Prostate cancer detection

[AlanP233040]

Prostate screening: what your primary care physician may not know

I have recently been diagnosed with an aggressive form of prostate cancer, treatment to follow which, in my case, will include hormone therapy and radiation. This diagnosis was a surprise: the presence of an aggressive prostate cancer is statistically unlikely at my older age. However, it is possible—and now I have a good chance to, if not eliminate, at least control this cancer. This is due to my curiosity, not a primary care doctor’s recommendation.

Much has changed in prostate treatment in recent years. Prostate-specific MRI imaging is now in wide use, and a new biopsy technique greatly reduces the chance of infection, historically a reason to avoid biopsy. Statistically, many men will get a form of prostate cancer (rates vary for different demographic groups). Less aggressive cancers may only require monitoring, while others can require treatment—surgical, hormone, radiation, or chemotherapy.

The prostate-specific antigen (PSA) blood test has been the primary diagnostic tool, but because PSA is not a reliable indicator of cancer, the next available step has always been a biopsy. A few years ago, during my annual physical exam, the physician recommended not “bothering” with the PSA test. “We now recommend that men over a certain age” (mine) “not get this test; even if you have prostate cancer you are likely to die from something else first,” was the explanation (not testing saves costs too). I didn’t accept this reasoning—genetic longevity runs in my family so I might not die from something else first, and I was curious—so I insisted on the test.

My PSA was 4.8, and while that could be seen as high, it was only slightly higher than previous tests. My thinking was that I could ignore it, and the doctor said nothing. My next physical, by a different physician, showed a PSA of 6.3. This doctor also said nothing, but this time, I booked an appointment with a urologist. This doctor ordered a prostate-specific MRI scan—paid by Medicare, based on the physician’s assessment that my PSA warranted further diagnosis. My scan indicated a high likelihood of cancer, so I had a biopsy (paid by Medicare), which confirmed I had an aggressive form of cancer (test criteria, Gleason 9).

The prostate-specific MRI scan is a diagnostic game-changer. It’s been in popular use for several years, yet neither physician performing my physicals looked at the PSA and suggested an MRI, or that I should see a urologist (both physicians work at two large NYC teaching hospitals). My curiosity about my PSA level is the only reason my cancer was found. The urologist knew what to do, but neither primary care physician (nor any of my friends) were aware of this MRI option. My experience indicates more people need to know about this issue.

[jazzgitbox]

I just had a DRE yesterday. It’s with a new primary care provider.He ordered the most comprehensive blood work I have had in years. Urinalisys as well. He did not order a PSA. The blood work was done before he saw me in the exam room. He was way old school down to the wooden tongue depressor and “turn your head and cough”. He said he felt some inconsistency on one side of the prostate and that he was ordering an MRI. I am African American and will be 62 next week. It makes sense. I guess he saw my slight worry and made sure that I knew he was not calling it cancer yet. But it won’t be on his watch and go undetected. My PSA last year was .05. My blood work came back witt everthing in normal range and my BP 116/65

I appreciate your post. It eases my concern some.