When Active Surveillance is not Active

[Aussieguy1]

Hi

I would like to share the experience I had with my new GP yesterday regarding requesting a PSA three months within my last test.

I requested the testing because my last PSA had slightly elevated to 6.6, my latest MRI has reported the finding of a new area in the mid zone of my prostate as a PIRADS 4 to accompany my existing PIRADS 4 diagnosed in 2019. I am awaiting a second biopsy within the public system of South Australia.

I have recently moved to rural SA from Tasmania where I was under the guidance/care of a urologist. Who diligently performed Active Surveillance protocol for my diagnosis of a Gleason 6 adenocarcinoma.

Anyway you would have thought by this GP response to my request that I was asking him for half of his weekly earnings. He wanted first for me to answer what difference it would make to my current treatment outcome, why would I be wanting to be tested for a PSA test three months from the previous testing and what was I expecting to gain from knowing the results as I was awaiting a second biopsy anyway.

Do other people on this forum feel that my request was unreasonable, I am under the opinion that changes indicate a three monthly PSA check under active Surveillance. Six monthly if all is good. Am I wrong in this assumption.

The outcome was he gave me the referral for the PSA test reluctantly. He stated to not ask again for at least 6 months, which I advised him I wouldn’t if it remains the same or lower. He asked me what will I want if it’s elevated more so, I said a PSMA pet scan if it ever reaches 10 or higher, hopefully not.

I left his office feeling anxious, humiliated and not advised. Has anyone else had this problem with monitoring? I thought Active Surveillance was meant to be Active. I will not be returning to this practice

My urologist here is in Adelaide 2.5 or so hours away, he will be performing the second biopsy on the 7 March. Do I just forget about PSA testing?

Thanks if anyone has any guidance or anything to offer as insight.

Ian

[Tall_Allen]

You will know more at your next biopsy. That is what is important.

[Aussieguy1 in reply to Tall_Allen]

Thanks Tall_Allen

Your right of course. I am just pissed at the way the General Practitioner acted towards me. He displayed not one iota of understanding or empathy towards my anxiety regarding the other area of PIRADS 4 which had previously not been discovered in my last three MpMRIs.

I know that the biopsy will offer the answers I was seeking and assist in the decisions making process regarding ongoing active Surveillance or treatment. But I was still wanting an PSA test to keep a check on things. I was still wanting some guidance, I was still wanting some reassurance and expertise from a health care professional. He offered none of these things.

Not to worry as I’ve found another GP who did offer all of those things, plus who was happy to take over my care.

[Nerka in reply to Aussieguy1]

Good for you! I just fired my GP who I saw once. Everything was about him and not me. First doctor I ever wanted to pan using the online reviews. Still angry. I have had some great specialist and some OK GP's. I will say that finding a good GP is much harder to find then finding a good specialist.

[Aussieguy1 in reply to Nerka]

I agree it is difficult to find a good GP. Luckily I have. I thank my anger with the previous one because it motivated me to be pro active.

It is still wrong though that some health care professionals treat you like a number. I understand that they are busy, often under the pump and see many clients in any given day. But if you have lost your empathy and your bitter with the position you find yourself in then perhaps it’s time to do something about it, not take it out on your patients.

I’ve since had my second biopsy, awaiting results. The urologist was great taking the time to answer all questions on the day. I was given a general anaesthetic, it was trans perineal and all other staff whom I came into contact with on the day were fantastic, their are some tremendous people working in health care.

Unfortunately this particular GP is all that you expect from a GP with no bedside manner and lots of arrogance. But I don’t have to worry about him anymore.

Thanks for your reply. Take care. I hope you also find a great GP.