Physicians Experienced in the Management of Prostate Cancer
Last Revised August 25, 1995
Physicians with special experience |
The team approach |
How to choose the physician who is right for you
Obviously it is very important for the prostate cancer patient and his family that they feel comfortable
that they have found a physician who is experienced in treating prostate cancer and who they are
comfortable talking to about the disease.
Some patients may want to take a very active role in deciding issues of treatment and long-term
management. Other patients may feel much more comfortable just finding a good physician and doing
as that physician advises them. Either way is okay so long as the patient feels he has made the
decisions that are important to him, and that the physician is telling him everything he wants or needs
to know. So how does the patient go about finding the right physician?
Physicians with special experience
Basically, there are three categories of physician who are liable to have more experience in the
management of prostate cancer than physicians in general:
- Urologists are specially trained in the management of disorders of the male and
female urogenital systems. Urologists are surgeons who have then subspecialized in urology. Some
urologists specialize even further into areas like pediatric urology -- when they tend to manage only
the urological and urogenital problems of children. A very select group of urologists consider
themselves to be subspecialists in urological cancers, including prostate cancer. The majority of
urologists are board certified by some appropriate organization -- which means that they have passed
a rigorous evaluation of their knowledge and experience. In America a board certified urologist would
be certified by the American Board of Urology. In Canada, the comparable organization is the Royal
College of Physicians and Surgeons of Canada.
- Radiation oncologists are specially trained in the treatment of cancers using
various types of radiotherapy. Like urologists, some radiation oncologists will subspecialize and may
have particular experience and expertise in the management of prostate cancer and other urologic
- Medical oncologists have received special training in the management of cancer in
general and solid tumors in particular. They have not normally trained to treat prostate cancer either
using surgery or using radiotherapy. A medical oncologist is only likely to become involved in the
management of prostate cancer when it progresses to advanced disease and the various opportunities
for curative therapy have been exhausted.
The team approach
A developing trend in some parts of America is a team approach to the evaluation and treatment of
prostate cancer patients. What this means is that a patient can be seen by one or more of a group of
physicians that may include a primary care physician, a urologist, a radiation oncologist, a medical
oncologist, and sometimes even a psychiatrist. You are more likely to find such a team approach at
specialized prostate cancer clinics associated with some major hospitals and universities.
How to choose the physician who is right for you
There are two basic steps to this process.
In the first place, you and your primary care physician need to decide together the type of specialist
you need to see initially. For the vast majority of patients, this will be a urologist. Depending on
where you live and the type of health care which is available to you, your primary care physician may
be able to offer you a referral to one or more urologists. If you belong to some form of health
maintenance organization (HMO), you may find that there is a smaller number of urologists to choose
from because the HMO has contracted only with those urologists to send them all of the HMO's
patients needing urological care. Rarely, if you are unlucky enough to be one of the patients
diagnosed with extensive ("metastatic") prostate cancer, your primary care physician may want to refer
you directly to a medical oncologist.
Secondly, you and your primary care physician need to decide who is the best specialist for you from
the available options. When you start to look for a specialist, there are a small number of things it is
wise to keep in mind:
In his book Prostate & Cancer (see ), Sheldon Marks, MD, a urologist, writes:
- The experience and training of the specialist you are looking for is important, and that can include
everything from where he or she went to medical school to how many prostate cancer patients he or
she is currently managing.
- The knowledge of other people is potentially valuable. Who do the other doctors in your area
consider to be the "best" physicians to help you? What do the nurses at your local hospital think? Do
you have friends or relatives who have had to see a prostate cancer specialist? If so, what was their
- You will feel most comfortable if you can find a specialist in whom you have confidence. This
does not necessarily mean he or she has to become your best friend! However, you need to feel able
to ask questions and get answers which you understand
"... there is no correlation between surgical skill and how well a doctor speaks or how many articles
and books he may have written. The doctor should be judged on his or her own merits. Whether or
not he or she practices in a community setting or at a powerful university teaching center has nothing
to do with the doctor's skills.
"What you really want is a caring and compassionate [physician], technically excellent, with a good
track record, outstanding judgment, a history of minimal complications [if he or she is going to be
your surgeon] and happy patients and referring doctors."