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what would you say about this doctor?

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Posted 3/29/2011 2:24 AM (GMT 0)
my brother in law went for a physical. Like me, he's 40.

He asked his doctor to perform a PSA test telling him about my experience and the doctor refused stating he was too young and that nothing worthwhile comes from PSA tests and that his DRE was fine.

My DRE was also fine and my PSA low but my urologist still thought it wise to have a biopsy ( thank God ).

So my sister is urging him to change doctor.

What kind of doctor refuses to allow a simple blood test?
Posted 3/29/2011 2:30 AM (GMT 0)
Your Sister is a wise lady !!
Posted 3/29/2011 2:33 AM (GMT 0)
Yes, why would his doctor refuse to do a PSA test if requested? That doesn't make sense, just another check box on a blood order for tests. I don't know of a single doctor in my experience that wouldn't do it just because a patient asked or was worried. Its not like a procedure or something invasive.

If this is literally the case, the answer is simple, your brother should find another doctor that will work with him, and not against him. Or he could go to a private lab and have the test done at his own expense for peace of mind. My local small town hospital will do one on request, with or without insurance.

David in SC
Posted 3/29/2011 2:38 AM (GMT 0)
I suggested the same, that he just go to a lab like Quest so that he has a baseline at least. We should all have baselines.

I don't know what's up with this doctor. I know that when my urologist suggested I have a biopsy because of my 2.4 PSA ( which went down to 1.9) the third time around before biopsy ) I started reading a lot online and read a ton of outdated stuff that said we should wait until 50 for PSA tests and that anything under 4.0 is considered nornmal. That is outdated news. perhaps this doctor just hasn't kept himself informed.
Posted 3/29/2011 2:39 AM (GMT 0)
I wonder if the insurance companies are pressuring this doctor.

This is another example of substandard care.

My doctors at Ford said that my son should start getting PSA tests at age 40 (7 1/2 years from now).

Mel

Posted 3/29/2011 2:41 AM (GMT 0)
i'm starting my son off at 35.

I'm 40 but I saw a few men younger than me in my surgeon's waiting room. This is not an "old man's" disease anymore.
Posted 3/29/2011 2:48 AM (GMT 0)
My sons are currently 27 and 33, both have promised a baseline at age 35, and I am certain they will.
Posted 3/29/2011 3:07 AM (GMT 0)
My grandson is 7. I've just scheduled his appointment!

<g>

Mel

Posted 3/29/2011 1:19 PM (GMT 0)
I think with the confusion around what is right for doing breast cancer and PSA, Drs and insurance companies are taking a very conservative position to save money.  Having family history would be enough for me to seek out another dr.

We just have our annual physicals yesterday.  Wife is due to mamogram and dr ask how long since last one as guideline has changed.  She is within even the new guideline, but dr said insurance is questioning more things now.  Even their procedure has changed on scheduling a mamogram.

 

Posted 3/29/2011 1:21 PM (GMT 0)
it's great to have insurance companies call the shots. probably great for our health.
Posted 3/29/2011 2:14 PM (GMT 0)
My doc didn't check the PSA box at my 50 yr physical because he read the European study that said screening PSA testing only saved one man in 1000 but resulted in many unnecessary procedures. (If under 55, white, DRE is negative, no history in family, and no symptoms - me. )

On the bright side all my other blood work was great.

After seeing what happened to me, he changed his opinion.
Jeff
Posted 3/29/2011 2:33 PM (GMT 0)
Unless I'm wrong the doctor works for you! Change doctors! I changed doctors after my stroke and just because I had never had a PSA before he gave me one on one of my 6 month blood works.Dre was fine.PSA not so fine!
Mel; way to think ahead. With the way people eat now and life styles,PCA is no longer an old mans disease. Most all of my friends have now had PSA tests.
Jeff we were the same,under 55(52),no family history, no symptoms and DRE fine.....Surprise!
Posted 3/29/2011 3:03 PM (GMT 0)
A Doctor with a big EGO would refuse to do that test. Kind of like, " I know what is Best." I would be finding another PCP, in short order.

Michael

Posted 3/29/2011 3:35 PM (GMT 0)
Context is important here.

If the physician is in an HMO or other managed-care situation, they may have rules about what is allowed period. I have been in such a situation in the past. You were always welcome to go outside the network, but you had to pay retail prices out of your own pocket, and the doctor was  not paid to evaluate or consider the results. In that case 'care' was absolutely managed.

My doctor runs whatever tests I ask for, but the nurses go off to check, and come back with warnings about what insurance won't pay for so that I'm aware of the potential costs.

 

Posted 3/29/2011 3:42 PM (GMT 0)

davidg said...
i'm starting my son off at 35.

I'm 40 but I saw a few men younger than me in my surgeon's waiting room. This is not an "old man's" disease anymore.

