How important is the DRE?

My doctor hasn't done a DRE for several years. I'm not sure why he doesn't. He's an internist. Perhaps he's shy or doesn't like doing that part? He's a great doctor, really good with diagnosis, so I don't want to drop him.

Do you guys insist if your doctor doesn't do this part? I do the annual PSA and keep track of that.

My GP will not do a DRE - says it is the realm of the urologist, who knows better what to look for.

I haven't had a DRE since my prostate was removed. My cancer was detected by the PSA instead of the DRE.

Squirm, my personal physician has always done a DRE as part of my annual physical. While she does a quite thorough job at least she is a petite woman with very small/thin fingers! (:
While nothing showed up with these annual DRE's she did monitor my PSA as well, very closely, which ultimately caused her to have me make an appointment with a URO - who also did a DRE, didn't find anything but ordered the biopsy based on my PSA history. While my DRE's never showed anything, I still believe based on all of the research I did - that they are a necessary 'evil.' (But again, for me, think - young, female Dr with small hands!!!)

For me, the DRE is what found my cancer four weeks ago. I have a large hard nodule but PSA is only 3.2. If I waited until the PSA was even more elevated before getting checked out I may be in a much worse situation.

My GP always did a DRE during the physical.

In my opinion a DRE is a "must" for any yearly medical checkup for an adult male.. it is part of the normal diagnosis work flow.

If you're 40 years of age then you physician should give you a DRE and also a PSA test. If not, then change your physician.

Maybe I'm being too conservative.. but these two "tests" are simple. Also, if treatment is necessary, trends are important when choosing a PCa treatment course of action.

I would tend to look for another family doctor if your current one refuses to perform DREs. While it may be specific to urology, it is still a standard part of a physical exam that a family doctor should be doing.

My former family doctor also went a couple years without performing one. When he finally did, he said I had a small nodule on the left side. This prompted me to visit a local urologist, who performed a VERY thorough DRE and promptly told me that I did NOT have a nodule.

But he DID tell me I had an enlarged prostate -- which is something that any family doctor should also be able to detect through a DRE.

I had had PSAs taken by both the family doctor and then the urologist when I saw him. The PSAs were in the 4 range. As a member of the medical coward's association, I declined the urologist's recommendation to have him perform a biopsy. This was 2009.

In 2010, my same family doctor would not do a PSA test that I had requested because he said my previous one was within the past 12 months and my insurance would not pay it. So I ended up skipping 2010's PSA test.

In 2011, the same family doctor ordered the PSA along with my other blood tests for my annual physical. His office called me within a couple days and said my PSA had spiked by about 2 points from the previous one in 2009 and said he was faxing the report over to my urologist.

I then went to see the urologist and finally agreed to do a biopsy -- which revealed PC. To make a long story short, this is why my former family doctor BECAME my "former" family doctor. Between not doing regular DREs and skipping one year of my PSA tests, my PC was discovered at least one year later than it would have been otherwise.

Getting back to DREs -- while they may not diagnose prostate cancer, they can detect tumors that are advanced enough to be bulging through the prostate capsule. And/or they can also diagnose BPH, which can lead to medicines that help improve the flow of urine.

My Dad, who had prostate cancer in 1997, was diagnosed at Mayo Clinic when a standard DRE revealed a lump on his prostate. One thing led to another and he quickly had an open prostatectomy to cure him of the disease.

So the DRE does have good purposes and should always be done. No reason why a family doctor should not perform one at least once a year.

Take care,
Chuck

July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate. Right
posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
First post-op exam 2/13/12, PSA <0.1.
Semi-erections now happening 14 months post-op & getting stronger.

Hi vn16,

I don't know why continued DREs would be necessary. After prostate removal there usually are no more DREs unless a local recurrence is suspected & the doctor is checking for lumps in the prostate bed. But, in your case, it seems unlikely there would be a recurrence.

I wonder if your doctor is perhaps an extremely cautious physician and feels best in leaving no stone unturned. That would seem a possibility.

Probably nothing at all to be concerned about.
Chuck

My PCa was detected by the DRE not by the PSA exam.

It's the first line of defense... particularly for younger guys. I've had yearly physicals since 20 when I got my first job out of college. I've had the same Internist all along. He did DRE's, maybe every two years until I turned 35 and then it was yearly. I didn't get a PSA until I was 41 when he responded after the DRE, "Curious. Feels spongy and lumpy." PSA came back at 2.6 or 2.8. DRE the next year, "Strange. I feel an overall firmness." Referral to Uro with a new PSA of 3.6 or 3.8.

I don't know when he would have started PSA's with me. 45? 50? Who knows... At the time, all PSA meant to me was "Public Service Announcement," but I definitely knew what a DRE was and why it was being done. I never complained, it was just part of his business, so it was done, basically, each time I went in for the physical. I was also almost totally asymptomatic except for frequent early morning urination, so the DRE definitely caught my disease.

My PSA never got over 1.3 ...BUT, I had nodules which started my journey.

So I and a few others think the DRE is/was a very good thing.

I read the original question to be if your family doctor (not urologist) did a DRE as part of a physical exam. I responded to add that even without a prostate my urologist thinks its still important, and does it as part of my regular PSA test appointment.

Everyone, thanks for your replies. I was always under the impression (and maybe I'm still correct) that the PSA value in the vast majority of the cases is the prognostic indicator for early detection.