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

"NickySantoro" ...

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.

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.

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.

 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 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

I've had the government up my butt so much that the DRE is a Ho-Humm.

Many thanks to all. You've confirmed what I suppose I already know.
It's time for a change of PCP.

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

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_Detection_Guidelin
es_36.asp?sitearea=PED

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.

Maybe he don't like doing DREs.  Find another doc.

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.