It still is primarily an old mans disease with a tragic small percentage of men in their 40s like you. Your post makes it seem like there's been a major change as to who can have PCa. That remains fairly constant. That said for those of you who have PCa in their 40s should recommend that their sons be tested in their 40s. Family history is a major factor although that doesn't include brother inlaws. I'd be very surprised if you saw more than one man in his 30s awaiting radical prostate surgery. The average age of men diagnosed is still in their 60s.
Posted 3/29/2011 3:46 PM (GMT 0)
I think I read recently, that the average age of a PC is 68. When I was dx at 56, my uro said I was one of his youngest PC patients he had ever had. We do seem to have a lot of men in their 40s for sure just here at HW, but then we just represent a single grain of sand with all the men with PC in the USA alone.

David
Posted 3/29/2011 4:21 PM (GMT 0)
I doubt that materially more guys in their 40s are getting prostate cancer now than, say, 10 or 20 years ago.  Instead, I suspect more guys in their 40s are getting tested -- and some of those guys (small %) end up having prostate cancer.  Before guys in their 40s started getting psa tests, very few guys in their 40s got diagnosed with prostate cancer. Doesn't mean they did not have it -- just weren't diagnosed.  The exceptions were those diagnosed with symptoms, and in many cases uncurable disease.  (First time I got tested, at 40, and with family history, the result came back 1.4 and said, essentially, "you are fine; it  is under 4.0").   Now, 1.4 at age 40 is not a reason to rush  off to the hospital, but it is certainly high for that age and someone should have said "watch this very carefully."  (fortuntely, i had read up a fair amount, since my father had recurrent prostate cancer at the time, so I know to watch it carefully).  Now, 7 years later, my psa was 1.5 at the last test.  So no big increase.  But I continue to watch it like a hawk -- get tested every 6 months -- even though doc said every year is sufficient. 

Posted 3/29/2011 6:43 PM (GMT 0)
What would I say to a doctor who refused to perform a test I thought was important..."Goodbye".

Tudpock (Jim)

Posted 3/29/2011 7:18 PM (GMT 0)
I'd be interested in what the diagnosed, mortality and treatment rates were back in the old days, before PSA testing. Did they die early, or much later in life, but with more advanced forms of cancer? Anyone seen before-PSA mortality or staging rates from way back when?
Posted 3/29/2011 7:22 PM (GMT 0)
What a mess!

I don't think this doctor has ill intentions at all. That fact is that doctors are being "blamed" for over treatment of our disease and there is a lot of bad messages being sent by several reputable organizations on who to test and when. In this case the ACS says "No". AUA says "Yes". The New England Journal of Oncology says "No". The NCCN says "yes". All say population based screening at any given age is wrong. What we have is a doctor that does not want to worry a patient that has barely a .05% of even testing positive. Even less than that it will kill him or pose a threat. But a high degree of likelihood that the test could lead to what we see in some books as "unnecessary" therapy?

Perhaps this is a case where the patient simply has to say "Look. I understand that this test is highly controversial. But I know enough that I won't feel good unless we do this test, this isn't on you doc...it's on me. Please run a PSA test and give me the results".

I believe that it's possible that a knee jerk reaction is as inappropriate as the doctor's actions seem. Some will tell you that this doctor is doing the right thing.

Tony
Posted 3/29/2011 7:27 PM (GMT 0)
James C.
In 1990, clearly before the PSA era, 40,000 men died of prostate cancer in the US. Roughly 50% of those diagnosed.

PSA screening saves lives. Some will argue that treating the disease has improved and that is why we see less men dying. But I see a bigger picture. The large increase in diagnosis of prostate cancer is also largely responsible for expanded awareness and research funding increases. So yes treatment has improved. Men are living longer with the disease. But men are also being treated in earlier stages. Anyway you argue it, the numbers this year are far more encouraging than they were in 1990.

Tony
Posted 3/30/2011 3:12 AM (GMT 0)
i'm grateful to have known that I had pc at 40. I can't imagine how much worse it would have been to have lived with it for 5-10 years before finding out.

I'm not happy to have gotten it, but my immediate instinct was to remove the organ with disease.
Posted 3/30/2011 2:27 PM (GMT 0)

davidg said...
i'm grateful to have known that I had pc at 40. I can't imagine how much worse it would have been to have lived with it for 5-10 years before finding out.

I'm not happy to have gotten it, but my immediate instinct was to remove the organ with disease.

PCa is slow growing even at gleason 7 you've had it for years before it was detected. Everyones immediate reaction is to have it removed, at least until they learn the fact that all cancers are not the same. Add in side effects and thus why men should take their time educating themselves on all aspects of treatment or AS if that's a viable option.
Posted 3/30/2011 3:14 PM (GMT 0)
Many great points.

Your friend should tell his dr that he understands the controversy, and would like him to conduct the test anyway. There are, as noted, several good intentioned and qualified entities, that advise against regular psa testing, If dr has an issue at that point, someone needs to remind the dr who is working for who. I absolutely know more about pca now than the primary dr who had me take my 1st psa test. He can't specialize in EVERYTHING.

Your friend's "emotional" well being is important too. A good result can rest his fears. A bad result can save his life. Sounds like a win win to me. And it without question HIS decision to make.

I hope his fears are rested.
Posted 3/31/2011 1:05 AM (GMT 0)
A PSA only costs about $40. If you get it done and your insurance won't pay for it it really is not that expensive to have peace of mind.
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