Friend Diagnosed

Got a call this morning from a Friend actually the wife. He’s in his 60s and started having his PSA checked about 4 years ago, according to his wife because I gave him a little push
Anyway apparently the PSA has been going up very slowly and very steadily, and when it got to 4. something, the urologist continued to tell him, that “it’s not a concern right now” . Well his most recent test came back at 5.6. At that point, the urologist wanted an MRI.

The MRI came back showing that whatever it is has escape the capsule. Not the news anybody wants to hear .
However he has not yet had a biopsy. He has wisely decided that at this point He would rather connect with a doctor at a major hospital and I am helping him with that. So while it sounds like a high likelihood that he has prostate cancer, there has been no official diagnosis and nnobody knows what it is specifically, what Gleason grade it is, etc.

For this reason, I cannot understand for the life of me why the urologist told him, that if he does nothing he’s got three years to live. Am I missing something, or is that the most irresponsible thing a urologist could say, pre diagnosis .

When my friend asked him so what is the game plan, urologist responded well we would put you on Hormone therapy. I don’t know maybe I’m losing it but my skin was crawling

Anyway I’m helping him with info, education, and trying to hook him up at a Major Manhattan Hospital where I know people who run the cancer center.

From the doctors comments to him, it sounds like Uro is assuming that my friends cancer is already gotten into the bones. PSA 5.6!!!. NO BIOPSY YET !!!
I don’t understand. Either I’m crazy and I forgot and everything I’ve learned here, or the urologist is a moron

Moron is too polite. I'm reminded of the comment: what do you call the guy who graduated last in his class at med school? Dr.

Prato - I would hope that something has been lost in the translation from doctor to person to person. Having a PSA less than 4.5 for a 60-69 year old is considered ok by many if there are no other indicators. Most of us who have been through the process would not agree with that but malpractice might be a little difficult to establish here based on that alone. Of course, some of the other comments are odd which makes one wonder about the doctor in general and what was said or heard. Just trying to be positive here although my first feelings are like yours.

Probably a lot has been lost in the translation or the manner the advice was given wasn't the best.

Anyway, I'll buck the trend and say the uro is doing him a favour. My father died from prostate cancer - he did nothing despite symptoms until it was far, far too late. All the uro is doing is saying is "Do nothing and you'll die from it". Clearly the psa is going up significantly - < 4 to 5.6 in 4 yrs. MRI says it has escaped the capsule. It's not said what areas are impacted now. The uro would be totally negligent to say, all is fine and you don't need to do anything. The message from the uro is he needs to do something. My opinion only.

F8 said...


PSA was rising. the doctor said it's below 4 so don't worry. PSA jumps over five and MRI shows cancer is out of the capsule. i'm not seeting the favor here.

You've completely misread my post, F8.

Several on the thread said the uro's statement to the friend that no action would lead to death was out of place.

My opinion is the uro is doing a favour to the friend by being upfront with the risks OF DOING NOTHING. And Yeah, you can die from PC from doing nothing. My father did. If my own mri indicated the PC had escaped the capsule and my uro said do nothing, then I'd consider it malpractice on his part.

My first uro missed the cancer twice before I fired him and got another, more competent, urologist. I called the first a "quack", and I still call him a "quack" as he was paid to do one thing for me and he blew that. It would have been nice to have known about my cancer 2 years earlier.

The most irresponsible statement, possibly.
But I fired my Uro right after he said my rise in PSA was nothing to worry about.
This was two years after my PROSTATECTOMY.

jasperx10 said...

F8 said...


PSA was rising. the doctor said it's below 4 so don't worry. PSA jumps over five and MRI shows cancer is out of the capsule. i'm not seeting the favor here.

You've completely misread my post, F8.

Several on the thread said the uro's statement to the friend that no action would lead to death was out of place.

My opinion is the uro is doing a favour to the friend by being upfront with the risks OF DOING NOTHING. And Yeah, you can die from PC from doing nothing. My father did. If my own mri indicated the PC had escaped the capsule and my uro said do nothing, then I'd consider it malpractice on his part.

and the irony is the uro did or said nothing until it was too late. still not seeing the favor.

jasperx10 said...
mri can't tell how aggressive the cancer is, but if it can sure pick up lesions if they've developed enough. Your friend needs to give you (pratoman) the results to have a look at.

Not sure i want the responsibility of not correctly interpreting a path report. I know my limits.

Sorry I don't have time to re-read and dissect/analyze. I'm going with moron.

Just my opinion: no favor telling a guy that “if he doesn’t get treated he will die in 3 years”, when 1, he hasn’t even had a biopsy yet and 2. The Uro has no way if knowing that.
If he wanted to get his attention, then “ whatever it is has escaped the capsule” would have been sufficient.

In any case, as I said, the important thing is , he’s getting to the right place for diagnosis and treatment. It could get we’ll be that the Uro is right and it’s a really aggressive cancer. My beef is with the way the Uro handled it, without even doing a biopsy.

Pratoman said...
Just my opinion: no favor telling a guy that “if he doesn’t get treated he will die in 3 years”, when 1, he hasn’t even had a biopsy yet and 2. The Uro has no way if knowing that.
If he wanted to get his attention, then “ whatever it is has escaped the capsule” would have been sufficient.

My father was initially told 5 yrs - and that was with treatment !
Maybe we're more upfront in Australia and that's why what your friend's uro said didn't bother me. And, he did add "without treatment". I still think that's a fair warning. Only the uro and your friend knows how bad "beyond the capsule is". Perhaps surrounding organs and structures are implicated by the mri, and uro didn't want your friend avoiding any action for several months. Like I said, maybe there's a cultural difference between here and with you guys. Dunno.

Anyway, your friend's decision as it's his body. It's always our responsibility in the end (to make the decisions that affect us) He can ignore uro if he doesn't like his words or manner and he can go for another Uro, or take no action.

Pratoman said...
Update: my friend went to see a diagnostic radiologist they he knows whose sole focus is using some kind of special ultrasound (3D Doppler histogram, according to his website), to diagnose and pinpoint cancers. This Dr told him he didn’t thing it escaped the capsule, at worst might have been bulging against it.

Nevertheless, he has an appointment with a hot shot Uro/surgeon at NYU langone next week with intent to get his opinion AND schedule a biopsy. So he’s on the right track.

Great news for your friend Pratoman. Man, that was a terrible reading of the mri OR advice by the uro. I take back everything said. But again, that's great news for your friend.