Just to add a very different experience…In 2008, my internist did a DRE as part of my annual physical (very fortunate he did this) and felt a nodule. My PSA was < 1.0. He sent me to a urologist who also felt the nodule but told me it wasn’t a concern with my low PSA . I insisted on a biopsy over his objections. He only took 3 biopsy samples because “I couldn’t possibly have prostate cancer with that PSA.” One was positive with a Gleason of 4+3. I had an RP at UCSF. Negative margins, final Gleason 4+4. My PSA was undetectable for 2 years and then began rising very slowly until it reached 0.2 in 2022. A PSMA showed a nodule in the prostate bed which was biopsied :Gleason 3+4. I am now taking Orgovyx and just completed 37 imrt treatments (limited to the prostate bed to minimize side effects because of pre existing conditions, at the cost of possibly not irradiating all the cancer), again at UCSF. My PSA is now undetectable but we won’t know the results until I’m off Orgovyx in September and then allow some time for my testosterone to return. Hope this helps someone. There is a significant percent of prostate cancer patients (10-20%) who have with very low PSA’s. Based on my experience, I am a strong advocate for the DRE as well as PSA…and for being an active patient.