Can advanced prostate cancer be felt ... - Prostate Cancer N...

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Can advanced prostate cancer be felt on DRE?

So I read about all the symptoms of early prostate cancer, which I guess there aren't any real symptoms at the early stages, but when a prostate tumor grows large enough to cause the advanced symptoms described on all the prostate cancer websites, can't it be felt on a digital rectal exam? I have had 3 DRE's in the past two months,,,one doc just about wrapped his finger around my prostate, and they have felt nothing abnormal. My PSA is 3.1 but have had urgency, some burning after urinating, groin pain and reduced flow, most of which seem to be getting better. I've had frequency issues and low output for a long time and have chronic prostatitis (CP). Urologist wants me to have a biopsy but I don't want to get the CP really agitated again. Any thoughts?

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That could be caused by inflammation.

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That's sort of what I'm thinking...more of the CP, but now that I'm 62 anything is possible. Thanks for getting back to me!

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Get an MRI

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Urologist doubt insurance will pay for one. He's at Cleveland Clinic...not sure that matters though. I'm willing to pay for one if I have to...they have the T3 MRI there. Thanks for the response!

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They will pay for a normal mri usually. Not sure about the t 3 but no need for the coil if you get one. My first one that located the tumor was a simple pelvis mri.

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How old are you. Medicare pays for sure

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62...not quite old enough.

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For sure get it before the biopsy

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I’m trying to go that route,,,thanks!

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DRE’s from two different docs showed nothing prior to my dx of stage IV mHSPCa. Biopsy just before dx showed my prostate nearly completely filled with cancer, 11 of 12 segments.

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Sorry to hear that...how are you doing now? What was your PSA?

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PSA at dx 8.2, GL8. Currently on Lupron/abiraterone plus IMRT to prostate. PSA 0.1 and trending down. I feel great! Fortunately I’m asymptomatic, so far.

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Good to hear!! Thanks for the replies!

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In my pre Dx time, my PCP was tracking a (DRE detected) nodule in annual visits. He mentioned it was small, and most likely benign. When he moved, my new PCP detected it also. He said in most cases it is benign, yet gave a referral to have a urologist examine it.

The Urologist confirmed its' presence. My PSA at the time was ~3.8. He recommended a biopsy, yet gave me the option to wait (AS) and be checked again later in 6 months. After I read up on what a biopsy entails, I decided the 6 month wait was the better choice.

The next visit to this same urologist resulted in a recommendation for biopsy. He said he detected nodule growth, and that it was a bit larger, at ~1/2 centimeter (DRE assessment). My PSA however had not changed. I decided to take his recommendation though, yet found and went with another urologist. From this point on, I wanted care from a well seasoned urologist. I found one with years of Da VIncÍ surgeries, and with nerve-sparing experience.

During my RP, my left nerves were spared but do to extra capsular PCa extensions on the right I lost ~2/3 of the nerves on that side. My nodule was on the right side. From what I learned, standard care uses PSA >= 4.0 as the line-in-the-sand for recommending a biopsy. If a nodule is also detected, this measurement can be relaxed in giving a recommendation.

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Sounds like you were on top of it. I’m trying to do the same but then get worried I’m waiting too long. Thanks for the reply!

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Sincerely wish you the best in choices going forward. Educating yourself and being proactive are key points. One last mention, when I found my urologist I was told he was scheduled out 6 months out.

I became proactive. I had information sent from my PCP and initial urologist, with an urgent request for an earlier appt. Within days, I was given an appt. for an office exam in 3 weeks.

Best of health brother!

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That standard of care psa of 4 is bull. Mine was out of the prostate at 4.21. So it was cancer at 2. Mri should have been my first test. I was to dumb to know my urologist was an idiot. What a pair that made. Everyone talks about doing unnecessary tests. Mri is easy and much more likely to show what’s going on. Get the finger and the mri. Then biopsy but mri guided so they don’t miss like my guy.

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I agree completely. When I was recommended the biopsy, I asked about a non-invasive MRI first. I was told it would not tell them as much, and that insurance would not cover it. Ah, what a health care system we have. As I said, educate your self, and be pro-active.

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Thanks for the advice,,,it's very much appreciated!!

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I agree with you, especially with your chronic prostatitis history. When symptoms like that arise, it is almost always prostatitis that relapses and remits. Why not just wait 3 months and have another PSA then? Instead of a normal PSA test, you can ask for a prostate health index (PHI) test (which includes PSA) which is less affected by prostatitis.

DREs are almost always negative. But if it is hard, it may be a sign of prostatitis. If lumps are detected, it may be benign cysts or cancer.

An MRI is a bad idea because prostatitis is a known source of false positives.

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Good to know about the MRI's and chronic prostatitis. My initial PSA was 5.5 but I had ran 3 miles the day before...big mistake. A month later it was down to 3.1. Waited another 5 weeks and had another one that was also 3.1. My father had prostate cancer and was diagnosed with a PSA of 3.3 and a gleason score of 10. He did have a nodule that could be felt however. I'm not sure whether low PSA and high gleason scores are inherited too....(my urologist didn't think so necessarily) so I don't want to wait too long.

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That zig-zag PSA pattern is typical of prostatitis. I've read that about 20% of prostate cancer is heritable, and I agree that the type of prostate cancer probably isn't. How long does it usually take for your prostatitis to remit? PC is always slow progressing while it is localized, so 3 months isn't likely to make a difference. If you are anxious, a biopsy can settle your mind, but I agree with you that poking holes from the rectum into the prostate may make the prostatitis worse. They can do a transperineal biopsy, which carries lower risk of infection.

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The first time I had a chronic prostatitis was 30 years ago and it lasted almost a year...since then I have a week or two every so often that things hurt in that area. Used to take Urised and drink lots of water and it would go away. This one seems to be lasting longer (3 months so far) though since the stress trigger (potential prostate cancer) is still bugging me.

