Necessary to see Uro for every PSA test?

I’m about 2 years out from completing SRT and had surgery before that. My PSA has been undetectable since SRT. My Uro orders the tests every 4 months and he wants to see me after every test for about $200 per visit with insurance. Visits last about 5 minutes with the doctor because I have no SE to complain about. I’m beginning to wonder if it is even necessary for office visits at this point if my PSA levels remain undetectable. Any thoughts on this would be appreciated.

I’m in the same situation as you. I don’t even see the urologist, I see his P.A. I call him Doogie, he’s about 16. I get my PSA score from Labcorp even before I see him. He spends 5 minutes telling me my results, which I already know. I then get a bill for $105 that my insurance doesn’t pay. I think I just talked myself in to firing my Urologist and going with my regular Doc. He orders all my other blood work anyway, he can just add the PSA. If it ever comes back anything but undetectable, I’ll see a specialist.

I get a psa when I see my GP locally, then message the result to MSKCC. As long as it stays undetectable, they are happy and so am I.

We all seem to agree!

Terry's Cellar said...
My PCP writes a script for my PSA’s and at the blood draw I request my RO and PCP receives a copy of the results. I no longer see or need a Urologist.

you are G6. the OP is G9. i also do not see a uro but that was after six or seven years

All about the Benjamins

As a added question to this topic as it pertains to high risk men: would any of u wait a year for your next PSA? After my last test in August of 2020, my urologist said I was doing well enough and out far enough in time to wait until August of 2021... kind of took me aback. I questioned him on it, and he was adamant in a nice way. Thoughts? Especially interested in your views JNF... thanks in advance

Michiganman, Good that you are PSA undetectable and a nice testosterone recovery after ADT. Looks like you have had extensive work to correct surgery effects. Hope you are doing well with all that.

How often do you weigh yourself? Have your Bp checked? Blood work for cholesterol and sugar and all? At your age, I am guessing once a year, maybe twice. But, if you haven’t had any adverse situations from these areas, once a year might be ok even though a lot can happen in a very short time. But you have had a very significant PCa involvement and we know how this stuff can turn negative when we least expect it. Why wouldn’t we stay on top of it for at least a few more years. A high point for recurrence is likely in the 5-8 year range according to many studies.

Your PCa was a high risk dx with very extensive treatment. At your stage, I can’t imagine an annual PSA test. If you really like your uro and know he is a leading edge PCa specialist, then follow his guidance. But, you are questioning it. So........you might get quarterly tests on your own plus his annual test and hopefully all be fine. But, if your quarterly tests show a rise then you will know what that means and you will catch it sooner than the expert would have. I am pretty conservative on this from experience watching other men and the advice from my urologist and medical oncologist. So I am in the “better safe than sorry” camp.

On the other hand, you might seek out a specialist PCa medical oncologist and get another assessment. Not much of an investment in either time or financial resources and could help your peace of mind.

MM, i don't know if you saw above, but as a G9 (4+5) with great pathology, I was tested ever 3 months for 2 years. My uro/surgeon then said he was good with 6 month testing, but let me choose 3, 4, or 6. He said I needed to pick the interval that I was most comfortable with.

My previous (4-month) test was fine at <0.014. However, my test last week (at 6 month because of a planned Covid delay) came back at 0.037, so uro wants next test in 3 months. I am his only patient who uses the 3-decimal PSA -- he uses a 0.05 test for his patients. Nonetheless, given the increase, he wants to keep a close eye on me.

Your uro should defer to your peace of mind, especially after your triple whammy. For all you know your PSA is increasing below the 0.05 level. Yes, you're not going to act on a slight rise, but you should be in the driver's seat. If you want to let your uro drive, that's fine, but it's your car. For high-risk guys, one year is a long time. If you remain undetectable, with 6-month testing, you'll have good news twice a year instead of once!

Djin

Which test are you referring to? The 0.1 or the 0.05 lower limit? I wouldn't bother with the 0.1 test. It's a PSA test for men with prostates. If you were <0.05 and the next test is <0.1, your PSA could still be increasing -- you would have no way of knowing. All you would know is it hasn't increased to 0.1 or higher. Going from a more- to a less-sensitive test is often a loss of information. Get a uPSA test yourself if your doc won't do it.

Djin

MichMan - I have similar situation to you. In “our” situation (surgery + radiation) and in my humble opinion, we do not benefit a whole lot from constant PSA testing since we are not going to do a whole lot about if a PSA test shows something at this point. I am certainly not running to my doctor and demanding a Lupron shot. I will deal with it at that time after consultation with the appropriate specialists who are not my current URO, RO, or GP. Whether I go to annual testing at five years as suggested by URO’s testing schedule remains to be seen but I see no sense in 3 month testing after a couple of years of good results. This logic does not apply for surgery patients who have not had secondary treatment and who knows how much PSA testing one should do for primary radiation treatment given the propensity for the results to bounce around.

I also see no point in ultra sensitive PSA testing after surgery and radiation. Nothing is gained as we move into a pass-fail situation now where we either have or don’t have a recurrence after best efforts. If the PSA becomes > 0.10 (my GP and URO both use this precision level) then it is time to keep an eye on it, not before. If that happens with 6 month testing then you probably got 3 extra months of rest. Again, I am not sure I am ready to go with annual testing but talk with me in 3 years and I will let you know my thoughts at that time. I am scheduling my first 6 month test this week as I move to the next phase.

Mumbo: thank u for your thoughts and rational. Your remarks about the uPSA test and standard test have merit, as I’d probably be taking no action until that .1 threshold, other than knowing things were inching in the wrong direction. I can see u are about 3 years behind me, glad u are doing well. We have actually been on the same testing timetable, I guess I just know things in the world of High risk cases can turn quickly, and I prefer to be the front man in my decision making. Nobody is watching my situation better than me! Lol! This wait for a year to me doesn’t sit well, and I think I’ll stay with the 6 month program. Thank you for your time and valuable input. Best, MM

Yes, you are the “front man” and by this point, you should know more than your URO, RO, GP about what comes next since you know the entire story, lived it, studied it, and talked with multiple doctors about it. I agree on the 6 month testing also but may feel differently some day if the numbers stay good

I am not sure that things turn quickly at this point that > 0.10 won’t tell you if you can find that assay method (Abbott Architect?). You get a bad result, wait 3 months test again. Wait for PSA to get high enough that a high priced scan might find something that simple scans don’t find. If you are lucky, maybe a lymph node or something in the local area shows up and you zap it and beat down PSA with ADT. If you are unlucky and the cancer has migrated, you go into full metastatic control mode with the best MO you can find. Or you go on ADT and beat the PSA down without having any idea of what is causing it or where it is. None of it sounds like much fun but that is the way it goes based on those that have gone before us. Maybe after Covid is solved, the same scientists will direct their attention to PCa and solve that problem in 12 months.