Doc says "Nothing to worry about," Trust Him?

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New Member

Date Joined Feb 2011
Total Posts : 2
   Posted 2/9/2011 5:56 PM (GMT -6)   
Hi guys, thanks for a great resource!

I'm a 57 year old healthy guy. I exercise six days a week, including long bike rides, and weigh 156 lbs at 5'11". I had some prostatitis 10-20 years ago, and it seems to come in go but in a very mild form. I've never had a PSA test. When I had a colonoscopy a few years, the doc noticed some prostate enlargement.

Recently I've had some episodes of very slow start when peeing. Once every few weeks, I'll get up to pee an hour or so after dinner, and it's "Whoa! What's going on?" I don't show any other symptoms, except perhaps some slight discomfort there occasionally. I usually go through the night without urinating.

I went to see my GP with a few complaints, and mentioned this. His response was, and I quote, "Oh, that's just from all the bike riding, we see it all the time." Then he rushed off. No digital rectal exam or other comments.

Note that the biking is nothing new, and I have a split seat that puts no pressure on the perineum.

So, should I:

1. Trust that if the doc isn't concerned I shouldn't be.

2. Go back to the doc and insist on further investigation.


3. Go to a urologist for further investigation.

Thanks for your help!


Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 2/9/2011 5:59 PM (GMT -6)   
He already made errors, age 57 and no psa testing yet, nor DRE  and added those background mentionables. Dr. Strum would have slapped the guy (LOL).

See a decent urologist and always question anything in medical things.    (both good for basic info on all urinary issues)

Post Edited (zufus) : 2/9/2011 4:03:12 PM (GMT-7)

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 2/9/2011 6:01 PM (GMT -6)   
Hello and welcome, Al

If you are 57, you should be getting an annual PSA test and DRE (Digital Rectal Exam). Many of us with PC never have any symptons before our diagnosis. You should have that done as soon as possible, if nothing else, to establish a base line for future tests.

My long term GP, inisisted that I begin both tests at age 50, along with my wife's prompting (she's a nurse). By age 56, I was fullly diagnosed with PC, with no symptons whatsover and feeling healthy.

Good luck and keep us posted.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Regular Member

Date Joined Aug 2009
Total Posts : 374
   Posted 2/9/2011 6:05 PM (GMT -6)   

Hi Al, and welcome to the forum. First of all, at 57, and having never been tested for a PSA baseline, you should do so promptly. The standard adage is that all guys should be tested starting at 50. Sooner if you have a history of prostate cancer in your family, or if you are of African American descent, etc.---I'm really stunned that your doctor wouldn't at least do a DRE when you complained...........I'm sure I'll be backed up by the rest of the members here, but please find a doctor, be it GP or urologist, who will order a PSA blood test and give you a DRE. You need to find out where you stand, whether or not you have suspicion of cancer or not. It may just be BPH and/or prostatitis, given your history, but you need to know and address accordingly.

Arnie in DE


Age 56 (biopsy & surgery)-PSA-3.9-Biopsy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3) 1/26/09-DaVinci Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA-Dr. David Lee
Path. Report- G7 (3+4)Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins
Continent at 3 mos.------ED improving
PSA at 2 yrs-<0.1

Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 2/9/2011 6:25 PM (GMT -6)   
Al, your doctor is likely making a good call --- for him. For you, perhaps not. Chances are remote that you've got a problem, but at your age you should have more real data to assure you of this than your doctor's opinion, as excellent and as well founded as it may be.

I encourage you to have a PSA and a DRE. As you can see below, I had a low PSA, and no lump evidence on a DRE, although one side was said to be enlarged. Because of a family PCa history my doctor sent me to a urologist who, when he looked at my PSA said, "What are you doing here!" But, he too was of the cautious sort and because of family history did a biopsy. He was surprised it showed cancer. I wasn't thrilled, but a heck of a lot happier to know it was there and treat it, than to not know it was there and not treat it.

