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March on with my current URO or changes horses?

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Prostate Cancer
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Posted 6/5/2018 11:04 PM (GMT 0)
My next visit with the vampire is coming up at the end of the month. The URO (surgeon) I have been treating with is about 120 miles away; my original URO is only about 55 miles away. I know that when BCR happens neither of these guys will be able treat me further. The main reason I have continued with the surgeon is for his benchmark PSA lab results. I have had a slight uptick in my PSA for the last 3 draws. Since my GP is town and the original URO is only an hour away, it would be so much easier to return to the original URO for PSA tests.

I know the first PSA lab result at the original URO’s office will be different, but it can be the new bench mark to gage the next steps. I also know I will freak out if the first PSA draw at the original URO is high, but does anyone see any reason for staying with the surgeon at this point in time?

Your input is appreciated

I really don’t have a signature block but here is the surgeon’s note from my last visit (PSA results come in after the visit)

59 y.o. male w/ high risk prostate cancer, He had a radical prostatectomy in 2015. He had Gleason 9 disease with seminal vesicle involvement. There is a focally positive margin. pT3bN0MxR1, Gleason 4+5 s/p RRP + BPLND (10/13/2015) and adjuvant radiation therapy. PSA has been undetectable. Never had hormonal therapy. He has good urinary control. Does not wear any daily pads.

Relevant PSA history: PSA 7/29/2015 6.76, 11/11/15 0.044, 1/19/16 0.041. Radiation completed Mid May 2016, PSA 5/25/16 0.026, 10/18/16 <0.020 ng/mL, 3/2/17 <0.020 ng/mL, 6/15/17 0.020 ng/mL, 12/27/17 0.026 ng/mL
Posted 6/5/2018 11:52 PM (GMT 0)
My feeling is that once you have had SRT, your surgeon is not of much use. I'd skip the long drive and get my PSA tested locally. I understand your concern about freaking if the local doc's PSA comes in higher. You could go for one last visit to the surgeon and get your PSA tested, and then the next day get it tested locally, and compare the results.
Posted 6/6/2018 12:47 AM (GMT 0)
"only an hour away" - just for a PSA test? Can't your local GP do that? As you correctly say, if you have a BCR, your next step is to see a medical oncologist - so what is the point of seeing either urologist now?
Posted 6/6/2018 2:07 AM (GMT 0)
fwiw...

I'm getting my psa's done at my pcp from now on. 3 blocks from the house. no reason to go to uro...except last week...for other reasons.....

peace out
Posted 6/6/2018 4:19 AM (GMT 0)
I would use what ever lab is close. Why are you not testing every 3 months, or did you just not post the recent results. Frequent testing would be more important to mr than which lab. Also agree with TA, You don't need a surgeon now or in the future.
Posted 6/6/2018 11:09 AM (GMT 0)
The reason I like to use the URO’s Lab is their results look more precise than the local Lab’s results. When the URO’s Lab reported my PSA as undetectable, the local lab did not. Below is a comparison of lab results.

URO’s PSA - 5/25/16 0.026, -- Local Lab 6/20/16 0.03

URO’s PSA - 10/18/16 <0.020 ng/mL,
Local Lab 12/19/16 0.05
URO’s PSA - 3/2/17 <0.020 ng/mL,


If I switch back to my original URO (there is no URO in my home town) I know his lab will be different, but his lab might be closer to the surgeon’s lab.

“so what is the point of seeing either urologist now?” I don’t think my GP’s office would continue to prescribe TRIMIX, Do you? Most of the time at the GP’s office I see the NP, not the MD and the NP is married to my nephew. So I am not even going talk about TRIMIX to the NP. I think a URO is the only one who will prescribe TRIMIX, correct?

Regarding “local treatment”, In December 2016, I had an episode of priapism and as instructed I went to the local ER. After waiting for an hour to see the MD, the MD walked in and told me he was not trained to treat priapism and that I should have drove over to my original URO’s town (an hour away) for treatment. The MD left the room and latter a nurse came back in and gave me a shot. The trip to the ER happened at midnight. I’ll trust the GP up to a point, but very few other medical providers in my home town.

Prior my PC diagnosis, the only time I went to a doctor was for stitches or a broken bone, but cancer changed everything.
Posted 6/6/2018 2:03 PM (GMT 0)
Every uro I’ve seen here uses in house labs. My gp is old school small so he doesn’t have the equipment to measure psa. Labcorp is contracted to come to his office to pull blood at certain times of the week. Your situation sounds as if it could be similar? You might ask your gp what lab they use for psa checks.

Another fwiw....My psa rose to .05 with the uro I had been using. For my next psa check I used my gp. It came in at .014 (labcorp...neighborhood gp). Now I didn’t know what was going on...so I went back to my uro (Old lab) to verify. It verified. So that’s my deal. I’ll stay with gp (labcorp) for psa checks.

But point being...if your local gp uses labcorp (which they may)...that might be an option that could save you some driving...or not.
Posted 6/6/2018 2:07 PM (GMT 0)
The gp uses a local lab that does all their work in house (at least that’s what they tell me)
Posted 6/6/2018 5:25 PM (GMT 0)
My local large hospital labs lowest score is <.1. I changed to a lab that can test down to <0.01. Labs that can test down to 3 didgets like .003 can be to variable from noise. My UROs cancer hospital says no action is taken till .2. But I like to know what is going on below .1 Anyway what I am trying to say is anything from .01 to .09 is insignificant anyway. All your numbers so far are in that range.
Posted 6/6/2018 5:38 PM (GMT 0)
ntzguy-

You have already had all potentially curative therapies, so you don't really need a PSA that is accurate to a second decimal point. What would you do differently because of the second decimal point?

Your Uro should be able to phone in renewal prescriptions for Trimix to the compounding pharmacy - it doesn't require ann office visit. In the future, keep some Sudafed around if you should have another bout of priapism.
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