Primary care doctor's opinion

[hwrjr]

I met with my new primary doctor today for the first time. My previous Primary retired in June after being my doctor for 40 years. We discussed my chart including 2 cancers, prostate and appendix. I completed Proton for the prostate in early 2015. My PSA had some bounces along the way, reaching a Nadir of .75 in jan/2017, but has been up and down a bit since with the latest number at 1.02. My local urologist who I see every six months thinks it’s most likely prostatitis and the RO who treated me at UFPTI doesn’t seem concerned either. He reminds me of my prostatitis history also. The RO said he wouldn’t be concerned until it’s 2.0 over nadir. In fact, he said no testing is approved by insurance until the ASTRO definition is satisfied.

After the exam concluded and the new doctor summarized the key points from our meeting he surprised me by saying he thought I had probably beaten the appendix cancer thing. He said he would be more worried about prostate cancer returning than the appendix cancer since the PSA had been erratic and is now at 1.02 after 6 years. I reminded him of the ASTRO Phoenix definition of BCF but he said nevertheless the readings would be of a concern to him.

Until today I had not worried much about the increases. As I said neither of my prostate doctors seem concerned. Maybe that’s just their routine answer to patients like me rather than speculating on the negative.

Anyone have an opinion of these PSA readings and the concern of the primary doctor today?

Here is my signature:

Age 69 DX 06/14 1 of 24 cores positive, 5% involved, (3+4), psa 6.2

2nd opinion from JH (3+3)

3rd opinion from UFPTI (3+4)

mpMRI Duke: 50% chance of SV spread

SV fusion biopsy Duke 10/2014 negative

proton at UFPTI 11/14-01/15

PSA:

07/15 2.5

01/16 1.3

07/16 2.6

01/17 .75

01/18 1.41

04/18 .76

07/18 .85

01/19 .79

01/20 .92

02/21 1.02

[Tall_Allen]

I think your PCP has opinions about things he is unqualified to have an opinion about.

[WilsonPickett]

When my PSA started rising, I was keeping track of it with my PCP. After it went up to about 4.3 we talked about the possibility of a biopsy and he said “you want to try and avoid a biopsy, they’re a bloody mess”.

Needless to say I got the biopsy and it was not a bloody mess. Now I have a new PCP. Internists are the coffee shop of medicine. You don’t go to the coffee shop for Omakasi.

[dadzone43 in reply to WilsonPickett]

Well, not all of us. 😷

[Magnus1964]

I don't think your primary care doctor knows what he/she is talking about.

[hwrjr]

I had my semiannual checkup with my urologist this week. He looked over my PSA numbers since 2015 and said I was stable. I asked how can you say I'm stable when I've had 2 consecutive increases since 2019? Those increases are meaningless, he said. If you had had surgery it would be different , but you still have a prostate and a long history of prostatitis. I'm very comfortable with your PSA he added. You dont have prostate cancer. He then reminded me that I was a Gleason 6 with 5% involvement from one core of 24 biopsy samples as if to strengthen his argument.

Then I mentioned the remark from the PCP and the urologist said I wish he hadn't said that. He said I know you worry about a recurrence but you shouldn't. I'd like to drill a hole in your head and let this unnecessary worry leak out.