Getting PSA tests, shoud I be having DREs too?

I just joined this site today and think I'll find it useful in many ways. I've studied matters of health and healing throughout my life. It's a passion and has likely served me well. So, right now, I'll get straight to the matter that got me joining this site. I've had a few prostate exams in my life. I had the digital method done once, maybe thirty years ago. In the past few years, I've had the blood test method done. All tests said I was doing great.
I've recently heard and read more about flaws in the blood test method, and that the digital might be a better, more conclusive test. I'd love to receive input on this, because I'm sensing I might need to be checked again and am wondering if I should seek out the finger over the blood draw.
I look forward to good conversations and lessons on this forum.
Thanks for being here.

Gave your thread a title. --PeterDisAbelard, moderator

Post Edited By Moderator (PeterDisAbelard.) : 4/9/2015 9:48:02 AM (GMT-6)

Gene,

By "blood test" I assume you mean a PSA test and since your last DRE (Digital Rectal Exam) was 30 years ago I imagine you are 50-ish or older. If you could tell us your age and your PSA score (4.0 is the usual upper limit of the totally arbitrary "normal" range) that would help.

You are right that PSA testing used for screening is problematical but, all things being equal, it is more given to false positives than to missing things. There are lots of factors besides prostate cancer that will make your PSA score go up but it is quite rare (although it does happen) for a man to have a dangerous prostate cancer without an elevated PSA. Your periodic blood tests are probably all you need but it is up to you.

They check for different things, so one needs both. A DRE tells the Urologist whether there is a lump requiring biopsy, stiffness indicating prostatitis, or whether the prostate is enlarged. But the DRE can be negative for all 3, yet there may nevertheless be something going on. A PSA (blood test) is an additional indicator. If it is low and DRE is negative, there is nothing further needed. Otherwise, further investigation may be necessary.

How old are you, and why did you have the previous tests done?

- Allen

There are several research projects to develop a test that is more accurate than the psa test, and also avoids the indignity of the DRE. But, those projects, while promising, have not reached the stage of being approved for general use. It may be a few more years.

For now, as Allen and others have said, both PSA and DRE are necessary for prostate cancer screening.

If you take a look at my stats below, you can see that my PSA never left the 'normal' range.  In fact, my PSA was actually the lowest recorded a few days prior to my surgery.  My age didn't fit the normal demographic for PCa. 

Ultimately, a DRE is what led the chain of events that ultimately revealed my disease.  If it weren't for a DRE last summer, I probably wouldn't have known anything was wrong... until things were way out of control.

Neither test is fool proof, but together they offer better clues on where you stand and what (if anything) should be the next diagnostic step.

Also I'm sure you'll note the various posts about doing the PSA blood draw BEFORE the DRE, etc.

I'm the last guy in the world who enjoys getting the oil checked, but I can't argue with the efficacy.  That said, I'm having a hard time convincing GPs that a DRE post-RALP is just adding insult to injury....

Good luck.

-------------------

- 43 yrs no family hist
- baseline PSA at 40 yrs 0.83
- July 14 Positive DRE, PSA 1.23.
- Aug 14 Pelvic MRI results: clean, except for a 5mm/3mm/2mm lesion on left extreme.
- Sep 14 Biopsy: left midcore (3+3, <5%), left base (3+3, 25%), right base lateral (3+3, 5%), left apex lateral (3+3, 20%), left mid lateral (3+3, <5%), left base lateral (3+3, 5%), plus 3 of 3 MRI-targeted shots positive with 3+3, 25% each.
- 1/20/15 Pre-op PSA 0.80
- 1/27/15 RALP/DaVinci, both nerves spared, at Walter Reed
- 2/6/15 Catheter Out
- 3/18/15 7-week post-op PSA UNDETECTABLE
- Continence recovery going slow but sure, down to one light duty pad/day
- ED minimal progress, currently on 50mg Viagra/day
- Path report: pT2c, total tumor volume 1.26cc (six total tumors, GL 3+3), neg margins, no cancer outside the organ (3.2cmX4.5cmX4.2cm, 27 grams).

Post Edited (Fred117) : 4/9/2015 4:44:13 PM (GMT-6)