! As Johns Hopkins urologist Patrick Walsh, M.D., says, “People ask for a second opinion all the time. If the situation were reversed, do you think your doctor would not make every effort to find the best possible surgeon (or radiation oncologist, etc.)? It’s your prostate, and it’s your life.”
Calvaresi-Lizardi says: “I always tell patients, if you’re uncomfortable or unsure with one provider and you feel you would benefit from seeing other specialists and getting a second opinion, there’s nothing wrong with that! Some people are almost ashamed to ask. But if you were building a house, you probably wouldn’t hire the first contractor who comes along. You might get a couple of quotes and go with the one you think is right for you.” How much more important is it, she continues, to take that kind of care with your own body? “We get one body! We can have many houses, but we just get one body, and we want to get the treatment that’s best suited for us.”
Who’s the quarterback of your treatment if several doctors are involved? Who’s in charge of your care? “Whoever is leading that treatment.” If you have localized prostate cancer and decide on radiation therapy, then the radiation oncologist would become the quarterback – but the quarterback can change. “If the patient is finished with radiation and then starts to develop lower urinary tract symptoms, the urologist becomes the quarterback again.” Or, if you need longer-term hormonal therapy or chemotherapy, your family doctor or oncologist would become your quarterback.
Note: Beware of the internet! “Your second opinion should not come from the internet. It’s a can of worms,” says Calvaresi-Lizardi. “There are many websites with false information.” One website that is not a can of worms is pcf.org, she adds. “PCF has a wonderful amount of great information for patients.”
What if you just have the one doctor and that’s fine with you? “If you’re comfortable with your urologist or oncologist and don’t want a different one, that’s great!” But you can still get multidisciplinary care if you also have a cardiologist, gastroenterologist, or other specialist, and providers are communicating with each other. “ It doesn’t have to be a brick-and-mortar multidisciplinary clinic.” For example, in a recent visit with a patient, Calvaresi-Lizardi noted some swelling in the patient’s ankles and sent a note to his cardiologist.
You can get a multidisciplinary consultation through telemedicine! One patient seen by Calvaresi-Lizardi and the multidisciplinary team was sitting at his home in another state. “The pathologist reviewed his slides that morning, the radiologist looked at his imaging studies, and we discussed his comorbidities. After hearing all the opinions of our team, he had a course of hormonal therapy at home. Then we saw him in the clinic yesterday and he will have his surgery here with us.”
Or, after hearing what a multidisciplinary team has to say, you might decide to “have the home team carry it out,” she adds. “Sometimes we just confirm what the doctors at home said. If you want to know, am I making the right choice, and we all agree, that’s very reassuring.”