hi all, i'm not sure if this question even has an answer, but i have some concerns with how my dad's urologist handled his PSA recurrence and i just want to know if what he did was "right"/standard or if it was careless. it's not to take him to court or report him or anything like that, it's more about
making him aware so this doesn't happen to his other patients, and hopefully it can be something he takes into consideration.
my dad had PSA recurrence in january 2016, after stopping lupron in june 2013 - he had started lupron and radiation in 2010 after RP failed. his PSA went down to 0 i think a few months after lupron was started.
so i actually have 2 issues:
1. surgery failed and the doctor waited around 7 months to begin any type of treatment. PSA post-surgery was around 2 (pre-surgery was 4). 7 months later he began radiation and hormones. is that normal to wait so long with a gleason 8?
2. when recurrence began in jan 2016, the doctor didn't do a scan or anything, and waited until october 2016 to do another PSA test. he told my dad the PSA was "undetectable" and "nothing to worry about
". the PSA had gone from 0.04 in january 2016 to just over 1.0 in october 2016. the doctor still did no scans and no treatment, telling my dad there was nothing to worry about
now, i can understand this for a gleason 6, but a gleason 8?? the doubling time is so fast and not doing a scan just seems so careless. of course, that whole time my dad's cancer was growing and he ended up having to get emergency spinal decompression surgery in feb 2017 because he had a bone met that was encroaching into the spinal canal. it was only at this stage that the doctor began treatment (the bone met wasn't discovered by the urologist, but by the emergency room doctor)
i know there is no point looking back, but i just feel like if he had taking action sooner, even got a scan, we could've got that met when it was still tiny and easier to blast. now it's radioresistant and again encroaching into my dad's spine. the cancer also seems to be spreading (we are waiting to find out for sure about
my dad was lucky enough to only have one met for over a year, despite the fact that his PC had mutated into the neuroendocrine type (we're still hopeful there is only the one met but the latest scans/bloodwork showed some suspicious findings), i think it was probably controllable at an earlier stage but i think since it's been disturbed via surgery it has now started to spread around to other places too.
anyway...just wondering if this is the normal action that the urologist should've taken, or whether i should talk to him about
it and ask him to be more attentive to future patients? is this a urologist that can be trusted with gleason 8-10 patients? he also never got an oncologist involved, aside from during radiation.
Jan 2010:Gleason 8 post-surgery / PSA 4 /PNI
PSA after RP:2
June 2013:Lupron stopped/PSA 0
Jan 2016 Chemical recurrence 0.04
Oct 2016 PSA just over 1
Feb 2017:PSA 0.45. mixed bone lesion T6 spine, surgery for spinal compression. Casodex/Lupron. rad to met & surrounding
High grade neuroendocrine carcinoma
Post Edited (snowcake) : 5/23/2017 7:09:41 AM (GMT-6)