audreyh1
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Great and important story and thanks for sharing.That's Public Service Announcement: on Prostate-Specific Antigen, or PSA testing.
I have a five page summary of my research, I'll spare you all that. I read all I could, but discounted everything that was not from the Cleveland Clinic, Mayo Clinic, Sloan-Kettering, American Cancer Society or National Cancer Institute. What follows is based on my unqualified findings. I was an Engineer, not a Doctor. If a medically trained member wants to correct my understanding, that's welcomed.
Background:
For those not familiar. The PSA test measures the blood level of PSA, a protein that is produced by the prostate gland. The higher a man’s PSA level, the more likely it is that he has prostate cancer. A reading from 0-4 is considered a normal PSA reading (though I learned that's a very generic range that's subject of considerable debate). "PSA velocity" or rate of change from test to test is also (understandably) considered an indicator.
My case:
In Dec 2012, my PSA was 1.8
In Dec 2013, my PSA result was 4.38
My GP referred me to a highly regarded urologist (first available appt 6 weeks later). They took a urine sample and he examined me for 5 minutes. Though I had no other symptoms or history, he scheduled a prostate biopsy, a painful procedure followed by days of blood in urine/stool and risks of infection. Prostate biopsies can come back inconclusive, and a urologist might recommend repeating the procedure as a result. As I had researched PSA testing and prostate cancer while waiting for my appt, I asked the urologist 'biopsy is painful and presumably expensive, would retesting PSA first be a good idea?' With no hesitation he said 'a retest wouldn't change my result,' and he added 'I have no idea what a prostate biopsy costs, but your insurance will pay for it.'
Having read that among about a dozen factors, a DRE (digital rectal exam, sorry) and sexual activity 24-48 before the blood draw for PSA could temporarily elevate the results. Of course I wasn't aware of either when the blood draw was taken, only learned after the fact. My GP did the DRE about 20 minutes before my blood draw.
A PSA test can cost less than $50. Prostate biopsies range from $1,000-$12,000 according to online sources FWIW.
I talked to our health care provider through their "ask a nurse" program, they thought a PSA retest was reasonable.
It's not lost on me what the underlying motivations of the various parties involved may be.
I called my GP to request a PSA retest. The nurse was surprised if not put off at my request, asked a lot of questions and discouraged me, but said she'd talk to the doctor. A week passed and she finally called and said they'd ordered a PSA for me. I went yesterday for the blood draw.
The nurse called me this morning, my PSA yesterday was 1.37. She was very surprised!
So I cancelled the biopsy. The scheduler didn't ask me why...
My intended bottom line here:
There's something to be said for patients taking a respectful role in their health care decisions. My point was not to highlight my case. I am sure some doctors rue the day the internet made so much health care information available, though I am sure others welcome patients who try to educate themselves as long as the patient respects the doctors knowledge and experience.
It's a good thing I'm not easily traumatized, some people might have suffered considerable anxiety being led to believe they might have cancer for almost three months. Unfortunately DW was more worried than I was, she's relieved this morning...
FWIW guys.
This part really bothers me:
With no hesitation he said 'a retest wouldn't change my result,'
First of all that the doctor dismissed a (cheap) retest, and instead insisted on an expensive invasive procedure with some potentially nasty side effects and yet a possibly inconclusive outcome. And clearly he was completely wrong about this.
I really dread dealing with doctors on issues like this, and it seems there are so many of them. It's more than "being informed" - you sometimes end up really having to fight for yourself - and you're the layman. You are forced to second guess your doctor. I can see many patients backing down and just doing "what the doctor ordered". What happened to "first, do no harm"? Something is way screwy.