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DRE Before PSA Blood Draw

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Posted 4/6/2013 9:35 PM (GMT 0)
I know this is controversial, its something i experienced and posted about a few months ago, and everyone (almost) seemed to think it was a no-no to do DRE prior to blood draw, and many felt i should find a new doc.
I have a friend who does research for a hospital (not PCa research) and he did a search for me, and found a bunch of stuff that points towards prior DRE making a small difference in PSA results, but not big enough to be "clinically significant", whatever that means. i guess small enough that the fluctuation can be attributed to the DRE or a number of other factors.

Anyway, I'm posting links to abstracts of what he found, hope thats ok, here. Maybe it will help someone.

http://www.ncbi.nlm.nih.gov/pubmed/1377290

http://www.uptodate.com/contents/screening-for-prostate-cancer/abstract/24,25

Anyway, i know its controversial, but i dont think there is a black and white line. Nevertheless, i decided to see another doc this time, i may still go back to the first one, but this time, i am seeing another.
Posted 4/6/2013 9:59 PM (GMT 0)
Prato you're right about one thing, there are a couple of opinions about this one, and I too researched the stew out of this subject and found opinions and "results" on both sides - but at the end of the day even if there is a SLIGHT chance of altering the test results, why take the chance????  nono

Makes absolutely NO sense to me to do the DRE before the blood draw whatsoever - Nuff' said. . . . . . . . . 

Posted 4/6/2013 10:15 PM (GMT 0)
Yooper - i do agree with you. Its one of the reasons i decided to see another doc. When the last doc did my psa after the DRE, it came back 2.7. This was 2 weeks after my reading of 2.2, and it nags at me whether it was due to the DRE, because it could be normal fluctuation. The doc even said to me when he took it, that if it came back a 2.6-2.7 it wouldn't concern him any more than if it came back a 2.2 again.
So i agree, even though i see research pointing to a small difference, its just as easy to do the psa before the dre as after.

I just posted my OP as another datapoint. (like we all dont have enough datapoints on this subject - sorry)
Posted 4/7/2013 12:31 AM (GMT 0)
I too had the first few Dr.s apply a DRE and then take a PSA draw. No insurance but canned all three! Dr. Stephen Strum says wait at least 72 hours after a DRE or sex to have a PSA.
Posted 4/7/2013 1:53 AM (GMT 0)
The first urologist i went to did a DRE before PSA. Never even had a baseline PSA done, they simply suggested this because they found nothing else during my exam. I was having issues in the lower right groin from a blunt trauma accident. (ran into a stair ballast) They could find nothing whatsoever and suggested it as an option. I took it and it came back 6.36. Second PSA after being on Doxycyclene for 2 weeks came back at 5.3. Free PSA was at 20.2%. Told to wait and rerun PSA in 3 months. I did not.

Saw a different Urologist and she did give me a DRE before administering a PCA3 test. Came back at 45, so had the biopsy and had 4 of 12 positive.
Posted 4/7/2013 1:59 AM (GMT 0)
Colorado you may want to rethink the sequence of procedures after some study as that seems ass backwards.................pardon the pun.

Too, I am a firm advocate of color dopplor imaging to target any needles. Read about Dr. Fred Lee please.

I wish you success!

Post Edited (Trepidation) : 4/6/2013 8:03:45 PM (GMT-6)

Posted 4/7/2013 2:54 AM (GMT 0)
Trepidation,

Thanks for your suggestions. I am rather new to this, could you please give me a better explanation? Loved the pun BTW. Any insight would be helpful.

Thanks!
Posted 4/7/2013 7:32 AM (GMT 0)
The major things that effect PSA are a biopsy and an infection.

While a DRE prior to a blood test may well result in the PSA being higher I doubt the difference is of great clinical significance. But I think guys will cope better with the whole threat etc of PCa if they do everything possible to prevent that nasty feeling you cannot avoid inside you when a PSA result comes back higher than the previous one.

Also I am not sure if there is a cumulative effect from the assorted things that can affect PSA. IE if you ride a bike 20 miles, then have sex, then go to your doc have a DRE and then get blood taken do you end up with three rises added together?
Posted 4/7/2013 8:10 PM (GMT 0)
After my RRP, I got notes from the Urology department saying that "ejaculation" can raise PSA and to avoid for 3 days prior to blood draw. I asked "but now that I don't have the plumbing, does this apply to me?" I never got an answer.

But in any event, it might make sense to test a little more often until you get a baseline. It seems to me they don't know what really influences the results...
Posted 4/7/2013 8:43 PM (GMT 0)
Yes, I agree. It is amazing there seems to be so much controversy and difference of opinion surrounding EVERY aspect of this disease. Very disconcerting for those of you who have been diagnosed, I'm sure, as it is for me as well.

Over the last 4 years, i have had PSA readings of

.7, 1.1, 1.7, 2.2.
So i fully expect another rise, there is no reason not too, especially since my biopsy showed one core of hi-grade PIN. I just hope that there is not a dramatic rise. Will know Wednesday, i guess.
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