Prostate Exams Are Not As Effective As PSA Test

For what it is worth. My PSA went from 0 to 6.0 in a year. I had DRE's that showed nothing. Urologist reccomended biopsy. I had six cores taken and one of them was positive. Did the surgery (the field dressed kind). Gave me ED (drug treatable). Have been cancer free for 17 years. I am very lucky.

Course

With all respect to all of you,I would not trade in surgery for ED, that is the first thing, or incontinence. The bottom line is you can't live forever, its about quality of life not how much you can squeeze in at the mercy of expensive surgery and the loss of dignity and the other misery that goes with being a victim of the medical system here. I'm three years down the line, symptom free, fit and well. But I am in control of my life, and not being bullied, coerced by doctors looking out for themselves nor by treatments that will do more harm than good, and certainly not going under the knife for anyone or anything. Happy New Year

I'm starting to think about being in the "do them both" camp. PSA provides a good trend data on one measure, but DRE allows the doctor to get a feel for what's going on. All the men in my mom's side of the family over about 65 don't have prostates anymore because of cancer, my dad's side has BPH issues, and mine is acting up early (it ain't anywhere close to the size of a walnut, bigger than many plums, and even after the antibiotics and CPPS treatment my urine flow rate is still about 16mL/s without meds, thought that's better than the 9-10 mL/s it was).

I don't dread the procedure, but I haven't come up with a non-embarassing way to have the "gee, doc, I think you really should shove your finger up my butt every year - what do you think?" conversation. Because of that it might not happen. I have already had several encounters where I was happy that I managed to squeak by without anything embarassing (DRE, palpation for varicocele), but after walking out and still hurting wondering if it was a good swap.

...but I haven't come up with a non-embarassing way to have the "gee, doc, I think you really should shove your finger up my butt every year - what do you think?

When talking with your doctor, just emphasis (over and over again) your close family history and express your sincere worries about getting prostate cancer. Tell them that it's something you're obviously worried about and that you realize some of the tests to check your prostate are embarrassing (hint, hint), but that you feel like you really want to keep a close watch on it. If that isn't enough of a hint that you want a DRE, I'm not sure what is. And if you're fine with just a PSA test, stay with the doctor. If you don't feel like they're addressing your concerns, find another one.

This is an extract from the American Academy of Family Physicians, it has a 15 point guidelines for male medical physicals, not that this changed my opinion which I made some time ago, but it does reinforce my concerns.

American Academy of Family Physicians

View all recommendations from this society

Released September 24, 2013

Don’t routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.

There is convincing evidence that PSA-based screening leads to substantial over-diagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

Also:

American College of Preventive Medicine

View all recommendations from this society

Released February 25, 2015

Don’t routinely perform PSA-based screening for prostate cancer.

More than 1,000 symptom-free men need to be screened for prostate cancer in order to save one additional life. As a result, increased harms and medical costs due to widespread screening of asymptomatic men are believed to outweigh the benefits of routine screening. There is a high likelihood of having a false positive result leading to worry, decreased quality of life and unnecessary biopsies when many of these elevated PSAs are caused by enlarged prostates and infection instead of cancer. This recommendation pertains to the routine screening of most men. In rare circumstances, such as a strong family history of prostate and related cancers, screening may be appropriate.

And:

American Urological Association

View all recommendations from this society

Released June 11, 2015

Offer PSA screening for detecting prostate cancer only after engaging in shared decision making.

Shared decision making (between health care provider and patient and, in some cases, family members) is an excellent strategy for making health care decisions when there is more than one medically reasonable option. Since both screening and not screening may be reasonable options, depending on the particular situation, shared decision making is recommended.

Recently had annual urology visit for psa result which came back at .3 which is low. But she has been monitoring a lump on prostate for a few years and it has grown. So she had me get a prostate mri which showed nothing abnormal but the mri gives one a number value of 1 to 5 with the 1 lowest and 5 the highest , I came in with 3. She told me I could wait six months and do another psa and see where we are at.

