Should men trust their Primary or Family doctor to monitor their PSA and prostate health?

 

Every day, unfortunately, we are getting new members to this PCa club many in their 30'3, 40's and early 50's who trusted their primary or family care physicians to monitor their PSA numbers and prostate health. There are recent examples of new members who had, several years before formal diagnosis of PCa,  PSA numbers that doubled and were well over "normal" numbers and yet unreported to the patients.

Last week in my discussions with my URO over my post pathology I asked him when he thought I started developing my PCa to the point it would have been detectable. Looking at my PSA numbers from my primary doc, from June 2009 to June 2010 my PSA increased from 1.5 to 2.5. (In June 2010 I asked my primary if I should be concerned about the rise and he told me that we normally do not worry or refer to a URO until the PSA is over 3 but he would do another PSA in 6 months to watch it closer, which he did). My URO said the 3 number is the generally accepted level for URO referral but other things have to be considered like a DRE, amount of yearly increase and more importantly family history of PCA. He said in my case with me being the third generation of PCa I should have been referred in June 2010 to him, but also with my outcome 6 months earlier diagnosis would not have mattered much. But as we all know 6 months to a year delay for some with PCa can be a huge difference in outcomes. Knowing what I know now I would have demanded that URO referral when my PSA hit 2.5.

Unfortunately my insurance BCBS of Al will not let me go to a specialist like the URO for yearly prostate screenings without a referral. But women like my wife can go to their OBGYM yearly for cancer screening and their "Lady Part" health with out any referrals. BTW with BCBS women do not have to pay the higher specialist co-pays at the OBGYN.

This needs to change for men, we all need to be able to have yearly prostate health check ups and screenings after age 40 or so with out referrals from a primary doctor and put our prostate health in the hands of the professionally trained. I think this could bring down the PCa mortality rate even further. It is all part of "Prostate Awareness"

There I have vented enough,

Terry the Water Guy

Steve,

You have a point about the cost of specialist, but as a moderator how many times have you seen members here post that when they did have a sudden significant increase or a high PSA number, their GP didn't tell them or suggest they see a URO. Do you think women should trust their GYN yearly check ups to the family GP? If insurance will provide the yearly visit for my wife to her GYN without a referral or specialist co pay why shouldn't men be allowed the same with an URO?

Jeff,

It is amazing how similar we are in our journey with PCa.  I want to go on record, I do trust my Primary and he at least called me about my PSA test increases and when I hit 2.5 he scheduled my next test for 6 months instead of a year out. But we too many times in this forum see where the primary GP's have dropped the ball on the PSA test numbers.

My son is also 34 and in June he had his first PSA and DRE at my primary GP's insistence as he is 4th generation and could someday make the same walk down the PCa path. His PSA was .7 but now he has a baseline to use in the future. BTW I was surprised but BCBS did cover the PSA and DRE screening because of our family history with PCa. The bright side is that if my son ever has PCa I am sure that by then a much better cure than burning or cutting it out will be available for him.

After learning the game of PCa alittle while, one finds that you can trust yourself the most so as to either hire, fire or get second opinions and such things. My uro doc was a complete 'richard' (lol) and took me 2 yrs. to fire his posterior, but glad I did back in 2004.
I find that having your primary doc (onco or whomever) is nice, but also chart all your psa's and records, and 'IF' (big if): if you can find a walk in psa testing or a freebie testing somewhere....get it whenever you wish and chart that too. It is not illegal to be proactive...although some soup n_zi type uro-docs would hope you believe only they can help you. I got monthly psa's after my primary treatment and ADT3 combo...high risk and wanted to know asap what my psa was doing. Sure enough ADT3 was starting to fail in 2004...fired the uro-dic and dropped his drug cash cow program....supposedly he figured I would die instantly (LOL), been using a drug he would never endorse or mention and still working for 7 years after the failing 2 yrs. of ADT3. (moral: never question an expert uro-dic).

Finding a righteous oncologist.....'priceless'!

Water Guy,

Maybe I was just lucky. I have been going to my GP for an annual physical since 2001. From the first visit he has done a DRE and included a PSA test as part of the other blood work. In 2009 my PSA went above 4.0 for the first time. He immediately refered me to a URO which resulted in a biopsy and subsequent treatment. Perhaps his standard of care is even higher than I thought.

Joe

My question is how many GP's, uro's and even oncology Drs. specialize in one specific area? How many men and women do they see daily with many other maladies? How can they be expected to be proficient in PC? I think it all starts with we with PC learning as much as possible via books and PC meetings to ask the best questions to any Dr. To discount those PC specific Dr.s is a mistake in my opinion.

