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  • DRE refusal

    Good morning. I am wondering, why are many primary doctors (including my own) refusing to do a dre? My doctor feels that the PSA test is a better indicator. A few of my friend's doctors also won't do DRE's. Is there some tudy or report that we missed. BTW - have appt with a new Urologist in early September. Will see if he does the DRE.

  • #2
    In addition to parameters such as prostate size, firmness/consistency, symmetry, etc., the DRE can detect indurations and nodules on the admittedly small prostate surface that the finger can access. About 50% of nodules turn out to be cancer--that's not nothing. Prostate density (PSA/prostate volume) is a much better indicator that something is amiss than PSA alone.

    Uros do DREs; many primary docs do not. I think if you aren't seeing a uro, your primary doc should do a DRE with the physical. (After my TRUS for BPH, my uro wanted a visit every 6 months rather than 12. He did the DRE only every year until he felt an induration on one side, then he did the DRE every 6 months. The induration eventually went away, but my final biopsy was triggered by a new nodule he felt, along with a slightly higher-than-expected PSA. The nodule turned out to be benign as well, but the biopsy found two high-grade lesions in other parts of the prostate.

    On a separate note, my mother's doc felt an anal lesion on DRE that turned out to be cancer. If I remember, it was only the second time that happened to this doc; however, the surgery that ensued may have added many years to my mom's life.

    Djin
    Last edited by DjinTonic; 07-31-2022, 10:32 AM.
    69 yr at diagnosis, BPH x 20 yr, 9 (!) negative biopsies, PCA3-
    7-05-13 TURP for BPH (90→30 g) path negative for PCa, then 6-mo. checks
    6-06-17 Nodule on right + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule was negative for PCa
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) acinar adenocarcinoma
    5% of prostate (4.5 x 5 x 4 cm, 64 g) involved
    Dry; ED OK with sildenafil
    11-10-17 Decipher score: 0.37, Low Risk:
    5-yr met risk: 2.4%, 10-yr PCa-specific mortality: 3.3%
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007 (nadir)
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (retest)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    12-18-19 (28 m) 0.015
    06-30-20 (34 m) <0.014
    12-30-20 (40 m) 0.037 (?)
    03-31-21 (43 m) 0.020
    07-13-21(46 m) 0.018
    01-25-22 (52 m) 0.023
    07-25-22 (5 yr) 0.039

    Comment


    • #3
      My Doc stopped the DRE after my prostate was removed...
      BD: 1959 PSA 4.9 11/2012 (no symptoms)
      Biopsy 12/2012 Negative
      PSA 5.9 05/2013 (still no symptoms)
      Biopsy 6/2013 3+4 (thank goodness for PSA tests)
      1 core positive (upper left), 1 suspicious (lower left) out of 12
      DRE: bump right side T1c; PCA-III = 20 (normala)

      Da Vinci 7/18/2013:
      Total prostatectomy with seminal vesicles (S13-6085, 1-29, 7/18/13, 29 H&E and 1 paraffin block)
      Invasive carcinoma involves left lobe of prostate only, extends from left apex to posterior mid region of left lobe Gleason 7/10 (4+3); G4 tumor comprises 75% of invasive carcinoma present
      Estimated total volume of carcinoma in entire prostate gland: 10%
      TNM: T2b NX MX (Stage IIA)

      PSA History:
      8/13 11/13 2/14 8/14 2/15 8/15 3/16, 8/16, 3/17,9/17,4/18, 9/18 PSA "undetectable" (PSA <.1)

      March '19 = 0.1
      April '19 = 0.10 <-- switched to uPSA tests
      June '19 = 0.10
      Sept '19 = 0.10
      Dec '19 = 0.09
      Jan '20 = 0.13
      May '20 = 0.2 <- standard test by mistake
      Jun '20 = 0.11 <- back to uPSA test
      Aug '20 = 0.16
      Jan '21 = 0.23
      Feb '21 =0.20
      Mar '21 - started ADT/HT, radiation scheduled
      Jun '21 Eight Weeks Radiation @MSKCC
      Jul '21 <.05 (T-Level 0)
      Feb '22 <.05 (T-Level back to normal)
      Aug '22 <.05 (T-Level still normal)

      Comment


      • #4
        Originally posted by dayglo View Post
        My Doc stopped the DRE after my prostate was removed...
        Yes, mine stopped too Nothing to palpate.

