DRE question

[michael00]

I have a question maybe someone can answer. I convinced a coworker to go for a physical and to request a psa test . He also planned on a DRE for the prostate. This morning he tells me the doctor would not do psa but said he could have it done when he goes for a colonoscopy. Additionally he stated they no longer do DRE's. Does anyone know what procedure replaces a DRE?

[Hidden]

Historically the sequence was : DRE, PSA, blind biopsy.

Currently enhanced to: DRE, PSA+free/PSA ratio, mpMRI, targeted biopsy.

The above test sequence demonstrate increasing sensitivity and specificity.

DRE is first, as it has the lowest of all, but since its cost is minimal they still practice it.

It also has to do with somehow evenly distributing business/turnover among various medical professional groups (urologists, microbiologists and radiologists).

[pjoshea13]

Nothing replaces the DRE. It continued to be performed in the U.S. when the PSA test became available, presumably because it was recognized that it added value. In my case, a nodule was found while my PSA was only 0.8, so I think it has a place in screening.

Except that the anti-screening lobby has caused a drop in both tests, at least in the U.S.

I can't speak to the conventions elsewhere. I know that Brits can request a PSA test from a National Health doctor, but I don't know if a DRE is then done before the blood draw.

Seems odd to refuse to do a DRE & couple the blood draw with his colonoscopy. What country are you in?

-Patrick

[SPEEDYX in reply to pjoshea13]

Agree...psa also needed .....when they did DRE on me it was totally smooth and I had no symptons...a biopsy of swollen lymph node confirm prostate cancer

[NotKidneyStones in reply to SPEEDYX]

Your situation parallels my own. I thought I had a kidney stone, and a CT scan showed swollen lymph nodes. PSA was 97. Biopsies showed PCa in Prostate n lymph nodes. ALL THIS a few months after DRE seemed normal.

[SPEEDYX in reply to NotKidneyStones]

Yes and my psa was 350

[michael00 in reply to pjoshea13]

This is in US. Minnesota.

It is a hospital i refuse to go to and i question their decisions

[Hidden in reply to michael00]

At the current unclear state of the corona virus epidemic, avoiding hospital visits for trivial issues is a wise prophylaxis.

[StePeteMN in reply to michael00]

Are the company's initials HP (or PN)? I was not screened at all in physicals at PN's family practice and got a DRE when I went to urology two years ago to find out why I couldn't pee. Then things got pretty scary.

[michael00 in reply to StePeteMN]

Neither of those 2 but i avoid PN

My wife and i walked away from them twice years ago. Doctor left the room for a minute. We talked and got up andwent somewhere else

[noirhole]

In my situation had a PSA done 10 years before I got diagnosed (40 to 45 yrs. old). I used that result as my baseline (0.46). Annually had DRE and PSA drawn. At diagnosis found nodule did PSA which was still low. And has remained "low" compared to others in this group. PSA has never gone above 16. I have both bone mets and soft tissue mets. If you have previous prostate cancer in your family or have a vasectomy I would find a Uro or other doctor that will do both each year as it could vastly extend your life. Be your own advocate. Push for your health care not for average care.

[Rocketman1960 in reply to noirhole]

I would also say tell your doctor to order the PSA and you will pay for the test. You need a baseline. My DRE was unremarkable. It was only a fast rise of PSA and biopsy that caught a Gleason 8 PC.

[noahware]

" he stated they no longer do DRE's "

I'm not sure who "they" is, but to not do routine DRE seems quite different than to REFUSE to do one when it is requested. Same goes for PSA. If a patient asks a provider, for a DRE or a PSA, he should get one, either from that provider or an associate.

Neither of these tests, whether alone or together, will always say conclusively if a man does or does not have PC. That is not a reason NOT to get either, or both. Information is information. How it is used or not used is a different issue altogether.

When I learned my PSA was 20, I was pretty sure I had cancer. When my urologist then did a DRE, he was REALLY sure I had cancer. In hindsight, the subsequent biopsy and scans simply added details and refinement to the basic story that DRE and PSA were telling me. Since I don't believe in "cures" I don't really even need those more refined details to proceed with a treatment plan, but I suppose it may become helpful at some point to get an idea of how well I respond to my treatment(s).

[michael00]

Thank you everyone.

