Differing PSA and DRE Results: What to do next?

Hi,

This is a great forum and I have learned a lot so far from the many posts here.

I'd like to present my dilemma as it has occurred quite recently.

I'll be 51 next month. For the past several months, I have been noticing that my stream has been slowing down and it takes more time to start. I almost never need to get up to go to the bathroom when sleeping.

I decided to go to a doctor about this. I didn't have PCP that I see on a regular basis, so I tried to find one near where I work in Lower Manhattan, but couldn't get into one quickly, or a good one that takes my insurance. I then found a doctor near where I live in Brooklyn who saw me the next day.

I told him the reason for my visit, about my prostate. Unfortunately, he didn't have the gel that he needed, so he said he will check it in the follow-up visit. In the meantime, I was given a blood test, EKG and Pulmonary test.

Two weeks later (which was Dec. 27th), I come back to get the results from the doctor. He tells me everything is very good - normal blood sugar, normal cholesterol, normal thyroid, and no chance of diabetes. EKG and Pulmonary results were very good. No mention of a PSA number.

As he was about to end my appointment, I told him that I wanted to find out more about my problem that could be related to my prostate. He said he will do a DRE. He did it and what an awful experience that was.

Anyway, he said my prostate felt enlarged and hard (that's all he said). That didn't sound too good to me. Needless to say, I've been somewhat upset about it.

He gave me prescription for Rapaflo. I've been using it for several days. It seems to help somewhat, but maybe I need to use it longer for better results.

He also gave me a paper to go for an ultrasound.

The next day, I call his office and asked if the blood test had a PSA score. They looked it up and said that it is 1.04. I was kind of relieved to hear that, as it is a good number. They said it's normal, but the nurse would not discuss anything else with me about it.

From reading these boards, I have learned that an enlarged prostate has not much correlation to PC. But maybe a hard prostate does.

I know that this might be limited information, but could this be PC? Could it be something else such as BPH or Prostatitis?

I don't eat red meat, dairy or spicy or barbecue foods. I do lots of walking - I can walk 10 miles without stopping. Not overweight (I'm underweight).

I haven't called the ultrasound place yet. I wasn't too crazy about the building it's in.

So, at this point, I'm not sure what to do or what to think.

Thanks for any comments there may be!

Welcome to HW.

You need a better doctor. you need a good URO to diagnose. It could be an enlarge prostate. What would be interesting is to see how much the Rapaflo has been affecting your PSA. DREs are a bit subjective and it would be better to have that done by a URO who does it more often. If you got a doc who doesn't even carry the right supplies in the office - well frankly I doubt the result and 10 is not a normal PSA.

A ultrasound would be good to see how large your prostate is. Many things increase PSA, BPH is a common one. You want to rule out all other causes before thinking PC. While this could be PC, BPH is the more likely explanation. PC rarely has symptoms, even at your PSA number, I wouldn't expect to hear of symptoms (not unheard of, but doesn't happen very often).

Hang in there,
Andrew

Jeffx
Sometimes we just need to get a second opinion and this is one of those times
I would start looking for a new pcp that takes your insurance and explain that you kinda lost faith in you're don't have any gel Dr. I'm not big on any Dr not addressing the reason I went to him/ her.
I've been in your position and did exactly what I'm suggesting of course mine di have gel

Fauntleroy said...
I had symptoms you describe plus frequent need to urinate day and night from an enlarged prostate, complicated by having an abnormal growth of the enlarged prostate, into the urethra.

None of this had anything to do with the prostate cancer that was growing symptom free

Didn't have "gel" to perform DRE, didn't mention PSA, said your prostate is hard without advising what it means..

I think you need to find another primary care doc and get yourself a qualified urologist to assess your current issues.

Thank you, I agree!

I also think you should see a good urologist. Maybe some of our NYC guys can recommend someone for you. (I'm pretty sure Pratoman lives in Brooklyn, so hopefully he sees this...)

Just so you know, nothing about what you're describing necessarily points to PCa--more likely BPH. But you'll need a good uro to help you diagnose and stay on top of this. Good luck to you!

Jeffx said...
"well frankly I doubt the result and 10 is not a normal PSA."

Thank you for the reply, but just to clarify, my PSA is 1.04, not 10.

Sorry about that, can't read early in the morning.

1 is normal and I doubt you have anything but an enlarged prostate. PC at that PSA is rare. It can happen, but the odds are against it.

Even with a PSA of 1.04, it is possible to have prostate cancer. Better to see an uro.

Hey I'm from Brooklyn I grew up in the East New York section and eventually moved to Flatbush.
You have a crappy doctor. Someone has to graduate in the bottom 10%. Find a better regular doctor. You need one just in general. Not sure if you need a URO


Mel

Hi. Not to worry you but there are some forms of prostate cancer that do not raise your PSA. Ductal and small cell for example. Depending on how you feel, you may need to get a biopsy. Not very conferable but it may give you peace of mind. In the small chance it is positive you hopefully would of found it early.

The ultrasound will give you a much better idea if your prostate is enlarged and by how much, and how much urine is being retained. A hard prostate most often indicates prostatitis, but that usually elevates PSA. At this point, you have no reason to suspect PC. Your presenting symptom is poor urinary retention.

You've got to see what your prostate size is. If it's enlarged (particularly in the transition zone), Proscar or Avodart is the drug of choice. If it's not enlarged and Rapaflo isn't doing much for you, there are about a dozen other of that type of drug you can try (they are called alpha-blockers). Your urologist, when you find one, should have samples - try some to see which works best for you. (Be careful taking them if your BP is low, if you are also taking ED meds, or meds for high BP. And get up slowly from bed or reclining position for the first few days). Often, these two kinds of drugs are taken together.

Jeff - It is possible that they ordered a color Doppler ultrasound. I've not had that one, except of my heart, so my knowledge here is limited. They didn't tell me if they used a color Doppler for my fiducial marker implant procedure, but I doubt it.

If the color Doppler US is anything like the standard ones, they will likely introduce an ultrasound transducer through the rectum to visualize your prostate. The probes vary in size, so just hope they use an appropriate sized device. They usually coat/lubricate the rectum with a numbing gel, so there usually isn't much pain, if any at all. I had two prostate ultrasounds - one with a biopsy and one when they implanted the markers. The biopsy was a total non-issue. Small, smooth probe. Just a bit "unusual" feeling as it was inserted, they nothing. The US probe used when they did my marker implant must have been larger, because it was more uncomfortable. Still, only painful when they pinched some skin when first introducing it. After that, no big deal. In both cases, afterward, no lingering discomfort from the ultrasound at all. The other procedures done at the same time. . . not that bad either, but unless you have been told that they want to do something else, we'll stop here.

Be forewarned, some uro's will tell their patients at the time they are going to do an ultrasound that if they see something suspicious enough in the ultrasound, they may just do a biopsy right then. I would resist that, unless you have already been given a course of prophylactic antibiotics before the ultrasound. I would not accept a trans-rectal biopsy without proper antibiotics beforehand.

Gp's{no gel who's kidding who? }do not like nor do they know how to give or interpret a DRE..Caution...a proper dre by a proper uro is not supposed to be comfortable...some times {operative phrase}we need to feel our pain...to rid ourselves of it...a mask is just that... See a Uro and remember who is working for who...

Hope4all said...
TAllAllen is correct a good urologist is number 1 and a good pcp is also important just a quick question who did the PSA as your 1.04 PSA should not be giving you all the problems you seem to be having
A urologist is really the only way to go in my opinion

The PSA was from the blood test the doctor's office did. That's all I know as of right now.