Warning ...Wizard Behind Curtain
Last updated: August 2021
When a tornado rips through Kansas, Dorothy and her dog, Toto, are whisked away in their house to the magical land of OZ. They follow the Yellow Brick Road toward the Emerald City to meet the Wizard. Along the way they meet a Scarecrow who needs a brain, a Tin Man missing a heart, and a Cowardly Lion who wants courage.
After a prostate cancer (PCa) diagnosis spins you in its whirlwind of conflicting emotions, we like those Dorothy and Toto met along the way need to look into our hearts, think with our brains, and look for courage. We too must follow the Yellow Brick Road, but our magical land may be called urology.
Meeting many wizards
Once here we meet many Wizards. The first is the urologist who may work his magic alone, or he may call on the other wizards from radiation or oncology. We soon learn the 3 wizards have magical powers and use robots, invisible radiation beams, and brew up some highly toxic potions that will magically help us or put our prostate cancer to a deep sleep - for a while.
Ask a man to name his primary prostate cancer provider, and most likely he will name one of the big 3. Sadly, we often overlook the one who many call the Great Wizard in our battle with prostate cancer. He, like the Wizard of OZ, often stands behind the research curtain. We seldom see or speak with this shadow figure, and yet it is this wizard's decisions and recommendations that ultimately impact the treatments we will receive.
Who is he? I am speaking about the pathologist who works with highly sophisticated technology. Behind the curtain he blends human insight with technology. When done, he examines the many biopsy samples provided by the urologist.
So often we may think that the pathologist is lab nerd behind a microscope. In doing so, we underestimate their critically important role. It is the pathologist who is responsible for ensuring that only the best of the best biopsy samples are examined and evaluated.
In pathology, a quality outcome is dependent on quality input. It is the pathologist who avoids decisions based on a garbage-in, garbage-out analysis. It is the pathologist who scans the many samples to determine both the Gleason rating and the Gleason grade group rating.
Based on the recommendations of the pathologist, your medical team is guided to which type of treatment will best meet the characteristics of your cancer. It is not just the Gleason score or Gleason grade group he is evaluating; he also looks deeper to understand how the cancer is behaving in your body.
Understanding the role
Today the role of the pathologist can also involve molecular diagnostics and testing to determine what treatments may be most effective given your genetic structure. If you are not familiar with molecular diagnostic tests, they are used to identify specific biologic molecules, and they can help with selecting a cancer therapy or monitoring a treatment's effects.1
The modern pathologist can examine DNA sequences and compare them to a reference genome to detect various alterations, and then interpret those alterations so that your physician can apply them in a clinical context.
Most patients do not understand the full scope of OR the role the pathologist plays in your treatment world. Make no mistake about it, he/she can play a critical role on your prostate cancer treatment team.
Finding out more
I think it could be good to talk to your urologist about the possibility of finding out more about the great wizard who is standing behind the diagnostic curtain.
After all ... he/she may be the one who most likely is influencing all of your treatment protocols.
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