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Posted 6/27/2013 5:35 PM (GMT 0)
My old doctor retired and I now have a new doctor who is recently out of residency. Just over 5 years ago I had many of the symptoms of low testosterone and the doctor tested me for total T only. It was sent to Quest and the result was 305 (250-1100). He told me that his experience is that men much under 500 have symptoms. He started me on Androgel, but I later asked him to switch me to Testim because Androgel wasn't working. Testim has worked very well for 5 years. I actually had to lower the dose after 1 year because it got my TT and FT too high. TT has been in the 500-800 range since.

I have had a PSA test every May at my annual physical. Here are the last 5 results:
2009 - 0.82 - run at local hospital
2010 - 0.83 - run at local hospital
2011 - 0.84 - run at local hospital
2012 - 0.70 - sent to Labcorp for some reason
2013 - 1.13 - don't know where run and doctor doesn't know (one would think she could find out)

She wants me to be retested, but Medicare won't pay for it because it is coded as a screening PSA. The local hospital would bill me $122 for a $25 test. I have requested recoding to a medically necessary code if justified. I have not heard back yet.

She has already suggested that I get off of TRT and see a urologist to have a biopsy if the next PSA result is also in the 1.1 or higher region. This seems like a gross overreaction to me, as my history and recent reading are not even close to the common trigger points for a biopsy (PSA vel. of 0.75 or 0.40, PSA over 4.0 or 2.5 or PSA doubling in 3 years).

I would like some opinions from people here, as many of you are very knowledgeable in PCa and associated tests like PSA.
Posted 6/27/2013 5:41 PM (GMT 0)
I forgot one item. I took four 25-30 mile bicycle rides 6-11 days before the blood draw. I was getting sore down there by the last riding day. However, I didn't do any rides for 6 days before the test. I think I also had sex with wife either 24 or 48 hours before the blood draw, but I'm not sure.
Posted 6/27/2013 5:46 PM (GMT 0)
I keep thinking of things to add. I'm 68 YO, with a BMI of 24.0. I take doxazosin for moderate BPH and have had BPH for at least 10 years.
Posted 6/27/2013 5:48 PM (GMT 0)
I think she is nuts and you should find a new urologist and medical group. Not sure how old a fart you are, but this stinks for sure. You do not even have the .75ng rise in a year that could be a trend for possible cancer. She even knows it , which why her group or office won't code it in a way for medicare. Its called fraud. And with numbers like that she knows it. Thats my view.
Posted 6/27/2013 5:54 PM (GMT 0)
Now with the added info, I may call medicare hotline myself, just saying. Obviously it ain't fraud till the coding changes, which it ain't. Those are great psa number for yore age and even younger. I wish I had those numbers and a GP or uro tried that nonsense with me. She'd be changing professions from shame after a few words from me. So as to cover all bases, this is a gender neutral opinion..
Posted 6/27/2013 6:03 PM (GMT 0)
Your PSA doubling rate is well beyond 12 months.

Keep monitoring but no need to do anything differently other than get a new urologist.

My PSA was also low, but doubling rate was quite a bit faster and resulted in me being tested positive for aggressive PCa.

Date PSA Doubling Rate (years)
20090720 1.0 2.72 years
20100128 1.3 2.57
20100728 1.6 1.98
20110107 1.6 1.53
20110805 1.2 1.49 unexplained drop
20120201 1.7 0.43 but only back to 2011 level
20120822 2.62 0.66 wait one more test to see if a trend
20130115 3.68 0.48 years, therefore biopsy
20130426 0.90 began Lupron March 28,2013
20130617 0.40

Opposite case of yours, and goal this year has been to lower the total testosterone whereas before the goal, like yours, had been to increase it.

Though I tried to blame my cancer on the Axiron testosterone underarm treatments (had been on testosterone injections several years prior), everything I have read says testosterone treatments do not cause Pca.

Once I had PCa however, the goal is now to starve the cancer of the Testosterone it feeds on. Thanks to Lupron my Testosterone is now below 3.

