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Anti-PSA Internal Medicine Doc

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Posted 7/7/2011 6:41 PM (GMT 0)
After 45 plus years of dealing with the military heath care system, they finally turned me loose into the wonder ful workld of Medicare and Tricare.  The new policy is when you turn 65, off you go to the civilian docs.  I met with my new Primary Care doc, an Internal Med Specialist yesterday.  Great guy, I really like him, except for one thing.  When going over my medical history with me he questined why I got a biopsy, why I got surgery after that, and why radiation after that.  He seems to be in the group that now thinks too many PSA tests are given causing unnecessary worry and treatment.  He quoted some number of lives actually saved from prostate cancer bounced against the number of PSA tests. He feels that if anything, active surveillance is the way to go.  I told him that I have decided to not second guess my treatment decisions and live with the results, hopefully without cancer.  He seemed fine with that.  I guess times are changing.  Since I turned 50 years old, all my doctors have ordered annual PSA tests.  I wonder if things are really going to change.  Squid.
Posted 7/7/2011 6:52 PM (GMT 0)
Another "malinformed" doctor.

PSA should not be ignored. It should be explained. This is a continuation of the confusing information by various articles and organizations.
You shouldn't second guess your decisions. By simply having a disease that was necessary to treat not once but twice means you likely were never a candidate for AS, at by definition of the so called experts. If I had a doctor tell me that (and I have but he wasn't my doctor) I would politely tell him to stick to why I was there and that my opinion and decisions are what's important to me.

Tony
Posted 7/7/2011 7:19 PM (GMT 0)
Other than his warped knowledge of Prostate cancer and the need for PSA testing, I really like this guy. After I told him I won't second guess my decisions, he moved on to the medical problems that were in his expertise to treat. I do wonder about his other patients over 50 who might not be getting PSA tests, but I wasn't there to debate this topic.
Posted 7/7/2011 7:23 PM (GMT 0)
He may be a nice guy, but I think I would be looking for another doctor.  If it weren't for the PSA tests over the years with steadily increasing numbers, and an internist who finally made it quite clear that I would be an idiot if I didn't see a urologist for a DRE and biopsy, I would almost certainly have soon found myself with advanced PCa and no longer any possibility of a "cure."  We never know what the future holds, and "cure" is almost certainly too strong a word, but the fact is I consider myself very fortunate to have had that DRE and surgery when I did.  If your guy had been my doc, I may well have ended up in a very bad situation indeed.

Ignorance of PSA isn't bliss. 

Post Edited (clocknut) : 7/7/2011 1:55:45 PM (GMT-6)

Posted 7/7/2011 7:30 PM (GMT 0)
Fellow Squid, how about giving this doctor stage three PC? Let him suffer with all the b.s. that goes along with it for a few months. I have a strange feeling he'd change his tune.
How is it that no one touts the benifits of the PSA test? If it saves just one life isn't it worth it?
NO second guessing from me at this point. The prostate is out, the cancer is hopfully all gone, I wasn't waiting to see what happens. Early treatment is an early cure as far as I have heard.
Posted 7/7/2011 7:53 PM (GMT 0)
I read a book called "The Big Scare" that felt PSA was of no benefit. (Written by an older urologist.)
The author might have needed a double blind clinical trial to prove the benefit.
I think the statistics of survival between USA and UK show that PSA and followup has survival benefits.
Posted 7/7/2011 8:42 PM (GMT 0)

I tend to agree that I don't think I'd fully trust a doc who held that philosophy. How will he respond in the future, if god forbid, there are issues?

Posted 7/7/2011 10:07 PM (GMT 0)
Hi:

I am just new to this site, with a new dx of advanced PC with a GS of 8/9. I endorse Tony's comment that PSA is valuable but it has to be explained to doctors.

A study from Johns Hopkins and the National Institute on Aging found that an increase in PSA level of more than 0.75 ng/mL per year was an early predictor of prostate cancer in men with PSA levels between 4 ng/mL and 10 ng/mL. PSA velocity is especially helpful in detecting early cancer in men with mildly elevated PSA levels and a normal digital rectal exam.

My PSA went from 3.8 to 4.8 in one year, and then from 4.8 to 5.8 in 6 months, yet I never heard the word "biopsy" from the two doctors reviewing these results! 8 months later it exploded to 29 and metastasized in the bone!

The Study was published in November, 2006 in the Journal of the National Cancer Institute, Volume 98, No. 21.

How do we get our Docs up to speed? I'm not sure, but I do think our Society has to emphasize that WE are the ultimate persons responsible for our own health. Had I done my research on this disease, I would have easily picked up the above Study, and perhaps received a 'cure' before it spread.

Houseboy
Posted 7/7/2011 11:22 PM (GMT 0)
Well folks I'm a 62 yr old Internal Medicine[and Geriatrics] doc in pretty good shape who,if you have seen a few of my posts I just had my da Vinci on 6/9.

It was as a result of a PSA of 4.5[no s/s at all] that lead me to my bx which demonstarted one out of 12 cores positive. And that was all I needed to know

In 33 yrs of medical practice I have seen too much not to be done with it once and for all and deal with the other issues we know so well which are relatively low on the scheme of things as we age.

Is this the right approaqch for all---no

But this is a very personnel disease with many twists and turns in the path to descion making that from my mind-set and clinical experience with so many prostae patients over the years was the only one that made sense to me.

Now somebody younger without the same expereince base can honestly look at recent ,somewhat conflicting data and reach a different opinion.

Now give him the hypoyhertical of having the disease--and maybe--just maybe--his view might change

Posted 7/7/2011 11:48 PM (GMT 0)
Subic,

I cannot understand how an MD can look at your biopsy Gleason score, your positive margins and your post surgery PSA rise and question your choice for treatment instead of AS and imply that AS would have been your best course of action! If you had a Gleason 6 biopsy and all < 0.1 post surgery PSA tests I could see his justification.

I would never go back to a doctor like that!

Dan
Posted 7/8/2011 2:00 PM (GMT 0)
The notion that we have to educate our docs just bugs me to no end. A Uro should know better and should be keeping up with his specialty. My mother is a retired 85 yr old psychiatrist who still reads her journals and attends conferences - and she no longer practices! We do need to stay up to speed as much as they do and thankfully we have the means like this forum to do so. But a doc who reaches questionable conclusions is not one I'd go to.
Posted 7/9/2011 9:25 PM (GMT 0)
Food for thought.

FACTS:

1)  Norman Schwarzkopf (1993) & Colin Powell (2003) had a biopsy and prostate removed

at Walter Reed Medical Center.

2) Their PSA's never reached 4.  Schwarzkopfs was 1.8

3) The U.S. President/Vice president, Senators & Representitives may all receive

care at Walter Reed Medical Center.

Posted 7/10/2011 12:53 PM (GMT 0)
If he is so far out of touch with PSA and PCa in men over age 50, I question what he could be good at. If he is a nice guy, then socialize with him, but find a doctor that understands the real world of a disease that 1 of 6 men will be treated for, and far more than that number actually has.
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