PSA alone “enough” for 62 yo man?

Is a dre recommended?

His previous dr insisted on doing both.
Now he has a new doc and he just does the PSA.

Thanks

I had yearly checkups with a DRE by every uro at the time for BPH and a fluctuating, but slowly rising PSA. After my TURP for BPH, I had 6-month visits, with the DRE every other visit. When my uro felt a slight induration on one side, he wanted DREs every 6 months.

The induration disappeared on its own, but at a subsequent visit my uro felt a new nodule, which triggered my last biopsy. The nodule turned out to be negative (about half of them do), but the prostate biopsy hit high-grade cancer elsewhere that required treatment.

I'd be surprised if the doctor skipping the DRE is a urologist. Only a small portion of the prostate can be felt with a DRE, but the size, consistency, and symmetry of the prostate can be monitored, along with other abnormalities.

The additive value of mpMRI on prostate cancer detection: Comparison between patients with and without a suspicious digital rectal examination (DRE) (2020)

"Diagnosis of prostate cancer (CaP) is based on digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) level. ... Therefore, the aim of our study is to investigate whether mpMRI provides similar advantages in detection of CaP according to the DRE findings.
...
Conclusions: Patients submitted to fusion biopsy and have a positive DRE are diagnosed more often with CaP, have higher grade disease and larger tumors. In patients suspicious for CaP and having a significant lesion on mpMRI one should combine targeted and systematic biopsy regardless of the DRE status."

DRE has vital role in early detection of prostate cancer (2015) (Editorial, no preview)

That said,

Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis (2018, Full Text)

"CONCLUSION Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting."

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IMO, one's attitude toward tests with negative results should not be "Well, once again, that sure was unnecessary!", but rather to say, after a positive test that provides early diagnosis: "That's unwelcome news, but thank you for the early diagnosis!" Do you really want to be in a position where metasatic PCa is diagnosed and you are asking yourself "Would I have known any earlier with a DRE?"

Djin

BBinSC said...
What's his PSA? Did his previous Dr feel anything abnormal in the DRE?

His PSA in 2020 was .36

His previous Dr said there was nothing abnormal.

azroadrunner said...
Speaking from my personal experience. I've never had a PSA in the range that would have caused alarm. Every DRE I've ever had (including a recent one - POST-diagnosis) revealed nothing suspicious. No history of PCa in my family. YET -- I was diagnosed with intermediate-level PCa and the only way it was caught was as an incidental find from a TURP procedure.

IMO: PSA tests alone for a 60+ year-old is borderline incompetence. As it is, both PSA and DRE might be false negatives -- doing only one of them is assuming a lot. I'm sitting on a Gleason 3+4=7 with 12 of 17 cores positive and the PSA and DREs over the years didn't reveal a darn thing.

Thanks for your thoughts.
This is very concerning.

He will not likely ask his Dr to do a DRE but I will be trying to pursuade him… to request one.

So I went online and found some Urologists approx 3 1/2 hour drive from home.

I’m thinking of trying to pursuede my hubby to ask his reg doc to give him a referral.
(The GP has to refer my husband to see the “specialist”)

I'd agree with the other comments, plus this one: A PSA that LOW in a 62 year old is unusual. Normally, at his age, a PSA on the order of 3-4 would be considered normal.

halbert said...
I'd agree with the other comments, plus this one: A PSA that LOW in a 62 year old is unusual. Normally, at his age, a PSA on the order of 3-4 would be considered normal.

So are you saying it’s possibly an error?

Thank you all for your advice and sharing information.

I may have to guilt him into it.
I shared with him that I have subjected myself to three colonoscopies in the past several years - due to my mother dying from colon cancer at the young age of 55.

I also get my mammograms and pap tests when scheduled.
I want to be “here” for him and our son. Having the tests/procedures done increases my chance to be “around” longer….

He needs to buck up.

Hi Girlie,

My husband was fortunate to have a very skilled PA who was closely monitoring my husband’s PSA and who also did regular DREs. He could feel a nodule—and my husband’s PSA was very low, only 1.7 at diagnosis. We joke that whoever does the DRE needs to have long skinny fingers.

You just may have to guilt him into it, but it will be worth it for peace of mind and fewer regrets down the road.

Good luck!

Girlie, yeah...keep working on him or get another doc. This is a ROUTINE test that only lasts a few seconds. Yes, it is a bit unpleasant for most of us but that's the price of having a man card. Prostate cancer is very treatable and usually curable when caught early. A nodule on the prostate is an early sign. Tell him to man up and just freakin' do it.

Jim

What prodded me into annual PSA and DRE starting in my 40's was my Dad and HIS adventure with PCa. And the knowledge that "every man on his side of the family, as far back as anyone knew, had prostate problems".

My urologist's PA is a young competent professional, and she happens to be attractive too. She has no qualms examining me, and I have no objections at all. None.

halbert said...
What prodded me into annual PSA and DRE starting in my 40's was my Dad and HIS adventure with PCa. And the knowledge that "every man on his side of the family, as far back as anyone knew, had prostate problems".

My husband has “inherited” his diabetes from his father but neither his father nor my father had prostate issues (as far as we know)
His father died due to heart disease at the young age of 66
and my dad was 79 when he passed.
I know my dad wasn’t getting annual PSA’s the last 5 years of his life
I don’t know about his father.
So there wasn’t much talk about it.
My mother wouldn’t have pushed him - she was not diligent herself about going to the doc/screenings.
She died at 55 from colon cancer - after ignoring symptoms for a few years and not getting it checked out.