Opinions about DRE
Question:
"Steve Kramer" wrote Nick, DRE’s are uncomfortable, but an absolute necessity in screening for PCa. PSA and DRE go hand-in-hand. Find a doc that doesn’t mind getting his finger dirty.
Even better, find one who uses a GLOVE. SHEESH! ;-) I.P.
Response:
"Steve Kramer" wrote Nick, DRE’s are uncomfortable, but an absolute necessity in screening for PCa. PSA and DRE go hand-in-hand. Find a doc that doesn’t mind getting his finger dirty. Even better, find one who uses a GLOVE. SHEESH! ;-)
Excellent idea! I’ll pass that onto my uro.
Response:
- Hide quoted text — Show quoted text – "Steve Kramer" wrote Nick, DRE’s are uncomfortable, but an absolute necessity in screening for PCa. PSA and DRE go hand-in-hand. Find a doc that doesn’t mind getting his finger dirty. Even better, find one who uses a GLOVE. SHEESH! ;-) Excellent idea! I’ll pass that onto my uro.
Heh! Buddy of mine told the urologist, "If I feel two hands on my back, you’re dead!"
Response:
My PCP is an internist and has yet to do a DRE during an annual physical. When queried about this he said that the PSA is a reliable enough indicator. He did send me to a Uro when my PSA took a bump. Fortunately, and two biopsies later, it proved to be a false alarm. That being said, my friend, age 60, was just diagnosed with PCa after a biopsy. His PSA was 1.8 but the doc felt something on the DRE. My thoughts are that I may need a different PCP. I believe that it may be time for a change but I’d like to get some other informed opinions on this issue and I can’t think of a better place than this to elicit them. Your comments would be most welcome.
Reminds me that as a younger man, my primary was a very young cardiologist, that took over the practice from my old time internist. He also told me that a PSA was enough and no DRE was needed. My now doc is an old timer that insisted on a DRE even though I told him I didn’t have a prostate anymore. I wonder if the younger guys are somehow a bit shy about the procedure? — "I’m not pompous and agrogant, I’m SNARKY" JK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories
Response:
Nick, DRE’s are uncomfortable, but an absolute necessity in screening for PCa. PSA and DRE go hand-in-hand. Find a doc that doesn’t mind getting his finger dirty.
– Hide quoted text — Show quoted text – My PCP is an internist and has yet to do a DRE during an annual physical. When queried about this he said that the PSA is a reliable enough indicator. He did send me to a Uro when my PSA took a bump. Fortunately, and two biopsies later, it proved to be a false alarm. That being said, my friend, age 60, was just diagnosed with PCa after a biopsy. His PSA was 1.8 but the doc felt something on the DRE. My thoughts are that I may need a different PCP. I believe that it may be time for a change but I’d like to get some other informed opinions on this issue and I can’t think of a better place than this to elicit them. Your comments would be most welcome.
Response:
My PCP is an internist and has yet to do a DRE during an annual physical. When queried about this he said that the PSA is a reliable enough indicator. He did send me to a Uro when my PSA took a bump. Fortunately, and two biopsies later, it proved to be a false alarm. That being said, my friend, age 60, was just diagnosed with PCa after a biopsy. His PSA was 1.8 but the doc felt something on the DRE. My thoughts are that I may need a different PCP. I believe that it may be time for a change but I’d like to get some other informed opinions on this issue and I can’t think of a better place than this to elicit them. Your comments would be most welcome.
Maybe he don’t like doing DREs. Find another doc. —
Response:
Reminds me that as a younger man, my primary was a very young cardiologist, that took over the practice from my old time internist. He also told me that a PSA was enough and no DRE was needed. My now doc is an old timer that insisted on a DRE even though I told him I didn’t have a prostate anymore. I wonder if the younger guys are somehow a bit shy about the procedure?
I was a bit surprised to be invited to "assume the position" with my urologist, after having had the RRP. As he explained to me, he was looking for nothing and hoped to find it as he examined the prostate bed. Two weeks ago I had my annual physical and my GP – who is quite aware of my PCa history as he is the gent who raised the alarm and sent me off to the urologist – performed a DRE even though he knew I’d been recently examined by the urologist. His explanation is that prostate trouble is not the only problem which can be diagnosed (at least partially) via the DRE. So…. (dare I say it? What the hell!) "Grin and bear it!"
