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Report from First Urologist Visit

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Posted 11/6/2019 7:50 PM (GMT 0)
Well, I just got back from my visit. Please see my recent threads for the story up to this point.

Overall, I like the doctor. He's young but was friendly and didn't rush the consultation at all.

He said that if he would not have recommended I get PSA testing despite my family history until I was older than I am currently. This surprised me somewhat but he emphasized that PSA values can be all over the place as my have fluctuated. He knows that the cat is out the bag now and I'm pretty much locked into more visits. He said we'd be seeing a lot of each other.

The DRE turned up nothing. He said my prostate was not enlarged at all and he found no abnormalities.

I mentioned the PHI test but he said that is not covered my insurance and he recommended against that until after I've had another regular prostate test in a month. He said no ejaculation for 72 hours. He had not heard about the heavy lifting prohibition.

He said something about a 4K score test that can measure your chances of having cancer. He said that this and the PHI test could be possibilities if my PSA came back at around the same 3.3 figure. He said he still wants to see my again even if the PSA number drops.

He is recommending against a biopsy at this point. He said insurance will not cover an MRI until a negative biopsy so the MRI is out for now. He also said that if I was to get a biopsy, I'd be the youngest patient that he's had that had gotten one.

He was pretty reassuring. I don't know how to feel now about getting the PSA tests since I was 41. Here's a urologist who is not a big fan of them for men in their 40s. This last week has sucked with anxiety for not only myself but other family members.
Posted 11/6/2019 8:09 PM (GMT 0)
Sounds like a good visit and I'm glad the DRE was negative. I'm not all surprised that he's not recommending a biopsy, but I'm ever so slightly surprised that he didn't prescribe an anti-biotic to check for infection. So when will you retest PSA?

Personally, I don't think PSA testing in your 40s is necessarily a bad idea, particularly given your family history. But in my experience doctors don't necessarily do a good job of setting the expectation for what the PSA score means. It's been said here that a high-ish PSA score is like the "check engine" light in your car. It can mean a lot of things and the chances are it's not PCa, but it's also something that you want to stay on top of.

At any rate, I'm glad you have this behind you and wishing you the best of luck with future PSAs and DREs!
Posted 11/6/2019 8:29 PM (GMT 0)
For the record, I started having PSA and DRE's from my PCP in my 40's--I never had a measurable PSA until I was 53, and my PCa was diagnosed at 56.

Well, you got through it, and now you know what to expect. I like your doctor--he's not particularly worried, and is playing wait and see..which isn't a bad plan.
Posted 11/6/2019 9:19 PM (GMT 0)
Jason, it sounds to me like you are getting excellent advice and care from your urologist. Hopefully you are a bit calmer as well. Let us know how the next PSA test works out.

Jim
Posted 11/6/2019 10:44 PM (GMT 0)
I asked about prostatitis but he said that he thought my PSA would be a lot higher and that I would notice symptoms if my prostate was infected.

He said something about "half-lives" connected to another PSA test and that I needed to wait a month. Not sure what he meant by that but I'll be going again in early December for the test and then will have a follow-up with him afterwards.

My PCP is a bit of an alarmist and his phone call to me with the results really scared the crap out of me and he did nothing to alleviate or allay my concerns. I think he wanted me to assume the worst. I'm a bit pissed about that especially given the very subdued reaction of my urologist who went so far as to specifically state that he does *not* think I have prostate cancer. Still, I have no choice now really but to pursue this and do all the necessary steps.
Posted 11/6/2019 11:17 PM (GMT 0)
Re your PCP, that was what I meant by my comment that PSA testing in your 40s isn't bad in itself, it's how the information is used. I'm not a doctor, but to me the logical thing for your PCP to say would have been your PSA was somewhat high, but far from alarmingly so. Given your family history, let's keep an eye on this.

