DRE and PSA question

Hello everyone. I'm new here and I need some advice. I don't have anyone I can ask questions about this so I searched the net and found this site. Looks like there are a lot of knowledgeable people here so I'm hoping I can tap into that brain trust. I'm 62 and just had a physical last week. My PSA was 4.8. At my last physical 2 years ago it was 2.4. My PCP told me my prostate was enlarged a little but that is common for a man my age and advised me to see a Urologist just to get a second opinion and see if any other tests are needed. I'm in great health other than the PSA number. My first question is, when should the blood be taken for the PSA test, before or after the DRE? Or doesn't it matter. The reason I ask is 2 years ago, blood was taken before the DRE. Last week it was taken after the DRE. If it should be taken before the DRE should I go back to my PCP and ask for another blood test or should I just make the appointment with the Urologist and explain to him what happened? I just want to make sure that everything is done in the same order so I can compare apples to apples. If the tests were done in the wrong sequence then the results could be invalid. Any advice or help you can give me would be greatly appreciated. Needless to say I'm worried sick over this. I know I'll have more questions later as I start this next chapter in my life. TIA for your help.

Welcome to Healing Well. As we are not medical professionals, the answers here to any question can be all over the map, but I think we all agree (and John's Hopkins says as much in their newsletters) that anything which disturbs the prostate, such as sex the night before, a DRE, rding a bike the day before, infection of the prostate, all stand a chance of increasing your PSA number. Thus the general consensus is to avoid all those things before a PSA test. So, draw the blood first.

Welcome to our corner of the world. The PSA test can be tricky and getting a weird result is possible for a number of reasons. My doctors always look at the tend of a number of tests (more than two). I'd ask for a retest.

When I went in just over a year ago my PSA had risen between annual test but my PCP decided to retest (after waiting 2 months and with clear instructions on what not to do) and when the retest came back even higher I was referred to the Uro. I'd ask for a retest to confirm the result.

But you still might want to consult with the Uro in any case. If that jump is true you might want more tests.

All the best,
Andrew

cad designer - I too am not a medical practioner, however I am shocked that your PCP would do a DRE in front of a blood draw for PSA. . . As others have stated above, you should not be doing anything that would disrupt the prostate gland for 2-3 days in advance of a blood draw for PSA. I'm guessing that your PCP didn't bother to tell you anything about that?

My input would be that you don't put too much weight on this latest PSA due to the circumstances. Find an experienced urologist and ask when you could have another PSA taken, and do it through him/her rather than your PCP.

Best to you.

Cad,

I can give you a specific result in my case. My PSA was 2.64 pre treatment (IMRT/HDR). A few weeks after treatment ended, PSA went up to 5.1, as the treatments had really irritated/inflamed my prostate. Four months after treatment, PSA had decreased to 1.31. After 3 more months I went to Urologist and had a DRE, and then 1/2 hour later had a blood draw for PSA, which showed an increase to 1.78. But after three more months (10 months post-treatment) the PSA was down to 1.06.

Obviously, the DRE had affected my PSA, probably by at least .5, maybe more. When I searched the connection, I found that DRE could easily increase PSA by an average of .9 points and that the max increase would show up about 1/2 hour after the DRE. Of course, some DREs are more aggressive than others, creating even more variability.

Even though my prostate is shrinking in size after radiation, it is still there and the DRE can affect PSA. I will make sure to get the blood test first in the future. Dumb thing is I knew the relationship, as did the Uro, but it just seemed to be forgotten in the rush of the appointment. Never again!! It scared the crap out of me. Hope this helps.

Definitely blood test then DRE.
I went to the University of Washington Cancer care center for my 2nd options. I was there for two full days talking to Med. Onc, Rad. Onc as well as Uro. Each one did a DRE. Hell, It got to where every time I saw a white coat I wanted to drop trol.
I did a PSA test both before and after the DRE’s and the numbers went up. After meeting with the last Dr. he told me that the numbers was up due to all the DRE’s the past two days.
PS: I’m also a CAD Designer.
bertb

Thanks everyone for all the information. I think what I'm going to do is make an appointment with the uro, explain to him what happened at the FP visit and then see what tests they will do. I'm sure they will start out with a blood test and a DRE so they will have a base line of their own rather than go on the data from the FP. I'll post back after I get to see the uro. Thanks again everyone.