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1st Consultant Appointment

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User
Posted 22 Oct 2022 at 20:05

My husband has a PSA of 3.02 and when his GP did a DRE he found an enlarged prostate with a nodule.  He has been referred to urology on a 2WW but he only has a phone appointment.  Without being able to examine him over the phone I'm so worried that the consultant will dismiss him and miss something.  How crazy is it that his first consultant appointment is over the phone, anyone else had the same?

User
Posted 23 Oct 2022 at 04:05

I think a physical exam is appropriate. 


I was referred on a two week wait. A locum GP had not put my PSA of 25 in the referral letter to the consultant. Because I was only 53 and had just had one incident of urinary retention I was almost immediately dismissed by the consultant. Just before I was about to leave I said "isn't the PSA of 25 a problem" he said "Oh that's new information I'd better exam you then". Anyway that was the start of my treatment, if I hadn't questioned things I would be in a very bad position by now.


The fact this is a phone consultation implies to me the consultant has already made up his mind, and thinks a physical exam is unnecessary. If the phone consultation doesn't go the way you would like, I would demand a second opinion.


BTW you shouldn't be fretting about this, prostate cancer is completely normal in an older man, it will need keeping an eye on or treatment. It is not a death sentence.

Dave

User
Posted 23 Oct 2022 at 09:18
I wouldn't get too stressed about the phone conversation - I may be totally wrong but I see it as a way that the NHS are trying to meet their targets with limited resources.

I went through the full diagnostic process of MRI / CT scan / biopsy during the first 'lockdown', at which time my PSA was something like 11 - no cancer was found. My PSA has now climbed to 19.2 - I am on Tamsulosin which I believe has the effect of halving the PSA result. I have again been put on the 2 week programme - my first appointment was by telephone & with a specialist nurse - this resulted in a 'fresh' MRI & an appointment for a 'face to face' meeting with a consultant, which is scheduled for later this week, to review the results of the MRI & determine the next step.

It is my understanding that these 'prostate' issues are not overly time sensitive - a few weeks here & there aren't likely to make much difference. I feel that everyone that I have met within the NHS have been very supportive & committed to resolving my 'problem' - that is if I have one !
User
Posted 23 Oct 2022 at 10:04
I don't think a telephone appointment is a problem. The first appointment is usually a conversation, a DRE and then a decision about whether an MRI and biopsy is required. The DRE is maybe less important since the GP has already felt a nodule. The conversation to gather lifestyle data and then decide to go to MRI can be made over the telephone without a physical exam.

I was referred on the 2ww last year (for a different kind of cancer, obviously) - my first appointment was by telephone, the biopsy was booked. I got the results by telephone as well. I think in these pandemic days, hospitals are probably wise to reduce face to face appointments where they can. Perhaps it would have been different if the GP had not believed s/he felt a nodule.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 23 Oct 2022 at 17:26

I'd wait and see how the phone appointment goes. He may well refer him for an MRI scan to see the appearances of the nodule etc. Or he might just suggest a further PSA test in a few months. Either way if he would feel better with a physical examination first from the consultant he should say it to him. My husband had Dre by gp, then consultant, both said it was enlarged.His PSA had been 4.7 but then 3.2 a few weeks later but they still did an MRI which revealed 2 nodules (pi-rads 4) which is suggestive of cancer, so biopsies done. Just got the news today that all biopsies were clear, so they'll keep an eye on him now, repeat PSA tests etc.

User
Posted 23 Oct 2022 at 17:39

Yes, the first thing on the prostate 2WW referral is usually the MRI scan, before you actually see anyone.

 
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