PSA/DRE testing

How many were informed to avoid sex, bike riding, strenuous physical activity, etc. for 48 hours prior to testing?
I've had four exams and not once was it brought up nor was infection mentioned as a possibility for an elevated PSA.
During my most recent exam, the nurse practioner was going to give me a DRE just prior to drawing blood for my PSA until I objected. When asked if that might skew the results, I was told "not really".
Am I wrong, is it a non-issue? Everything I've read indicates it is an issue.
For the record, I've since had a biopsy and I'm a gleason 6, but I'm losing faith with the professionals I've encountered.

Welcome to HW.

Yup, all of those are known to raise PSA.

Sounds like you need different medical professionals on your side.

Andrew

The studies I've seen have been very small, but the effect of a DRE on a PSA test seems to be modest at best:

"no significant increase in serum total and free PSA at 10, 30, 60, and 120 minutes after DRE. These results suggested that DRE did not disrupt cellular architecture within the prostate gland."

Prospective investigation of change in the prostate-specific antigens after various urologic procedures

"There was a statistically significant difference in the complexed PSA and total PSA before and after manipulation, with the exception of cystoscopy. On review of the data, it was clear that not all changes were clinically significant."

Effect of prostate manipulation on the serum levels of complexed prostate-specific antigen and total prostate-specific antigen

"Digital rectal examination causes a modest increase in total and percentage of free PSA."
Effect of Digital Rectal Examination and Needle Biopsy on Serum Total and Percentage of Free Prostate Specific Antigen Levels

"There was no significant increase in complexed PSA levels after flexible cystoscopy and digital rectal examination"

Prostatic manipulation has a minimal effect on complexed prostate-specific antigen levels

I'd guess that it could make a difference if the DRE were really vigorous - usually they aren't.

There's a clinical trial in Israel that aims to resolve this question:
Evaluation of PSA Blood Levels Prior to and After Digital Rectal Examination

- Allen

Robertmp,

Welcome to HW's family! Agreeing with the others.

To answer your initial question, no, I was not informed of any of those issues. But my PSA was 126 when I had my PSA checked!

Take care,

Dave in Bartlett, TN

My GP did bring up avoidance of ejaculation prior to my 2nd PSA test, but really, if your PSA is quite a bit over the 2.5, as in 10 or greater, it's a good probability that short-term irritation is not going to cause a substantial pass/fail differential.
Also, in seeing where there seems to be (in my mind anyways), quite a few Dx's with low PSA, the default still remains that PSA is a reason to look further, and not a Dx.