I tell you the above as an example that cautious is good. Go do the cautious thing and then I hope you'll report back.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02

Forum Moderator

Date Joined Jan 2010
Total Posts : 7087
   Posted 2/9/2011 7:02 PM (GMT -6)   
I did not have a PSA until I was 56. It, with the resulting biopsy, found that I had very advanced PCa.
Go get a PSA. Period. Don't make the errors I made.
DaVinci 10/2009
My IGRT journey (2010) -

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2461
   Posted 2/9/2011 7:23 PM (GMT -6)   
I don't wont to scare you but you shouldn't take your doctors word on this one. At 57 you should get a PSA test and a DRE. Make an appointment with a Urologist as soon as you can.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21 months) undetectable
Latest PSA test (2 years) <.008 ?

Forum Moderator

Date Joined Sep 2008
Total Posts : 4276
   Posted 2/9/2011 7:29 PM (GMT -6)   
Coasting, I agree with the previous replies.  IMHO this is a serious breach of protocol from your physician.  I would probably fire him and find another PCP.  In the meantime I would suggest consulting a urologist.  The urologist will definitely give you a PSA test and do a DRE (hopefully in that order).  He will also probably tell you that you need to have these done annually by a competent PCP.
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:

Veteran Member

Date Joined Jan 2010
Total Posts : 2845
   Posted 2/9/2011 9:31 PM (GMT -6)   
you have got some nice support here
- just remember - BEFORE THE PSA BLOODWORK - to have 2-3 days with no prostate activity - no sex - with partner or by self; no bike riding - horseback, etc - any activity that can create a false positive... and no DRE before bloodwork - bloodwork first then the DRE....

-this is a great avenue for information that can calm the fears and give information to help you take control of your body -
-if the doctor is your regular guy, ask him for the tests, so to set up a timeline for your PSA... and if refuses or diminishes your request - get another doctor.

-wishing you all the best...

Veteran Member

Date Joined Jan 2009
Total Posts : 2243
   Posted 2/9/2011 9:47 PM (GMT -6)   
Please dont trust him. Have a PSA test and DRE if nothing else just for piece of mind. Heck he might be right about the bike riding but at your age the annual PSA is so important. My DRE was fine but I had a rapid rise in PSA from 2.5 to 3.7 from one year to the next and my PCP sent me promptly to a Urologist. Looking back it started with frequent urination but also I began falling asleep in my chair and I am not a nap guy. Hope it all goes well for you and that your bike riding days last a lifetime.
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4
Started IMRT Jan. 2010 72gys
7month post SRT PSA .2

Regular Member

Date Joined Jan 2009
Total Posts : 189
   Posted 2/10/2011 12:44 AM (GMT -6)

You might want to talk to your doctor about his thoughts on PSA testing before you go running to someone else.

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 2/10/2011 3:56 AM (GMT -6)   
The Dr had you get a colonoscopy and NOT give you a DRE and a simple blood test to see what your PSA was ? Does he do periodic EKG's or Cholesterol screening ?

Seriously whatever it is that makes you go to this guy, STOP

If its from bike riding get a better seat, but at least you will have a baseline test

Regular Member

Date Joined Jan 2011
Total Posts : 78
   Posted 2/10/2011 5:14 AM (GMT -6)   
If I learned anything from my PC experience it was this:
Your GP knows a little about a lot, but doesn't know a lot about anything.  I knew more about PC after a day of research than my GP does today.
My Dad had prostate cancer at 52 and I had a PSA of 4.1 at age 40.  My GP said that it was "probably nothing".  So much for that philosophy.
I like my GP and still go to him, but I now know that it is smart to question him and that you need to be your own advocate.
PSA 3.9 - October 2010 at annual physical
PSA 4.1 - November 2010 after a month of antibiotic, DRE Normal
Age 41 in December 2010 at Dx of 6 of 12 cores positive T1C and Gleason 3 + 3

Scheduled for open RP on 2/14/11 at Mass General

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 2/10/2011 5:33 AM (GMT -6)   

First reaction is that the doc has slipped up - a little.
I'm afraid you've opened Pandora's Box. You can't know unask the question inside your head that presumeably goes something like "Is there something seriously wromg with my prostate?"
The solution is thus to get a PSA test done as a minimum, then a DRE. You've already had good advice about letting the prostate have a rest before having the PSA test. (The thinking in Holland, the biking-mad country where I live, is that special bike saddles with gaps in them may not do a lot of good re the prostate)

Will it be okay to go back and ask your doc to have a rethink? Is this a doc you've known a long time? As that can sometimes make it easy to talk to them and sometimes harder.

