Hi There!

My name is Vincent. I had an open radical prostatectomy in 2002. I was diagnosed at age 33. My family history is very strong. Prior to my diagnosis I worked in finance and private equity for 14 years. After my diagnosis, I decided to become a doctor and just completed my internal medicine residency in 2013 after a multi-year journey through a PostBacc program and medical school. It was fascinating to get to 'go behind the curtain' after having been a patient. I am now a primary care physician. Oh the places you'll go!

[MikePollard]

Wow some story. Congratulations!

[Hidden in reply to MikePollard]

Thank you Mike. It has been an amazing ride.

[Chubby42]

Well done m8 congrats

[Hidden in reply to Chubby42]

Thank you!

[jshp2013]

Welcome Mr.Vincent. I hope, Your experiences and expertise will help this family of forum members. Can you suggest some treatment and medications for prostate enlargement.

Regards.

[Hidden in reply to jshp2013]

Medications for benign prostatic hypertrophy are usually alpha-adrenergic blockers (e.g. tamsulosin [Flomax]), 5-alpha-reductase inhibitors (e.g. finasteride [Proscar]), and various combinations.

See: emedicine.medscape.com/arti...

[JoelT]

Welcome Dr. Vincent. Given your medicsl history abd that you are a primary care doctor I am wondering if you recommebd PSA tests for your patients?

[Hidden in reply to JoelT]

Hi Joel - Always an interesting topic and one of my primary clinical interests (obviously ). The USPSTF (United States Preventative Services Task Force) and the AUA both looked at the same two studies in order to come up with their recommendations. I have opted to follow the AUA recommendations for PSA screening - PSA test every TWO years from 55-69, with modifications based on family history or patient preference. The USPSTF went WAY to far in absolutely discouraging PSA. What they need to discourage is overtreatment.

The problem with the data is that we are looking at really two different diseases and mixing them together. One disease is the aggressive form of prostate cancer and the second disease is the indolent form. Allow me to use some rough numbers for illustration - of all the men diagnosed with prostate cancer, let's assume that around 20% have disease that will kill them, the remaining 80% men have a slow growing cancer that will not affect their mortality.

When you then ask if screening this group will improve mortality - the benefit of screening is blunted as 80% of men were never going to die from their disease and screening would never do anything for them. However, the benefit to the 20% with mortal disease is huge... but how to find them? Through watchful waiting, active surveillance or genetic testing of tumors we will hopefully be able to identify the 20% while we still have time to intervene, while at the same time sparing the 80% of men who have disease that will not affect their lifespan.

[JoelT in reply to Hidden]

So, Have you had problems getting insurance reimbursements for the PSA tests that you run?

[Hidden in reply to Hidden]

I hope you don't let your patients slide by without a DRE. My PSA was in the normal range at 2.7. The DRE turned up a very palpable tumor which ended up being gleason 8. I was diagnosed a few months ago and treated a couple of months ago, age 66. BTW, when will Medicare add a code for HIFU?

[Hidden]

Nope.

[Darryl Partner]

Hey there! Glad you are here. Hope all is well.

[Hidden]

Hi Darryl! Chugging along here..... Good fun☺ Hope to see you soon.

[Magnus1964]

Diagnosed at age 33, I thought I was a goner when diagnosed at 42. But 23 years later I am still here and doing well so far.

[Hidden]

Ummm you look familiar to me. I am happy to hear how well you are doing and best of luck.

Bill Manning