Been coming on here for over a year now,since a friend of mine got diagnosed & so I know the importance of a psa & dre but our new doctor refuses to carry out a dre & quotes the American academy of family practitioners advise that its not needed & can cause problems!
Dr refusing to do DRE : Been coming on... - Advanced Prostate...
Dr refusing to do DRE
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Nugger
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64 Replies
•
Show him how,
PSAed• in reply to
He probably knows, but can't quite put his finger on it !
ok, I'll get my coat.....😀
Both no DRE and PSA? Because more harm than good? So how was diagnosis done? The so-called recommendation here is likely a mis-translated version of the awful 2012 US Preventative Services Task Force recommend. The idea was that PSA testing (not sure about DRE) was dangerous because people make bad decisions afterwards - which is a kind of evil paternalism. So more and more men are being diagnosed with metastatic prostate cancer because they never had a PSA test.
Looks like your friend's doctor doesn't do any independent thinking and relies on lousy recommendations that he or she read five years ago. Maybe time for a new doctor?
JohnInTheMiddle wrote -- " Both no DRE and PSA?... " I did not read that ??????
Nugger wrote -- " ... but our new doctor refuses to carry out a dre ... "
If for some reason you do not wish to change to another doctor (I would immediately find another Dr.) then insist on bloodwork that includes PSA + demand a 3TmpMRI. If denied -- quickly exit the room.
And more and more men are being diagnosed with advanced PCa because testing was never done. That was a very bad recommendation, which has since been modified (after killing perhaps thousands of men by delayed or no detection of early PCa.)
I should mention - my PSA never went to alarming levels - it normally hung around under 1, when the PCa was detected via a DRE (yes!) it was ~3 (which wouldn't set off alarm bells with most GPs. ) In my case the urologist was rather adamant about doing a biopsy and he was right. Good MD - absolutely awful office staff - I left bleeding after one nurse tried to do a flow test she was not qualified to do (involving inserting a metal tube up my kazoo..) I left the urologist because of his staff (and the difficulty in talking with him - we never really hit it off.)
Sticking his finger up your ... can cause problems??
Only if he doesnt trim his fingernails.
• in reply toStill_in_shock
Is this why you're still in shock?
Many doctors don't know how to do it properly.
I agree that if a doc refuses to do a DRE, they are probably not well practiced in the nuances of what the prostate should feel like and you wouldn't like that doctor passing judgment on your situation anyway.
A urology specialist nurse told me the same thing, ie that GPs or primary care doctors can't do DREs properly. A consultant urologist did my DRE and said it felt normal. I have never understood this because an MRI on my 36 mm prostate indicated a 14 mm tumour in the lower left quadrant. Why would he say that felt normal? Is it more to do with squishiness or firmness?
Most tumors are non-palpable.
My doctor only did a perfunctory DRE every year. And deliberately did not do an annual PSA. And I accepted that and didn't pay attention. (Also apparently DRE has a rather poor diagnostic value.) Then the backache. Six months to figure it out! Then diagnosis: PSA of 1700, spinal cord emergency and high volume mets. I was with my doctor since my 20's. Doc is retired now and we still have a kid at home. Thank heaven for triplet therapy and exercise. My sense is there's a scandal out there in terms of primary health care quality.
My older brother had a similar situation. His doctor never checked his PSA during his annual checkups until he had problems urinating. By then his PSA was 115 when it was finally checked, and he of course had high risk PC by then. Primary care has been negatively impacted by the emphasis in medicine on subspecialty care, the vacuous use of electronic health records, compensation based on relative value unit productivity, pay-for-performance metrics, and a lack of consistent data about its clinicians and performance. I'm sorry for your terrible experience. 🦊
I recently met a guy who has a nasty form of G10 disease that has mets into the bones and lymph nodes and luckily no organs. His great KP docs managed his disease off of just a PSA level of </= 2.0. He was into his early to mid 60's and had ed and urinary issues that were NEVER followed up with a DRE. A subsequent doctor about 5+ years later noticed these challenges in his chart and finally offered him a DRE. He said that her words were "Oh shit" and sent him right over to urology. This guy has "undifferentiated prostate cancer". This form of prostate cancer is more rare and does not typically produce PSA levels of concern. So, yes, DRE's are a valuable tool!
I changed primary doctors when the examiner refused to look and see if my hemorrhoid was external or internal.
My tumor was linear and flat, undetectable by DRE! TG for scans technology
I can think of a few choice words for that doctor. I had my primary care doctor for a few years when I was diagnosed with PC by another doctor. When I had the next visit with my primary she wanted to do a DRE to know for herself what was going on. This increased my already good feeling about her by another 120%. Doctors who do not feel comfortable touching their patients should find another profession. I hear that plumbing is lucrative.
that is a sign that the Dr is a lazy moron
Very few Drs do DRE's anymore in Australia. They say it really is a little antiquated compared to the now standard PSA testing.
