How would you grade your “biopsy urologist?” Did you keep him or her or did you move on?

Show some loving to the  “biopsy urologist” post. It may behoove you.

I wrote this post some time ago.  I had noticed how many times on the various prostate cancer message boards that patients got their diagnosis, made a decision and then went elsewhere.  In many of the discussions the “biopsy urologist” was never mentioned, a technician so to speak.

A couple of things. Why not keep the lines of communication open with the original urologist? He or she might be a good resource for the future.  In general I don’t think the urologist is “upset,” ” offended,” or “disappointed” if you do something else other than his recommendation, or done by someone else other that him or her. I really believe this, yet I know it’s not true for all.  So no reason to burn a bridge. If you have to go out-of-town to be treated (no matter what the treatment) you’d have to agree that it would be an advantage to have someone local in whom you have a good relationship. Just a few days ago a patient said he may to go to Miami for HIFU. He said he’d only have to spend the night and that the urologist there had done over 3,000 of these procedures. He would have to fly there from the Atlanta area. And then he said this, ” They will be putting a tube into my abdomen to the bladder and bypassing the urethra. I will be taking it out at five days.” Now… in medicine tubes are tricky. In my book I state an old urologic adage, ” Don’t buy shoes in the morning and don’t pull tubes at night.”

If there is a problem with voiding when the tube is removed, and your doctor is in Miami and you are in Atlanta… you get the drift. Maintain that working relationship and as in this case, I quickly offered to be of service if there were problems with his recovery when he got back. That has been established “before” the problems and I was appreciative of his calling me with his plans. It was a “courtesy call” so to speak.

A patient comes to mind of mine that chose radiation to treat his cancer. This was years ago.  He had his treatment in the Atlanta area and had all sorts of urinary problems early on, which in time abated.  I bet I either spoke to him or saw him thirty times in the course of two years.

I have never had a more grateful or appreciative patient in my career. He must have referred at least a hundred patients to me. I went fishing on the lake near his home and his wife made breakfast for me and my brother. I have said to him and others many times that ” my closest patients and  the ones that refer me the most friends and family are the ones I don’t operate on.”

One comment made by a patient on this blog (see if you can find it) mentioned that he’d been on three continents and had trouble finding a suitable urologist. I hope it is not that hard.  Am I being somewhat blind to the difficulties that patients face and the problems of how urologists or doctors in general are perceived?

What has been your experience? What was the fate of your “biopsy urologist?”

My brother wrote neat little songs. One he wrote about cars. I’ll get and put on this post later. But the analogy of the car and you urologist comes to mind.

Be kind to your car.

Take care of your ride.

Make a … big a…deal

out of those wheels.

Be kind to your car.

6 Replies to “How would you grade your “biopsy urologist?” Did you keep him or her or did you move on?”

  1. edit this on May 4, 2010 at 11:13 am | Reply Mike C
    Dear Dr. McHugh,
    My GP, a member of the Ohio State Medical Group referred me to Dr. Geoffrey Box, a urologist at the Ohio State Medical Center. Dr. Box, who was quite young, did my biopsy and recommended surgery. I was leaning toward DaVinci LARP, since I had been doing my homework, and I asked him how many DaVinci procedures he had performed. He said 50 in the year since he had finished is training in the method. Talking with another urologist who did not do LARP, he said I might want someone who had done at least 200 such procedures as it took time to build the skills, and a number of others I spoke to said the same and recommended a number of urologists. I eventually went with Dr. Rashmi (Rush) Patel, the partner of the urologist who first suggested 200 procedures as a guideline, who had done well over 200 in four years, and I’ve been very happy with the result, especially as my surgery was somewhat more difficult than the biopsy suggested it would be. It took about 4 hours, rather than the expected two and a half hours, as the prostate was significantly enlarged. I would rate Dr. Patel highly, not only because of the results so far, but because of the level of attention I got from him. I have since been somewhat concerned that the young urologist might have been offended that I left him and your post relieved my concern somewhat. I muust say I was higly impressed with Dr. Douglas Martin, a radiation oncologist at OSU Medical Center, whom I consulted about IMRT while making my decision. He provided me his phone number and email address in case I had additional questions. I did, and he responded promptly to them. If I had chosen radiation, he would have been my man.
    Mike C.


  2. I kept my biopsy urologist, Dr. James Roberts, and he did an open radical prostatectomy at Sharp Memorial (San Diego) and is continuing follow up care related to my prostate cancer. Why not? He has been honest and thorough the whole time. Has a good reputation in town as well. Part of my decision to stay with Dr Roberts may have had something to do with the fact that I am a scientist (microbiology PhD) and responded to the risk for diagnosis and diagnosis by doing a lot of homework–reading many medical papers on the subject as well as the contents of the NCI web pages devoted to prostate cancer, as well as several other major medical sites.

    Therefore, when I went in for the biopsy, then the cancer diagnosis, surgery, and follow up I was able to fact check much of what he had to say. In my opinion, he was honest, careful to explain details needed and to answer any questions (that he had answers too). At no point did it seem like he was try to sell me on surgery and he offered a second opinion for radiation therapy. Roberts did urge me to act soon because the tumor appeared, from the biopsy, to be large. I went home after the diagnosis discussion and added up the facts and risks: age 60, psa of 4.6, biopsy Gleason 6 sum, and 7/12 cores positive for cancer and 2 more with ‘ASAP’. Plus, a family history of prostate cancer, plus BPH symptoms. I figured that he was right, the tumor might still be contained in the prostate but with a life expectancy of up to 25 more years being decisive now made sense.

    After prostatectomy (unilateral nerve sparing open retropubic) G remained 6 but the left lobe was 75% tumor and the right 25% tumor. Margins all negative and no invasion of surrounding tissues.

    I have found in various online and FB forums that many people, when they see ‘Gleason sum 6’, insist that my tumor had to be indolent and to check out AS. My urologist felt that wasn’t a good idea and the medical literature consistently shows that some G 6 tumors do spread. NCI guidelines also recommended treatment vs. AS for my case (T2c after all). Fact is, we don’t really know enough about pathogenesis of prostate cancer (do higher Gleason tumors start out low and progress or do they only appear as higher grade?) and our tools aren’t perfect (with 7 out of 12 positive cores there seemed to be a real risk of an upgrade in Gleason sum–which I luckily avoided).

    In other words, I think that I made the right choices and those were guided by that initial urologist whose actions seem to consistently point to being in my best interests.

    Liked by 1 person

  3. I cannot speak highly enough about Dr Thomas J Polascik, Duke University Hospital.. I had three previous prostate biopsies. My fourth biopsy was a combination prostate and seminal followed by focal cryo therapy performed by Dr Polascik. From the patient’s view point, Dr Polascik’s biopsy procedure was heads up above, anything I had previously experienced.


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