BTW, I used to get DREs from my PCP once I turned 40--I always assumed that was something most PCPs did, but maybe not. (I had a female PCP and once I mentioned it was a bit embarrassing to have her do the DRE and she responded "well, how do you think I feel about it?")
Posted 11/7/2019 2:30 AM (GMT 0)

JasonB176 said...
Well, I just got back from my visit. Please see my recent threads for the story up to this point.

Overall, I like the doctor. He's young but was friendly and didn't rush the consultation at all.

He said that if he would not have recommended I get PSA testing despite my family history until I was older than I am currently. This surprised me somewhat but he emphasized that PSA values can be all over the place as my have fluctuated. He knows that the cat is out the bag now and I'm pretty much locked into more visits. He said we'd be seeing a lot of each other.

The DRE turned up nothing. He said my prostate was not enlarged at all and he found no abnormalities.

I mentioned the PHI test but he said that is not covered my insurance and he recommended against that until after I've had another regular prostate test in a month. He said no ejaculation for 72 hours. He had not heard about the heavy lifting prohibition.

He said something about a 4K score test that can measure your chances of having cancer. He said that this and the PHI test could be possibilities if my PSA came back at around the same 3.3 figure. He said he still wants to see my again even if the PSA number drops.

He is recommending against a biopsy at this point. He said insurance will not cover an MRI until a negative biopsy so the MRI is out for now. He also said that if I was to get a biopsy, I'd be the youngest patient that he's had that had gotten one.

He was pretty reassuring. I don't know how to feel now about getting the PSA tests since I was 41. Here's a urologist who is not a big fan of them for men in their 40s. This last week has sucked with anxiety for not only myself but other family members.

I believe in annual PSA tests beginning at age 40. why not? did you ask him how old he was when he had his first PSA test? if not ask him next time.
Posted 11/7/2019 12:30 PM (GMT 0)
As a non-professional patient, I agree more with your PCP than with your urologist. If he weights so much the age factor, he could also consider that your current PSA is definitely unjustified and too high for your age since the prostate is not enlarged and he discards prostatitis. However, the previous peak five years ago suggests a history of prostatitis, so that it may be the cause of this flare. Prostatitis is often asymptomatic and it raises PSA in a random way, not necesssarily to very high levels. I hope this is the case. I also believe that prostatitis and enlarged prostate are two different and independent conditions but, again, I am not a medical professional. Anyway, considering your familiar history, you should have another PSA test soon (I guess you are aware of that). And I would insist for further tests, particularly a mpMRI or a biopsy, if PSA remains in its current level. about taking PSA tests in your 40's, it may be a controversial issue but you decided to play that game and now it is clear you need some close follow-up because of the results, therefore this is irrelevant for you right now.
Posted 11/8/2019 11:51 PM (GMT 0)
Jason,
It goes without saying that some doctors would recommend more aggressive measures to see if any PCa is at work. On the other hand, it appears this Uro established a good rapport with you, gave you plenty of time, listened carefully to your concerns, and though he's not a fan of PSAs for youngish men and isn't racing to do a biopsy, he plans on following up with you frequently ("He said we'd be seeing a lot of each other."). That last point is Number One. Even if it's PCa, it's highly unlikely you need immediate treatment. Close monitoring seems like the right call. Sounds like you're in good hands.
Posted 11/9/2019 7:10 PM (GMT 0)
I was going to suggest an MRI if they either found or didn't find anything. My Uro had me do MRI first, then they used that in the biopsy to target specific areas more specifically. My PPO insurance paid for the MRI - abeit was costly - prior to having any biopsy done.

I was 47 when finally diagnosed, having had PSA doubling every 18 month for four years, to ~8.5

Im now 40 months cancer free with PSA <.02, so not registrable..
Posted 11/9/2019 8:00 PM (GMT 0)

Jason said...
He is recommending against a biopsy at this point. He said insurance will not cover an MRI until a negative biopsy so the MRI is out for now.


