Very Different DRE Interpretation

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New Member

Date Joined Jun 2008
Total Posts : 2
   Posted 6/23/2008 9:36 PM (GMT -6)   
I am new to the forum and to prostate cancer. My question is regarding T2c versus T3a staging from my urologist and a radiation oncologist. As far as I can tell, the only difference in the way they staged me was based on the DRE and I'm finding it hard to believe there's that much difference when the DRE is performed by two different doctors. Of course I'd rather believe my urologist since his staging predicts better survival rates, but in choosing a treatment I really need an accurate staging on which to base this very important decision. Has anyone had anything like this in their PC adventure?? I am seeing the urologist this week and would like to be able to ask some intelligent questions. Thanks for the help.
February 2008: PSA rise to 6.1 from 4.4 in
April 1, 2008: Meeting with Dr. Judd Moul , suspicious DRE with "discreet nodularity", biopsy scheduled.
May 12, 2008: Biopsy , TRUS indicates prostate volume of 43.3 cc, calcifications in transition zone and right mid zone, no hypoechoic lesions, and median lobe evident.
May 22, 2008: Results of biopsy discussed with Dr. Moul and Dr. Rampersaud. Gleason 3+3 in right base, right mid and right apex, as well as left base. Left mid demonstrated atypical small acinar proliferation and the left apex demonstrated 3+4 adenocarcinoma. Transition zone was negative. Probable stage of T2c. Dr. Moul recommends surgery and fells that he can remove all the cancer. Referred to radiation oncologist for second opinion.
June 3, 2008: Met with Dr. Bridget Koontz, radiation oncologist, who conducted DRE finding "small to moderate sized prostate with a firm right gland extending superiorly outside of prostate capsule. Left base is firm as well. There is also a nodule present in the left base". Dr. Koontz staged me at T3a, with full staging pending. Offered a clinical trial of radiation preceeding prostatectomy, or radiation of 8 weeks followed by 2 years of androgen deprivation therapy. Dr. Koontz thinks there is a high risk of requiring adjuvant radiation should I choose prostate removal. VERY DIFFERENT DIAGNOSIS FROM MOUL!!
June 6, 2008: MRI and bone scan at Duke.
June 10, 2008: Results of June 3 PSA test is 5.7.
June 12, 2008: Dr. Koontz reports that bone scan and MRI shows no apparent spread of cancer beyond the gland.

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 6/23/2008 10:02 PM (GMT -6)   
Sorry you had to come here but welcome to the most helpful prostate forum on the net. The oncologist obviously thinks that he can feel the extraprostatic extention. Bluntly, this can simply be the physical attributes of the doctor, meaning long narrow fingers may be a little more dexterous and sensitive in that confined space. You are certainly correct in saying that you need the best possible idea of stage in order to plot your best course of treatment. I would seek at least a third opinion and possibly a prostascint scan (fused with MRI) in an effort to get a better idea of where I stand (it is not foolproof but may be of value). The radiation before surgery offer is somewhat unusual in that this is normally discouraged as the argument goes that scaring due to radiation makes the surgery more difficult.
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.1 undetectable

Regular Member

Date Joined Jul 2007
Total Posts : 242
   Posted 6/24/2008 8:19 AM (GMT -6)   

I experienced something similar, GetBetter. My family physician didn't notice anything on the DRE, told me everything felt normal, but referred me to a urologist since my PSA was 3.0, which was high for a 49 year old man. The urologist he sent me to did a DRE and told me he felt a "hardness" near the outer rim and told me it very well might be a tumor. I wanted a second opinion so the next urologist, who ended up doing my surgery, also felt the hardness on the DRE  but told me he had done enough DREs to feel comfortable in telling me that he thought it was just a calcification, not a tumor. Long story short, I chose surgery and fortunately the pathology report showed negative margins, negative seminal vesicles and negative extraprostatic extention, and was kept at T2c.

Yes, it's a tough decision you'll have to make, and a third opinion is a good idea. I didn't get one because I felt comfortable with my surgeon and knew that he had an excellent reputation and track record. I hated not having control but I had to put my trust in him and thank God, so far, he appears to have been right. Good luck in your treatment, whatever it may be.




Biopsy: Diagnosed March 25, 2007. PSA 3.0. Gleason 6. Five of twelve samples positive with <5% each. No perineural invasion seen.
Surgery: May 21, 2007, Florida Hospital, Orlando,FL
Post-op Pathology: Upgraded to Gleason 7 (3+4), negative margins, negative capsular penetration, negative seminal vesicles, lymph nodes left intact, multifocal perinural invasion, 15% of prosate involving cancer in both lobes. T2c
Continence/Erections Out of pads at five weeks. Fully continent and can achieve erections.
Post Surgery PSA: Five tests, all <0.1
Family history: Great-great grandfather died from PC. My Father had his prostate removed at age 67 in 1997 and has had an undetectable PSA ever since. I was diagnosed at a much earlier age and had a more agressive cancer than my father. Go figure.

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 6/24/2008 9:34 AM (GMT -6)   

I don't have anything to add to your question, but would like to welcome you here.  So here it is:  :-)  

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