My First Dr. Smith Visit

Well, Today was my long awaited for visit with Dr. Smith from Vanderbilt. I have had the appointment on the books since the middle of November. It is tough to get things accomplished when I am home one week and working out of state the next.

The visit started with a interview with his resident a Dr. Wang, I believe Alice was her first name. She went thru what they know from my records and then asked me to fill the blanks. She stated I was good case for AS as my last uro had stated. She went thru what that would look like at Vandy. I was a little worried she did not mention a confirmatory biopsy. She stated the PSA every 6 months and a biopsy at about the 12-18 month mark.

We talked about the surgery option and went thru the pluses and minuses. We talked about radiation and said I should do very well with either option.

My wife asked a few questions about things that were bothering here. She answered them. I talked about my main concern of how many pathology reports come back changed and how many of those were upgraded. She explained that it does happen and some are up and some are down and some stay the same.

Once we finished she met with Dr. Smith and about 10 minutes later he came in and introduced himself. I had read a review or two on here suggesting he was a hard salesman for cutting. This was absolutely not the case today. He has great bed side manner. He even took notes about how many kids and grandkids we have and where they live.

He explained the G6 and what all it entailed. We discussed the velocity of my PSA and said for a G6 it added another aspect to the problem. He stated typically when someone comes in he is pretty sure what the decision should be, so maybe that is where the pushy part comes in. He said with my family background with the cancer, and the PSA velocity it was a hard decision to make.

He talked about the AS program and did include a MRI which I have scheduled for April 24 and a confirmatory biopsy which is scheduled for May 22. I explained my main concern before choosing any option was to make sure what the monster really is. I am thinking Mothra vs Godzilla here. He agreed that it was a great thing to be worried about.

My wife's main concern is with AS and if I am only a G6, but when they get ready to do treatment if needed it may escape the capsule. That is mine as well. He took time to explain the odds on that and how it does happen a very small percentage of the time but not often. He did not lie and said that is a possibility but it is his job to help make sure that doesn't happen. He took his time with her until she had no more questions. He did not appear to be in a hurry to get out of the room and on to the next patient. This was way better than the uro that did my biopsy and follow up in November.

It was funny, he talked about AS, surgery and radiation and gave them all credit and I believe he described them fairly accurately from all that I have learned on this site.

That said we will move forward with the process using him as my Urologist. We will see what the MRI and biopsy show. Oh, I did ask if the next biopsy if there would be samples from the anterior and he did say that he always takes some whether the MRI shows anything or not. He said they are not looking for any G6 since we already know I have that. Just trying to make sure there is nothing worse hiding in there. He said there is about a 30% chance that they will find something more with my velocity, but also cited that a non cancer PSA for a healthy 53 year old with a 35 cc prostate was about .6. He also calmed my wife's fear when he said all high PSA is not cancer driven.

Overall a good visit.

Larry

yikes!

Post Edited (Blackjack) : 1/28/2019 7:34:42 PM (GMT-7)

bbqdude…..

I'd suggest you print the statement out below. Show it to Dr. Smith. Tell him who gave it to you. And get your doctor's opinion on it before taking it as fact.

Blackjack said...
This risk of progression is THE SAME for initially low-risk men (like you) whether they decide to have immediate treatment, or they decide to start out on AS.

Good luck on your biopsy.

yikes!

Post Edited (Blackjack) : 1/28/2019 7:35:28 PM (GMT-7)

yikes!

Post Edited (Blackjack) : 1/28/2019 7:36:22 PM (GMT-7)

What you're describing sounds like a normal AS program and should work great for you.

Keep us updated on your progress.
Andrew

yikes!

Post Edited (Blackjack) : 1/28/2019 7:36:49 PM (GMT-7)

It's easy to underestimate the need to connect with and trust our primary physicians. And, a visit like this helps cement that relationship.

Bbqdude, Dr. Smith was my surgeon. Your description sounds familiar. My experience with him was a bit different than so many have, as far as follow up treatment. I was very high risk and did not have the greatest possible post op path. He surprised me by advising me to wait until there was clear evidence of failure before getting additional treatment. I think most folks would have hit my case with additional treatment within a few months(and most docs would have recommended same). I was very surprised when I asked him "what's next" and he answered "nothing, not yet". But, low and behold, I have made it 5 years now. So, he was different, but also certainly knows his stuff. BTW, for an eye opener, try to look up how many papers he has published on prostate cancer research. That amazed me.
EDIT: Forgot to say: I would have loved to hear those words "AS for you", but he told me it was out of the question. If he gave you that option, you have won the PC lottery.

Thanks again for all the comments.

Redwing- sorry, I am a Predator fan. I had fun with a guy at the Split Mitt in Flint last week by wearing my Pred's sweats in there. I did stop to get some coney dogs. They do have that figured out in Flint. I may try to find a BBQ in Lansing next week if it exists.

I used to travel around doing BBQ competitions a few years back. I got pretty good. My team finished 88 out of about 5000 in the country in chicken and 122 in ribs. Needless to say I have turned into a little bit of a bbq snob.