Please Tell Me Your Experience With An Abnormal Digital Rectal Exam (DRE)

I went to a free Health Screening for men one Saturday morning at age 53.

Part of the screening was a DRE that came back as having "nodules."

I found another URO who confirmed.... My PSA never got over 1.3 and the original biopsy came back as a Gleason 6. After robotic surgery the biopsy was upgraded to a 7.

The scary part is that my new GP did a DRE before the URO and he couldn't feel the nodules... Well, he couldn't feel the nodule due to him being a small guy with small hands... Heaven only knows what would have happened had I seen this new GP first

The following is my story

In August 2013, I went to a new internist for a checkup. My wife and I sold our house in June of that year and temporarily moved into an apartment as we awaited the building of a new home in a 55 plus community in a new town. As this home is near a hospital, I thought it would be a good idea to establish a relationship with a new internist who had privileges at this hospital. At my checkup, he did a DRE and as he did it I felt no discomfort. I expected no problems as I've never had a problem with a DRE since a bout with prostitis in the late 1990s. However he said he felt a pea sized nodule. Bingo! My PSA came back at 1.6, down from 1.9 the previous year which was 1.4 the year before that.

My research showed up to a 50% chance that the nodule might signify cancer. He suggested a urologist and I made an appointment. I assume the position and he does the DRE. He finds nothing, NADA. I said that can't be. My internist felt a pea sized nodule. He does the DRE again. What fun it is. Again nothing. He gets his physician's assistant to do one and he feels nothing either. The uro does not seem to see the need for the biopsy. I stick my neck out and say I want it anyway. He says well maybe there was a firmer area and he agrees to do it. When the results came back he originally called it a Gleason 6 T1C and I had to remind him of the nodule or firm area and he changed it to a T2A. And now, my path report has graded me a T2C, Gleason 7 3 + 4.

So, did this new internist have longer fingers to catch the nodule that the uro and his PA could not find?. Is the DRE that subjective? With a PSA of just 1.6, did I have a potential virulent stain of cancer that did not put out much PSA or at age 63, did I just have a good chance of having Gleason 7 3+4 prostate cancer anyway? Either way, I think luck played a real part in this.

I guess I was also lucky because my internist performed the DRE just one month before the AAFP recommended that perhaps I shouldn't be given a digital rectal exam.

What I take away from this is that even with all the numbers and the metrics, each of us is an individual and luck plays a part as well. Good luck everyone! You are your own best advocate!

The problem with DRE's is that different doctors can feel different things..Urologists who perform many DRE's are much better at it than GP's tend to be...A DRE has two possible results. Normal or abnormal. That's it. An abnormal DRE virtually always results in a biopsy. But since many doctors have trouble detecting an abnormal prostate gland, the test is worthwhile only if performed by an expert...

MY GP does not do DREs. My PCa was initially diagnosed from a higher than expected PSA (my first PSA) in a yearly checkup. GP sent me to a respected uro for followup.

First Uro said he felt something, GP no, second time they reversed their positions. Not sure it has any validity unless there is some glaring abnormality. It will prep you for the larger probes to follow

In Feb 2009 I had a annual physical scheduled with my PCP. Towards the end of the physical I asked my doctor why he hadn't preformed a DRE. He stated that I didn't need one. I questioned him farther stating that he hadn't done a DRE in my previous two annual physicals. He said with my age (57) and low PSA (1.8) it was totally unnecessary. I remind him that during my previous annual exam the DRE was skipped only because I had just had treatment for hemorrhoids and I want to let things heal first. Again he said a DRE wasn't necessary.

Six months later (August 2009) I'm at my local teachering hospital (UCSF) to have my hemorrhoid issue farther investigated. The PA doing the exam said since he was already going "there" anyway, he was going to do a DRE before starting the hemorrhoid portion of the exam. Guess what, he felt a nodule on one side of my prostate. At the conclusion of the exam, the PA stated it was very important to follow-up with my PCP about the prostate nodule, that this wasn't to be ignored or delayed.

When I called my PCP's office he referred me immediately to a urologist. At the first visit with the urologist, he confirmed that there was indeed a nodule and he scheduled me for a biopsy. The biopsy found Gleason 4+3 in one core <10%, of the fourteen cores taken. The irony was that no cancer was found in the two extra core samples taken directly from the nodule, the cancer was found elsewhere in the prostate.


I had a second opinion of the biopsy slides at UCSF. The biopsy was upgraded to Gleason 4+4. After much deliberation on my part about treatment course, I switched from radiation + ADT (the radiologist recommended 2 1/2 years of ADT) to RP surgery. I had the surgery in May 2010. I just passed my 5 year point with my last PSA <.020. I've been happy with my treatment and recovery. I often wonder , if not for the insistence of a PA, how long would it have taken to uncover my high risk cancer and would I've had the same success in my treatment.......

TG

When I was in my 40's I had a GP who performed a DRE every year. I moved to another town, and my new GP performed neither DRE or PSA testing. After years without checking, I went to see a urologist about a completely innocuous condition, a varicocele. As a matter of principle, the urologist performed a DRE and instantly identified a nodularity. He brought in another URO, who confirmed, and they ordered a PSA test. Based on the results of that, a biopsy was ordered. Really all the information is in my signature. As you can see, I face a lot more risk than I might otherwise have, directly because my condition went undetected.

Needless to say I am angry that a very easy, non-invasive test could have caught this so much earlier--and that the opportunity for early detection was denied to me because of a misapprehension that generalized statistical analysis is the same thing as health care.

I mean, come on! This is not an MRI or some lengthy process involving complex machinery!! It is a low-cost diagnostic procedure consisting only one finger and one butt. No one's going to go broke or cause delays by making this a routine test.

Garys experience was unfortunately not unusual. He has bulging discs and serious back issues for which the Dr blamed his symptoms. When he was having trouble urinating the primary did a DRE. Said it felt a "little off". Ordered PSA that came back at around 10. He told Gary he would keep an eye on it. For 3 years Gary saw him regularly, including several visits for vomiting and upper back pain in shoulder blade area. Gary weighed less than 130 lbs. No follow-up on high PSA or unusual DRE (whatever that was). Finally a visit to ER resulted in referral to gastroenterologist who ordered PSA. Gary's Sig tells the rest of our sad story. Despite the unreliability of tests, our guys need to be aware and advocate for testing and follow-up or referrals from their primary.