DRE Post-RALP?

Probably a stupid question.

After I enrolled in MediCare I found a new internist PCP. I was lucky since previously his panel was full and he wasn't accepting new patients. But then he moved to a new group which presented an opportunity to sign on. Educated at one of the best med schools and residency programs. Tons of experience w/ nothing but excellent reviews. His nurse told me he spends 1-2 hours with his new patients at the initial consult (he spent 1.75 w/ me). I've never had such a thorough consult with a doc. I didn't know they made 'em like that anymore. Normally after the first 20-25 minutes my other docs start to wind down the conversation.

Well, naturally I related that I was treated for PCa w/ a RALP a few years back. He read over the surgeon's notes and pathology report. He also reviewed my PSA history. He said he wasn't worried about any future recurrence (easy for him to say). Then when it came time for the hands-on exam he checked the heart, reflexes, etc...and then instructed me to bend over the table and pull down the shorts. W/ no prostate I thought those awful days were over with. For God sake, I thought that was one of the few benefits of having a RALP. But who was I to question a doc with over 30 years experience?

Just curious? RALP patients: Do your PCP's still do DRE's at your annual checkups?

My GP did it during annual physicals... He "also" scooped out some poop to test...

I was double radiated and see my urologist regularly. He has not done a DRE since the initial one before the biopsy. He says there is no need as much of the prostate is scar tissue, that the radiation field was so wide and intense that there is no way a recurrence would come from the prostate bed, and that with a continuing undetectable PSA that there is no evidence of recurrence. My long time PCP that referred me to the urologist said he would not even deal with the prostate as long as my uro is involved.

In the last three years he has retired and i have seen three other PCPs in the practice and each wanted to do a DRE, out of routine as it is one the routine exam list on their computer. I explain to each that why it is not needed which prompts a detailed explanation and they all have said they have learned a lot about PCa from me.

I question the value of continued DRE post RP when there is continued undetectable PSA. If there is enough PCa to feel, it would clearly first show as rising PSA long before it could be felt. Also, with the anatomical changes and scar tissue and expected adhesions from the surgery, how would the doc determine feeling a tumor? We have all read and been told that under the best of circumstances a DRE is more art than science and different docs feel different things. I have a meeting with my uro next week and I will ask him about his approach.

If post RP DRE is routine and necessary, I see this as another positive QOL reason to use radiation as a primary treatment.

An RO did one during an SRT consult


.

Not my PCP, but my MO several times. Checking for prostate bed growths, which would have been nice had it been so.

Not post RALP but post radiation for me. Uro and RO both told me no need for DRE unless I start seeing increases in PSA. PCP wanted to do one each time but, like JNF, I explained why it was not necessary and he was just as relieved as I was...

Jim

Your GI would be looking for bowel cancers primarily with the regular colonoscopies. I read where a DRE is one of the methods for looking for anal cancer. In my history my docs that did a DRE always said they were examining my prostate without any mention of anal cancer screening.

I suspect that docs get in a routine and stick with it, perhaps even in the face of conflicting evidence to the contrary. The PCP probably just follows the routine list on the practice computer that includes a DRE on a regular exam for all men over a certain age without regard to aspects of the specific patient history.

It would be an interesting survey to take on the forum to see how many are regularly subjected to a DRE as a routine part of their follow up and whether it is done by a treatment specialist or the PCP.

Go Hoosiers.

Go Bucks you guys are on a roll. Rare year when both football and basketball are top rated. I’m cheating for you in the football playoffs.