@EarlVanDorn- was the Dr. who did your PSA labwork familiar with your history infection/inflammation? As many of us have mentioned here, when a PSA is elevated, especially in a younger patient, one of the first assumptions (if the patient had been abstinent for a few days) is prostatitis, and the common intervention is a course of antibiotics and a retest after the course of antibiotics. My DH went through that several… actually many times over the past years. It wasn’t until PSA didn’t come down after the course of antibiotics, and the #s were rising into ranges that were of concern, that we went to plan B. Another cause of elevated PSAs is long bike rides. Are you a bike rider?
As an aside, one time the antibiotic he was on for suspected prostatitis was Levaquin, and at that time we were on a trip across country; he stumbled on some gravel on a slightly pitched terrain, broke his ankle in 3 places, tore the syndesmosis ligament and fractured his fibula. Now its possible the levaquin, which was later discovered to be associated with spontaneous tendon ruptures, could have been the cause, and its possible the ligament snapped first and he stumbled second. Don’t know, and no we weren’t interested in the class action suit against levaquin, even though he now has permanent hardware in his ankle (including a piece of the drill bit that broke off during surgery) and permanent numbness and discomfort in his foot- none of which are good for a long distance runner. My point in this digression is that there are risks with many treatment options. Could have been a side effect of the levaquin. Or he could have been a klutz.
And to be fair, most Drs are not going to call lab results in to patients over the weekend. So if your path report was completed at the lab by the pathologist, sometime on Weds the 27th (as you said), the results would have been faxed or emailed (can’t assume all facilities use the same EMRs so they many have to email or fax) back to your Drs office either that day or the next (Thursday), and as @jordansmom1 said, your Dr. would need to see and review the results before he/she or someone else potentially relayed the information to you. At some offices the labs are reviewed at the beginning of the day, some at the end, after all patients have been seen. So, possibly your Dr. didnt get the report until Thursday, and didn’t review it until Thursday end of day. Or, he reviews the reports in the morning, maybe it didnt come til later in the day Thursday, so he didnt see it until Friday. So maybe they could have called Friday… or waited til you were in on the next business day (Monday) for your appointment. I understand your angst, but honestly, I wouldn’t be upset with the Drs office for this if that is what happened.
BTW, that 8 year old article about the patient who used “active surveillance” back then. There is a follow- up article from 2009 where he apparently went for another opinion at Hopkins, well known to be a top facility for Prostate CA (as i mentioned earlier, many path reports are read there). I can’t pull up the article without paying, so no thanks, but I would be very curious, if he had diagnosed prostate CA 8 years , whether he has moved on to other treatments at this point. Our surgeon told us (this is from memory) that if the Gleason score goes up to 7, its time to act. No more “active surveillance”. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-watchful-waiting
@EarlVanDorn – I’m pushy and insist on getting a copy of the actual pathology report, which is easier now than it was years ago.
We dropped a doc who did a biopsy on my husband and then disappeared on vacation for two weeks. His staff refused to tell him the results because the doctor (in solo practice) hadn’t reviewed them. It was stressful for no good reason, even though the biopsy turned out negative.
I’m not a fan of the notion that only the doctor can tell you what the biopsy report means.
Disappearing for 2 weeks with no backup?? Thats inexcusable. But waiting over the weekend the results with an appointment scheduled for Monday, thats different. Some patients cancel their appointment when the get the result over the phone, when there might be something that needs discussing or addressing (like how often the patient should be monitored, what the benchmarks are, signs to watch for, discussion of treatment plans for any symptoms, discussion of potential interaction of enlarged prostate with bladder function, etc.) That should be done at the follow up appointment, not expect the Dr or whoever to do it over the phone. And no, its not just to generate a billable hour. Of course, if the patient cancels and then there is something they should have known to watch for or do and they didn’t, and there is a problem, the Dr will probably get blamed. My BIL ended up with an acute problem when his enlarged prostate caused acute urinary retention. That was an emergency, but it had been discussed as a possible event with his BPH, and he knew what the cause was and what he had to do, since it was discussed at his follow up appointment where they reviewed his positive biopsy.
We have a folder of the PSA results, the biopsy results, the MRI results, etc. Yes, the patient should take responsibility for their healthcare.
Oh, and I read further that 8 yr old article about Peter Bentley. The recommendation for active surveillance was made at by the doc at Hopkins, as back then that was a relatively new treatment approach. So the 2008 and 2009 articles were about the same 2nd opinion at Hopkins. Now that approach is pretty commonplace for non-aggressive, non-symptomatic, contained prostate CA.
They are not supposed to consider monetary cost. They are only supposed to consider medical benefits and risks in the patient outcomes.
Of course, throwing in monetary cost makes some screenings and procedures even more dubious. Both as individuals looking at our own health and taxpayers subsidizing socialized medical insurance for some (Medicare), do we really want to waste a lot of medical care dollars on procedures of dubious value? Medical care consumes a huge portion of GDP in the US compared to other rich countries, and the cost keep rising. Do we really want to spend medical care money on wasteful care? Note the other thread where complaints about the high cost of medical insurance are made: http://talk.collegeconfidential.com/discussion/comment/19252653/#Comment_19252653 .