I think I was very lucky with my doc: we have known her a while.
I was only 48 when I went along for a general check up; she hesitated and sucked her pencil while working out which boxes to tick for the blood test and said that they might as well do a PSA even though I wasn't 50!! The test answered a question I hadn't really asked and here I am!

I think you will have to go to the next stage rather than end up worrying about what might or might not be happening. I hope you are simply a guy with an enlarged prostate.

Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr CT
66Gy 28 Apr to 11 Jun 10
Tired + weird BMs
14 Sep 10 PSA <0.1
12 Jan 11 PSA <0.1
Erection OK

Regular Member

Date Joined Jan 2010
Total Posts : 363
   Posted 2/10/2011 10:07 AM (GMT -6)   
In case it hasn't been mentioned yet don't trust him. devil

I trusted my GP and it resulted in a long delay in treatment when she didn't inform me of a rise in my PSA tests (which I had to insist on to begin with) GPs today are overworked and are at best vaguely familiar with most diseases. When the average insurance Co is only paying a pittance for each checkup they have to rush you through to make ends meet.

Educate yourself, take charge of your life.

Good luck and good health.
Dave in Durango CO


Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04....... 06-07-10 PSA <0.04..... 08-03-10 <0.04...... 10-26-10 <0.04...... 1-25-11 <0.04
05-03-10 1 week without pads
06-28-10 Success!!

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 2/10/2011 1:31 PM (GMT -6)   
The lab's system took some of the choice to say anything or not out of the doctor's hands. The test results were a great big long list, as it was for all kinds of stuff like sodium, cholesterol, pH, sugar etc, but they all had an upper or lower safe threshold marked alongside (or both) thus my PSA level was flagged up with an asterisk* as being too high and needing attention!!!


Regular Member

Date Joined Jan 2010
Total Posts : 363
   Posted 2/10/2011 2:37 PM (GMT -6)   

Just an FYI my 5.5 PSA was flagged with a big "HIGH normal range (0.00-4.00)" in the lab report, the Dr still didn't do a followup or let me know about it even though I had asked for the tests and discussed the chances of false positives with her at a previous appt. Odd thing is she did mention a slightly elevated cholesterol reading from the same set of lab work.

My current Dr posts the results on a patient portal which allows me to check out results online within a week of the tests and schedules a followup appt to discuss the results. My old Dr's policy was "don't worry if you don't hear anything it's good news". Sadly I believed her.

Bottom line is today one has to take charge of their treatment, all the way back to diagnosis.
Dave in Durango CO

New Member

Date Joined Feb 2011
Total Posts : 2
   Posted 2/10/2011 7:07 PM (GMT -6)   
Thanks for all the great advice, guys. I value it, and I hope this won't bug you, but here's the thing: I realized that I am asking advice from a very biased sample.

For many of you, a PSA test has literally saved your life. To get a more balanced view, I need to also ask in a forum of guys who had complications due to false positive PSAs (e.g. sepsis or complications from the biopsy). A forum like that doesn't exist, of course.

Being an ex-scientist, I find studies like this one compelling.

But maybe the results of those studies are only relevant for screening done on men with no symptoms.

I still haven't decided, but I think I will call my doc tomorrow and ask him what his thinking is, then decide what to do from there. I'm still weighing your input.

- Al

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 2/10/2011 8:48 PM (GMT -6)   
That study relates to screening of the general population. As you indicate, you are no longer a member of that group. :-) You have symptoms that might indicate PCa -- being fit and healthy does not in any way preclude you from PCa.

What do you do?

a. Trust that your GP is correct and it is the bike-riding.
b. Lay off the bike-riding for a week and see if the symptoms improve.
c. Have the PSA test and DRE and take it from there.

My choice would be b followed by c -- and yes I am biased. Your GP/uro may want to try a course of antibiotics before the PSA test to minimize the risk of a false positive caused by prostatitis.

You can have the PSA and DRE without continuing to biopsy and the risk of sepsis and subsequent over-treatment. If your view is that you won't proceed with further treatment whatever the outcome of the tests, then there is no point in taking the tests. If so run with option a (do nothing).

However I suspect the scientist in you will want to know, even if you eventually take it no further. Good luck.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but now 0.4, doubling time 7 months
No radiation but ADT coming unless I can slow down the rise...