Response:
Nicky, DRE is much needed – my PCa was detected by DRE while my PSA was 0.5. In my opinion a PSA test alone is not sufficient – you need a "talented finger" to feel your prostate. My PCP did not like what he felt and sent me to a Urologist. What came next was a DRE, TRUS biopsy, then prostatectomy. It is your body and your life – insist on DRE during annual physical. I am glad I did. Good Luck, Sammy J. Hutcheson PCa 5/2000
– Hide quoted text — Show quoted text – My PCP is an internist and has yet to do a DRE during an annual physical. When queried about this he said that the PSA is a reliable enough indicator. He did send me to a Uro when my PSA took a bump. Fortunately, and two biopsies later, it proved to be a false alarm. That being said, my friend, age 60, was just diagnosed with PCa after a biopsy. His PSA was 1.8 but the doc felt something on the DRE. My thoughts are that I may need a different PCP. I believe that it may be time for a change but I’d like to get some other informed opinions on this issue and I can’t think of a better place than this to elicit them. Your comments would be most welcome.
Response:
I’ve only been a member here for about a week, and I’ll share my story soon. But I wanted to pass along a link to the American Cancer Society cancer detection guidelines that indicate the PSA and DRE should be performed — they are complimentary tests. Other groups suggest the combo as well. And a normal DRE should not forgive an abnormal PSA, and a normal PSA should not forgive an abnormal DRE. Same thing with mammograms and breast lumps in women. http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detecti… I would ask any physician who does not do a rectal exam as part of a routine annual physical whether he thinks that screening for colorectal cancer might be another indication for a rectal exam, at which time a stool specimen could be checked for the presence of blood. Colorectal cancer is the third leading cause of cancer in men and the third leading cause of cancer death in men. Even though a urologist is probably more adept at performing a DRE than a primary care doc, I’m not willing to forego a rectal exam by my physician just because he may be less experienced — an abnormal exam is an abnormal exam, regardless of who finds it. There is no substitute for a complete physical exam, regardless of the number of blood and urine tests and x-rays and other scans we might get. We must be our own health care advocates. Be well guys.
Response:
My PCP is an internist and has yet to do a DRE during an annual physical. Your comments would be most welcome.
I’ve had the government up my butt so much that the DRE is a Ho-Humm.
Response:
My PCP is an internist and has yet to do a DRE during an annual physical. When queried about this he said that the PSA is a reliable enough indicator. He did send me to a Uro when my PSA took a bump. Fortunately, and two biopsies later, it proved to be a false alarm. That being said, my friend, age 60, was just diagnosed with PCa after a biopsy. His PSA was 1.8 but the doc felt something on the DRE. My thoughts are that I may need a different PCP. I believe that it may be time for a change but I’d like to get some other informed opinions on this issue and I can’t think of a better place than this to elicit them. Your comments would be most welcome.
I think your doctor is right most of the time. Most men with cancer will experience a rising PSA before there is anything that can be felt in a DRE. However, as your friend demonstrated, there can be exceptions. The DRE is a cheap and easy test, so most doctors do it. However I have to also say that most doctors probably can’t tell the difference between a prostate with no tumor and a prostate that has a tumor. A typical general practitioner may do hundreds of DRE’s, but has never had the opportunity to do them carefully on men that are known to have cancer and compare what he felt to what showed up on an ultrasound, x-ray, or MRI test. So you could switch to another doctor who does DREs, and still not be any better off. The first urologist I saw, a man who should have been an expert at doing DREs found nothing on mine, although two different radiation oncologists who examined me a month later did find a tumor – both in the same spot. They later pinpointed it exactly with an MRI. The same problem occurs with breast exams for women. Studies have shown that most doctors just don’t have the focused experience to be able to perform a breast exam correctly and diagnose what they find. If I were you I would consider this behavior by your doctor to be a bit suboptimal but not wildly so. It may not, by itself, be grounds for switching doctors. Unfortunately, really competent doctors who keep up with their studies and think hard about their patients are in somewhat short supply. Alan
Response:
My Man to Man group recommends that for the DRE and PSA monitoring men should use their urologist. That makes a lot of sense. My wife’s new PCP, a young guy, doesnt do the pelvic exam her former PCP did. He’s part of a medical group, and I assume he expects my wife to use the GYN doc for that. Also makes sense to me. However, it is more expensive that way. But not by that much when you consider what’s at risk.
Problem is, most men do not routinely see a Urologist unless they are having urological problems. Many insurance plans require that covered routine physicals and screenings be performed by a Primary Care Physician, not a Specialist. Incidentally, insurance companies also generally recognize Gynecologists as Primary Care Physicians. — JerryW Please respond to newsgroup; email address is fake 2/11/04 PSA 2.6, Suspicious DRE (age 62) 2/23/04 Biopsy: Gleason 3+4=7, T2a, left lobe 5/18/04 RRP, Path: Gleason 4+3=7, T2c, both lobes 7/13/04 PSA <0.1 10/12/04 PSA <0.1 1/18/05 PSA <0.1 4/26/05 PSA <0.1 10/13/05 PSA <0.1
Response:
My PCP is an internist and has yet to do a DRE during an annual physical. When queried about this he said that the PSA is a reliable enough indicator. He did send me to a Uro when my PSA took a bump. Fortunately, and two biopsies later, it proved to be a false alarm. That being said, my friend, age 60, was just diagnosed with PCa after a biopsy. His PSA was 1.8 but the doc felt something on the DRE. My thoughts are that I may need a different PCP. I believe that it may be time for a change but I’d like to get some other informed opinions on this issue and I can’t think of a better place than this to elicit them. Your comments would be most welcome.
