In 2008, my PSA was 1.0. My primary doctor did a DRE, felt a nodule and sent me to a Urologist. The Urologist also felt the nodule but said I could't have prostate cancer with such a low PSA. He told me to return in six months and get another PSA. I asked what he would do in six months if my PSA remained low. He said he would do a biopsy. I asked why we were waiting six months since he was going to do a biopsy regardless of my next PSA. He admitted it didn't make sense to wait. During the biopsy he only took three samples because he said I couldn't possibly have PC. One sample tested positive, I had an RP and my final Gleason was 4+4. I had a recurrence 16 years later and was treated with EBRT. My PSA is now undetectable. The morals of this story:
-A small but significant percentage of men have non PSA producing PC.
-The DRE may have saved my life. It is not customarily done and many say it's unnecessary. It can be a life saver for men like me, it's quick, cheap and has no down side other than brief discomfort. I am very unhappy that it's not being done more often.
-If your doctor proposes something that makes no sense, don't hesitate to speak up.