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How long would you see your cancer specialist if your PSA was unmeasurable since the operation?

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Posted 5/28/2015 3:29 PM (GMT 0)
Hi,

I had my prostatectomy 6 years ago in April. All is well, thanks, no detectable PSA and it hasn't spread.

My question is: Should I keep going to the surgeon who did the operation for annual checkups?

He'd like to see me forever. That's ok. He is a top surgeon in a top hospital. He is out of my network now so I have to pay for it myself which amounts to about $3-400/annual visit. I can do that. (I am on Medicaid otherwise but the issue is the quality of care, not money, for this.)

I see my GP twice a year and he gets a PSA each time as well as countless other tests. I talked with his office. his wife, the receptionist, thought I should still see the surgeon but I am not convinced. She said to find out what tests they take. As far as I can tell, they just do a PSA, so if that's all, it would seem easy to say the GP should be on top things should something come back.

I did have a low platelet count in the past few years but my surgeon doesn't think the numbers are too low and doesn't seem concerned. Nothing else is relevant, as far as I know.

So, how long would you see your cancer specialist if your PSA was unmeasurable since the operation and it's now 6 years post-op?

Is a GP equipped to recognize signs of recurrence? I have confidence that he is up to the task otherwise.

What would you do?

Many thanks.

Cheers,

John
Posted 5/28/2015 3:57 PM (GMT 0)
I would stick with a local urologist and GP until I needed the skill of the surgeon, whom I assume is also a urological oncologist…being from a top hospital, lidat. Congrats on your being! Just curious, were you graded higher than a gleason 6?. Yes I know a gleason score is a category. Messy paradigm. Whot? {inside quip…not to worry lipwak1}
Posted 5/28/2015 4:03 PM (GMT 0)
your GP can do the annual PSA tests. A rise in that number is enough to detect a occurrence.

Seeing the surgeon is nice, but not needed.

Most of us end up back with our URO or GP after treatment.

Andrew
Posted 5/28/2015 4:14 PM (GMT 0)
Thanks both of you.

My Gleason was 7 (4+3).
(More info above and beyond this all here: http://myexperiencewithprostatecancer.blogspot.com)

Yes, my surgeon is a urological oncologist (and more...)
Posted 5/28/2015 4:38 PM (GMT 0)
At 3-400 a visit, I can see why he'd want you coming back forever.

Unless you're having urological issues, that money might be better spent elsewhere.

My healthcare system only had the URO do one post procedure followup and assigned my case to a cancer monitoring department. Every six months I get a reminder to do my PSA, the nurse emails me the result. I only see the URO when I need to or if the PSA result is not within the expected range.

Andrew
Posted 5/28/2015 4:40 PM (GMT 0)
Thanks!
Posted 5/28/2015 5:09 PM (GMT 0)
Ditto... If it wasn't for my T Meds - my URO would have sent me packing and let my GP do an annual PSA.
Posted 5/28/2015 5:48 PM (GMT 0)
I agree with the other guys..If you are getting a PSA test every 6 months from your PCP that's more than enough..The urologist-surgeon's job is done..Should your cancer return, it will be a Medical Oncologist who takes the lead not a Urologist or surgeon.
Posted 5/28/2015 6:11 PM (GMT 0)
Good to know. Thanks all!
Posted 5/28/2015 6:24 PM (GMT 0)
I get my PSA tested once a year at my annual physical exam. That's all you need at this point.
Posted 5/28/2015 6:31 PM (GMT 0)
I'm in the same boat. I had my surgery In Feb. 6 years ago and my PSA has been undetectable since. I see my GP for a physical once a year and he does a PSA test. I also see my URO once a year (6 months apart) and he does a PSA test. The only reason I see the URO is to get my trimix prescription.
Posted 5/28/2015 8:04 PM (GMT 0)
John, sounds to me like you're a great cash cow. Unless your PSA starts to rise and/or you have some other urological problems that only this surgeon can diagnose/treat, I don't see the point of continuing to see him.