Also we don't do Transrectal Biopsy's anymore - too much chance of infection. We only do Transperineil Biopy's.
In reading some recent posts on this forum it looks like that in the USA a few still practice the old style riskier biopy's .
I would find another doctor.
As a family member with PC I informed my brothers and nephews of my aggressive Gleason 8 cancer. My oldest nephew is 49 and his doctor refused to do either test until he was 50. In my group of 10 radiation buddies getting roasted was 2 men 43 years old and one was a doctor.
My first ever PSA was 99. Subsequent appointments with urologist, surgeon, and RO, all of which did DRE. Thank goodness a few second opinions were virtual! Not sure what good DRE's were, as scan indicated prostate was "normal" size.
He should know how to do them. I've wondered how scientific they really are.
If he refuses to do the DRE don't demand it. Get a different doctor. There is a sad tendency over the last 20 -30 years of doctors relying too much on lab tests and scans, etc, ignoring the physical exam, as if we are in the Star Trek age with Dr, McCoy and his hand scanner. I could tell stories of diagnoses missed because of poor or no physical exams.
Prostate cancer is not the only cancer that occurs within reach of the finger.
Neither PSA testing or DRE are 100% effective.
PSA is better than DRE for detecting very small cancers, DRE will detect larger cancers that are only producing low levels of PSA.
Neither will detect certain types of prostate cancer and unfortunately these are often the most dangerous types.
The best method is NMR and if you are in a high risk group then that is probably the way to go.
After my DRE I told my doc I wanted a second opinion! He put the glove on his other hand…
At least he didn't have both hands on your shoulders. 
Mine was found via DRE. PSA hadn’t climbed much.
I believe DRE only examines part/most of prostate. Not all. IIRC.
yes, it examines mostly the side of prostate abutting the rectum...of course. Docs cannot feel the anterior of the prostate.....where my PCa is located.....transition/anterior. DRE is neither highly sensitive nor highly specific for PCa diagnosis, but then again neither is PSA!!!
This is the policy of AAFP based in 2018 guidelines. This was confirmed by a study in Europe published in '22 or '23 as applicable to screening of YOUNGER men. There are downsides in either case: OSA screening carries a risk of false positives, unnecessary surgery and complication; DRE can miss a large portion of the gland.
My experience: The last GP I went to while I had a prostate didn't do DREs; he told me that he relied on PSA history and symptoms, and if either indicated possible problems with the prostate, he referred the patient to a urologist. And then when the urologist did the DRE, it was brief and relatively painless, so I was happy to have avoided the presumably less-expert poking around by the GP.
Best wishes for the most favorable outcome!
Many thanks, really enjoy reading everyones comment's & will look for another doctor. YOU GUYS ROCK 👍
Hi, you can do your test in a private clinic.
just read a article yesterday that suggested DRE was not really necessary in most cases nowadays. Practiceupdate.com.
j-o-h-n disagrees. In fact, he still insists on a DRE, despite his RP.
Nothing beats a simultaneous test between me and the doctor....but we must wear rubber gloves up to the elbow.........
Good Luck, Good Health and Good Humor.
j-o-h-n
Kitchen gloves...with a little Palmolive
Yes the black ones with the little fur at the end....... "Fingerless French ticklers kitchen mitts".......(As seen on TV)
Good Luck, Good Health and Good Humor.
j-o-h-n
############ THE END #############
Madge would be proud of you for soaking in it.
What exactly would you be testing the doctor for.
A heart beat. j-o-h-n's Dr moonlights at the city morgue.
Only on ladies night.........
Good Luck, Good Health and Good Humor.
j-o-h-n
You like mummies. 🥁🥁
Yep no talking.......... But you must bring along an audio tape of a woman moaning and saying the 6th letter word of the alphabet and the word god over and over.....
Good Luck, Good Health and Good Humor.
j-o-h-n
I just have tapes of complaining....will that suffice?
Not if they're not complaining: More baby, More...........
Good Luck, Good Health and Good Humor.
j-o-h-n
If you get a really experienced MD j-o-h-n - he can do it with both hands on your shoulder.. tadaboom...
Maybe he ran out of ky
I would find a new doctor.
When I first went for care at Kaiser, my PSA was consistently around 20 (repeatedly, over two months, after a six week course of antibiotics for prostatitis). Kaiser Primary Care didn’t do a DRE because they were sending me to Urology (I was fine with that, figured the Urologist would do one).
