Another "controversial" post????
To: Prostate Problems Discussion <PROSTATE@MAELSTROM.STJOHNS.EDU>
From: Hubert Few <hfew@atl.mindspring.com>
Subject: [Circle] All or Nothing?
Cc: circle@rattler.cameron.edu
Sender: owner-circle@rattler.cameron.edu
From: HELDER EN KLAAR <hj.scholten@TIP.NL>
>>>As some of you know I am certainly not a proponent of
PSA testing in symptomless men, because of its propensity
to track indolent disease. <<<<
Ok, I'm 42 years old, see how the above applies, or doesn't apply to me.
This is indeed a difficult issue to address. My first PSA test was added to my routine blood work by my primay care physician *without* my knowledge.
I got the news of a "high reading" (they didn't bother to tell me *how* high, or that PSA did *not* necessarily indicate PCa) and an urgent recommendation to see a urologist. (it was 15.2) Well gee, it seems the urologist was booked solid for 3 weeks, thus began the "WW" (worrisome waiting) portion of my diagnosis.
Meanwhile my employer saw fit to change HMO's (going from a choice of 3, to a choice of 1, a new one)
Thus delaying my diagnosis further, and adding to the stress of the situation.
After going to a *new* primary care DOC for a referral, and another week delay for appt. with Urologist, I was asked "why am I seeing you today? (uro speaking)
"Well, I have this high PSA reading" (confirmed by second test, at my
request by my new primary care physician =14.4) "Ok, let's have a look" (my *FIRST* DRE EVER was performed at that point.) His only comment was "it's a little firm".
He later did an ultrasound needle biopsy of 4 cores. Results: 1(rt.apex 100% involvement 3+4 gleason 7 "moderate differentiation, adenocarcinoma) 1(rt.mid 75% 3+3,6, ditto) 1"minute focus", 1 benign tissue.
There is no question in my case this doctor would have missed my cancer were it not for the elevated PSA, which incidently, he shook his head and questioned why someone under 50 was even *given* the test at all.
So, a couple of things come to mind. First, if a physician advises a patient to have a PSA test done, (remember, nobody *asked* me if I wanted it done) it should be fully explained what the implications are, or *AT LEAST* given comprehensive literature which explains that a high (or borderline) PSA does *NOT* always mean cancer. Conversely, it should be explained that a PSA test won't accurately predict *all* prostate cancer (per my understanding)
>>>>> Many times one reads about
strange discomfort in the groin area and undefined
vague testicular pains, <<<<
This describes my "symptoms", I had (have) intermittent mild pain in my right testicle, and some urinary dysfunction which I thought *nothing* about prior to being diagnosed with PCa.
>>> The question is (concerning PSA testing)
how frequently. I suggest that to construct a
meaningful curve you need at least 4 readings a year
and preferently even more.<<<<
And in the mean time? I see guys getting all worked up over readings of <4, here my reading was 15 and I did not have a *clue* as to the significance, how would you have handled this scenario?
So, admittedly I am biased. The *only* reason I had that test at all was because my first doctor, dumbass that he was otherwise (*he* never gave me a DRE in 8 years of going to him) probably was glancing through an AMA journal and thought "Hmmm, that sounds like something I should be doing".
Some past "good advice" from the above doc included him phoning me in a prescription for a "cholesterol lowering" drug that I since learned was to be used only on people "unresponsive" to dietary measures with a reading of over 1,200.....mine was a whopping 225, and the test was taken without any "fasting" since they did not tell me I needed to. I didn't take the damn drug, had no intention of taking it without reading up on it first. BTW, in two weeks time my cholesterol level was lowered to 170 just by limiting my intake of animal fat.....duh, a no brainer, eh????
I dunno, my "luck" in this case is a mixed bag, but I am afraid it probably points to a bigger problem.....poor education on PCa on the part of both primary care physicians *AND* their male patients.
I *STILL* do not have the results of my DNA "ploidy" tests, and I have
already undergone a surgical lymph node removal and Iodine-125 seed
implants....do I *want* to know the results of the ploidy tests??? (I ask this in all seriousness)
So, you got to remember what kind of "competent" doctors you are dealing with out there. I'm sure they exist, but depending on "luck of the draw" or the mandates of one's HMO is a piss poor way to reasonably expect "adequate and informed" medical care!
>>>>All or nothing? I think not. There must be something
in between, I don't see it yet but maybe someone has
a suggestion.<<<<
On this I whole-heartedly agree. I would suggest scrapping the whole
regulatory process for primary care physicians, give them competency tests with the results *CLEARLY* displayed in the lobby of their practice, you know, like they grade sanitation conditions in restaurants!
Oh, but they're *FAR* too busy and self-important to be "inconvenienced" by such rigorous testing, Hell, they might miss a round of golf, or worse yet, miss referring patients to clinics that they have a financial interest in! (Ask me about my knee surgery sometime)
Did I say that? Damn, and I was trying so hard not to be "controversial".
Regards,
Hubert
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