Jim
Posted 5/28/2015 8:22 PM (GMT 0)
I just wanted to err on the side of caution. Plus, he had told me he wanted to see me for the next five years when we first talked about the getting the surgery so I had reason to believe that that was a good idea. Last year I asked again, how long do you want to see me? He said forever so I'm rethinking that this year.
Posted 5/28/2015 8:57 PM (GMT 0)
If you pay me $300 for a visit, I'll find a way to take your blood and send it for a PSA reading ;-)

On a serious note, I've thought about this too. Before surgery I asked my surgeon who is now my uro (not going back to my old uro who diagnosed me, didn't like the way he handled things), what happens after the surgery, he responded that he "would be my quarterback" which is fine. But assuming my PSA remains at zero (still not comfortable making that assumption for some reason) for another year and a half, he will have me coming just once a year. At that time, I think I might just get tested by my PCP. I know enough to call my uro if the < ever disappears from my results.

Congrats BTW, on 6 years of being PSA and Cancer free. That's awesome.
Posted 5/28/2015 9:42 PM (GMT 0)
Thanks. I too don't want to go back to my urologist as he tried to steer me to a Dr in his medical group without mentioning that he would profit from that albeit only as a member of that group. My GP should be fine for now. If I need a urologist I'm going to to want to look elsewhere.

What is the "<"?
Posted 5/29/2015 1:38 AM (GMT 0)
The less than sign before the number in the PSA results which means PSA showed lower than the test can detect, ie, undetectable.
Posted 5/29/2015 1:40 AM (GMT 0)
I see, thanks.
Posted 5/30/2015 11:09 AM (GMT 0)
We just saw the urologist for the three month and the six month test after the RP. The tests after that were with the GP.
Posted 5/30/2015 12:16 PM (GMT 0)
Good to know, thanks.
Posted 5/30/2015 2:31 PM (GMT 0)
lipwak John,

I am in the same position. 6 years in July! PSA UNdetectable at <0.02.

I just had my 6 year visit with the surgeon. I too can't figure out why he asks me to come back. I like the guy. He apparently removed all of the tumor. But that's it.
He did not fix my ED. I had my incontinence fixed by another Uro specializing in sling surgery.

Even if I come out on the short end of the 3% chance of recurrence stick, he won't be the one doing the Onco, Rad, Freezing, HIFU, Kung Fu, or whatever.

I see my GP for a physical every year and he orders blood work with a PSA from the same lab.

I just don't see the point of going back to the surgeon. In fact I just put on my calendar for Feb 2016 to cancel my 2016 appointment!

Thank you for inspiring me.

Jeff

Post Edited (Worried Guy) : 5/30/2015 1:22:24 PM (GMT-6)

Posted 5/30/2015 3:19 PM (GMT 0)
Well, sorry to hear that your experience wasn't as rewarding as mine. That's one reason why I kept going back, in addition to believing that him watching over me was better than anyone else. I guess I don't need to anymore.

Kung Fu, now that's an idea! :)

Cheers
Posted 5/30/2015 5:06 PM (GMT 0)
Jeff, why are you calling your PSA detectable, with the <.02? Was the "<" a typo?
Posted 5/30/2015 7:10 PM (GMT 0)
Pratoman
Good catch! I corrected it. I should have written "Undetectable."
I'm quite pleased with the results - except for the side effects.
Jeff

Post Edited (Worried Guy) : 5/30/2015 1:21:23 PM (GMT-6)

Posted 5/30/2015 9:57 PM (GMT 0)
Glad you corrected it Jeff. I like to see everyone here do well, needless to say. And particularly the guys like you, who have the same post surgical pathology as me, .... and worry alot.
Posted 6/1/2015 10:28 PM (GMT 0)
I'm coming up on my 4th anniversary of my DaVinci encounter(8/1/11). I have been blessed with undetectable PSA's for 3 years all of which have been ordered by my surgeon. Last Aug. he said to me "nothing personal, but I don't want to see you again". I can take a hint. My GP will now be monitoring my PSA, that's fine with me? 1 snake
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