What Typically Happens on the First Visit to a Urologist?

I shared my situation last week here:
https://www.healingwell.com/community/default.aspx?f=35&m=4161449

So, what usually happens on your first visit to a urologist? They said to get there 15 minutes early so I’m sure there’s a lot of paperwork but what comes after that?

Is the DRE performed on that first visit? Is there any prep required for that? Or is more blood-work to confirm the PSA count usually performed before a DRE takes place?

If the DRE does take place, I’m assuming the doctor would then immediately recommend a biopsy if he feels there’s an abnormality. Or do they sometimes recommend some type of scan (MRI?) before a biopsy?

I’m trying to steel myself for a cancer diagnosis. I just would like to know as much about what will happen on that first visit as possible.

Thanks!

Post Edited By Moderator (Pratoman) : 11/4/2019 6:55:33 AM (GMT-7)

Jason,

It's stressful, to be sure. Please try not to project too far.
At this visit, yeah, there will be paperwork. After that, you will most likely meet the doc--or maybe an NP--who will go through your records with you. You'll have a DRE, which is no biggie. If you've never had one, you drop trou, lean over the table, and the doc or NP will roll up on the stool behind you, put a glove on, add some vaseline or K-Y, and tell you to take a deep breath. It doesn't usually take more than a minute. They'll give you some kleenex to wipe with, and then back on the chair or table for more conversation.

Likely they will recommend a biopsy and schedule it--it usually will be within a few weeks or a month. For THAT, they will give you prep instructions. They may also suggest--if they found a lump or something else abnormal--having an MRI first.

Feel free to ask plenty of questions--and be wary of any Urologist who proclaims that you have cancer without a biopsy. Also be aware, that at your age, you probably DO have diagnosable PC--but your odds of having PC that is dangerous is pretty low.

halbert said...
Jason,

It's stressful, to be sure. Please try not to project too far.
At this visit, yeah, there will be paperwork. After that, you will most likely meet the doc--or maybe an NP--who will go through your records with you. You'll have a DRE, which is no biggie. If you've never had one, you drop trou, lean over the table, and the doc or NP will roll up on the stool behind you, put a glove on, add some vaseline or K-Y, and tell you to take a deep breath. It doesn't usually take more than a minute. They'll give you some kleenex to wipe with, and then back on the chair or table for more conversation.

Likely they will recommend a biopsy and schedule it--it usually will be within a few weeks or a month. For THAT, they will give you prep instructions. They may also suggest--if they found a lump or something else abnormal--having an MRI first.

Feel free to ask plenty of questions--and be wary of any Urologist who proclaims that you have cancer without a biopsy. Also be aware, that at your age, you probably DO have diagnosable PC--but your odds of having PC that is dangerous is pretty low.

I'm thinking that's it's very likely that he will find something during the DRE that is abnormal but on the off chance my prostate seems to be normal, do they ALWAYS recommend a biopsy regardless? If so, I'd be inclined to think that I'd want to see the results of the follow-up PSA blood-work before a biopsy is performed.

Also, when you say 'my age', do you mean because I'm 47 as against being in my early 40s?

Thank you!

Post Edited (JasonB176) : 11/4/2019 8:32:49 AM (GMT-7)

"I would never volunteer for a DRE, but it's not terrible, either."

I was very unhappy about submitting to my first DRE. I have to laugh to myself when I think about now.

All of the above. Good luck with your visit and try to stay calm. The first visit is pretty easy since nothing is known at that point and the doctor's usually let you know the options and that the decisions are up to you. It will either make sense to you or visit another doctor to get another opinion. At some point, you will get the general idea of what to do next and do it.

I started having DRE's at annual physicals years ago since my Dad has PCa and had them for other things over the years. They are a little uncomfortable but do not hurt and are over quickly. If the urologist feels something, he will tell you and may suggest a biopsy given family and odd PSA history. You can suggest the MRI if it is not mentioned. You make all decisions and can make any suggestions you want. The doctor will let you know if they are a good idea, covered by insurance, etc.

Michael_T said...
I had missed your earlier thread that you had linked to. FWIW, several guys in their 40s with lower PSAs than yours posted about their diagnoses. I can see how that can lead you to think the worst. (As per your, "I'm steeling for a cancer diagnosis.")

But...keep in mind that we're not a representative sample on this forum. There are lots of guys with your numbers that had negative biopsies and had no reason to hang around here anymore. And keep in mind that most biopsies *are* negative.

I know this is easier said than done, but I'd just try to take it each day and not fixate too much on a worst case scenario at this point. I hope you have a productive Uro appointment and wishing you best of luck as you go through this.

You’re right – I did take those replies from men in their 40s and basically assume that I’m almost guaranteed to have cancer. You make a good point, however, about the sample not being really representative of the whole male population with PSA concerns in their 40s. Those not diagnosed wouldn’t tend to hang around.

So, what if both the DLE and a biopsy don’t indicate cancer but a retest of my PSA still shows it around the 3.3 value? What then? Watchful waiting? I can’t imagine treatment would be prescribed but I have no idea.

Thanks.

This may have been covered in your previous post responses but always make sure you behave a few days before PSA tests, no sexual stuff or riding bikes or anything else reported to affect PSA values other than PCa.

Jason, what I meant is a statistical reality: Your odds of having a positive PCa biopsy is roughly equivalent to your age. At 50, it's 50/50, etc. HOWEVER, the vast majority of PCa diagnoses are low risk or very low risk--which means you keep an eye on it and act later.

Others have pointed out that with your PSA history it's entirely likely you'll get more antibiotics to take and a retest in a few months. The really important concept to grasp is that PC is characterized by slow, steady PSA rises over a period of time....measured in 6 month or year increments. In my case, over a 4 year period my PSA went from <0.1, to 0.5 to 1.0 to 2.0 to 4.3. Infections tend to cause big bounces both up and down over time.

Thanks everyone for your helpful replies. I will report back after I've had the appointment.