Questions to ask the Oncologist

Hi Zuca. I'm sorry that you have had to come here but welcome to the forum anyway.

There are lots of us here who have been down the same road on which you and your husband are just starting out. It's good that both the bone and CT scans are clear as that means the cancer is contained in the prostate.

You need to ask the oncologist what husband's Gleason score is and the T grading of the tumour. You should also ask if he will get radiotherapy treatment and for how long.

I suggest you visit the Prostate Cancer UK website and download the Prostate Cancer Toolkit. Once you have worked through that you will probably have many more questions. Please come back again and ask us as someone will definitely have been where you are at the moment.

Prostate Cancer UK website link

Best wishes for Christmas and the New Year.

As per Seamus, do some investigation, write down questions to ensure they’re answered,

Ask why they recommend a particular treatment plan over another, ie radiotherapy, surgery, surveillance, biopsy or  hormone therapy. That way you’ll know why others were discounted, ask if approach cure or management.

Gleason scores - 

TNM rating

all the best for the journey 

J

The danger I found was at diagnosis I was a bit "shell shocked" and although the Doctor went through the treatment options there was no discussion and I was told this is the best treatment for you and we can start with HT then with a clear Bone Scan move onto RT and that's what happened. It did lead to a feeling of loss of control that was gradually overcome. I actually found that talking to a councilor was a help in sorting out feelings and reasons. It was something I had always dismissed in the past but found it was a great help. 

Best wishes for speedy and successful treatment.

Reg 

My apologies if you find my response disturbing but I feel quite angry at what you have written.  NOT at you!

It may be that you have some information that you haven't included, perhaps because you haven't realised its significance.

The detail I refer to is your husbands PSA the Gleason score from his biopsy, how much of the gland is affected from the biopsy and MRI scan and whether the cancer has spread outside the gland from the MRI.

This will indicate how aggressive the cancer is and whether it is "early" or "locally advanced".

Similarly you ought to ask the oncologist for details of the CT and bone scan as these will indicate if the cancer has become advanced (metastatic).

What's the best treatment depends on which stage the cancer is. Since.the CT and bone scans were "clear" it seems as if it's NOT advanced.  However, it's vague and could still be locally.advanced.

Your next question then could be, is the tumour contained in the gland.

I.hope you understand the law of informed consent.

Any healthcare worker irrespective of their knowledge, expertise.or rank legally needs to gain your agreement to carrying out even the most minor intervention, which otherwise could be considered as assault.

As long as you don't actually say "NO" or refuse to comply, then the worker can always claim.you gave implicit consent.

Consent however must be "informed", i.e. firstly.you should have been given information about the benefits of a treatment, the risks and the alternatives.  Furthermore, the worker must ensure that a) you have.understood the information and b). if you are capable.of.understanding or lack "mental capacity" as defined by law.

From what you write it doesn't appear that any of this has been done, therefore.you can either passively accept what you're being told or ask some probing questions.

These could include, why has your husband been referred to an oncologist and not a surgeon?

Why apparently has he not been offered surgery.  The treatment he's being TOLD may not be the only option.  It is as much up to the patient to choose what suits them.best, not just the healthcare worker.

Who decided what the "best" treatment option was.  Was this the oncologist, another doctor or a multi-disciplinary team.  It shouldn't be up to just one person from one speciality.

Why has he been started on hormone treatment.  If the cancer is contained in the gland, Gleason 3 + 4 or less and PSA under 10, hormone therapy might be considered overtreatment.

I was given a choice of radiotherapy or surgery, I chose surgery, I never saw an oncologist, I've never had hormone therapy.  It isn't clear why such an apparent patriarchal approach has been taken in your husbands case. 

If you haven't been given answers to these questions alteady. or aren't given them at some point, then it is questionable if this is actually illegal

It makes me angry to think that such practices are still carried out, it seems, with impunity.

It's not a matter.of questioning their clinical judgement about their own specialties, but you can't expect a surgeon to be an expert on oncology and vice versa.  A team decision is usual and better than an individuals.

I would however challenge their moral judgment, you have a right to be informed, you have a right to understand, you have a right to be told all options and a right to make a choice.

.

Whatever the outcome, Indo hope you have a good festive season and it all turns out OK.

I do suggest you look up more information about tests and treatment choices for early and locally advanced prostate cancer on THIS Macmillan website.

The Prostate cancer UK website is also informative

I take my wife with me for any consultations as sometimes it can overwhelm you and it's nice to have support. I accept that not everyone is able to have some one with them.