I'm not a doctor, but I think the finger just determines whether or not a
biopsy is warranted.  The staging is apparently based on the findings from
the biopsy.

I believe that few doctors will order a bone scan unless the PSA is high and
the gland is hard with tumors, and/or the Gleason score is high.  According
to the Partin Tables, low PSA, one lump, and Gleason 6 cells would rarely
indicate metastacized PCa.

jimhoney

...and why do Urologists have such BIG fingers?

On 10/19/04 3:45 PM, in article hfqan0lj3llutnc99chqdsoa0coofotnfq@4ax.com,

Not always very good.

After my PSA came out at 6.3, I had a DRE by a general practitioner
and then by a urologist, both of whom said they felt nothing.  Then
when I was examined for a clinical trial at the National Cancer Institute,
both the radiation oncologist and her resident did DREs, and each
independently reported a tumor in the same place.  The lack of
perception by the urologist was one of the reasons I chose not to
let him operate on me.

NCI also reported my PSA as worse than the original (though it
may have gone up) and reported that my Gleason score was 4+3
on the very same slides that my regular HMO reported as 3+3.

I don't believe that means that this is all an inexact science.  Rather
I think it means that some "experts" are more proficient than others.

I am one of those.

One theory about that is that if the PSA and Gleason are in
the "low risk" category, the chance of finding anything on a
bone scan is extremely low.  If they are higher, then the
bone scan may show something and, if it does, it can
influence treatment options.

There have been studies correlating the results of bone scans
with PSA and Gleason to support the above theory, but
I don't remember the citations or the numbers.

I had a bone scan because it was a pre-requisite for my
entering the clinical trial.  It showed nothing.  But that doesn't
really mean that I have no metastases.  It only means that if
I have any they were too small to appear on the scan.

I thought that staging had to do with whether there was a
"palpable" tumor, i.e., one that a finger could feel.

There are other ways to spot a tumor besides a DRE and a
post operative examination.  The NCI doctors did magnetic
resonance imaging of my prostate and showed me the pictures.
The tumor showed up vey clearly.

   Alan

You are correct, sir.  The doc can feel almost all of one-half of your
prostate.  But remember, the needle biopsy gives him some information as
well.  You'll note (below) that I went from a T2c to a T3b.  At the same
time, I went from a 90% of the prostate to a 50% of the prostate.  Once they
got that think on a slab, it's a lot easier to figure out.

That educated finger saved my life.My PSA was 2.9 it was my uro's DRE that
caught the mess that led to the biopsy that blew down my denial that I
built and found a 4+3 Gleason score.That led to the surgery that has been
so far good with less than 0.1PSA,people are too upset over cancer so they
go after PSAs andDREs andMDs as easy targets it is not that simple but it
is important to want to live and live well.

I first went to my family doc. He is a GP and not a urologist. I had
DRE's each year starting around 8 years ago. Slowly my prostate enlarged
but his exam (along with a PSA) always came out OK. Finally, on my visit
in 2003, the results of my PSA were elevated and he referred me to the
Uro. The biopsy came back positive (Gleason 3+3) and had the RRP.
Looking back at the situation, I kinda wish he had sent me to the Uro
earlier (or at least I should have sought one out - but didn't think
much of it at the time - although it was getting harder to pee normally)
 I am not sure of the possible outcomes but will never know at this
point. Maybe just Walsh's book or Sheldon's book would have at least
pointed me in a "better" direction. Oh well...."Pass the Caverject
Honey! Let's try this again!"

Philski

It depends on what is found in the biopsy.  In the great majority of
cases, the chances of finding anything in a bone scan are very low, so
it is not worth the trouble.  From what you say,  I would guess you are
in that category.   Also, unless metastasis is well advanced, the
results of a bone scan can be hard to interpret.   Sometimes doctors may
decide a bone scan is useful to establish a base, particularly if they
think there is enough of a likelihood of recurrence after treatment.

DRE is somewhat subjective, so different doctors can differ on whether
or not they feel anything.   Urologists are usually better at it than
primary care physicians, and of course after a biopsy shows cancer, that
may make it easier for the doctor to know where to look.   In a great
many cases where cancer is detected by PSA testing,  the DRE is
perfectly normal.  But some men have their cancers detected through DRE
although their PSAs are normal.  That is why both PSA testing and DRE
are recommended.

After a radical prostatectomy, everything can be examined minutely.  So
there is a difference between presurgical and post surgical staging.
Post surgical staging would have to be at least a T2a and often is a T2b
or T2c (depending on the classification scale that is being used).  T1c
is a presurgical staging meaning that the DRE didn't show anything.

My GP detected the lump and my PSA was only 1.4.  He referred me to
the URO and he too felt the lump and scheduled the bio.  Results from
the bio were 12 cores, 5 positive on right and 1 positive on left.
T2a, Gleason 6, 3+3.  At my age of 48, weighing the various options, I
decided to go for the robotic RRP.  However, I still elected to do the
bone scan and MRI.  Results were negative from both scans however
there was some arthritis in my right shoulder.  Something else to look
forward to.  RRP was 12/15/2003.  Post-op margins were clear.  Every
PSA since has been <.1
My first visit to my GP I eagerly thanked him for the early detection.
He then got on his soapbox and proceeded to preach to me about
dodging this bullet does not make use immune to heart disease.  We
have to keep the cholesterol under control and bla bla bla.....

Anyway, PSA 1.4 was not the flag that triggered the referal to the
URO, it was the "Educated Finger".

MrBill
age at diagnosis 48
PSA 1.4
Gleason 3+3=6
T2a
12 cores, 5 right positive, 1 left positive
robotic RRP 12/15/03
PSA 4/2/04, 7/8/04, 10/11/04 = <.1
pad free 8/15/04
age 49