GREG'S LEGACY

Specialising in the human experience of Living with prostate cancer – warts and all

MYTH: Who owns the patient?

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It was the wrong type of vacuum pump to fix ED

In the US (Australia too), urologists diagnose and perform initial treatment of around 90% of all prostate cancer cases. The disease is usually detected via PSA screening or after investigation of urinary complaints. The urologist does the biopsy. The urologist does the primary treatment.
 
An oncologist is almost never involved.
 
The urologist continues to “own” the patient going forward. Seventy to 80% of the patients die with prostate cancer, not of prostate cancer. (snip) Urologists prescribe hormone therapy to rob prostate cells of the androgen fuel they need to thrive. This therapy suffices for most men and they remain under management of the urologist.
 
Oncologists are still not involved in the treatment of these patients.
 
Any of these patients who don’t die of something else first eventually see their hormone therapy stop working. (snip) The urologist continues to monitor the patient as their PSA rises. The increase can be slow, lasting months. Urologists continue to “own” this patient.
 
Oncologists are still not involved.
A small minority of urologists will perform regular scans on their patient to monitor the spread of the disease. Most do an initial scan after the PSA starts upward and only do additional scans when the patient complains of symptoms. Urologists engage in “watchful waiting” to see how the disease develops.
 
Oncologists are still typically not involved.
 
Prostate cancer usually spreads first to bone. At some point, the patient’s condition deteriorates enough that the urologist knows additional therapy is necessary. This is usually due to pain. If the pain is isolated, the urologist will refer the patient out for radiation treatment to “quiet” spot pain caused by tumor growth. The radiologists return those patients to the urologist’s control after that procedure.
 
Only when the patient is broadly metastatic and symptomatic will the urologist refer the patient to an oncologist. Once that happens, the urologist “loses” the patient and the oncologist takes over.
 
Who “owns” the patient is important. From the patient perspective, they have a multi-year relationship with the urologists so there is a comfort level there. From the urologist perspective, the patient is a revenue source. 

Read more:

I had to learn this lesson by experience.  Urologists know that hormone therapy cannot destroy tumours or cure cancer yet they keep up the treatment until it fails.  Even then, my urologist wanted me to continue using the ADT because he had nothing else to offer me.  I haven’t been back to him since.  I have taken over ‘ownership of the patient’.At that time, I visited an oncologist from St Vincents in Melbourne.  He wasn’t interested and told me to come back when I needed pain management via radiation or chemotherapy – effectively leaving my ownership with the urologist. I continue the ownership of the patient.

Since then, I instigated palliative radiation at the Peter McCallum Cancer Institute (Melbourne) through my GP (General Practitioner).  I didn’t need either the urologist or the oncologist.  Whilst at Peter Mac, their chemical oncologist tried to get me involved in a trial.  The pre-condition was that I must also be on ADT (Zolodex) for him to qualify for funding of the trial.  I chose not to participate.

The point of all this is that since the ownership of the patient is fixed in the minds of the doctors, they are too busy securing their own status and income source rather than finding the best treatment for the patient.  Ask yourself, has your urologist or oncologist offered treatments that they do not handle?

Don’t leave the ownership of your disease rest with any one doctor.  Stay in charge of your own destiny. 

Read our post about Palliative Care as they can help co-ordinate medical, psychological and social connections so that you remain in charge.

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