General urologist scope in Urologic oncology

[Frogger27]

How much do general urologists manage cancer patients? I see at academic institution I am at that most of the cancer patients are seen by the fellowship trained doc. Do general urologists in PP get to manage all of the urologic oncology patients (kidney, bladder, prostate, etc) or is Urology also moving to a field where you need fellowship training to manage (like ortho and other specialties) specific patient populations?

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[cpants]

Most general urologists manage lots of cancer, especially prostate cancer and bladder cancer. Bladder cancer is largely managed endoscopically and this is bread and butter urology. Prostate cancer in many cases is managed nonoperatively with active surveillance or radiation. Many general urologists also perform major oncologic surgery such as nephrectomy or prostatectomy, and these cases are by no means limited to fellowship-trained individuals outside of an academic setting.

If you want to do major oncology work in an academic center or major city, fellowship may be necessary.

 

[armybound]

I interviewed with a couple of groups of "group practice" general urologists. Both groups did every oncologic case that they wanted, including partial nephrectomies, prostatectomies, and cystectomies. I'm not sure if they did RPLND and caval thrombi.. those don't come along all too often.

In my (academic) practice, my "diagnosis grid" is set up so I can see pretty much any oncologic case. My chairman has encouraged me to perform any case I feel like performing, even though I have several oncology partners. It has been my choice that I will evaluate and counsel patients on options for more complex surgical problems (partial nephrectomy, cystectomy) and will surgically manage anything else (orchiectomy, TURBT, etc). My oncologic partners will refer me TURBTs and prostate biopsies and such.

Residents often tell me they want to do an oncology fellowship so they can do the big oncologic cases. You don't HAVE to have a fellowship to do that stuff. You can make your practice whatever you want. But as cpants points out, in an academic practice with oncologists as partners, you might not be too busy with oncologic work.

 

[Donald Juan]

Onc fellowship is not required for most uro onc. Robotic prostatectomies, nephrectomies, partial nephrectomies, TURBTs, orchiectomies, are all things that most urologists come out of residency being able to do. Cystectomies and nephroureterectomies fall under the "maybe" category of whether or not you wish to do them in general practice; many people in private practice don't care to do them just because of the high complications, in depth hospital care, and long case time compared to the reimbursement. RPLNDs (especially post chemo/rads), IVC tumors, or just especially difficult cases of the above (i.e. post radiation RALPs) are gonna be more likely to be at the academic centers with fellowship trained people, but really it just depends on the comfort of the surgeon. There are certainly general urologists that refer all big cases out if they don't feel comfortable or are overworked with simpler cases.