I went home and read the report and felt the mri evaluator even though found nothing and put at three gave me an uneasy feeling so have decided to proceed with biopsy, guess I am being proactive but donot want to take chances. Only have one life.

I don't dread the procedure, but I haven't come up with a non-embarassing way to have the "gee, doc, I think you really should shove your finger up my butt every year - what do you think?" conversation. Because of that it might not happen.

First, understand you are dealing with a concern regarding your life based upon family history. What on earth is there to be embarrassed about when you seek consultation on that topic? Would you be embarrassed to ask for diabetes screening if you had a family history of it? Of course not. Next, I find it difficult to believe that any man who has had a DRE has been embarrassed by it. (In fact, some men may enjoy it.) If some have been embarrassed, they simply don't understand the purpose of the medical profession which is, simply put, to educate, prevent, and then cure.

Next, I find it difficult to believe that any man who has had a DRE has been embarrassed by it. (In fact, some men may enjoy it.) If some have been embarrassed, they simply don't understand the purpose of the medical profession which is, simply put, to educate, prevent, and then cure.

First time the anticipation was the worst. Thinking "oh great, she's going to want to feel around. Will it hurt? Will I get an erection?" Then when I got away without having it done there was some relief. Then by the next visit I was feeling bad enough that when my doctor said she really needed to feel what was up I didn't care. She was careful and respectful and it wasn't embarrassing or painful (which tells a lot about her skills, since the exam was for prostatitis).

However, so far all the times it has been done the doctor brought it up and all I had to do was get in position and take a few deep breaths. The embarrassing part now is the conversation, especially as I'm officially too young for screening to be recommended - but I'm already having noticeable prostate issues.

In my recent experience, neither DRE nor PSA is sufficient to warn of malignant problems. Specimens obtained in my recent TURP contained some suspicious cells and so we scheduled a biopsy to get a better idea of what is going on. Up to now, there had been no indication of cancer, just typical older man BPH symptoms that drugs did not relieve very much. Will report back after the biopsy.......

Had my first DRE in my 20s and the doctor probably wasn't checking my prostate at that age. He was feeling for rectal tumors and other things that can go wrong in the rectum. I didn't know anything about DREs at the time and was surprised to get one but other than the shock of having the doctor's finger up my butt, it was painless.

Had a second one a few years later. In my late 20s. Several years before I had another one but I was in my 30s still and not at the magic 40 mark for beginning to get a rectal exam every year. Have been getting one at every physical for years now and I'm not in my early 50s. I get that some guys dread getting a rectal or the thought of it and that is enough to keep them from getting regular checkups but after the first two or three times I don't get what the big deal is. Not painful. No real discomfort or at least not every time.

Guys who are homophobic overreact to DREs but the exam isn't anymore sexual that having your testicles checked for lumps, which is not sexual at all. Since there are other reasons for a rectal exam than just checking the prostate, it is worth the check every year just in case. It is probably hard to figure out the real reasons why guys avoid doctors and a rectal exam may not be the main reason for this.

Not that it matters but I meant to say that I'm in my early 50s and not what I said in the post below. I only meant to say that I'm not a old guy but have had enough DREs over the years to think that it is not a big deal to get one. I don't worry about that at all before a physical exam.

If 1 test was sufficient, there wouldn't be 2 or 3 or 5...

The older you get, the higher the probability of prostate cancer. Follow your urologist's recommendations.

Prostate-specific antigen test, or more commonly known as the PSA, tests the levels of PSA in the blood. Elevated levels of PSA are indications that something is going on with the prostate and further testing should be done. The PSA and the DRE are the two primary tests to determine the health of the prostate but results can be inconclusive, determine that there is no problem, or lead to a life-saving diagnosis.

For the past several years my GP always did a PSA as one of the many blood tests for my check-up. It was always within the prescribed range every time until July 2015. Results exceeded the acceptable threshold of 4.0 so he sent me to a urologist. I was relieved when the urologist first said my prostate felt normal but after a more in-depth PSA, he decided a biopsy was in order. The biopsy confirmed that there was cancer in my prostate. The calculations put it in the low range of medium level cancer. After consulting with the specialists, reading about the many options, and serious consideration; I decided that radiation would be preferable to surgery: just monitoring and hope it didn't get any worse didn't seem like a good idea.