I go to Kaiser Urology and the Urologist didn’t do one. Only wanted to wait and repeat the PSA a fourth time. I even reminded him that Primary Care had not done one because I was getting sent to Urology. Urologist dismissed me…no DRE, no MRI. Said the MRI was more accurate than his finger. Told me to wait 8 weeks then he’d order the MRI if my PSA was still elevated. It was truly shocking. I had never been to a Urologist for a first time appointment where they did no exam.
My PSA went to 29 before they did the MRI. What did my MRI show? 3 cm x 2 cm PIRADs 5 lesion which had already escaped the prostate and was in the right seminal vesicle. Had the first Urologist done a DRE, he very likely would have felt something. (Second Urologist did a DRE prior to biopsy and did feel firmness on the right.).
I fired the first Urologist and reported him to the State for potential negligence. He did nothing but ignore my significantly elevated PSA and delay my diagnosis.
All of the major PSA test manufacturers have a statement in their package inserts that the PSA needs to be used in conjunction with the DRE for prostate cancer screening. As others have said, it is because of the potential for high grade cancers which don’t produce much PSA but can be felt on DRE.
Here is an example from the Roche Total PSA package insert:
”Intended use
This assay, a quantitative in vitro diagnostic test for total (free + complexed) prostate‐specific antigen (tPSA) in human serum and plasma, is indicated for the measurement of total PSA in conjunction with digital rectal examination (DRE) as an aid in the detection of prostate cancer in men aged 50 years or older. Prostate biopsy is required for diagnosis of prostate cancer. ”
Thé FDA requires that for a reason: cancers which do not produce much PSA.
I made a huge mistake in not pushing back on that first Urologist, firing him and not immediately going elsewhere. For a Urologist to completely skip any sort of exam (let alone the DRE) on a new patient presenting for evaluation of a significantly elevated PSA is lazy and bad medicine.
My freind had a DRE and said to the doc - Last time I had this done it cost me 30 bucks and her name was Candy.
Seriously, I ahd a GP for over 30 years. He did everything. He gave me a DRE as well. When he retired, I got a new doc. I felt that there may be something wrong. She refused to give me one. Said she wasn't good at it. I knew nothing about PCa so I said OK. She gave me a PSA test and it was 4. Never had a followup call. Now, a 4 is not really high for a 63 year old, but it's borderline. She never said we will test you again in a couple months. Nine months later I went back and said something is wrong, I want a DRE. Nope. She referred me to a urologist and ordered another PSA test. It took two months to see him. PSA was now 9. He did a DRE and during it he was saying how there was normally nothing to worry about, etc. Then all of a sudden he said "Oh.." I thought "I'm screwed". He ordered a bipsy and, yup, G9. Metastatic to my bones. I always wonder if it had been caught the first time she reused a DRE, would it be metastic?
The only reason I was diagnosed was because the urologist opted to do a DRE after a kidney stone problem even though my PSA was normal. Ie 2.7.He felt the something and did a TRUS biopsy which came back at Gleason 3++3.
Refered me to another urologist who pushed for surgery (which I regret, knowing what I know now I would have gone for radiation) turned out post surgery Gleason was 4+3 which ended up metastising into pelvic bones 6 months post surgery.
If the doctor is skeevy about using his finger........... tell him he can use a pipe cleaners instead and to remember to only smoke cigars ..
Good Luck, Good Health and Good Humor.
j-o-h-n
If a doctor doesn't put his finger in it, he puts his foot in it!
During a physical with my GP and with an elevated PSA, the DRE found a lump on my prostate... Follow up with Urologist confirmed lump, subsequent biopsy confirmed cancer.
Take it or leave it... But it has merits. The GP was an old school Doc that knew definitely what he was doing.
Not reading much understanding here for docs so I'll offer support for the reluctant ones. The USPSTF guidelines and all the talk about "unnecessaries", "risks", "over treatments", etc. IMO are some of the many reasons we must be patient detectives, patients scientists and strong self advocates. Also, mpMRI's are not standard clinical practice here in the US - such a shame. For too many years my DRE's missed my well tucked in lesion - I came to learn too late DRE's miss far too many early stage lesions. This is an interesting discussion about screening guidelines. medpagetoday.com/publicheal...
I had to nag my new GP for the DRE (new insurance, new doctor -- previous doctors had no qualms about doing it). Took 3 visits. That DRE, at age 66, revealed a palpable tumor that got me sent to a urologist for a biopsy. Gleason 8. My PSA at the time was only 2.7. The GP refused to order that. The urologist was surprised that he had to order it. Anyway, wave this in front of your foolish doctor.
my general surgeon does my colonoscopies every 5 years and checks my prostate while I’m under anesthesia. Then the findings are in my portal with colonoscopy results.
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