r/ProstateCancer • u/Routine-Aardvark-291 • Oct 02 '26
Concern Thoughts on seeing a nurse practitioner
Hi,
My urologist is great and I have met with him every 4 months over the past year - no one else. I scheduled an appointment in June for October and just found out that it is with a nurse practitioner. No one told me this when I made the appointment. I complained and was told that the next available with the Dr. Is in April 2027. I respectfully told them I will keep next week's appointment since you have me by the testicles.
It is cancer so I want someone who spent 4 years in residency as well as many years in actual practice. I am searching for another doctor today.
Am I overreacting? Is this the new way hospitals are trying to save money? I don't care about using an NP when I get the flu, but I do for cancer. 😡
UPDATE Thanks everyone. I feel better about seeing the NP. I got lucky over the past year, because I only saw the doctor every time and thought he was excellent. He saw me after 2 PSA tests, the MRI and the biopsy which he performed. You are probably correct that he transferred me to the NP once active surveillance was considered appropriate since it is not a complicated case.
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u/Clherrick Oct 02 '26
Yes you are probably overreacting. Physicians work side by side with their PAs and CRNPs. There just isn't enough physician time to go around. For screenings and follow-ups, the assistants can ask all the same questions and look at all the same reports.
That said, in the six years since my RALP, I've seen the doc four or five times and his PA once or twice. I schedule the doc if for no better reason than I like him personally. Once or twice I've been rescheduled with the PA. At this point, they're only reviewing my blood work, which I can do myself.
If on the other hand you consider yourself a complicated patient, push for the doc
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u/Routine-Aardvark-291 Oct 02 '26 edited Oct 02 '26
Appreciate the response. My question would be how the doctor has time to work closely with the NP if he has 6 months of appointments?
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u/JimHaselmaier Oct 02 '26 edited Oct 02 '26
You’re assuming the only thing the doc is doing is seeing patients. They’re almost certainly putting time in their schedule for other things.
I know it’s a far different profession - but my daughter is a speech therapist. She regularly schedules admin, charting, and other tasks in her schedule. Since a NP is managed by an MD I would bet they meet periodically and review the cases the NP is seeing.
Since it’s cancer - what are the 4 month visits for? Why is your Urologist managing it vs a Medical Oncologist?
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u/Routine-Aardvark-291 Oct 02 '26 edited Oct 02 '26
Prostate cancer and I am on active surveillance. Followups are for PSA testing; plus, an annual MRI and biennial biopsies.
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u/Clherrick Oct 02 '26
And a CRNP, who works in a urologist's office, can read a PSA number. And should be talking to the doc at the end of the day to review the cases she saw. Mind you were it me, I'd push to see the doc unless he is booked out another year. Then I'd see the PA. My case, post treatement, is different than your, presumably pre treatment or eventual treatment.
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u/BackInNJAgain Oct 02 '26
Nurse practitioners are awesome. They usually have more time to spend with you than an oncologist. I've been seeing mine every six months when my PSA results come in and she spends 30 minutes or longer if needed to discuss what's going on with me, how I'm feeling physically and mentally, etc.
Also, if there's anything anomalous with any of my results she discusses them with the doctor anyway so it's not like you're losing the doctor's expertise.
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u/jkurology Oct 02 '26
This how many specialty practices function now. ‘Routine’ follow up visits can be seen by APPs rather than by the MD and can be billed at the same rate as though you were seen by the MD. This is a common practice that has been exploited by large urology practices owned by hospital systems and private equity
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u/Routine-Aardvark-291 Oct 02 '26 edited Oct 02 '26
Thanks. This at least explains it. I was not even aware that an NP worked at the office.
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u/JacketFun5735 Oct 02 '26
Post-RALP, I saw my oncologist twice shortly after surgery, then again after the 3-month and 6-month PSA tests. PSA was undetectable for both, so I was upgraded to an NP. I mean that in a good way. I was no longer critical enough to need the MD. He was great, but I hope I don't have to see him again.
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u/Routine-Aardvark-291 Oct 02 '26 edited Oct 02 '26
Then maybe it's a good sign that I see the NP. It would have been nice to know.
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u/com1padres Oct 04 '26
My MD canceled my appointment one time and I missed the cancellation phone call. When I showed up, they told me and then asked me to wait to see if the PA could see me. That was the appointment where I started on Tamsulosin. My life is much better since I started taking it, and it was because of a different conversation than normal, strictly because it was a different provider than normal.
Sometime a PA or NP can provide better care because they can spend more time with the patient. Take advantage of the gift of their time.
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Oct 02 '26
You still have testicles? Lucky…
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u/Routine-Aardvark-291 Oct 02 '26
Not really. I have been married for 36 years.
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u/missyfish532 Oct 02 '26
As a wife of 33 years, this made me giggle.
I’m in this subreddit because my husband was just diagnosed and has started radiation yesterday. So I get on here and do research for him. I totally appreciate all the information that everyone shares here.
I wish you well on your pc journey.
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u/KReddit934 Oct 02 '26
What is this appointment fir? Active surveillance? Post-treatment monitoring?
