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aldenrobert (@aldenrobert)

PSA Persistence after RP and Salvage Radiation

Prostate Cancer | Last Active: Dec 30, 2022 | Replies (18)

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Hi Kevin,
Having read the article from NCCN, do you think a DRE is required if US
PSA is negative? I found it to be unclear.
Thank you,
Glad to hear you are stable. Great news!

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Replies to "Hi Kevin, Having read the article from NCCN, do you think a DRE is required if..."

Perform routine DRE's? PSA? You decide.

A few years ago the medical establishment decreed that routine PSA testing be discouraged or declined (mine only continued as a professional courtesy).

Likewise, a few years ago, I switched from an excellent primary care physician (female) who always did a DRE, to an excellent new doc (male) who has never done a DRE on me in the 12 years with him. I was surprised. He said is was no longer recommended.

Someone somewhere in the medical establishment must have decided that the DRE "yield" in PCA was too low to justify, or perhaps there were too many false positives.. I always thought this odd since I seem to recall that in the early days of PSA testing, the literature indicated the DRE picked up some cancers that PSA missed. In the case of my physicians, they belong to the same major medical center.

So, DRE? Here's the experience of a friend, same age as me whose PCA diagnosis proceeded mine by six months. He was not receiving a routine DRE. His PSA's routinely ran in the high one's. One day, he was temporarily moved to a different primary care doc. This one did perform a DRE and found a suspicious nodule. It was biopsied. His PSA was 2.1; the biopsy was significant Gleason 7/8. He proceeded to Brachytherapy then EBR and now on Lupron (and hates it).

So, I concede that this is anecdotal, but should we continue to do DRE's? How are these medical decisions being made? On what data?

So, what about PSA? Should we have discontinued routine PSA testing? I have a 30 year record of PSA tracking over time, and it caught my PCA, but not before my doc was convinced that an annual PSA value of 1, 2, 4, and finally 7 justified evaluation. We should have done an MRI at 4 for sure or more frequent testing after 2. How are PSA values being employed today to make evaluation decisions? What are the guidelines, Based on what data?