My youngest son's recent experience with doctor's attitude about PSA screening

My youngest son, just turned 30, is the General Manager of a chain restaurant in Greenville.  He finally has full coverage health insurance on his own for the first time, paid 100% by his employer ( a rare thing these days).

He went for his first full physical as an adult this past week.  And he surprised the doctor and said that he wanted his PSA checked as a baseline.  This was based on many conversations he and I have had in recent months, he was originally going to wait till he was when his older brother had his last year, but decided to do it.

He said the doctor tried every trick in the book to nix the idea.  Said the current thinking was, that there was no way a 30 year old had any risk and did not need the test.  Wanted to know why he wanted one, so my son told the doctor that his father was dealing with advanced PC and was diagnosed at age 56, and that he wanted to be on the safe side with a base line test.

Doctor tried to belittle that thinking and told him that it would be overkill, and that there were risks with taking the test.  My son, clever boy, asked the doctor what risk?  Doctor told him there was even a risk getting the blood test.  My son reminded him that the doctor was already drawing several tubes of blood for the other blood work during the physical, and why didn't he warn him about the risk for those blood draws.  I thought that was a great come back.

In the end, the doctor consented to the wish of the patient, I believe my son said it was only going to cost 20 bucks extra.  Told him, if he had to pay out of pocket, I would give him the twenty bucks.

Just thought it was interesting how hard the doctor tried to talk him out of it.  Shouldn't have mattered to the doctor, but guess he was doing his job.  Hope this same doctor doesn't work as hard at trying to discourage other men from getting their PSA checked in the future.  And hope this isn't going to be trend of these "new standards" from here out.  I just don't like where it's going.  Geez, its just a simple blood test.

Proud of my son for following through.  At his age and general health, not remotely expecting him to have any significant PSA, will let you know when I know the results.

Now both my boys have their baselines done, and as a PC dad, I feel much better in so many ways.

david in sc

Some docs take the new recommendations as gospel. You also have that "I'm the doctor" thing. My doc wouldn't have run my last PSA if I hadn't asked him. I told him he was already drawing a full panel and their lab does PSA, so why not, since it had been over a year since my last one.

Good thing I did.

Like Dave, I'm not sure I like where all this is going. I don't want to assign ill intent yet, but this issue bears watching. I'd also ask that doc why he's so adamant about deferring that test. If a 30 year old is astute enough to ask for the test, he's probably prepared to study the results.

Post Edited (halftrack) : 9/7/2013 2:56:24 AM (GMT-6)

Good for your son! It sounds like he's a quick thinker; I admire that.

(For the following question, let's not revisit the whole screen / don't screen firestorm; thanks in advance.)

I'm definitely in favor of screening, and perhaps we can have a discussion about the strategy for early screening? With a G9 case diagnosed at age 55, I'm certainly concerned for my two sons (30 and 27). Both of their grandfathers had it too, though at about age 70.

I'm curious about the early baseline at 30. For instance, I've heard of screening starting at 40 for a baseline, check at 45, then annually at 50. Perhaps that's just a general strategy, and with significant risk factors should it start earlier, or be more frequent?

For those already planning on screening, what early screening strategies make sense?

Good for you and your son. Thirty is pretty young, that's for sure, but given your history I can fully understand his concern.

How different the approach is with other "screenings" for other diseases. I've been telling my brother for years that he has sleep apnea, and he finally consented to a sleep study. The medical folks did a great job of informing him about the diseases and the possible health consequences of untreated sleep apnea. They spent ZERO time trying to dissuade him from taking the test. Yet, with prostate cancer, it seems that more time is spent counseling regarding the horrors of incontinence and ED than talking about the consequences of untreated prostate cancer.

Well, one might say, being treated for prostate cancer has side effects that will plague a man for the rest of his life. He might have stress incontinence, for example. Speaking as someone who has been dealing with sleep apnea for more than 8 years, try sleeping with a CPAP machine and mask every night, looking like Darth Vader's brother, having to lug the machine and associated paraphernalia along when you travel or fly, and dealing with the romance-killing aspects of sleep apnea gear....there are always side effects to treatment for serious medical conditions.

Good for your son, David. Let's hope this test and all future tests come up negative.

We had previously agreed to 35 for my boys, but since he was having his very first adult physical on his own, he actually talked to me in advanced and asked me what I thought. I figured there was no harm in him doing it at 30 instead of waiting 5 more years, and it was because of family history. Unlike his dad, he's a constant worrier about everything, so it was as much to put his own mind at ease, as much as pleasing me.

He's quick on his feet and real street smart, it doesn't take guff from anyone (don't get me wrong, he's very polite like all my children), but has no problem standing up for himself.

Sure his number will be microscopic for his age, and if so, I will advise him to re-test at 40.

David

Hi David!  So good to hear that your son was so assertive.     I think the doctors really pull that, "I'm the doctor" stuff on woman.  Yet, we have heard many tales here.

You are still in our thoughts and prayers!

Hugs,

Aimzee

A chip off the old block, David. You did well.

As for the doctor, I admire his willingness to take a stand, but he took the wrong one. He should take a stand against against over treatment, not against over diagnosis.

Your son having his PSA tested at 30 instead of 35 or 40 does not prevent anyone truly needing a PSA test from having one. It is not a zero sum game. The blood is already drawn and the incremental costs are miniscule.

It serves as a baseline and nothing more.

LupronJim

The doc would seem to be following "the guidelines", which I hate to see. Yes, I am a firm "test early, test often" proponent at this point.

But, as already suggested, he may also be thinking of the cost if denied by insurance. I don't know where $25 comes from. Mine bills "retail" as $125 as of June 2013. If covered, negotiated prices are less, but if denied outright, I have to pay the full retail. I'm sure docs are aware of the impact of an unexpected $125 hit on young folks.

Regardless, standing up for what they believe should be done instead of tweeting or texting about a bad doc visit in progress is admirable in any young person these days.

David, so glad your son stood his ground. Just can't help but wonder how many men would have backed down after the doctor convinced them he knows better than them. You have to look out for number one....it's a message that seems to be reinforced everyday. If that had happened to me and the doctor refused my request, I would be looking for another doctor. Many years ago our family doctor (who my wife worked for at the time) went off on me when I questioned why he wanted to put my daughter in the hospital because she had a cold. He was very condescending suggesting I was not intelligent enough to understand why certain test needed to be run. In the end the overnight stay and test revealed nothing more than a cold. Needless to say, he was fired as our family doctor after that.