Veteran Member

Date Joined Nov 2009
Total Posts : 7270
   Posted 2/10/2011 11:22 PM (GMT -6)   
Let me be more blunt.
This situation is bordering on malpractice.
Harsh words, but let me use another term: Standard of Care.
You are not receiving a reasonable standard of care. Period.
Your last comment is not that of a scientist. It is that of a patient who is understandably afraid of the PSA result. But I have to believe that you know what you should do.
Get the test.

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 2/11/2011 3:00 AM (GMT -6)   
Dave: I would like to think that my doc is simply good, but maybe her level of care is alert to stuff like this as there is PCa or other cancer in her family or something?? (Just a guess)
When I phoned her (oh so long ago) to ask about my results she had not read them, she opened them on the computer glanced down the list while I listened to her going, "um, er, yes, um, er, right" etc, then said "Oh, um, I think you'd better come in and see me again, your PSA result is higher than it should be, I'll put you through to my receptionist so you can make an appointment for this week." That was perhaps a bit of an abrupt way of putting it to me, but it also had the effect of introducing me to the idea that I might have PCa, so that I would have read up on it a fair bit before I was sent to see a uro.

Mel: I almost agree with your opinion of Al's doc, but I do think you are right to indirectly remind us that what we'd really prefer is not to have anything wrong with us or just not to be frightened that there might be something wrong with us.

Al: The reason I don't fully agree with Mel about your doc is that final judgement must wait to see how he reacts to your request for a review of your situation. I thus hope you get a positive, useful and helpful response.


Regular Member

Date Joined Nov 2010
Total Posts : 143
   Posted 2/11/2011 4:17 AM (GMT -6)   
I was having my Cholesterol checked and I asked the lab nurse what else does the Dr. have checked besides my cholesterol? As she was taking more than one tube of blood, she said oh things like like your liver enzymes (good I do drink) Blah Blah and your prostrate. I was like that's silly I have no symptoms of any prostrate problems. I was 49 getting ready to turn 50. I went in for my cholesterol consultation all was fine but my PSA was a little high. Finger wave was normal but I should see a specialist nothing to worry about just have it checked. Silly but I made the appointment. Went to the appointment the Dr said there is a 1 in 3 chance you have cancer my heart sunk. He did the finger wave something felt funny but not like a tumor. Lets do the biopsy. Still a little silly but a little worried. Did the biopsy waited on the phone call, call came. You have cancer like I was ran into a brick wall.
My cancer was found by chance I had no symptoms. You have symptoms you have nothing to lose by having the test, You have your life to gain by having them. Does having PC change your life? yes. Is it the end of your life? Not most of the time if you get it treated. GET THE TEST DONE!

Post Edited (p_elliott) : 2/11/2011 10:58:32 AM (GMT-7)

Veteran Member

Date Joined Nov 2009
Total Posts : 7270
   Posted 2/11/2011 11:33 AM (GMT -6)   



I don't care what how his doctor reacts.

The guy is 57 and never had a DRE or a PSA??? These are normal and accepted practices. This should have been done 7 times by now.

Sorry, in my book this is malpractice and it could end up costing this patient big time.





Forum Moderator

Date Joined Sep 2008
Total Posts : 4276
   Posted 2/11/2011 12:53 PM (GMT -6)   
I've gotta say I pretty much agree with Mel all the way on this one.  Any doc that has not offered a PSA and DRE to a 57 year old patient who presents with urinary symptoms is missing a cog in his wheel IMHO.
Al, I think you are missing the boat when you say you feel you are getting biased advise from this group.  Actually what you are getting is "educated" advice from men and women who have had to deal with PCa...sometimes for years.
And, let me join Mel in being blunt.  As my dear departed mama would have said, "Son, you are putting your head in the sand on this one".  As a scientist and presumably logical thinker you should want DATA.  Reading miscellaneous articles about the dangers of overtreatment is interesting and educational but does nothing to provide you with DATA for decision making.
'nuff said, ignore the advice given on this thread at your own peril.
Tudpock (Jim)

Veteran Member

Date Joined Feb 2010
Total Posts : 3998
   Posted 2/11/2011 1:16 PM (GMT -6)   
Al -- listen to these guys and take your scientist cap off.  time to start thinking smarter, not harder.
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
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