I just had another talk with him

He's going to find another doctor and get it done

[Tall_Allen]

The DRE is of questionable value, especially by PCPs who don't take adequate time to feel around and don't have the experience to interpret what they feel. Perhaps his PCP knows he is untrained to detect anything with a DRE. Perhaps your friend should have it done by a urologist instead. Some researchers have developed mechical "fingers" that may do a better job, and with improvements in ultrasound technology, the end of the DRE may be approaching. PSA should be given to every man 55-70 after he understands the issues surrounding the test.

[lincolnj8 in reply to Tall_Allen]

Yes!!

[NotKidneyStones in reply to lincolnj8]

I would make that 40-45 for the African American community.

[lincolnj8 in reply to NotKidneyStones]

Referring to a PSA test should be given to every man 55-70.

[NotKidneyStones in reply to Tall_Allen]

Hi Allen!

[yamobedeh]

Just prior to my Dx of G8, stage 4, my DREs had all been "unremarkable" as had 2 prostate ultrasounds. It was only after I paid for an MRI which confirmed a large tumour that the hospital took my case seriously, with a subsequent bone scan suggesting a met to a femur. My PSA had gone from 4 to 8 to 20 over 6 months, so despite the "normal" DRE and US, the rapidly increasing PSA and a PSA ratio going from 0.12 to 0.1 suggested (later confirmed) that I had an aggressive form of PCa. Find a different doc, preferably at a highly rated prostate cancer center.

[lincolnj8]

GET the PSA test. My doctor never gave me one for many years. I didn't know what it was till I was on my death bed in the hospital getting blood to stay alive. When they gave me a PSA test, my PSA was at 800. Demand the psa test now..

[Hidden]

It’s simple in my mind, wont give a PSA test following by a digital, I am moving on. Period. BTW....... over 120 PSA tests since 2003. Now a days, every three months. Ever wonder about why a high number of the new members are metastatic at first Dx?

GD

[Miket218]

About five years before my PC was found I developed what the docs thought was begnin prostate hyperplasia. They (4separate docs, one of whom is a urologist) all did DREs and concluded I didn’t have cancer. They based their conclusion on the fact they didn’t feel any nodules. My PSA was rising fairly slowly and they all said a biopsy wasn’t necessary until my PSA hit 4.0

Finally, in 2016 it hit 4.6 and a biopsy revealed Gleason 7&8 cancers.

When a DRE is done the doc is only feeling the back side of the gland.

When I had it removed a few months later the pathologist found a section which was a Gleason 9.

Most of the gland can’t be reached. Insist on a biopsy if you suspect PC.

[MeliaQuinn]

My husband at the age of 50 was also told by his PCP that the gastroenterologist would look at his prostate during his upcoming colonoscopy. NOT SO! When my husband asked - the gastroenterologist said he does not do that during a colonoscopy. I don’t know why PCP’s tell their patients this misinformation.

[Hidden in reply to MeliaQuinn]

Bs

[Muffin2019]

I would find another doctor , DRE and PSA is very important.

[larry_dammit]

Get another doctor, may have to go to a urologist to get tested. My doctor did it as part of my annual with a full blood panel.

[RonnyBaby]

When I heard about this 'doctor' and his approach to assisting patients with reasonable test requests I think this doctor should NOT be in any front line role for patient treatment(s) or public service.

This 'doctor' needs to be terminated .....

[Hidden]

It doesn’t make sense to me Mike ? Either?

[LeeLiam]

Remember, draw blood for the PSA before the DRE or a couple of days after. DRE, like bicycle ridng, ejaculation and other things can spike the PSA. My PCP did not know that.

[michael00]

Thanks again everyone, here's an update.

The guy I'm referring to is just plain scared because of my situation. Stage 4, glesson 9. He has now decided to see my urologist who i have a lot of faith in. So he will be getting the tests he wants.

[cmeek1]

My PSA never went above 3.5. My PCP did DRE and felt nothing. My urologist did a DRE and felt a nodule. Biopsy revealed Gleason 8. In my opinion, the urologist saved my life.

[j-o-h-n]

Give up DREs? Shoot, that's why most urologist become urologist........

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/12/2020 8:45 PM DST

[kenner]

A DRE never showed any abnormalities when I had it done...yet my PSA was 37 ! Biopsy showed cancer in 3 out of 4 lobes. PSA test is very important...I would have been dead a long time ago without it.

[pjoshea13]

Michael,

Here are the results (so far) from an on-going Urology Times poll:

"Is DRE still a relevant tool in the management of prostate cancer?"

YES: 78% (900)

NO: 16% (185)

Not sure: 6% (68)

-Patrick