Prostate cancer used to be solely the domain of the urologist, a doctor who specializes in the urinary tract system and treats conditions such as bladder and prostate cancer. In the past, prostate cancer was almost always treated with surgery to remove the diseased prostate, a procedure called prostatectomy. Today, the urologist remains integral in a patient’s prostate cancer care. They help patients determine if screening is the right thing to do, make the diagnosis of cancer, and help walk patients through options for treatment. The urologist helps the patient access other specialists in cancer care, which may include a medical oncologist and radiation oncologist. In some parts of the United States, especially in areas that are far from major medical centers, the local urologist may still be the only expert available to treat prostate cancer.
Most major medical centers involve a team of specialists in the care of prostate cancer patients. This change from a single specialist to a team reflects the fact that there are now many options available to prostate cancer patients. Additionally, many treatment protocols now involve a combination of therapies for the best outcomes, such as radiation therapy and hormone therapy or surgery and radiation therapy. The team’s job is to gather as much information from the patient as possible and to work together to personalize treatments so that the patient receives the best possible care for his unique condition.
Prostate cancer therapy may include one treatment or a combination of surgery, radiation, drugs, and regular monitoring.
An anesthesiologist is a doctor who specializes in sedation, anesthesia, and monitoring of patients during surgery or other medical procedures. You will typically meet with the anesthesiologist prior to your procedure to discuss your medical history and what you can expect during the operation. Your anesthesiologist may ask you about prescription medications you take and any alcohol or recreational drug usage in your past. It's important to be honest because these factors may affect the type and amount of anesthesia you receive. Remember, this is confidential!
Your medical center may include a dietician on your care team to help recommend healthy eating plans during treatment. Patients who maintain a healthy weight and lifestyle often have more treatment options available to them because they don’t have other conditions, such as obesity, diabetes, and heart disease, that can complicate treatment. A qualified dietician holds a four-year degree from an accredited program, though many practitioners use the title without adequate training.
A medical dosimetrist is a specialist in the area of radiation oncology. The dosimetrist has expert knowledge of oncology treatment machines and calculates the dose of radiation each patient receives. The dosimetrist's goal is to provide the most effective dose of radiation while minimizing side effects for the patient.
A general practitioner, sometimes also called a family doctor, diagnoses and treats a wide range of ailments, in addition to being responsible for the general wellness of patients. This is the doctor you visit for routine physicals, minor injuries, and common illness like flu or strep throat. General practitioners are typically the first doctor you see for more serious conditions as well. If you need a specialist, a general practitioner will refer you. In many areas, especially those without a large medical center or hospital, the general practitioner performs initial prostate cancer screening.
This doctor may be the same person who performs imaging tests to diagnose cancer. However, in this role, this specialist uses imaging tools such as CT Scans, ultrasound, or magnetic resonance imaging to guide treatment. For instance, the images may guide the delivery of precise treatments, such as laser or radiation therapy, directly to the location of the tumor, or to do a targeted biopsy.
Medical lab technicians help doctors assess and diagnose illness by performing test on blood, urine, and other bodily tissues. Technicians are skilled in the preparation of specimens, analysis of results, and operation of specialized machinery that automates testing. You may never meet the lab techs who work on your case, but they are behind the scenes making sure your healthcare team has the best information to work with.
Your medical oncologist is responsible for determining whether or not you need drugs to treat your cancer. All medical oncologists are trained to treat prostate cancer; however, some centers have medical oncologists with special training in cancers of the genitals and urinary tract. The medical oncologist helps make decisions about treatment plans for prostate cancer. For patients who require medicine, such as chemotherapy, hormone therapy, immunotherapy, or targeted therapy, the medical oncologist might become the primary doctor on the care team.
Patients who undergo chemotherapy or take medication for cancer will often work with oncology nurses, who monitor and manage medication, administer chemotherapy, and coordinate care needed from other specialists.
Nurse, Counselors, and Coordinators
A team of experts assists doctors on the care team. Those experts include oncology nurses, who will administer chemotherapy and other medicines, perform the tests used for monitoring the disease, and help patients cope with side effects. Case managers and patient coordinators are also part of the care team. These experts will help patients coordinate care across the team. They will also help patients make connections with experts, such as nutritionists, who can help with dietary concerns, or endocrinologists, who can help patients who are taking hormone therapy. Social workers with expertise in oncology may also help patients get help with personal challenges such as coping with the emotional burden of prostate cancer as well as helping patients navigate financial concerns, including questions about insurance coverage and family medical leave.
You probably won’t ever meet your pathologist, but this doctor is important. The pathologist examines the slides made from tissue taken from your prostate when you have a biopsy. These tests help determine if you have prostate cancer. They also help determine the severity of the disease and can work with your urologist to decide if any further testing should be done on your biopsy sample.
The pathologist determines the Gleason Score for prostate cancer. The Gleason Score tells urologists how different the cancer cells are from normal prostate cells and also how much of the prostate has been affected. This information helps the care team determine the best treatment options.
The physical therapist works with patients to help them build back or maintain strength and mobility during and after treatment. For instance, prostate cancer patients who take hormone therapy may experience muscle loss or bone loss as part of therapy. The physical therapist, in coordination with the medical oncologist and nutritionist, can help patients manage these side effects.
Your radiation oncologist will determine whether or not you need radiation to treat your cancer. Radiation oncologists specialize in using ionizing radiation to kill cancer cells. Radiation therapies include brachytherapy, which involves placing radioactive seeds in the prostate to deliver localized radiation therapy; intensity modulated radiation therapy (IMRT); a highly focused, non-invasive form of radiosurgery (for example, the CyberKnife®); and external beam radiation therapy (EBRT), a traditional form of radiation that beams radiation at the tumor from outside the body. Proton beam therapy (PBT) is another form of radiation you may encounter.
The radiation oncologist may work with a dosimetrist, a specialist who knows how to calculate radiation dosage and distribution. Radiation oncology centers also have nurses who specialize in the care of patients undergoing radiation treatments.
A radiologist uses imaging tools to diagnose cancer and help the doctor determine the cancer's stage and grade. This helps the physician make a treatment plan. Not every patient needs imaging tests at diagnosis. Your doctor will help you decide if you need any imaging tests and which ones are right for you.
Ultrasound technicians use high-frequency sound waves to create images of soft tissue within the body. These technicians are also called medical sonographers and may specialize in certain areas of the body. Your doctor will use the images the ultrasound tech creates to guide diagnosis of your condition. Ultrasound technicians are not doctors, but they require advanced medical training and certification. The American Registry for Diagnostic Medical Sonography (ARDMS) provides three levels of credentialing for ultrasound technicians.
Primary care doctors will refer a patient to a urologist if prostate cancer is a concern—for instance, if a PSA test performed during a checkup comes back higher than normal. The urologist will take a history and perform a physical exam (which usually includes a digital rectal exam) and other tests (including additional PSA testing) to learn more.
If prostate cancer is suspected, the urologist guides the patient through his options, such as getting diagnostic imaging or a biopsy to confirm the diagnosis, or scheduling follow-up screening to monitor the condition.
Once prostate cancer is diagnosed, your urologist will discuss which treatment options are recommended for you. The urologist manages patients on active surveillance monitoring protocols, performs prostatectomy to remove the prostate, may perform other focal therapies or perform procedures to help patients urinate better as well as many other procedures related to prostate cancer treatment. The urologist will partner with an anesthesiologist to manage sedation during surgery. Your urologist may also prescribe medications to help with any urinary symptoms or erectile problems you may be having.