I think getting biopsy results over the phone can depend on the doctor and the situation. DH went in for a biopsy on his thyroid. The doctor didn’t wait for the follow up visit in a week. He called him at home on a Thursday night to tell him he had cancer and needed to make an appointment with a surgeon asap. DH was able to call the next morning to schedule an appointment. He has his surgery pretty quickly and has been cancer free for a year. Could the doctor have waited the week to tell DH? Sure, but I am glad he didn’t. I believe there are a lot of doctors who do the same sort of thing.
Yes, as consolation points out, 4+3 is worse than 3+4 on the Gleason scale, but IIRC, DH’s surgeon commented that research has shown that pathology reports after surgery have frequently found that Gleason 6’s were in fact 7’s, as the cores are only getting select samples within the prostate.
And this is a thread about prostate CA. Lets please not get off topic about healthcare costs. As was pointed out, there is another thread for that.
Glad your DH is doing well, michigangeorgia. And yes, if there is an urgency with a positive lab result that gets the patient referred to the surgeon quickly, of course thats an appropriate thing to do.
I think it all depends on the circumstances. My physician got my biopsy results on a Friday afternoon, and saw no need to call me and tell me when there was absolutely nothing I could do over the weekend, but worry. So he called me first thing Monday morning and gave me the name of a surgeon, I called and was able to get in that afternoon for a consultation. My physician had my records sent over so the surgeon would have them when I met with him. I am so glad he did not call me on a Friday afternoon - absolutely no good would have come out of it.
I’m going to be very delicate in what I say here, but everyone on this board is in transition from middle-aged adulthood to senior. As we all get older, a very slim minority here is going to escape the reality of having diagnostic testing done at some point - for some it will come more often; for others, very rarely. But it will help your peace of mind if you go into these testing situations/biopsies assuming everything is going to be OK. I’ve been having biopsies since my early 30s due to thyroid issues; and of course, being a female, I had yearly pap smears/blood work, etc. I have had several breast biopsies (cluster of breast cancer with maternal cousins) as well as biopsies of the lining of my stomach when I’ve had upper endoscopies; then there’s been the skin biopsies due to moles and a history of melanoma in my father. In all that testing, once have I ever gotten that phone call that no one wants to get. After reading this thread, I’ve realized that all that experience has taught me that it’s (whatever is being biopsied) usually nothing and not something to allow yourself to get worked up over while you’re waiting. Go about your life and believe that no news is good news. Yes, I’ve been able to do that in the almost two years since having a cancer diagnosis, so if I can do it (a very anxious personality), anyone can do it. It just does no good to put your life on hold while waiting because if you do that, as you age and more of this stuff comes up, it will eat you inside and out, worrying.
Honestly, the day I got that phone call, I had so put out of my mind that I’d even had a biopsy done that, for an instant, I couldn’t figure out why my doctor’s office was calling. Whenever I’m having something biopsied, two days later I usually can’t remember how long they even told me it would take to get the results back.
The worst week of our lives was in 1987 waiting to hear whether my H’s testicular cancer had spread. On a Monday we were told that we’d hear something by Friday. We were sitting on pins and needles all week and my husband wouldn’t call until late Friday afternoon to find out why we hadn’t heard anything. They nonchalantly told us that it hadn’t spread. Good news but we wonder how long they had known and when they planned to let us know. His prognosis and future treatment all hinged on whether there was metastasis.
Conversely, I was called by my doctor immediately after having a thyroid biopsy and told to come in that afternoon. It makes a big difference to minimize waiting and worrying.
I did some lawyer advertising a few years ago (yes, I know…) and signed up a products liability client who had been diagnosed with cancer. Her biopsy was in March. In July, the surgeon who performed the biopsy sent her a letter from another state informing here that she had bladder cancer and should see an oncologist. She was mad and I was mad just hearing about it.
Well, the MRI machine broke yesterday! So DH waited and waited for them to fix it, as he couldn’t easily reschedule again without having to reschedule 2 other appointments again.
A friend of mine has a lump in his neck. He has had it for a few months. Finally went to the doctor. He had an ultrasound. Then a CT scan. Now the doctor wants to do a biopsy. The biopsy is scheduled in three weeks. Seems like long time to wait to me.
If after an ultrasound and a ct scan, doctors want to do a biopsy, are the doctors seeing something in the scan?
Hope he was able to complete his scan @jym626. The way these appointments line up, as well as how relevant the results are, makes one eager to stay on schedule.
Had to wait all day. Missed several business appointments. Had a headache from having to not eat all day and the dye. And had to stay well hydrated, which is a challenge for a person with prostate issues
BTW, Dstark, DH’s urologist shared with us that when they asked staff, in front of the patient, to schedule a radiological study (CT/MRI or whatever) that they had different “code words” that indicated the urgency of the exam without upsetting the patient. If a dr on the phone says they’d like you to get one scheduled, and it is scheduled in 3 weeks, that sounds less urgent than “let’s call immediately and see if they can fit you in”.
Some of the “code words” were not all that difficult to differentiate. I cant recall the specifics, but it also included things like “First available” vs “next” etc.
