Sufficient Investigation?

[Nordman]

My brother is a bit of an ostrich, over his prostate problems. He ignored his poor urinary flow for years, and despite my repeated advice which he ignored, he subsequently had to be admitted to the emergency department due to significant obstruction. His GFR had fallen dangerously to 10.

He was in hospital for 2 days then discharged with a catheter and told he was on a waiting list for a TURP. This was 4 months ago.

The only investigations he received in the hospital were a kidney function and PSA blood test, DRE and abdominal ultrasound. Since his discharge the only follow-up has been some repeat blood tests via his GP surgery, where they do not give him the results and he doesn't press them. The GP was reluctant to give him his PSA result and said it was too soon after his obstructive episode. About 2 months ago he found from the nurse taking blood that a prior PSA was 8. That is the only result he has had.

Despite being catheterised he is up 4 times every night and has to apply abdominal tension pressure to urinate into the catheter bag. He had difficulty having one catheter change because of this, and it reverted very quickly, so he has just continued with the 4 times per night issue for months, again against my advice!

Father died from prostate cancer at 82. Mother from ovarian cancer at 82.

I am concerned that he has had a limited investigation, and could have PCa. I believe he does not want to know, but he denies this.

I have repeatedly tried to get him to be proactive but without success. Am I overconcerned about this, and the doctors have been able to diagnose simple hyperplasia from the limited tests he has had, ie possibly from the prostate density ratio alone?

[KocoPr]

It’s heartbreaking to see a sibling just ignore their health when it is obvious something is wrong. I am in the same boat as you.

You can lead a horse to water…

[Nordman in reply to KocoPr]

Yes, a very apt expression.

I would like my brother to be more proactive, but I have the additional concern over whether he has had a proper investigation of his prostate in the first instance.

Given the investigative procedures for suspected PCa that I am currently going through, I don't understand why at the very least he has not had a prostate MRI.

Also, given his obvious symptoms, can they make an accurate and definitive diagnosis from just a DRE, blood test and abdominal ultrasound? IMO it seems to be taking a chance.

[lowT163 in reply to Nordman]

Fear. He knows he should.

[Tall_Allen]

When he has the TURP, they will examine the tissue for prostate cancer. It might be a good idea for both you and him to have germline genomic tests.

[lowT163]

you are right he needs to listen to you.

[Nfler]

With a Psa of 8️⃣ I would def push for an MRI biopsy, it’s def indicated. Also if they do the turp they should test tissue then as well, only concern is hope they don’t spread it during procedure as I’ve read that is a caution. Therefore would push to get MRI ASAP. Good luck n we’ll keep praying 🙏 for you…

[Jeremiad53]

Life WITH Prostate Cancer is not a bowl of cherries, with chocolate, but there is joy, and love. I can ride my bike, walk my dog, play with the grandkids. I have been nearly 7 years with stage 4, with mets in my bones. Life is good, tell him he doesn't need to hide from reality. Reality is just fine. The worrying is the worst, seriously when you let that go and understand that you have little control over bad reports, or how bad things will get. You even have no control over when you pass away. Add in, that is the same way it is for everyone. People just do not know, they think they do. They live life free and easily, because the accept that they will live forever. Why can't he do the same?