New Urologist

I’ve been a patient of the same urologist at a nearby medical clinic since my vasectomy about 15 years ago.  I like my physician, but the office and staff have become increasingly unresponsive over the years.   This time, it took literally a month to hear back from an assistant when I inquired multiple times about having routine testing prior to my appointment.  It got worse from there, as it became clear that my only point of communication was not even familiar with some diagnostic technology.  For example, I tried to confirm that they used the standard for prostate imaging, a multiparametric 3T MRI that would be comparable to the one used for my last MRI in 2019.  She could only refer me to the MRI department for information.

Ultimately, I was never able to discuss my concerns with the urologist or with his colleague to whom his assistant referred me for a biopsy.  Messages on MyChart and those left with the office were routinely ignored.  My last interaction with the office was a call when the urologist’s assistant alarmingly indicated that a biopsy was urgent because the MRI showed that I still had a PIRADS 4 lesion that is “almost certainly cancer.”  (It’s not.  The correlation is not well established, at worst possibly 50-50)  Even though the same lesion was targeted in two negative biopsy samples in 2019, she enthusiastically indicated how essential it is to biopsy it again to confirm the cancer and start a treatment plan.

Weeks later, I finally heard back from the colleague’s office (again from an assistant and not the physician). After pressing for information, I was able to find out that the scheduled biopsy was not targeted or guided in any way.  They were simply going to use the old-school method and randomly skewer the area of the single lesion and cross their fingers that they didn’t miss.  Well, at least that’s what the assistant said, perhaps being able to talk to the physician would have been helpful!

Given my increasing frustrations with the local clinic, I decided to get a second opinion shortly after the local urologist’s assistant referred me for a biopsy.   I first contacted the great team at the NIH. The imaging experts there were happy to review my new MRI results.   It took under a week to get a copy of the images, send them to the NIH team and get a new MRI report that now had a comparison to the MRI from 2019.  All this while waiting to hear back once from the local urology office!

The new report was reassuring, “We don’t see a change in the single lesion you have.”  In fact, all the indicators listed in the report were essentially identical to those in 2019.  Phew.  The only change was that my prostate had grown in size.  Even so, the increase was consistent with the PSA increase.  My “PSA density” has actually decreased slightly.  I offered to send this new comparison information to the local urology clinic, but never heard back, of course.  The urologist at the NIH was willing to have me travel there for another evaluation, MRI and possibly another biopsy.  After the last trip in 2019, I was not looking forward to another trip.

Ultimately, I scheduled a second appointment with a urologist at the University of Chicago who was referred to me by the NIH urologist back in 2019.  I saw again him a couple weeks ago.  Armed with all my test results since 2019, I gave his resident physician a full background of my saga.  She spent more time in one visit listening to my concerns than I have been able to spend with my local urologist over the last 5 years.  After she consulted with the staff urologist, he recommended that there was no need for a biopsy at this time.  Instead, I will repeat labs in 6 months and consult with him again at that time.

Suffice to say, I have a new urologist moving forward.  It’s an hour longer to drive there in Chicago traffic, but well worth it.  Plus, if I ever do need another biopsy, I confirmed they are performing transperineal MRI fusion-guided biopsies, essentially the same as the NIH.

When you can’t get a response from a physician over the course of 3 months to discuss your concerns with them, it’s time to move on.  I appreciate that physician’s assistants can do a wide variety of work for the physician, especially if it’s for a flu or less serious illness. On the other hand, there is no substitute for even one discussion with your physician when a biopsy and cancer are on the table.