If you are interested in external beam radiotherapy for your prostate cancer, you probably want to be treated by someone who knows what they are doing! How do you find such a specialist? We asked a respected community specialist in radiation oncology who really understands the treatment of prostate cancer how he would go about this himself? This article was written by Matthew Katz, MD. Dr. Katz is a board-certified radiation oncologist who practices in Lowell, MA. He also serves as the Chair of the IT Development & Resources Committee for ASTRO, the world’s largest professional society for radiation oncology.
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External beam radiation treatment and surgery can be equally effective in the curative treatment of prostate cancer. External beam therapy differs from surgery and brachytherapy in two key ways: it’s noninvasive and it requires multiple treatments over a period of several weeks.
In my opinion, it’s worth meeting with a radiation oncologist if only to hear about this treatment option. However, the field of radiation oncology is like a “black box” and is not well understood (even by other doctors), so defining quality is a challenge. Below are some potentially helpful things to keep in mind when you meet with a radiation oncologist:
1. Get a doctor, not a technogeek — Doctor means “teacher” in Latin; your radiation oncologist should be able to communicate well in plain language. Radiation oncologists are trained in particle physics, cancer biology, and clinical medicine. It’s a highly technical, specialized field but your doctor shouldn’t make you feel like (s)he’s from outer space and speaking in Klingon.
Overall, the human element of cancer care should be more important to your doctor than the technical elements of radiation treatment. (S)he should be more focused on you than on the latest, “cutting edge” technology. Don’t get me wrong; modern treatment techniques do matter. But empathy, communication skills, and good judgment are more important characteristics in my doctor than whether (s)he’s a technophile with a CyberKnife.
2. Experience — with perspective — Find out if (s)he is board certified. You don’t need to see a pure prostate cancer specialist to get excellent care; community-based radiation oncologists with an interest in prostate cancer can also provide top quality treatment. There have been new technical advances over the past decade, and (s)he should be up to date on the latest techniques and relevant research.
Prostate cancer expertise isn’t enough. Your doctor should be able to discuss how prostate cancer fits into your overall health, as sometimes other health conditions may play a role in treatment decisions and the risk of side effects. Make sure you feel (s)he is accounting for your personal preferences and health concerns rather than suffering from tunnel vision.
3. Collaborative — Even if the doctor has tons of experience, avoid the ones with “Me hammer, you nail” syndrome. (S)he should help you obtain the information you need to make decisions for your health and peace of mind. You should feel comfortable asking questions and shouldn’t feel pressured to make a decision. You should feel it’s a dialogue rather than a one-way conversation.
(S)he should be curious in learning more about you and your priorities throughout the decision-making process. If (s)he can’t make you comfortable that you’re getting a balanced perspective comparing external beam radiation to other treatment options, move on and keep looking for the right doctor.
4. Confident — Your doctor should be assertive and can comfortably discuss management of any possible treatment-related side effects. (S)he should be comprehensive in explaining prognosis, treatment options, possible side effects, and the risks/benefits of external beam radiation. That said, avoid anyone who is overly confident, promising “risk-free” treatment. No technologic advances can guarantee either a cure or the complete absence of radiation-related side effects.
5. Accessible and involved — External beam radiation treatment is a multi-week treatment, and you may have questions that come up before, during, or afterwards. Your doctor should be available and willing to address any questions or concerns.
Ask about who monitors you through treatment. Your doctor should not delegate this responsibility to a nurse, physician’s assistant, or trainee but will remain involved throughout your full treatment course.
6. Meet the team — Radiation oncology is a collaborative endeavor between the doctor and other health care professionals. This includes your radiation oncology nurse (who will help you and your family with supportive care and possible side effects), your radiation therapists (who will help you settle into your treatments each day), and your medical dosimetrist and medical physicist (who use sophisticated computers and their expertise to help your doctor develop the technical aspects of your treatment plan). For more details, visit the RTAnswers web site.
Communication is essential among everyone involved in the planning and delivery of your treatment. If you’ve decided you like the doctor, don’t stop there. Ask for a “tour” and meet the rest of the treatment team. I would want to know that the entire team works well together if I’m going to see them every weekday for several weeks. I’m biased toward doctors who behave as “first among equals” both with the other team members and with patients (see point 3 above).
7. Cleanliness is next to goodliness — Unlike going to a surgeon, a radiation oncologist’s office and the treatment area are often essentially one. It doesn’t have to look like the latest issue of Interior Design magzaine,but cleanliness and organization are important. In radiation oncology, being anal retentive is a good thing. Your doctor should be paying attention to detail since radiation treatment for prostate cancer is highly technical and requires precision to be done safely, so a messy office or exam room is not a good sign.
8. Who does (s)he work for? — Make sure your doctor doesn’t have any conflicts of interest that concern you. If you’re offered a clinical trial or treatment with a “cutting edge” technology, make sure you ask all the questions you need to feel comfortable with that doctor and that technology. If you feel the doctor is biased, and seems to be favoring a less standard approach, do some homework or consider another opinion before moving ahead — “trust but verify.” If you aren’t convinced that the doctor is acting in your best interests, it’s time to move on.
9. Location, location, location — Distance can be a constraining factor logistically or financially since multiple radiation treatments are given over a period of several weeks. If you’re referred to a radiation oncologist, make sure you’re comfortable with both the doctor and the travel time needed for treatment.
These tips are not comprehensive but give you some idea of some issues to keep in mind. Take the time to explore all your treatment options as well as active surveillance to determine what is best for you. Consider reviewing it with your primary care physician as well.
There’s always some uncertainty, regardless of whether you opt for external beam radiation, brachytherapy, surgery, or active surveillance. However, you need to find a doctor who you trust to act in your best interests. Careful consideration and research should help you feel more confident that you’ve made the right choice.
THE "NEW" PROSTATE CANCER INFOLINK 