COST? What are the costs if you don't get the best diagnosis and then protocol. There are many groups out there

 to aid in deferring costs. PAACT comes to mind but there are others IF you look.

I'm with Goodlife here. PCa is just one of hundreds of ailments your PCP needs to know about ~ they are generalists not specialists.

I go and see mine annually but it's just for a general health check ~ there's not much they can do in 10 minutes as it was for my last visit!

If I want a PSA test or an aspirin prescription, I just ask. There is no problem ~ but if I don't ask I don't get.

I'm not all that happy with my GP (I'd rate him "adequate"), but he did the PSA tests and the DRE every year. He sent me to the uro for a check when my PSA numbers started looking bad. The GP said if PSA doubles in a year, or if it goes over 4, that's the indication that a uro consult is needed. Mine didn't quite double (went from 2 to 3.7), it was two years rather than one, and it didn't quite hit 4, but he sent me to the specialist anyway. Both the GP and the uro said they couldn't feel anything, and my prostate wasn't very big, but a biopsy was done.

Biopsy found cancer, out with the prostate, and, I hope, it's happily ever after.

(I'll preface this post with the comment that, as a Brit in Holland, I don't have the same cost/insurance issues as there are in the USA)

If it hadn't been for my family doc (GP) they wouldn't have found my PCa.

My wife gets regular smear tests and has just passed the age threshold to start getting called up for 5-yearly breast exam, and the smear tests are done by the GP. But otherwise neither of us ever had or have regular checkups.
I still can’t be sure why, as I did not feel ill or anything, but one day in the year before I was going to be 50 I simply chose to go and ask my GP if I could have a check-up. She was the one who suggested it was time for a PSA test and the rest is history.

Had I not been diagnosed with PCa back then, then I guess I would still be going to the GP for regular PSA testing, and while my blood test was done at a hospital less than a mile away it is even easier these days as she now shares a phlebotomist with all the other GPs in her building so your blood can be taken at the surgery and sent to the lab without you having to go to the hospital yourself
However, having been referred to and then treated by a uro for my PCa, my PSA testing now gets done by the uro because from the outset he/they insisted that it is their lab that does the tests. This does mean several 4-hour roundtrips each year to a more distant hospital in Amsterdam, but there is however total continuity. The continuity and conformity is not just with who one sees and talks to, but with how and when the blood sample gets processed.

For routine screening there is thus no reason why more cannot be done by a primary GP and thus be closer to home and be a lot cheaper etc.

Alf

Water Guy,

Excellent post!

My husband "thought" he had a good GP too. Turns out, he's not-so-good.

He/We didn't even know what a PSA was back in 2006. If the high score had at least been notated on the front of his file, much like is done for a diabetic, then the GP would have had a flag to be more viligant in his monitoring. I would bet that every diabetic that is seen, has their sugar level monitored on each visit.

You stated " It is all part of "Prostate Awareness," and I agree. I think this should be taught to young men in high school! If schools can teach kids about reproduction and STD's, then they should be able to teach them about this very important gland and the risk associated with it.

We shouldn't have to know what our specific illness is before we go to the doctor, but we at least have to learn to ask doctors to see our executive profiles and ask "Gee, Doc... they have a big 'ol "H" next to this one.... what is it, and why is it HIGH? Cancer, you say? Let me get to a urologist!"

I wonder too how long I should make a two hour drive to get a psa test. I am one year out from RP and thankfully still undetectable. Seems at some point I am more at risk of a traffic accident than any benefit of going to the same doctor for psa followup. What do some of you think?

At any time you feel your GP isn't doing the job, it's time for a change. My PSA was steady for years (until surgery, now it's <0.05) My GP nor myself had any idea there was cancer looming inside. Took a colonoscopy to find the cancer...

I trusted my primary, it got me a long delay in treatment. PSA of 5.5. up from 2.5 at the last visit and she never bothered to tell me. It was almost 20 months before my next "annual" exam, I thought I was in good health so I put it off.

She also missed a lump on my last DRE, she said my prostate felt "normal" a week later the Uro immediately felt a "1.5 CM lump on left lobe" No substitute for an experienced finger I guess ;-)

Many of us have no choice but to trust the primary we have, ins won't allow us to just waltz off and see a specialist on our own. I never did get an explanation on why I wasn't informed of the increase. BTW I now have a new primary.

Full story in extended sig'

___________________________________________________________

Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.

Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

05-03-10 1 week without pads
06-28-10 Success!!
Today pills are nice but not necessary.

PSA history
04-23-10 PSA <0.04....... 06-07-10 <0.04..... 08-03-10 <0.04...... 10-26-10 <0.04...... 1-25-11 <0.04...... 5-03-11 <0.04...... 8-04-11 <0.04