5 Things to Know About Referring a Patient for Prostate Cancer Surgery

A Keck Medicine of USC urologist explains what referring physicians should know about sending their patients to prostate cancer specialists.

When deciding whether to refer a patient for prostate cancer surgery, physicians have a lot to consider — and to communicate to their patient.  

Here, Rene Javier Sotelo, MD, a urologist with USC Urology, part of Keck Medicine of USC, shares five things referring physicians should know about sending their patients to prostate cancer specialists.

1. The earlier the referral, the better. 

With any referral to a prostate cancer specialist, time is of the essence, Sotelo stresses. Early referrals ensure patients will be evaluated by a specialized team that reviews all available treatment options and recommends the most appropriate approach for each individual.  

“Timely referral allows patients to receive expert guidance early in the course of their disease,” he says. 

Among several scenarios in which a patient should be referred to a prostate cancer specialist, the most common, Sotelo explains, is when prostate cancer has been confirmed through a prostate biopsy. 

Keck Medicine prostate cancer specialists also see patients referred for the following scenarios: 

• Suspicious lesion identified on multiparametric prostate MRI 
• Incidental diagnosis of prostate cancer following surgery for benign prostate enlargement 
• Previous diagnosis managed with active surveillance 
• Recurrent disease developed after initial radiation therapy 

In addition, Keck Medicine is a referral center for patients with complex disease or complications resulting from previous prostate cancer treatments — such as urinary fistulas, bladder neck contractures and other reconstructive complications. 

2. It’s helpful, but not essential, to perform certain evaluations before referral. 

Most patients are referred because of an elevated prostate-specific antigen (PSA). But it’s “extremely helpful,” Sotelo says, if referring physicians order a multiparametric prostate MRI and, when available, a prostate biopsy to help streamline the evaluation. 

Even so, it’s not a problem if the patient has not yet undergone these studies, he adds. “At Keck Medicine, we have the technology, expertise and resources to complete the entire diagnostic workup, from advanced imaging and prostate biopsy to staging, allowing us to develop a personalized treatment plan for every patient.”  

3. Understand and address patients’ common misunderstandings. 

“One of the most common misconceptions,” Sotelo says, “is that a diagnosis of prostate cancer means the disease is incurable and that only palliative treatment is available. Fortunately, that is not the case for most patients.” When detected early, prostate cancer is often curable, he notes. Multiple treatment options offer excellent oncologic outcomes. 

Patients also typically fear that they will permanently lose urinary continence or sexual function after surgery. “Thanks to advances in robotic surgery, refined surgical techniques and careful patient selection, we are now able to perform minimally invasive procedures that offer faster recovery and excellent functional outcomes for many patients,” Sotelo says. 

Referring physicians can educate patients that “prostate cancer is no longer treated with a one-size-fits-all approach,” he says. Today, personalized treatment can be tailored to each patient’s specific disease and goals. 

4. A referral leads to complete cancer care — and doesn’t always mean surgery. 

A referral to Keck Medicine is not simply a referral for surgery, Sotelo notes. Keck Medicine’s multidisciplinary team manages the entire spectrum of prostate cancer care. 

During the initial consultation, specialists address any concerns that typically arise after hearing the word “cancer,” determine whether they have the information necessary to establish an accurate diagnosis and complete any additional evaluations as needed. 

After fully characterizing the disease, the team reviews all available treatment options and recommends the approach that best fits each patient. These options might include active surveillance, robotic surgery, focal therapy, radiation therapy or other treatment modalities. With any option, the team always takes a personalized, multidisciplinary approach. 

The team also manages the functional consequences of the disease and its treatment, such as urinary incontinence and erectile dysfunction, with the goal of preserving or restoring each patient’s quality of life. 

5. Know where to send patients for prostate cancer care. 

Patients can be referred to any of the hospitals within the Keck Medicine health system for prostate cancer care, Sotelo says. This includes Keck Hospital of USC, USC Norris Cancer Hospital, USC Arcadia Hospital and USC Verdugo Hills Hospital.  

“Reassure patients that they are being referred to a center with specialists dedicated exclusively to the treatment of prostate cancer and with access to state-of-the-art technology,” Sotelo says. 

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Novid Parsi

Novid Parsi is a freelance writer for Keck Medicine of USC.

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