Prostate Cancer Community

I don't see a need to seek out clinical trials in your case. There's no getting around the DRE, even if you were to have the Prourocare imaging done, since it's a post-DRE scan, as you noted. And, if you go to their website, you can see their process involves a rectal probe.

Having something put up your backside unfortunately goes with the territory in prostate tests. The DRE is just part of the doctor's toolkit. It's getting kind of routine for me--having them before diagnosis and after treatment. I wish I could avoid them, but it's only a few seconds. A DRE is uncomfortable but should not be painful.

You can minimize the discomfort when you "assume the position" like this: face the exam table, lean over it, put your forearms onto the table, and shift your weight away from your feet onto your arms. This position will help you relax and make the exam easier. Breathe normally.

DREs can find cancer that PSA misses, and vice versa.

As far as the recent studies go, the U.S. study failed to show an EARLY benefit to screening:

""So far, only a minority of men enrolled in the PLCO study have died, so it may be premature to make generalizations about the ultimate results of the trial," he says. "We don't have enough data yet about the youngest men in the study - those in their 50s - and it may be that over time, we will, in fact, see a benefit from screening."" Study lead author Gerald Andriole, in "No Early Mortality Benefit From Annual Prostate Cancer Screening, U.S. Study Shows" Science Daily, March 24, 2009, www.sciencedaily.com/releases/2009/03/090318171156.htm

Best wishes.

Galileo, Thank you. You were right, I went back and looked at the web site and saw the probe. When I re-read the information on the device It looks like it takes a digital picture of the prostrate that can be stored and reviewed over time by the doctor to see if any abnormalities are developing. I've been reading that a PSA test might be a good idea for men over 50, which I will be in a few months. Given that the recent studies have said that the PSA test can be unreliable could this be a better alternative to the PSA test? At the bottom of the company web page there is a picture of the image which looks pretty clear. There was a company news release that said that the clinical study was moving along well. What happens after the study is over can you then begin to have these images taken if you want?

To put things in perspective, a DRE saved my life. A urologist found a lump on one side of my prostate, even though my PSA was only 1.23. Two months earlier, my GP said my PSA was "insignificant", and even though he did a DRE, he missed the lump. I have found that before the doctor puts his finger in, I take a deep breath, and relax my muscles down there, and the insertion and DRE time is not painful at all. Also, be sure to keep breathing during the procedure; nice slow breaths. Many men say the feeling can actually be erotic. I never found that to be true, but whatever the feeling, it is worth it. Get it done!

footballfan,

I don't think the machine in question is a replacement for PSA testing. If the product is successful, it will still be some time before it's widely available, anyway. It looks like an intermediate test between DRE and biopsy.

There ARE alternatives to PSA testing in the pipeline, and even available upon request, like PCA3...but only a few labs do these tests and then you also need a doctor who is trained to interpret the results.

By the way, the most helpful way I've seen of understanding the implications of the recent studies on prostate screening was the way the online newsletter Science Daily put it--no evident mortality benefit over 7-10 years: www.sciencedaily.com/releases/2009/03/090318171156.htm The study author says it may be a completely different picture for younger men--like you--in their 50's, with a longer natural lifespan ahead of them. Time will tell. In my case, I had Gleason 7 at age 43, and my doubling time was less than 3 months. Untreated, I don't think I would have outlived prostate cancer. PSA and DRE, together, alerted my doctor that something was up. Now--did PSA and DRE save my life? I don't know. Only time will tell. But even if they didn't save my life, they may have extended it, and given me years without having to be on systemic treatments.

BTW, and I know this doesn't apply to your situation, but PSA is very reliable and very important AFTER treatment. It's a great "canary in the coal mine" that alerts us to recurrences and, in the case of men with systemic disease, helps them measure the effectiveness of various systemic treatments.

Just my 2 cents. I wish you well.

Hello Fan, This is simply an automated scan that seeks FDA approval to be a substitute for a DRE. The reason they do a DRE before the imaging is to correlate both methods and ultimate improve the specificity of a DRE and for the method to be approved by the FDA.

That said, the conflict created by these studies should not deter any man to be tested. It is not the test what is the problem. It is what is done with the information provided by the combination of DRE and PSA. Although the PLCO study done here indicated no benefit, none of the authors are able to explain the reduction in PCa deaths since the commercialization of the PSA test. How can there be a 35% reduction in deaths when this study showed no benefit? The answer is complicated, but one of the reasons is that in this study, both sides of the study received PSA tests. It had a high degree of contamination. Worse, many of the men (some 4,000 in the screened arm) went untreated after having a high PSA. In short, it was no small wonder this trial showed no benefit.

In the European ERSPC trial they found that screening every 4 to 7 years there was a 20% benefit in deaths reduction. Sounds worthwhile? I think it is!

Do not fret about getting tested. The DRE is nothing. Is fast and not painful and added to a PSA blood test can be an early warning system to avoid being diagnosed with advanced prostate cancer.

RalphV

Fan:

As a post note to this discussion - a DRE should be done AFTER you have had the blood drawn for your PSA. Also NO heavy exercise or sex for 72 hours before blood draw. All of these can affect the PSA result. TomT

Bless u pumper103: I will repeat for everyone (all caps) ...DEMAND THE PSA BLOWW DRAW BEFORE THE DRE LAST -- ALSO, KEEP THE 72HR QUARANTINE Now why do we have to battle to get the doc's to agree with the small proceedure change...especially the urologists? I discovered this after 4 annual physicals had PSA jump form 1.7 to 4.9...each year had return visit for ONLY THE BLOOD DRAW...and (drum rollllll) results PSA back to 1.7 ..Four annual physicals...hummm...Very interesting...makes u wonder.