If you don’t live in a city, finding a urologist who specializes in treating prostate cancer can be a major challenge. Usually your choice will be limited to who your primary care doctor will refer you to, generally a local urologist. But before you take this step you need to be aware that all urologists are not created equal.
Furthermore, the average community urologist has a medical practice most of which involves treating problems like infections, impotence, incontinence and kidney stones. He may be an excellent doctor, but he does not have time to keep up with what is new in the fast moving prostate cancer field. Also, without the opportunity to treat large numbers of men with this disease, how can he be familiar with the advantages and disadvantages of all the new treatments?
So you need to develop the “I’m from Missouri and you’ve got to show me” mindset and ask the tough questions: How many cases of prostate cancer has he treated successfully? And if he recommends surgery, how many radical prostatectomies has he performed overall, and how many in the past twelve months? Does he perform nerve-sparing surgery, and if so what is his success rate with preservation of both potency and normal urinary function?
Unless you have the aggressive, high-risk form of prostate cancer my best advice is to resist your natural desire to rush into treatment that will compromise your quality of life. Of men diagnosed over 50%have slow-growing, low-risk disease and do not need immediate treatment. However, if you have the “just get it out” attitude, bear in mind that your community urologist is most likely not doing anywhere near enough radical prostatectomies to qualify as or stay proficient.
Despite the well-documented over-diagnosis and over-treatment of prostate cancer, during the past decade, the number of prostatectomies performed each year has more than doubled. And since all the marketing hype surrounding “the robot that can operate,” increasingly men are traveling to high volume centers that offer robotic surgery. But remember, it’s the man behind the robot who is actually performing the surgery, and you don’t want to be on his learning curve. Unless you find an experienced and highly skilled surgeon, a satisfactory outcome is extremely unlikely.
Many men are way too motivated to submit to radical treatment for what is typically a non-life-threatening condition. A combination of the urologist’s preference for surgery and most men’s desire for closure, leads to tens of thousands of unnecessary radical prostatectomies every year. You are about to make a pivotal decision that will affect the rest of your life. So before you make any treatment choice, you owe it to yourself to get a second opinion from a prostate cancer specialist—even if it means traveling to a city where such practitioners are available.
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