Speaking of DRE exams...

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compiler
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Date Joined Nov 2009
Total Posts : 7197
   Posted 2/24/2010 12:13 AM (GMT -6)   
Once your prostate is removed (ie: surgery), is there still a need to do a DRE?
 
If so, is it more or less painful?
 
(I never found DREs to be too bad)
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights.

Next Event: First post-op PSA on 3/1/10


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 2/24/2010 3:39 AM (GMT -6)   
Yes, a DRE might still be necessary -- if your doctor suspects there is still something in the prostate bed. I have not had a DRE post-surgery, so can't comment on the pain level.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
19-month: 0.09 (maybe)
ED:
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. Have "graduated" to just the pump.


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3731
   Posted 2/24/2010 5:37 AM (GMT -6)   
I have had several DRE since the surgery. It usually happens when I go into the office to get the results of my PSA.
Supposedly they are checking to see if there is anything "unusual". The first one was a little sore.

I'll admit it, I am a skeptic. The method seems so crude how can it be useful? To me it seems like it is the only way the Uro can justify having me come to the office to get my results. Maybe it's a quick profitable item that they check off on the insurance reimbursement form. A quick poke around and they paid for a tank of gas. (I know that is not fair to say.)

Has anyone ever had their Uro found something by DRE before the PSA showed it?
(Maybe that should be a new question.)
Jeff

Cajun Jeff
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Date Joined Mar 2009
Total Posts : 4088
   Posted 2/24/2010 5:39 AM (GMT -6)   
Mel: My Dr always does on at each of my visits. I can say it is no big deal.

Jeff T
Cajun Country
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 2/24/2010 6:15 AM (GMT -6)   
Mel, our urologist hasn't done a DRE since surgery. However, when we thought we were facing a recurrence, the radiation oncologist (a woman, no less!) did a DRE on John...
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 2/24/2010 6:16 AM (GMT -6)   
It depends on the doctor. I am close to the two year mark since surgery and have not had one.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
20 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/24/2010 10:06 AM (GMT -6)   
I get one each visit. I asked him why, he said it was to feel for any unusual growth, changes internally in what is left of the prostate bed and the rectal wall. Any of these areas, which were involved in being cut out, could have abnormal tissue regrowth or incorrect healing, scaring, and other issues, so the exam let's him check that things are healed and staying in good condition. Just because the prostate is cut out doesn't eliminate other things happening in that area. His statement....

I think this gets back to the conversation yesterday, about the need for them in general. If I hadn't had one after surgery, I'd ask for one. Men do tend to avoid them, and I am sure guys here breathe a sigh of relief, thinking they never have to have them again, but that's a mistake. DRE's are a central part of men's health and shouldn't stop being done. You are cutting yourself short on maintaining good health by avoiding them or not asking. Just my (strong) opinion, of course. A man should never get old enough or have enough removed to stop the need for them.

As far as differences, the only one I notice is I no longer feel the massage impulses when he does it.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN

Post Edited (James C.) : 2/24/2010 9:09:45 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/24/2010 10:22 AM (GMT -6)   
Both the radiation oncologist and my uro still have done DRE's on me since my open surgery. I only thought I was through with them.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 2/24/2010 10:22 AM (GMT -6)   
You can't help but wonder about who did them first and what the patient thought. :-)
Diagnosed at 54
PSA 8.7 Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7 Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09 Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence Pad free week 5
PSA 6/6/09 <0.1 PSA 9/10/09 <0.1


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 2/24/2010 10:46 AM (GMT -6)   
So is the DRE better or worse (RE: pain, etc.) than before surgery?
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights.

Next Event: First post-op PSA on 3/1/10


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 2/24/2010 10:59 AM (GMT -6)   
Mel,

Beating a dead prostate here but yeah ... everyone I know loves to give them (the gift that keeps on giving) -- even after prostate is long gone -- no one likes to get one!

But no big deal.
Age 59, 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
11/2008 Biopsy: 1 of 12 cores 5%, Gleason 3+3 - Sona showed size 140+ cc (110 grams post op).
02/03/09 open RRP surgery , Nerve sparing both sides, 1 day in hospital, Day 4 first BM,
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
02/18/09 Cath out, passed a 1cm oblong STONE within hours.
03/06/09 Started Levitra@20mg / Viagra@100mg / (04/01) Cialis@20mg -- (no effect yet 02/2010).
04/01/09, 07/07/09, 10/01/09, 01/15/10 PSA <0.1
08/09-09/09 MUSE@1000mcg (alpro ache) @500mcg -- less ache.
10/09-11/09 TrimixGel@(500/300/100mcg): 60, 70,80%,
02/10 TrimixGel@1000/300/100mcg - 80-90% - (with cialis) - just @ usefulness.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/24/2010 11:10 AM (GMT -6)   
Mel,

For me, before surgery, uncomfortable slightly painful. After surgery, awkward, but no pain at all.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


t-dog
Regular Member


Date Joined Dec 2009
Total Posts : 154
   Posted 2/24/2010 11:21 AM (GMT -6)   
Just make sure he takes off his class ring! Tim
Dx at 50 in 12/09 Merry Christmas its cancer....
3 of 12 positive, right side only, psa at dx 2.6 free%14
gleason 3+3=6
routine physical, no symptoms
Da Vinci performed Feb 2k10 by Dr Marc Milsten [hes got mad skills]
99% continent from cath out, mr happy fully functional at 2 weeks out!
path showed same gleeson with no other blips other than one slight margin, organ confined 20% right, 5%left, 34grams
 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/24/2010 12:41 PM (GMT -6)   
Mel, it's not uncomfortable for me, maybe I am stump broke enough to not care, but it's just another thing he does. No pain, no discomfort, no problems..
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 2/24/2010 1:37 PM (GMT -6)   
Mel,
Neither my urologist nor my GP has done a DRE since surgery.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11.5 months test 1/21/10 result 0.004

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