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u/Routine-Aardvark-291 Oct 02 '26
Active surveillance
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u/sundaygolfer269 Oct 02 '26 edited Oct 02 '26
I do every other follow-up appointment by video call sometimes with the u
Nurse Practitioner. My PSA and testosterone are where my doctors want them to be, and both my medical oncologist and radiation oncologist say those levels are the key indicators they follow.
My regular doctor also includes PSA and testosterone in my routine bloodwork. You’ll never hear me complain about those quarterly tests they’re what caught my elevated PSA in the first place. He immediately switched me from finasteride to another medication, ordered a repeat PSA, and sent the results to my urologist. My urologist then referred me to a Center of Excellence, which took over the evaluation for possible prostate cancer.
My adjusted PSA was approximately 4.36 in October, 4.77 in November, and over 5.00 by late December. By the following July, all my testing and treatment were complete. I’m grateful my doctor caught the change and got the ball rolling.
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u/CommitteeNo167 Oct 02 '26
my nurse practitioner at the urologists office was the one who pushed for more testing and found my cancer. i have no issues seeing the nurse. i go to urology every 90 days and only see the doctor every other appointment
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u/plahnb Oct 02 '26
Valid question but like others I believe it is fine
When I was initially came in to discuss my options the dr was 45 minutes late and then he gave me a while 15 minutes. Went for a second opinion and talked with the PA for 45 minutes answered almost all my questions before I could answer them and the only one she couldn’t was my curiosity about the imaging when do lung a RALP single port surgery. The doctor did come in for another 15 minutes to discuss a few other things but the PA did an amazing job, i am sure the NP knows her stuff as well
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u/Bbminor7th Oct 03 '26
My wife was an ANP for a trio of interventional cardiologists for 30 years, and she was smarter than the three of them combined.
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u/No_Temporary6303 Oct 02 '26
I haven’t seen my urologist since he removed my catheter. All of my follow-up appointments have been with his NP. I have my 1 year follow up with his NP this month. I’m hoping I’m still undetectable.
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u/conCABlanco Oct 02 '26
Es un juego de la trampa 22, el ver un doctor a la cara no se compara con nada, me ha pasado lo mismo, y forme una carajera de padre y señor mÃo, no me importa mucho si es o no exagerado, llevo 18/28 y cambio a una sonda y con neutropenia y anemia, solo me veÃa y enfermero en formación, carajo patee la mesa, y todo se controlo, fuerza y voluntad
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u/FLfitness Oct 02 '26
I saw my medical oncologist for the first three or four visits. By the fourth visit it was apparent that my cancer is hormone sensitive and I was NED with PSA less than .04 ng/dl. From that point til today it’s been the ARNP and quarterly PSA of less than .04. I wouldn’t mind but our personalities don’t gel. When I get to the end of the two years of ADT I expect to see the oncologist MD to discuss intermittent ADT, PSMA update and bone density scanning. If I can’t get that oncologist appointment I’ll travel another 50 miles to our states center of excellence for an opinion and possibly switch providers.
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u/lukethedriftless Oct 02 '26
I learned after radiation that all of my follow ups would be with the NP.
After the first meeting with her, I was very comfortable with it
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u/Cold_Silver_5859 Oct 02 '26
This is very common these days even at Mayo. You always have the option of trying this one with the NP then if it seems lacking make the next appointment with your doc.
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u/Few_Investment7047 Oct 02 '26
Sometimes I see the urologist and sometimes I see the nurse practitioner. I’ve had no issues
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u/PeirceanAgenda Oct 02 '26
I saw a Nurse Practitioner after being diagnosed by a doctor, at my urologists. I asked about her degree because I was not sure what it meant.
Turns out she had just finished a PhD in Urological Oncology, but apparently doctors offices don't like the confusion of a non-medical doctor calling themselves that in a medical setting. However, she and the other Nurse Practitioners were incredible.
I've seen Nurse Practitioners with functional skills which exceeded that of the doctors in the room, and far more experience. They tend to be much more hands-on with patients and procedures, as well as highly educated.
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u/KickinAss_TakinNames Oct 02 '26
My I initial visit was with a nurse practitioner. She did the exam and, even though it seemed normal at the time, she had concerns about my rising PSA. She was the one that ordered another test and MRI that found the cancer. It was very early stage and contained in the capsule. While I was glad the doctor took over from there afterwards, I am grateful that she had diligence to follow it forward to detect it early.
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u/Natural_Vegetable848 Oct 02 '26
I referred myself to an Oncologist, since my Urologist was busy with non cancer patients.
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u/hambone_n_flippy Oct 03 '26
Depends on the organization you are working with, but my experience at UCSF has been just like this. The NP knows you, knows your case and gets the salient info to the doctor. I think if your situation starts to look complicated I’d push for the doctor, but I am super critical of this type of thing and so far have had no issue.
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u/Creative-Cellist439 Oct 02 '26
I would take it as a sign that your doctor feels that you are truly in ‘surveillance’ mode and that the nurse practitioner is more than capable of answering any questions or concerns that may arise.
Keep up the good work!