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Doc says "Nothing to worry about," Trust Him?

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Posted 2/9/2011 10:56 PM (GMT 0)
Hi guys, thanks for a great resource!

I'm a 57 year old healthy guy. I exercise six days a week, including long bike rides, and weigh 156 lbs at 5'11". I had some prostatitis 10-20 years ago, and it seems to come in go but in a very mild form. I've never had a PSA test. When I had a colonoscopy a few years, the doc noticed some prostate enlargement.

Recently I've had some episodes of very slow start when peeing. Once every few weeks, I'll get up to pee an hour or so after dinner, and it's "Whoa! What's going on?" I don't show any other symptoms, except perhaps some slight discomfort there occasionally. I usually go through the night without urinating.

I went to see my GP with a few complaints, and mentioned this. His response was, and I quote, "Oh, that's just from all the bike riding, we see it all the time." Then he rushed off. No digital rectal exam or other comments.

Note that the biking is nothing new, and I have a split seat that puts no pressure on the perineum.

So, should I:

1. Trust that if the doc isn't concerned I shouldn't be.

2. Go back to the doc and insist on further investigation.

or

3. Go to a urologist for further investigation.

Thanks for your help!

Al
Posted 2/9/2011 10:59 PM (GMT 0)
He already made errors, age 57 and no psa testing yet, nor DRE  and added those background mentionables. Dr. Strum would have slapped the guy (LOL).

See a decent urologist and always question anything in medical things.

www.marinurology.com 

www.wmfurology.com    (both good for basic info on all urinary issues)

Post Edited (zufus) : 2/9/2011 4:03:12 PM (GMT-7)

Posted 2/9/2011 11:01 PM (GMT 0)
Hello and welcome, Al

If you are 57, you should be getting an annual PSA test and DRE (Digital Rectal Exam). Many of us with PC never have any symptons before our diagnosis. You should have that done as soon as possible, if nothing else, to establish a base line for future tests.

My long term GP, inisisted that I begin both tests at age 50, along with my wife's prompting (she's a nurse). By age 56, I was fullly diagnosed with PC, with no symptons whatsover and feeling healthy.

Good luck and keep us posted.

David in SC
Posted 2/9/2011 11:05 PM (GMT 0)

Hi Al, and welcome to the forum. First of all, at 57, and having never been tested for a PSA baseline, you should do so promptly. The standard adage is that all guys should be tested starting at 50. Sooner if you have a history of prostate cancer in your family, or if you are of African American descent, etc.---I'm really stunned that your doctor wouldn't at least do a DRE when you complained...........I'm sure I'll be backed up by the rest of the members here, but please find a doctor, be it GP or urologist, who will order a PSA blood test and give you a DRE. You need to find out where you stand, whether or not you have suspicion of cancer or not. It may just be BPH and/or prostatitis, given your history, but you need to know and address accordingly.

Arnie in DE

Posted 2/9/2011 11:25 PM (GMT 0)
Al, your doctor is likely making a good call --- for him. For you, perhaps not. Chances are remote that you've got a problem, but at your age you should have more real data to assure you of this than your doctor's opinion, as excellent and as well founded as it may be.

I encourage you to have a PSA and a DRE. As you can see below, I had a low PSA, and no lump evidence on a DRE, although one side was said to be enlarged. Because of a family PCa history my doctor sent me to a urologist who, when he looked at my PSA said, "What are you doing here!" But, he too was of the cautious sort and because of family history did a biopsy. He was surprised it showed cancer. I wasn't thrilled, but a heck of a lot happier to know it was there and treat it, than to not know it was there and not treat it.

I tell you the above as an example that cautious is good. Go do the cautious thing and then I hope you'll report back.


Sheldon AKA Sleepless
Posted 2/10/2011 12:02 AM (GMT 0)
I did not have a PSA until I was 56. It, with the resulting biopsy, found that I had very advanced PCa.

Go get a PSA. Period. Don't make the errors I made.

Posted 2/10/2011 12:23 AM (GMT 0)
I don't wont to scare you but you shouldn't take your doctors word on this one. At 57 you should get a PSA test and a DRE. Make an appointment with a Urologist as soon as you can.
Posted 2/10/2011 12:29 AM (GMT 0)
Coasting, I agree with the previous replies.  IMHO this is a serious breach of protocol from your physician.  I would probably fire him and find another PCP.  In the meantime I would suggest consulting a urologist.  The urologist will definitely give you a PSA test and do a DRE (hopefully in that order).  He will also probably tell you that you need to have these done annually by a competent PCP.

Tudpock (Jim)

Posted 2/10/2011 2:31 AM (GMT 0)
coasting-
you have got some nice support here
- just remember - BEFORE THE PSA BLOODWORK - to have 2-3 days with no prostate activity - no sex - with partner or by self; no bike riding - horseback, etc - any activity that can create a false positive... and no DRE before bloodwork - bloodwork first then the DRE....

-this is a great avenue for information that can calm the fears and give information to help you take control of your body -
-if the doctor is your regular guy, ask him for the tests, so to set up a timeline for your PSA... and if refuses or diminishes your request - get another doctor.