The first part of the treatment was a female hormone shot to reduce the size of my prostate. After waiting about six weeks for the hormone to work, the forty radiation treatments began. It wasn't as bad as I expected except for the tenderness in the nether regions. I wondered why they recommended using unscented Dove soap but after washing with Zest, I understood why. Although things are slowly getting back to normal, I still have some urinary problems but Proscar, Rapaflo, and Saw Palmetto have that pretty well under control. The female hormone still hasn't worn off completely but the doctor said that could take a year or more. More importantly, I've had three PSA tests since my last treatment and all were less than 0.1 - well below the threshold of 4.0. Thinking back, I had at least one of the classic signs of prostate problems: hard to start peeing. But I had no pain, normal sex, no discharge; and even after a high PSA, a DRE showed a normal prostate.

A high PSA test does not mean that you have cancer. It indicates that something is going on with your prostate - something in your diet, an infection, or something more serious. Additional tests will confirm why the PSA is high and can be treated accordingly. The PSA should be part of your regular physical.

Ben Stiller, the actor, recently announced that he had been treated for prostate cancer and he attributes the PSA as the vehicle that saved his life. See: https://medium.com/cancer-moonshot/the-prostate-cancer-test-that-saved-my-life-613feb3f7c00#.qimjxjk0u . While he chose surgery and I opted for radiation, we both agree that it was the PSA that caught the cancer early enough to save our lives. The simple PSA could save your life too. Additionally, don't ignore other symptoms - regardless of how minor.

My Dr. only uses PSA test. I have never had nor has she ever done a DRE, she states it's out dated and totally ineffective. I had a PSA level of over 7.0 when tested in 2013, of course my Dr. insisted I go to the urologist and even made an appointment for me, however after reading about the consequences of prostate biopsy and the associated risks and irreparable side effects, I felt I would take my chances and not deal with the urologist and associated anxiety and very high expense. The high PSA result being probably due to an enlarged prostate or BPH, I do not have the symptoms of prostate cancer, I am now in my mid 50's now, I have stopped wanting to be tested for PSA, I feel I am informed, but also fit and well. On target for my three score years and ten. All about informed choices and weighing up the risk against consequences. This is just my way, its not everyone's way.

@BigEasyGuy

What are the symptoms of prostate cancer? If you have BPH leading to a PSA of 7, what are those symptoms as opposed to cancer?

Effective or not, I absolutely love it when my attractive female doctor gives me a digital prostate exam. I only wish she used more fingers and that it would last long enough to make me ejaculate.

@Jds4med

For Prostate Cancer:

•Burning or pain during urination.

•Difficulty urinating, or trouble starting and stopping while urinating.

•More frequent urges to urinate at night.

•Loss of bladder control.

•Decreased flow or velocity of urine stream.

•Blood in urine (hematuria)

For BPH or Enlarged Prostate

•Difficulty starting a urine stream (hesitancy and straining).

•Decreased strength of the urine stream (weak flow).

•Dribbling after urination.

•Feeling that the bladder is not completely empty.

•An urge to urinate again soon after urinating.

•Pain during urination (dysuria).

@BigEasyGuy

I think you'll find that the symptoms of the two are the same until the cancer is well advanced. In fact, treatable prostate cancer frequently has no symptoms.

PSA has about a 20% false negative result. That means you can have a normal PSA and still have cancer. It is true that DRE is not sensitive to early cancers. The combination of the two tests gives the best protection. Getting a DRE is not the end of the world.

All about choices people, if you read the entry I made some time ago about recommendations by the following::

American Academy of Family Physicians

American College of Preventive Medicine

American Urological Association

Its clear it purely about choices.

Nobody is questioning the choices, just your judgment. Remember that the physician who treats himself has a fool for a patient. Our doctors should not be our bosses, but should be our consultants and technicians. They make recommendations and perform procedures - we listen and make choices. Refusing to listen is bad judgment.