Date Testosterone
20090720 153 Low
20100128 906 High (injections every 2 weeks)
20100728 870 High (injections every 2 weeks)
20110107 263
20110805 140 Low
20120201 646 Axiron underarm daily
20120822 325
20130115 293
20130426 024 Low (began 4-month Lupron on March 28)
20130617 003 Uber low
Posted 6/27/2013 6:31 PM (GMT 0)
Thanks for the replies. She is actually my PCP. She wants to send me to a urologist for a biopsy. My wife and I both think this is nuts too.

@T1cN0M1b-in-FL - How do you feel with a TT level of 3? Energy, strength, sexual, depression, etc. For several months before my old doctor tested me for T level, I was having moderate depression, losing some strength and had ED. Even 50 mg of Viagra did little to help most times. Now I have no need for Viagra.
Posted 6/27/2013 6:41 PM (GMT 0)
I would get another one on principle alone. Though I do believe in second chances and so on, I have big doubts about her ethics and not sure any discussion would change any thing. But who knows.
Posted 6/27/2013 6:45 PM (GMT 0)
Welcome.
I don't think you need to see a urologist about a biopsy at this point with those numbers. Your PSA is low for someone with BPH.
The next time you see the PCP, you might ask about the Free PSA blood test. (Higher is better on this one.)
There is PSA density, PSA divided by prostate size. (Lower is better.)
Some PCP's are paranoid about lawsuits and try to aggressively refer every symptom.Good luck.
Posted 6/27/2013 7:01 PM (GMT 0)

logoslidat said...
I would get another one on principle alone. Though I do believe in second chances and so on, I have big doubts about her ethics and not sure any discussion would change any thing. But who knows.

I would be very willing to get another PSA test, but Medicare only pays for 1 screening PSA every 12 months. Excellus BCBS said that they will cover it if medically necessary. Since BCBS will reject a screening test and the hospital will bill me $122, I have no intention of throwing away that much money on something that is unnecessary. I have reviewed the applicable medically necessary ICD-9 codes and don't see one that fits. I doubt that code 790.93 - Elevated PSA is valid. I think that I need to find a new doctor.
Posted 6/27/2013 7:12 PM (GMT 0)
You may want to talk to a Uro if only to get your PCP straightened out. I'd be surprised to find out you have anything to worry about. PSA only a measure that something may be up, not what is up.

The rise could be for almost any reason, your bike ride, infection, BPH, a bad day at the lab. The is just an indication that something may need to be looked at. But your numbers a so low an have risen so slowly, it's hard to think there is anything really wrong here but a good Uro can tell you for sure.
Andrew
Posted 6/27/2013 7:24 PM (GMT 0)
Do it, don't get sucked into a medical dark hole, We did with my wife quite a while back, when I was shall we say less knowledgable.
Posted 6/27/2013 7:29 PM (GMT 0)
I would be happy to pay the copay to see a uro. Hopefully he/she would not be one of those who still believes that TRT causes PCa. I'm leery of doctors after what we saw when my wife has OvCa 4 years ago. The surgery was done by her GYN and the head of general surgery at the local hospital and it was a fine job of surgery. She was thankfully low stage and low grade. The local oncologist was a total waste. We went out of town to a gynecologic oncologist and he wanted to put her on anti estrogen drugs and perform another operation or 6 sessions of chemo. We got a recommendation for another gyn onc and he was great. I had found some very recent studies and he was well aware of them and happy to discuss them with us. What I read and he confirmed was that what the first gyn onc wanted to do would have actually harmed any future treatments if the cancer came back and treatment was necessary. Her local and operating gyn was in agreement with the good gyn onc except for repeating CT scans.
Posted 6/27/2013 10:37 PM (GMT 0)
OF--

Based on your results and age, you don't need to get a repeat PSA or see a urologist for a biopsy.  Another PSA at your annual physical next year will suffice. 

All the best....Tim

Posted 6/28/2013 2:18 AM (GMT 0)
Hello OF,

I agree with Tim G's advice above, sounds safe and reasonable to me.

Good luck,

david
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