I don't share your reluctance to talk to doctors. I actually enjoy information sharing with them, and have learned a lot by doing it. I'd much rather spend a few visits talking if that will avoid a visit being probed, prodded and treated. One trick I've learned to avoid unnecessary doctor visits and co-pays, is to have the lab test Rx faxed to the lab. I seldom see a doctor after a lab test -- usually it's a f/u call or email.
I should have better communicated that each bullet point was not meant to be viewed as a doctor visit. I was seeing it more as as a diagnostic flow chart (I can't draw it with boxes and arrows in these posts) with the bullet points representing decision points.
A few comments on your comments:
1> ...Patients will be again screened and most assigned to an antibiotic to eliminate UTI or prostatitis. After a month or so they will be retested. This is a common practice.
Do you really think it's common? I speak to few guys who get this, especially in community practice. I was expecting lots of pushback on this. Let me play devil's advocate:
- Resistance to antibiotics is increasing at an alarming rate
- There are some rare but serious SEs associated with many antibiotics, especially fluoroquinolines (e.g, Cipro -- the one most widely prescribed for UTIs)
- They increase the rate of MRSA and C. Difficile infection
- Most prostatitis does not respond to antibiotics
3> I see no reason why step one does not include the Free test along with the PCA urine test.
The reason is mainly cost. There are other reasons including the PSA that those tests are validated for, no research to back up PCA3 use before a negative biopsy, and that their use will probably cause more confusion than answer any questions if they are used too early.
6>A 5ARI is a good call for BPH, but the science of it's use of still open to the many debates about 5ARI and the risk of reducing PSA is likely and also controversial. (repeat visits to monitor the 5ARI progress)
Again, no visits necessary. Not very controversial imho, but I know there are some holdouts who see it differently. I'm sure this has been actively discussed on this board.
All this for a guys with a PSA at 2.5 is an awful lot.
The point of such a decision flow chart is to avoid
biopsying every guy who walks in the door with a PSA of 2.5+ or 4+, which is the way it goes most of the time now.