That is not necessarily true as paulmerc noted. However, my urologist told me that they had no problems with insurance covering the MRI prior to biopsy in the Twin Cities, he has heard at conferences that some doctors around the country get some pushback. Mine was covered by my Medicare insurer with no problem and they tend to set the coverage standards when the government ok’s something.

On the other hand, your data is not convincing quite yet to proceed full speed ahead so the doctor may feel he cannot make a compelling argument for it at this time if questioned by a private insurer. That is not a bad thing actually so rolling with the punches for now may be a good idea. If one of your future PSA’s jumps, then you can revisit. Sounds like you like the doctor so trust the process for a little while IMHO.
Posted 11/9/2019 8:20 PM (GMT 0)
I just took his word for it about the insurance not covering the MRI until a negative biopsy is produced. If I really wanted one, I suppose I could call my insurance and see what they say. I have a terrible plan and pay everything out of pocket until $4700 anyway. I'm going to go with his recommendation to wait until December's retest before taking the next step. Even if my PSA stays at the 3.3, he may recommend the free PSA test and another one he was telling me about. This would be before a biopsy. If my PSA should drop, he may recommend to just wait for a while.

I know I'm not out of the woods by any stretch and this waiting is still not easy. I don't really have much choice as I'm not ready to jump into a biopsy yet. I'm learning to live with a steady daily anxiety that is new for me.
Posted 11/11/2019 4:01 AM (GMT 0)
Congrats on a negative DRE. That’s a big sign of relief for sure. Looks like you are in good hands - literally smile
Posted 12/3/2019 3:59 AM (GMT 0)
My doctors didnt test me until I was older, and at 44yr I had negative DRE, but I still had G7 prostate cancer because it was at the frontal Apex... luckily it was found with a biopsy.... with your history, I would play it safe... monitor that PSA...

Zzarth
Posted 12/3/2019 5:19 AM (GMT 0)
My husband is 45 years old and his PSA was 2.3 in July 2018 and then 1.9 in January 2019.
His DRE was normal. The urologist last year assured my husband that he is fine and had nothing to worry about due to his “ normal” psa...
My intuition was telling me something was not right. The average psa for a man in his 40’s is 0.7 .
I encouraged my hubby to see another uro , this time at top notch UCLA in January of this year. Due to family history and the elevated PSA ( relative to Age) The uro decided to be cautious and ordered an MRI .
The rest is history.
In April my 44 year old husband had his prostate removed. The tumor was in the anterior of his prostate which cannot be felt by Dre and usually not found with random biopsy. Only detected with MRI.
He has recovered well from surgery, with no lasting side effects. I’m glad we pushed for the MRI.
You have to be your own advocate and push these doctors.

Stay vigilant. Early detection is key.

Post Edited (Leah77) : 12/2/2019 10:48:58 PM (GMT-7)

Posted 12/3/2019 5:23 AM (GMT 0)
Jason, where are you located? The cash price for a 3T MRI at UCLA is around $1200.
That’s what we had to do. Money well spent!
Get an MRI!
Posted 12/3/2019 4:18 PM (GMT 0)

JasonB176 said...

He said something about "half-lives" connected to another PSA test and that I needed to wait a month. Not sure what he meant by that but I'll be going again in early December for the test and then will have a follow-up with him afterwards.


It takes time for PSA to "decay" to a lower level thus the term half-life is used as the time it takes to become half of its original value like radioactive isotopes. Not directly applicable in your case but he is saying to give it a little time and see where it goes. You should also behave a few days prior to the PSA test (sex, bike riding, etc) to insure it has settled down as much as possible for the next reading.

Post Edited (Mumbo) : 12/3/2019 12:49:02 PM (GMT-7)

Posted 12/4/2019 5:37 PM (GMT 0)
Biopsy trauma can cause elevated PSA. One of my biopsies doubled my PSA, and another one tripled it, for six months. My doctors at Johns Hopkins were familiar with this possibility, and were not concerned.
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