"I am a 65 year old man. I have been seeing the same Dr for about 20 years...maybe longer. When I turned 50, she suggested a routine of annual DRE of my prostate. I agreed. The first time, I was REALLY nervous! After that, I LOVED it and looked forward to it with each annual routine physical! Yesterday, I went to see her for my annual physical. We covered all the usual and she was heading for the door when I realized that she had not examined my prostate! I said "Wait....Carol, what about my prostate exam?!" She said, "Oh, we don't do those anymore...we just rely on the PSA test result."
Have you heard of this before? Is this for real? Is this a new trend? She explained that her associate docs weren't doing anymore and so she stopped, also."
Is skipping the DRE (Digital Rectal Exam) a new trend? It could be. 1. Because, supposedly, the accuracy/sensitivity of the PSA (Prostate Specific Antigen) has increased and, 2. Most men dread the exam. (Doctors aren't trying to make them pleasurable.😎 Maybe if they did, men wouldn't mind the exams - they might actually look forward to them. 😁)
Though, from my perspective, there should always be a baseline established. With both the PSA and the DRE. At some point, if we live long enough, BPH (Benign Prostate Hyerplasia - or Enlarged Prostate) will become an issue. The baseline can help in determining if there could be a different problem.
I can't remember the last time my doc did a DRE -
The PSA can detect small cancer cells. And that is why some urologists are saying there are too many unnecessary biopsies and prsotatectomies being performed. That baseline can help with that. And a "watchful waiting" plan can be established.
26 comments:
I can't say anything I'm sure of, but it was interesting.
Hugs and bisous, my darlings Jean and Pat.
My doctor still does it....and it never fails....when the fingers go in...I get hard.
My Dr a urologist said you can get a lot of false readings from just a PSA and the DRE is more accurate.Ejaculating can give you a higher than normal reading,truck drivers also can get a higher reading from bouncing around in the seat
neved had a DRE
My female doctor will do one whenever I ask for it but the blood draw is more common these days.
Sad to hear that they are taking more and more health care shortcuts. Medicine and health care is more and more about big business.
My urologist always did both the PSA and the DRE. My PSA's were up and down, up and down. Then they were up and up and up, and then doctor felt the tumor. Then he did the biopsy, and it was positive. A week or so before my radical prostatectomy, the hospital did an MRI, which was really cool to see all the pictures. The MRI verified the exact location of the tumor, which was where the biopsy said it was, which was good. As the PSA replaces the DRE, the MRI will verify the tumor. That way there's nothing being pushed up your ass.
The first time I had a DRE was when I was in my 30s, the practice was a teaching practice ... so without knowing what was going to happen, I had a dozen students watching my doctor perform it ... no big deal ... currently my Urologist does it every 6 months when I see him, my Primary never does it. I am pretty good about getting PSA and testosterone tested, I am on shots for testosterone, so blood work for PSA, testosterone and liver function are done ever 6 months ... who kne 63 would be so busy!!!
I think the decline of the DRE is part of the decline in time a doctor spends with a patient in order to increase profit as so many doctors are now incorporated in large private medical companies where the bottom line is more important. If a doctor can avoid doing the DRE and just pass the patient off to someone else to draw blood and run tests and then only speak to the patient if things are amiss, it minimises time and effort, especially if PSA or other tests are more accurate. Not saying this is a good thing: far from it as I believe people's health is being short changed in the pursuit of profit.
Wouldn't it be great though if every man had a bro he could go to for regular extended DRE, who was trained enough to detect changes in the prostate and balls and who would listen to issues instead of men being in competition with each other and conditioned with homophobia?
I examine mine all the time. :) And yes, PSA's are the new standard.
I suspect it has everything to do with the Doctor's time, what insurance companies will pay for, and anything that they can do to speed up the process.
And then the doctor's liability, the blood test is not as subjective as a manual exam.
In the US it's all about the cost and liability.
Hugs and bisous.
My doctor did not do a prostate exam at my last physical. He mentioned that the blood test would be done. Since I have not had any issues in the past, I felt that was OK.
The end of an era! LOL!
My uro, who found my prostate cancer 10 years ago, did not do a DRE once I finished my radiation treatment. When Covid hit he retired and I started with a new uro that he had recommended. I was surprised that at my first visit he did a DRE but I assumed it was because it was my first visit with him. Several weeks ago I went in for a routine check and he said he wanted to do a DRE. I “got into position “ but told him I was surprised that he would check me since I have had radiation and my prostate is charred. He said it could become deformed anyway and he felt it was good to make sure no cancer or other deformation was there. He said he checked guys who had prostectomies because there could be something left behind that becomes cancerous. Besides, I don’t mind them.
I get both because my PSA is usually whacky.
I guess that if somebody gets a 'normal' reading, they rely on the PSA alone...
XOXO
Does the OP realise that he doesn't have to rely on a Doctor to do a DRE that he loves so much?
I suggest he looks into the Aneros Forum and what prostate massagers have to offer in terms of prostate health and what he loves so much about DRE: it's a whole new world for men's sexual enjoyment with the possibility of multiple orgasms that don't even require an erection or contact with the penis at all.
I've been on both sides of the PSA testing question.
My GP stopped doing DRE's and PSA's a few years ago, citing new research findings. Got sick a couple of years ago - losing weight and not feeling good. Lots and lots of tests and finally he called for a PSA - which came out at 20! A lot more diagnostics found a marble of cancer in prostate, which was zapped a year ago, and PSA tests are now under 0.5.
15 years before I had a PSA of 6, and a series of annual biopsies that showed wonky cells but no cancer. My urologist at the time, a top guy at Harvard Medical School and a wonderful human being, eventually said what he saw in the biopsy slides rarely led to cancer and we should watch and wait.
I checked back in my erotic journal and found I'd been vigorously fucked a few hours before the blood draw for the PSA, which probably explained the test result. Should be standard advice for active gay men to not test right after sex , huh?
Looking back, it was probably a mistake to discontinue the routine PSA tests after the first scare.
I think PSA is a much better way. Often if a problem can be detected by DRE it could be too late to do anything. I know from personal experience that PSA can detect cancers that would not be detected by DRE for years to come ... and has is true with all cancers, earlier detection is key!
I am 86 and my doctor still does the PSA and the DRE every year. The previous doctor said we don't do the DRE anymore, but it sounded like laziness.
Thank you for your great blog !
My former doctor (a very handsome man) used to do the DRE every year in addition to the PSA. When he moved I had to find a new doctor (during COVID) and he did not do the DRE. Also, a number of years ago I would regularly see a urologist and of course he did the DRE. But since I wasn’t having any issues and my PSA was consistently good, he said to only see him if I was having issues.
My PCP doesn't do them. He just does the blood test. So I go to a urologist once a year for one. I feel "safer" with a DRE. Both my PCP and the urologist are male. I think they empathize better with prostate situations. Not that a female doc is less competent technically, but...
@ Huntley - That's the right course to take. you've got a good urologist there. Hang on tot hat one!
@ Big Dude - I would think a male physician would better understand and empathize with any issue involving a guy's genital function. Yet, SO many men are still too embarrassed to discuss problems even with their male doctors.
Hi ! In France, It's quite right, now an annual PSA test is sufficient. Exploration is not necessary.
@ Jean-Marie - Good to know that the current practice is wide-spread. Thanks!
@whkattk:I feel the same way. I isn't necessarily a conscious thing. My PCP, when he still did the DREs, said he felt the same way. He was more comfortable with a male doing it. I have NO qualms talking to him, and even use words like dick or cock...He's the best.
DRE begins at 50, 40 if you have relevant family history.
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