Prostate Cancer Incidence

I had my quarterly visit with my urologist including the blood draw for PSA and T yesterday. He and I have a great relationship and we always take the last appointment of the day so we can talk and normally spend an hour or more.

He brought me up to date with his experience this year. He works primarily with PCA and BPH and his urology practice has 43 docs. So far this year he alone has 50 newly diagnosed PCA patients. This is a huge increase for him and the practice has also seen a significant increase this year. Of these only one has qualified to pursue AS. In past years he would normally have about a third or more that he would encourage entering the AS program. He said the overall practice has seen a sharp increase in the proportion of high risk and advanced cases compared to a few years ago. He said this is troubling and also appears to be a national trend. He visits with his referring PCPs regularly and for the most part they have not reduced the screening in their practices. So they are all looking for other aspects that could explain this trend.

He also provided some interesting statistics on biopsies. He related that the national average for positive biopsies is about 52%. In his group of 43 urologists they average 65%. His average is 90%. He explained that he takes the biopsy very seriously and will exhaust other indicators before biopsy unless it is clearly indicated by high PSA and/or positive DRE. He thinks many urologists are too quick to go to a biopsy before ruling our infection, BPH, etc. He uses Avodart in many cases in order to isolate PSA rise due to PCa when other indicators aren't strong enough to order a biopsy.

He always has a conference with the newly diagnosed patient and usually includes the wife, friend, partner etc. when explaining the situation. These usually take between one and two hours. So in the first three months this year he has done 50 of these. I told him his approach is rare and that apart from the actual, and hopefully curative treatment, this has been the best part of his service to me as a doctor. I cautioned him not to streamline the process and related some of the stories we have heard here on HW.

After the busy PCa start this year he stated he is actually looking forward to a 10 day trip to China next week. He goes each year and teaches Greenlight Laser Therapy as well as other treatment aspects dealing with prostate conditions and cancer to many of their urologists.

In a few days I will get my PSA and T report, hopefully one is down and one is up...... in that order.

JNF
You have an awesome Doctor. If mine spent more than 20 minutes with me, it would be a record. My first Uro, during my initial consult of a rapidly rising PSA, did not emphasized that he felt I most likely had cancer and only suggested a biopsy. If we had better communication, I would have done it sooner,,,I tully did not get the info I should have. Well, I'll not look back, just go forward without I shoulda ,woulda.

Your PSA drop after treatment and holding at undetectable is remarkable. Good on ya and keep it going. Looks like you really dodged a bullet.Keep the faith, keep posting, keep us informed, your story is inspirational.
Wings

JNF, that is a terrific doctor. The only doctor I've ever had like that was my radiation oncologist at Vanderbilt. He patiently explained everything, and answered every question I had. Every other doctor, everywhere, seems to have his hand on the doorknob during conversation. They're all pressed for time, and I'm thinking they must have to see 10-12 patients per hour or something. Ten minutes is a long discussion with any of them.

When I got my original diagnosis call from my urologist, 4 years ago almost exactly, it was a 15 minute phone call while I was still at work. Brief, number-focused, with a suggestion to set up some follow up tests for staging. I was rather devastated, probably white as a sheet, and struggled for the words to tell my wife about it when I got home.

I can't imagine a nice relaxed conversation about that situation. Sure would be nice, though.

Great uro...I just wouldn't want to be second or third in queue...

If I see any doctor within 1/2 hour of the scheduled appointment, that's a treat. I try for the first appointment in the morning, but that's not always good because they'll just be late getting in. By the end of the day, they're probably well over an hour behind. But we the patient mustn't be late, oh no.

My initial guess is that he is well known in the Atlanta area as an expert. The practice is substantial and they are getting tincreased referrals from the PCPs.