-wishing you all the best...
HUGS
BRONSON
Posted 2/10/2011 2:47 AM (GMT 0)
Please dont trust him. Have a PSA test and DRE if nothing else just for piece of mind. Heck he might be right about the bike riding but at your age the annual PSA is so important. My DRE was fine but I had a rapid rise in PSA from 2.5 to 3.7 from one year to the next and my PCP sent me promptly to a Urologist. Looking back it started with frequent urination but also I began falling asleep in my chair and I am not a nap guy. Hope it all goes well for you and that your bike riding days last a lifetime.
Michael
Posted 2/10/2011 5:44 AM (GMT 0)
http://blogs.crikey.com.au/croakey/2010/03/22/psa-screening-is-a-public-health-disaster-says-cancer-doc/

You might want to talk to your doctor about his thoughts on PSA testing before you go running to someone else.
Posted 2/10/2011 8:56 AM (GMT 0)
The Dr had you get a colonoscopy and NOT give you a DRE and a simple blood test to see what your PSA was ? Does he do periodic EKG's or Cholesterol screening ?

Seriously whatever it is that makes you go to this guy, STOP

If its from bike riding get a better seat, but at least you will have a baseline test
Posted 2/10/2011 10:14 AM (GMT 0)
If I learned anything from my PC experience it was this:

Your GP knows a little about a lot, but doesn't know a lot about anything.  I knew more about PC after a day of research than my GP does today.

My Dad had prostate cancer at 52 and I had a PSA of 4.1 at age 40.  My GP said that it was "probably nothing".  So much for that philosophy.

I like my GP and still go to him, but I now know that it is smart to question him and that you need to be your own advocate.

Posted 2/10/2011 10:33 AM (GMT 0)
Welcome,

First reaction is that the doc has slipped up - a little.
I'm afraid you've opened Pandora's Box. You can't know unask the question inside your head that presumeably goes something like "Is there something seriously wromg with my prostate?"
The solution is thus to get a PSA test done as a minimum, then a DRE. You've already had good advice about letting the prostate have a rest before having the PSA test. (The thinking in Holland, the biking-mad country where I live, is that special bike saddles with gaps in them may not do a lot of good re the prostate)

Will it be okay to go back and ask your doc to have a rethink? Is this a doc you've known a long time? As that can sometimes make it easy to talk to them and sometimes harder.

I think I was very lucky with my doc: we have known her a while.
I was only 48 when I went along for a general check up; she hesitated and sucked her pencil while working out which boxes to tick for the blood test and said that they might as well do a PSA even though I wasn't 50!! The test answered a question I hadn't really asked and here I am!

I think you will have to go to the next stage rather than end up worrying about what might or might not be happening. I hope you are simply a guy with an enlarged prostate.

Alf
Posted 2/10/2011 3:07 PM (GMT 0)
In case it hasn't been mentioned yet don't trust him. devil

I trusted my GP and it resulted in a long delay in treatment when she didn't inform me of a rise in my PSA tests (which I had to insist on to begin with) GPs today are overworked and are at best vaguely familiar with most diseases. When the average insurance Co is only paying a pittance for each checkup they have to rush you through to make ends meet.

Educate yourself, take charge of your life.

Good luck and good health.
Dave in Durango CO

__________________________________________________________

Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04....... 06-07-10 PSA <0.04..... 08-03-10 <0.04...... 10-26-10 <0.04...... 1-25-11 <0.04
05-03-10 1 week without pads
06-28-10 Success!!
Posted 2/10/2011 6:31 PM (GMT 0)
The lab's system took some of the choice to say anything or not out of the doctor's hands. The test results were a great big long list, as it was for all kinds of stuff like sodium, cholesterol, pH, sugar etc, but they all had an upper or lower safe threshold marked alongside (or both) thus my PSA level was flagged up with an asterisk* as being too high and needing attention!!!

Alf
Posted 2/10/2011 7:37 PM (GMT 0)
Alf

Just an FYI my 5.5 PSA was flagged with a big "HIGH normal range (0.00-4.00)" in the lab report, the Dr still didn't do a followup or let me know about it even though I had asked for the tests and discussed the chances of false positives with her at a previous appt. Odd thing is she did mention a slightly elevated cholesterol reading from the same set of lab work.

My current Dr posts the results on a patient portal which allows me to check out results online within a week of the tests and schedules a followup appt to discuss the results. My old Dr's policy was "don't worry if you don't hear anything it's good news". Sadly I believed her.

Bottom line is today one has to take charge of their treatment, all the way back to diagnosis.
Dave in Durango CO
Posted 2/11/2011 12:07 AM (GMT 0)
Thanks for all the great advice, guys. I value it, and I hope this won't bug you, but here's the thing: I realized that I am asking advice from a very biased sample.

For many of you, a PSA test has literally saved your life. To get a more balanced view, I need to also ask in a forum of guys who had complications due to false positive PSAs (e.g. sepsis or complications from the biopsy). A forum like that doesn't exist, of course.

