Who Should Diagnose Your Prostate Cancer? The Crucial Role of Diagnosticians vs. Proceduralists
Prostate cancer is a complex disease that requires a thoughtful, multi-disciplinary approach.
However, as Dr. Mark Scholz and Ralph H. Blum emphasize in The Invasion of the Prostate Snatchers, the system is often skewed toward proceduralists—doctors who specialize in surgeries and radiation treatments—who are frequently the first point of contact for newly diagnosed patients.
This creates a fundamental issue: proceduralists are trained to perform treatments, not necessarily to determine whether those treatments are the best option for a particular patient.
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To ensure optimal outcomes for men diagnosed with prostate cancer, it is essential to differentiate between three distinct categories of medical professionals involved in the process:
- Proceduralists – Urologists and radiation oncologists who specialize in specific treatments, such as prostatectomies or radiation therapy.
- Diagnosticians – Medical oncologists, family practitioners, and internists who evaluate a patient's overall condition, guide them through various treatment options, and determine the best course of action.
- Reference Doctors – Pathologists and radiologists who analyze biopsies and imaging scans to provide critical diagnostic data.
The Danger of Proceduralists Functioning as Diagnosticians
- Proceduralists Focus on Their Specialty, Not on Comprehensive Patient Needs: Proceduralists spend years refining their surgical or radiation techniques, performing thousands of procedures with precision and efficiency. While this makes them highly skilled in their respective treatments, it does not mean they are the best at diagnosing prostate cancer or assessing whether intervention is necessary.
The nature of their training and practice often leads to a bias toward recommending procedures they are skilled in performing, rather than considering less invasive or alternative treatment options. - The Risk of Over-Treatment: One of the core messages in *The Invasion of the Prostate Snatchers* is that many men undergo unnecessary radical treatments when active surveillance or other non-invasive approaches might be more appropriate.
When a proceduralist is the diagnosing doctor, there is a higher likelihood of aggressive treatment being recommended—even when it may not be in the patient's best interest. The financial incentives of performing procedures further complicate this dynamic, potentially influencing treatment decisions. - Lack of Holistic Patient Care: A proceduralist's role is primarily technical: they execute the treatment but may not have the time, training, or inclination to consider the broader health implications, lifestyle factors, and long-term quality of life concerns that come with different treatment choices.
On the other hand, a diagnostician—such as a medical oncologist—takes a more holistic view of the patient's condition and can guide them through the complexities of prostate cancer management. - Misinterpretation of Diagnostic Data: Diagnosing prostate cancer is not just about detecting cancer cells—it requires careful analysis of factors such as Gleason scores, PSA trends, and imaging results. Reference doctors (pathologists and radiologists) provide this crucial data, but a diagnostician is best equipped to interpret it in the context of the patient's overall health.
A proceduralist, driven by their focus on treatment, may not prioritize a thorough evaluation of all diagnostic variables before recommending surgery or radiation.
The Best Approach for Patients: A Collaborative Model
Given these concerns, the ideal scenario for prostate cancer diagnosis and treatment follows a structured, multi-disciplinary approach:
- Diagnosis by a Medical Oncologist or Experienced Internist – The first point of contact should be a doctor who is focused on diagnosing and guiding treatment decisions, not performing procedures.
- Diagnostic Data from Reference Doctors – Accurate pathology reports and imaging results should come from trained reference doctors (radiologists and pathologists).
- Treatment Planning by a Diagnostician – Based on the diagnostic data, a medical oncologist or a well-informed internist should evaluate the patient's options and discuss a tailored treatment plan.
- Referral to a Proceduralist (if necessary) – If surgery or radiation is deemed the best course of action, the diagnostician should refer the patient to a highly skilled and experienced proceduralist.
- Ongoing Oversight by the Diagnostician – Even after a procedure, the diagnosing doctor should continue to monitor the patient's health, considering long-term outcomes and managing any side effects or complications.
The Prostate Cancer Warrior's Conclusion: Keeping Prostate Cancer Patients in Control
When proceduralists act as diagnosing doctors, patients are at a higher risk of receiving biased treatment recommendations that may not align with their best interests.
By ensuring that a medical oncologist or other non-proceduralist takes the lead in the diagnostic process, men can make more informed decisions about their care, with a greater likelihood of preserving their quality of life.
In the world of prostate cancer treatment, the right doctor at the right stage of the process can mean the difference between unnecessary procedures and a carefully managed, patient-centered approach.
That's why proceduralists should not function as diagnosing doctors—because true healing starts with unbiased, well-informed decision-making.
About the Author
Scott Oliver, 66, is living well with prostate cancer after dedicating more than 4,000 hours to researching the condition. His first goal is to help men reduce their risk of developing prostate cancer through proven lifestyle strategies.
When diagnosed, his mission is to help men avoid unnecessary prostate surgeries that can lead to devastating complications such as incontinence, bleeding, permanent impotence, and a loss of length.
Scott Oliver is not a doctor and does not offer medical advice; however, he is healthier and fitter than he has been in decades. Through his articles and videos, he shares hard-to-find, uncensored information on proven alternative therapies, effective fitness methods, and repurposed drugs, content that most doctors won’t mention and search engines suppress.
He is an accredited member of the National Writers Union (NWU) and the International Federation of Journalists (IFJ), the world’s largest organization of professional journalists. Scott is also the author of What If Cancer’s Best Defense Is Free? Sleep as a Defense Against Cancer: A Former Royal Marines Commando’s 4,000-Hour Research Roadmap, where he reveals how sleep repairs DNA, restores immunity, and strengthens the body’s natural defenses against cancer.
You can always contact Scott Oliver here with your questions and suggestions.
In addition to the insights from The Invasion of the Prostate Snatchers - which I highly recommend you read - I reviewed several additonal, reputable studies and guidelines support the distinction between diagnosing and treating physicians in prostate cancer care which you can see below:
- Multidisciplinary Team (MDT) Approach: Research published in the Prostate Cancer and Prostatic Diseases journal highlights that MDTs, comprising various specialists, provide comprehensive evaluations of prostate cancer cases. This collaborative approach ensures that all treatment options are considered, reducing individual specialty biases and leading to more personalized patient care. Multidisciplinary Team (MDT) Approach: https://www.nature.com/articles/s41391-024-00803-5
- Specialty Bias in Treatment Recommendations: A study in the Prostate Cancer and Prostatic Diseases journal found that urologists and radiation oncologists often recommend treatments aligned with their specialties. Specifically, urologists were more likely to suggest surgery, while radiation oncologists favored radiation therapy. This underscores the importance of involving diagnosticians who can provide unbiased treatment guidance. Specialty Bias in Treatment Recommendations: https://www.nature.com/articles/pcan20143
- Impact of Specialist Consultations on Treatment Decisions: Research indicates that patients newly diagnosed with prostate cancer who consult with radiation oncologists are more likely to receive active treatments compared to those managed solely by urologists. This suggests that the consulting specialist's background can influence treatment choices, highlighting the need for diagnosticians to guide initial evaluations. Impact of Specialist Consultations on Treatment Decisions: https://pmc.ncbi.nlm.nih.gov/articles/PMC5959849
- Guidelines from the British Association of Urological Surgeons (BAUS): BAUS emphasizes the role of MDTs in prostate cancer management. Their guidelines recommend that patients receive information on all possible therapeutic strategies from a team of specialists, ensuring balanced discussions about the advantages and side effects of each option. Guidelines from the British Association of Urological Surgeons (BAUS): https://www.baus.org.uk/_userfiles/pages/files/Publications/MDT%20Prostate%20Cancer%20Guidance.pdf