        Djin
        69 yr at diagnosis, BPH x 20 yr, 9 (!) negative biopsies, PCA3-
        7-05-13 TURP for BPH (90→30 g) path negative for PCa, then 6-mo. checks
        6-06-17 Nodule on right + PSA rise on finasteride: 3.6→4.3
        6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
        Nodule was negative for PCa
        Bone scan, CTs, X-rays: neg.
        8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
        SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
        pT2c pN0 pMX, G9 (4+5) acinar adenocarcinoma
        5% of prostate (4.5 x 5 x 4 cm, 64 g) involved
        Dry; ED OK with sildenafil
        11-10-17 Decipher score: 0.37, Low Risk:
        5-yr met risk: 2.4%, 10-yr PCa-specific mortality: 3.3%
        9-16-17 (5 wk) PSA <0.1
        LabCorp uPSA:
        11-28-17 (3 m ) 0.010
        02-26-18 (6 m ) 0.009
        05-30-18 (9 m ) 0.007 (nadir)
        08-27-18 (1 yr.) 0.018 (?)
        09-26-18 (13 m) 0.013 (retest)
        11-26-18 (15 m) 0.012
        02-25-19 (18 m) 0.015
        05-22-19 (21 m) 0.015
        08-28-19 (2 yr. ) 0.016
        12-18-19 (28 m) 0.015
        06-30-20 (34 m) <0.014
        12-30-20 (40 m) 0.037 (?)
        03-31-21 (43 m) 0.020
        07-13-21(46 m) 0.018
        01-25-22 (52 m) 0.023
        07-25-22 (5 yr) 0.039

        Comment


        • #5
          I get a rectal exam from my GP every year as part of my annual physical. When I mentioned that I no longer have a prostate, he said that I still had a rectum.

          Next time I'll have to remember to say, "oh yeah... I just used it this morning!"
          Late 2012: PSA 4, age 62 all DRE's 'normal'
          Early 2014: PSA 9.5, TRUS biopsy (false) negative
          2015: PSA's 12 & 20, lots of Cipro ... Mar '16: PSA 25, changed Urologist

          Jun'16: MRI fusion biopsy, RT base, 2ea 15-40-100% G8(4+4)
          Aug'16:DVRP, "broad cut" 11 LN-, neg margins, gland 53g, 25% involved
          multifocal EPE, PNI, BNI, bilateral SVI, pT3b N0
          Dec 2016: Mrs: Dx stage 4 NHL/DLBCL, Primary Bone Lymphoma
          spinal RT boost+6X R-CHOP21+6X IT MTX via LP.
          Remission ended 2020, Follicular NHL. Currently active surveilance.

          Mar 2020: older adult son, T-cell acute lymphoblastic leukemia (TALL)
          Hyper-CVAD + pegaspargase, RBC transfusions in NYC amid COVID-19

          Bone marrow transplant Oct 2020, currently in Remission
          Jan'17: began Lupron ADT, uPSA's ~.03
          May'17: AMS800 implanted, revised 6/17
          Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
          Jan 2018-Jan 2022: PSA's <0.008, T=50
          Apr'18: Dx radiation colitis, Oct'18: Tx sclerosing mesenteritis
          June 2020: younger adult son, small bowel resection
          adenocarcinoma of lower ileum (SBA) w/+lymph node, stage T3a-N1
          Adjuvant chemo: 12x FOLFOX, currently in Remission

          "Everyone you meet is fighting a battle you cannot see"

          Comment


          • #6
            After my prostate was removed, I thought I was done with DRE's. But my urologist who is very good, says that there can be tumors and things that can occur in the rectum without a prostate.
            Diagnosed at Age 56
            March 2018 uro DRE detected;
            Biopsy April 2018 6/12 positive adenocarcinoma;
            4 (3+3) and 2 (3 + 4);
            PSA 2.7;
            Bone Scan and MRI suggested all contained;
            Radical on July 5, 2018; ½ nerves spared;
            Post Biopsy confirmed all contained; lymph nodes and nerves all negative; pT2 pN0
            09/20/2018 PSA <.01
            01/04/2019 PSA <.01
            04/17/2019 PSA <.01
            07/15/2019 PSA <.01
            11/18/2019 PSA <.01

            Comment

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