Being an ex-scientist, I find studies like this one compelling.

www.bmj.com/content/341/bmj.c4543

But maybe the results of those studies are only relevant for screening done on men with no symptoms.

I still haven't decided, but I think I will call my doc tomorrow and ask him what his thinking is, then decide what to do from there. I'm still weighing your input.

- Al
Posted 2/11/2011 1:48 AM (GMT 0)
That study relates to screening of the general population. As you indicate, you are no longer a member of that group. :-) You have symptoms that might indicate PCa -- being fit and healthy does not in any way preclude you from PCa.

What do you do?

a. Trust that your GP is correct and it is the bike-riding.
b. Lay off the bike-riding for a week and see if the symptoms improve.
c. Have the PSA test and DRE and take it from there.

My choice would be b followed by c -- and yes I am biased. Your GP/uro may want to try a course of antibiotics before the PSA test to minimize the risk of a false positive caused by prostatitis.

You can have the PSA and DRE without continuing to biopsy and the risk of sepsis and subsequent over-treatment. If your view is that you won't proceed with further treatment whatever the outcome of the tests, then there is no point in taking the tests. If so run with option a (do nothing).

However I suspect the scientist in you will want to know, even if you eventually take it no further. Good luck.
Posted 2/11/2011 4:22 AM (GMT 0)
Coasting:

Let me be more blunt.

This situation is bordering on malpractice.

Harsh words, but let me use another term: Standard of Care.

You are not receiving a reasonable standard of care. Period.

Your last comment is not that of a scientist. It is that of a patient who is understandably afraid of the PSA result. But I have to believe that you know what you should do.

Get the test.

Mel

Posted 2/11/2011 8:00 AM (GMT 0)
Dave: I would like to think that my doc is simply good, but maybe her level of care is alert to stuff like this as there is PCa or other cancer in her family or something?? (Just a guess)
When I phoned her (oh so long ago) to ask about my results she had not read them, she opened them on the computer glanced down the list while I listened to her going, "um, er, yes, um, er, right" etc, then said "Oh, um, I think you'd better come in and see me again, your PSA result is higher than it should be, I'll put you through to my receptionist so you can make an appointment for this week." That was perhaps a bit of an abrupt way of putting it to me, but it also had the effect of introducing me to the idea that I might have PCa, so that I would have read up on it a fair bit before I was sent to see a uro.

Mel: I almost agree with your opinion of Al's doc, but I do think you are right to indirectly remind us that what we'd really prefer is not to have anything wrong with us or just not to be frightened that there might be something wrong with us.

Al: The reason I don't fully agree with Mel about your doc is that final judgement must wait to see how he reacts to your request for a review of your situation. I thus hope you get a positive, useful and helpful response.

Alf
Posted 2/11/2011 9:17 AM (GMT 0)
I was having my Cholesterol checked and I asked the lab nurse what else does the Dr. have checked besides my cholesterol? As she was taking more than one tube of blood, she said oh things like like your liver enzymes (good I do drink) Blah Blah and your prostrate. I was like that's silly I have no symptoms of any prostrate problems. I was 49 getting ready to turn 50. I went in for my cholesterol consultation all was fine but my PSA was a little high. Finger wave was normal but I should see a specialist nothing to worry about just have it checked. Silly but I made the appointment. Went to the appointment the Dr said there is a 1 in 3 chance you have cancer my heart sunk. He did the finger wave something felt funny but not like a tumor. Lets do the biopsy. Still a little silly but a little worried. Did the biopsy waited on the phone call, call came. You have cancer like I was ran into a brick wall.

My cancer was found by chance I had no symptoms. You have symptoms you have nothing to lose by having the test, You have your life to gain by having them. Does having PC change your life? yes. Is it the end of your life? Not most of the time if you get it treated. GET THE TEST DONE!

Post Edited (p_elliott) : 2/11/2011 10:58:32 AM (GMT-7)

Posted 2/11/2011 4:33 PM (GMT 0)

Alf:

I don't care what how his doctor reacts.

The guy is 57 and never had a DRE or a PSA??? These are normal and accepted practices. This should have been done 7 times by now.

Sorry, in my book this is malpractice and it could end up costing this patient big time.

Mel

Posted 2/11/2011 5:53 PM (GMT 0)
I've gotta say I pretty much agree with Mel all the way on this one.  Any doc that has not offered a PSA and DRE to a 57 year old patient who presents with urinary symptoms is missing a cog in his wheel IMHO.

Al, I think you are missing the boat when you say you feel you are getting biased advise from this group.  Actually what you are getting is "educated" advice from men and women who have had to deal with PCa...sometimes for years.

And, let me join Mel in being blunt.  As my dear departed mama would have said, "Son, you are putting your head in the sand on this one".  As a scientist and presumably logical thinker you should want DATA.  Reading miscellaneous articles about the dangers of overtreatment is interesting and educational but does nothing to provide you with DATA for decision making.

'nuff said, ignore the advice given on this thread at your own peril.

Tudpock (Jim)

Posted 2/11/2011 6:16 PM (GMT 0)
Al -- listen to these guys and take your scientist cap off.  time to start thinking smarter, not harder.

ed

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