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I have a friend who takes a tricyclic antidepressant when he gets a flare up - no one knows why it works, but it does. I saw where they are experimenting with next gen sequencing of DNA in the urine to find evidence of unknown pathogens. It's kind of a mysterious illness.

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Have you tried cranberry capsules?

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No...I'll do some research on them though. Thanks!

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Get a color sonogram by someone that knows how to use it to look for prostate cancer. It's not expensive. You can just pay the cost if necessary.

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I'm looking into that option...thanks for the advice!

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Fly out to Datolli clinic in Sarasota. They are very very good at it. They have been using color ultrasound for prostate cancer diagnosis for many years.

And they also don't believe in mixing blood and prostate cancer cells.

It's worth the trip and an overnight stay.

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I'll check them out,,,thanks!

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I was diagnosed in Canada with stage 4 PCa, G4+3, at PSA of 20, and one met to femur. Prior to that, the DREs and 2 ultrasounds were "unremarkable." I also had burning and small urine flow, for which my MD prescribed Cipro, which is now the subject of several class action lawsuits because of peripheral nerve damage it has caused. I then found a Chinese allopathic/naturopathic doc who did testing for ureaplasma, which was confirmed as the likely cause of my urinary issues, along with an enlarged prostate. I paid for some expensive advanced blood work tests which were "inconclusive." I then paid for an MRI, which found large tumours, and only then did my RO agree to do a biopsy using their own MRI data, which then led to my diagnosis. After losing faith in our health 't care system, I went for treatment at the Dattoli Cancer Center in Sarasota, FL. To date, 2 years later, my PSA is around .008. PSA of 3-4 is considered normal, and PSA values over 1000 are not uncommon. I wouldn't rush into a biopsy just yet. Don't agree to take powerful antibiotics before you get tested for ureaplasma as a possible cause of your urinary irritation. If you have it, as most people who have had multiple sex partners have been exposed to it, it is easily treated, and your partner should be treated as well. If you have BHP of the prostate, you can discuss possible treatments with your family doc. The key is to monitor your PSA, and if it begins to rise above 4 over several months, you might consider an MRI or a PET scan. The TRUS biopsy is maybe 65% accurate, and it often misses cancer in the anterior portions of the prostate, unless you have MRI data to guide the needle placement. For now, please don't obsess on the possibility of having PCa.

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Thanks for your reply. Good to hear your PSA is staying low...hang in there!

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A word about MRI. Insurance does not usually want to pay. A biopsy is cheaper. We have a healthcare ruled by money - no surprise there. I also had a zigzagging PSA and my uro did NOT want to biopsy without MRI. Insurance said no. After another PSA bounce way upward he tried again. Said he spent 45 minutes arguing with them in a peer-to-peer review of my case. And he got them to authorize! Had a 3TmpMRI. Easy. No coils used. Clear, normal, PiRads score 1. I feel fortunate. Doc who interpreted MRI said looked consistent with BPH. Bottom line is find a doctor who will advocate for you. My uro seems to think we are in a time now when we ARE trending towards MRI being the logical step BEFORE biopsy. Says more insurances are willing to pay for this prior to biopsy because it may save money in the long term. Think over treatment and reduction of costs of dealing with side effects from biopsy. Good luck to you.

P.S. I have what I consider (I work in the healthcare field, btw) to be a low tier "cheaper" health insurance. Huge deductible, small network. Find a uro who behaves like a pitbull for his patients.

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Very glad everything was benign! I'm not sure my urologist will fight that well for me. It's hard to get him to even sit down and talk to me. May be time for a new one. Thanks for your reply!

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Find a medical or radiology oncologist for a consult before you do a biopsy. Uros cut. It's what they do. Hit the research trail and read the posts by Nalakrats, PJ O'Shea etc.

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TRUS biopsy is maybe 65% accurate, unless they use MRI data with it.. Do the MRI, even if you have to pay for it.

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"Benign" is a misleading word...let's say that everything looked normal for now. But yes, this is my second Uro. First one I didn't trust. mostly because of his bedside manner or lack thereof. Keep looking. My insurance is not exactly the platinum standard and I wound up finding someone I can trust. Peace to you in the future

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A DRE got me sent to a urologist for a biopsy. Uneven firmness was the red flag. Gleason 8, tumor detected one side only (hence the uneven firmness). PSA was only 2.7 so the DRE test did it's job. After prior TURP I was not a candidate for RP. I was steered toward external beam radiation but chose HIFU instead. That was almost 3 years ago.

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My father had a PSA of 3.3 and a positive DRE also with a high gleason score so it sounds like the combination definitely works. Glad things are working out for you!

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...but when a prostate tumor grows large enough to cause the advanced symptoms described on all the prostate cancer websites, can't it be felt on a digital rectal exam...

The answer is yes. It does not have to be all that advanced for it to be detected in the DRE. I was 52 and had both urgency (felt like I could never get there in time), and frequency (4 to 5 times during the night) My Urologist found firmness he did not like when he did the DRE. My original PSA was 5. The DRE was followed by a biopsy. Gland half filled with cancer, Gleason score 7 (3+4). I had R.A.L.P one month later. PSA has been undetectable ever since (2011).

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That is so good to hear that you have undectectable PSA since 2011! Thanks for sharing your experience with me. I can't believe that kind of information isn't out there somewhere, but I hadn't been able to find it. My PSA is currently 3.1 but I have symptoms of prostate cancer pretty much all the time with the chronic prostatitis. Was the urgency and frequency pretty much with you full time or did it come and go? Sometimes I only have to get up one time during the night and then sometimes I have to go 4 or 5 times. Thanks again for replying!

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