It's your body and you have every right to self determination. Just do so with adequate knowledge.

I had absolutely NO symptoms of prostate cancer, or any other prostate problems, other than a 4+3=7 Gleason score when the biopsy was done as the result of a slightly elevated PSA (5.7 IIRC). While prostate cancer is most often a slowly growing cancer, that is not always the case. To me, not being screened is the same as a woman choosing not to have mammograms. Yes, it's all about choices; but, making the choice not to be screened can have deadly results. I don't find that a risk I want to take.

To decide what is efficacious treatment for you is of course your prerogative. Most treatable prostate CA has no symptoms. How could you tell if you had an enlarged prostate without a DRE? It's entirely up to you but the bone pain and fractures from metastatic prostate CA is intense and unremitting. I'd go for the biopsy.

My adoptive dad and my blood uncle both came down with prostate cancer about 2 years apart. Because it was caught in time both there lives were saved. My dads doctor did DRE and found there was something wrong. PSA can have false positives so for a few seconds of embarrassment go in and have a DRE down. SO SUCK IT UP BUTTERCUP CAUSE IT MAY BE A LITTLE BIT OF A BUMPY RIDE.

SO SUCK IT UP BUTTERCUP CAUSE IT MAY BE A LITTLE BIT OF A BUMPY RIDE.

Lines like that don't exactly help. When medical professionals have had to check things out up there on me it's been more embarrassing than anything. Seriously, the most uncomfortable rectal insertions I've had have been ones that I have done to myself, because I've been in the "be a man" mindset. The medical ones I've had have been a little uncomfortable because they've been for what turned out to be bacterial prostatitis and CPPS, but nowhere near as bad as I thought they would be. Sure, it's awkward - after all, someone you barely know is putting things in your butt - but there are plenty of other awkward things in many doctor's visits.

I HATE, HATE, HATE the physician's office and there's nothing erotic about any of it. But the DRE is quick, painless, and really no big deal. It's all over in 30 seconds flat.

I feel that both exams done in conjunction with one another is the best course of action. A digital exam can determine size or structural issues early even when a PSA test comes back normal. Likewise a prostate that feels completely normal to a doctor may have a high PSA number.

Hi everyone. All I would say (purely my personal opinion) is that if you have an opportunity to be tested / assessed for various potentially life - threatening diseases / conditions (especially the older you get )- then go for it). I agree with what others have said about some of the tests not being foolproof etc. Everything is up to the individual to decide. I have had a couple of DREs in the past decade...not exactly erotic, but..equally relatively painless and (as others have also noted) generally over in 30 seconds or so. So....no prostate cancer in my case*. I also went for the abdominal palpation / ultrasound to check for possible aortic aneurysm (also clear).

*But...I do have Colorectal Cancer - which came as a total shock - especially as my Faecal Occult B T had been clear only 3 months before (so, yes, nothing is 100% foolproof). I had become anaemic (but with no obvious symptoms), which was picked up purely by chance as the result of a routine blood test. So, I had to undergo a gastroscopy / colonoscopy....but it saved my life as a very, very early stage tumour was detected. As part of the pre op assessment, I had to have rectal and groin swabs taken (MRSA / VRE checks) whilst I was naked (which is a whole other story, recounted on Zity). To be honest, it was more amusing than embarrassing and certainly not erotic 'in the moment'!!!

I would guess many tests done as part of a checkup are 'ineffective' as they normally produce a no problem found result in 99% of cases. Those in the 1% might not agree it was ineffective though. Just a hunch from my non-medical trained view.

As unerotic as the real thing is, I thought it was worse for the doc than the patient!

@fmnoosk

With prostatitis you want to have a doctor at least try to figure out what is going on so the appropriate treatment can be used. If it is bacterial you'll need to get an antibiotic that is effective against the type of bacteria you have, and if there is a muscular component you may need to have pelvic floor work. I was on alpha blockers for a couple months just to help things clear out, but I'm off them now and there was no mention of finasteride.