My Man to Man group recommends that for the DRE and PSA monitoring men should use their urologist. That makes a lot of sense. My wife’s new PCP, a young guy, doesnt do the pelvic exam her former PCP did. He’s part of a medical group, and I assume he expects my wife to use the GYN doc for that. Also makes sense to me. However, it is more expensive that way. But not by that much when you consider what’s at risk.
Response:
Not all PCA has a high PSA, plus DRE screens for rectal cancer too. Ergo I expect it. Steve U
Response:
Nicky, My PCP is a female Family Practitioner. My PSA was 2.6 in February 2003, and again in February 2004. During my annual physical in February 2004, my doctor as usual did a DRE and felt an irregularity on the prostrate. She sent me to a Urologist, and well, you can see from my signature that I did have cancer. If it had not been for the suspicious DRE, I might not have been diagnosed nearly as soon as I was. At the time, 2.6 was not considered unusually high for someone my age. Most Urologists now would probably consider this reading marginally high for a 62-year-old. I would be concerned if you are 50 years of age, or older, and your physician is not doing both tests at least annually. We have heard of many cases where PCa was suspected on the basis of DRE alone, without a necessarily high PSA, and later confirmed by biopsy. — JerryW Respond to Newsgroup; email address is fake 2/11/04 PSA 2.6, Suspicious DRE (age 62) 2/23/04 Biopsy: Gleason 3+4=7, T2a, left lobe 5/18/04 RRP, Path: Gleason 4+3=7, T2c, both lobes 7/13/04 PSA <0.1 10/12/04 PSA <0.1 1/18/05 PSA <0.1 4/26/05 PSA <0.1 10/13/05 PSA <0.1
– Hide quoted text — Show quoted text – My PCP is an internist and has yet to do a DRE during an annual physical. When queried about this he said that the PSA is a reliable enough indicator. He did send me to a Uro when my PSA took a bump. Fortunately, and two biopsies later, it proved to be a false alarm. That being said, my friend, age 60, was just diagnosed with PCa after a biopsy. His PSA was 1.8 but the doc felt something on the DRE. My thoughts are that I may need a different PCP. I believe that it may be time for a change but I’d like to get some other informed opinions on this issue and I can’t think of a better place than this to elicit them. Your comments would be most welcome.
Response:
"NickySantoro" … My PCP is an internist and has yet to do a DRE during an annual physical. . . . Your comments would be most welcome.
Your story implies three things to me: 1. Your PCP is shy about DREs, 2. He hasn’t the experience to recognize a marginal DRE anomaly, and 3. He’s not as informed as he should be about PCa screening. I’d ask him to explain all three concerns if he’s otherwise impressive — but always wonder what OTHER chapters he slept through in med school . . . and start shopping for another PCP. Or are you 25 years old, which might skew his advice? I.P.
Response:
: My PCP is an internist and has yet to do a DRE during an annual : physical. When queried about this he said that the PSA is a reliable : enough indicator. He did send me to a Uro when my PSA took a bump. : Fortunately, and two biopsies later, it proved to be a false alarm. : That being said, my friend, age 60, was just diagnosed with PCa after : a biopsy. His PSA was 1.8 but the doc felt something on the DRE. : My thoughts are that I may need a different PCP. I believe that it may : be time for a change but I’d like to get some other informed opinions : on this issue and I can’t think of a better place than this to elicit : them. Your comments would be most welcome. The DRE, never welcome, is the first thing I think any competent physician should perform. If he or she is at all experienced he will detect any unusual lumps or bumps on the surface of the prostate capsule and make a recommendation from there. He may suggest that a PSA be taken, especially if the patient is around 50 (some say even lower). Ideally, none of this antigen will be found in the bloodstream because it’s supposed to be a "closed system," and the equipment used to detect it is quite sensitive. As a man ages, some leakage will occur, even if cancer is not present (or detectable). Unfortunately, very high PSA levels usually have no noticeable effect on the individual but leakage is taking place and that indicates a rupture, which is indicative that something is "eating" its way through, and that something is probably cancer. I am not a physician, but I am a PCa survivor (4+ years now) and these comments are offered for what they’re worth. Ken Bland