Talk Cancer

Question:

Ron B, The uros at my group do the first PSA at 6 weeks. Theyecpect it to be <0.1 unless it started very high. My own uro say many docs have gotten away from DRE post op, because psa is more sensitive. But he still does them because he wants to know if there is anything there like scar tissue that could be interpreted or misinterpreted as a recurrence later. So the DRE is there in the record as a baseline if the psa rises later. Steve U

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Walsh ALSO mentions a post-op DRE. (digital rectal exam). What do they feel for after the prostate is gone? Thanks again, Ron B. Chicago

My doc has this on his list of to do’s also Ron.  Once a year. Dale j. —

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What do they feel for after the prostate is gone? I’ve always wondered about this also.   It may be to check that there is no swelling or other unexpected consequence of the surgery.   My urologist was still doing the DRE at 4 years from surgery.  Recently, he has usually had a medical student with him, so I guess the student gets a chance to see what it feels like if no prostate is present. While he is doing the DRE, he is also checking for abnormalities in the rectal wall, which is one other purpose of the exam.

My surgeon does this also.   Next one will be in Dec 05 along with the usual PSA, which will be 3 years post, with fingers crossed. Dale j. —

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I wonder about that everytime I’m bent over in the doctor’s office.  My doc only says, "something that aint right". —

– Hide quoted text — Show quoted text – What do they feel for after the prostate is gone?

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Mine reduced it from every visit to every other visit.  That was at about 3 years out. — Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA  .1  .1  .1  .27  .37  .75 PSA  .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA  .07 .05 .06 .05 non Illegitimi carborundum – Hide quoted text — Show quoted text – My GP (at Johns Hopkins) does not do DRE after RRP. jimhoney Thanks for the advice on my earlier post. As I was studying for tomorrow’s PSA test as Alan suggested , I thought of these 2 questions: From Walsh’s book…the PSA half life is about 2-3 days…so wouldn’t the first post-op PSA test be OK at almost 5 weeks? (33 days) My doc usually does them at 4 weeks…I don’t know why, I’ll ask him in 2 weeks when I see him. (A nurse does the blood draw early tomorrow and I see him 2 weeks later…where they can draw it again if needed.) And two: Walsh ALSO mentions a post-op DRE. (digital rectal exam). What do they feel for after the prostate is gone? I’ve always wondered about this also.   It may be to check that there is no swelling or other unexpected consequence of the surgery.   My urologist was still doing the DRE at 4 years from surgery.  Recently, he has usually had a medical student with him, so I guess the student gets a chance to see what it feels like if no prostate is present. While he is doing the DRE, he is also checking for abnormalities in the rectal wall, which is one other purpose of the exam. Thanks again, Ron B. Chicago

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While he is doing the DRE, he is also checking for abnormalities in the rectal wall, which is one other purpose of the exam. My surgeon does this also. Next one will be in Dec 05 along with the usual PSA, which will be 3 years post, with fingers crossed.

That’s gotta hurt!

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Thanks guys for the great answers. They made a lot of sense. And as I.P. said (and I agree)…the prep for ANY test is not a problem (no matter HOW bad it might taste)…it’s the results that "I" am concerned about. Good health to everyone and thanks again, Ron B. Chicago

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– Hide quoted text — Show quoted text – While he is doing the DRE, he is also checking for abnormalities in the rectal wall, which is one other purpose of the exam. My surgeon does this also. Next one will be in Dec 05 along with the usual PSA, which will be 3 years post, with fingers crossed. That’s gotta hurt!

My fingers crossed, not his, LOL Got a chuckle on that one Steve. Dale j —

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Thanks for the advice on my earlier post. As I was studying for tomorrow’s PSA test as Alan suggested , I thought of these 2 questions: From Walsh’s book…the PSA half life is about 2-3 days…so wouldn’t the first post-op PSA test be OK at almost 5 weeks? (33 days) My doc usually does them at 4 weeks…I don’t know why, I’ll ask him in 2 weeks when I see him. (A nurse does the blood draw early tomorrow and I see him 2 weeks later…where they can draw it again if needed.) And two: Walsh ALSO mentions a post-op DRE. (digital rectal exam). What do they feel for after the prostate is gone? Thanks again, Ron B. Chicago

Response:

- Hide quoted text — Show quoted text – Thanks for the advice on my earlier post. As I was studying for tomorrow’s PSA test as Alan suggested , I thought of these 2 questions: From Walsh’s book…the PSA half life is about 2-3 days…so wouldn’t the first post-op PSA test be OK at almost 5 weeks? (33 days) My doc usually does them at 4 weeks…I don’t know why, I’ll ask him in 2 weeks when I see him. (A nurse does the blood draw early tomorrow and I see him 2 weeks later…where they can draw it again if needed.) And two: Walsh ALSO mentions a post-op DRE. (digital rectal exam). What do they feel for after the prostate is gone?

I’ve always wondered about this also.   It may be to check that there is no swelling or other unexpected consequence of the surgery.   My urologist was still doing the DRE at 4 years from surgery.  Recently, he has usually had a medical student with him, so I guess the student gets a chance to see what it feels like if no prostate is present. While he is doing the DRE, he is also checking for abnormalities in the rectal wall, which is one other purpose of the exam. – Hide quoted text — Show quoted text – Thanks again, Ron B. Chicago

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I recently went for a follow-up visit to my Urologist following a seed implant in June 04, he also performed a DRE and reported that he felt no tissue. I failed to ask for an explanation, but assumed that he meant "no abnormal prostate tissue." Tom

– Hide quoted text — Show quoted text – Thanks for the advice on my earlier post. As I was studying for tomorrow’s PSA test as Alan suggested , I thought of these 2 questions: From Walsh’s book…the PSA half life is about 2-3 days…so wouldn’t the first post-op PSA test be OK at almost 5 weeks? (33 days) My doc usually does them at 4 weeks…I don’t know why, I’ll ask him in 2 weeks when I see him. (A nurse does the blood draw early tomorrow and I see him 2 weeks later…where they can draw it again if needed.) And two: Walsh ALSO mentions a post-op DRE. (digital rectal exam). What do they feel for after the prostate is gone? I’ve always wondered about this also.   It may be to check that there is no swelling or other unexpected consequence of the surgery.   My urologist was still doing the DRE at 4 years from surgery.  Recently, he has usually had a medical student with him, so I guess the student gets a chance to see what it feels like if no prostate is present. While he is doing the DRE, he is also checking for abnormalities in the rectal wall, which is one other purpose of the exam. Thanks again, Ron B. Chicago

Response:

My GP (at Johns Hopkins) does not do DRE after RRP. jimhoney – Hide quoted text — Show quoted text – Thanks for the advice on my earlier post. As I was studying for tomorrow’s PSA test as Alan suggested , I thought of these 2 questions: From Walsh’s book…the PSA half life is about 2-3 days…so wouldn’t the first post-op PSA test be OK at almost 5 weeks? (33 days) My doc usually does them at 4 weeks…I don’t know why, I’ll ask him in 2 weeks when I see him. (A nurse does the blood draw early tomorrow and I see him 2 weeks later…where they can draw it again if needed.) And two: Walsh ALSO mentions a post-op DRE. (digital rectal exam). What do they feel for after the prostate is gone? I’ve always wondered about this also.   It may be to check that there is no swelling or other unexpected consequence of the surgery.   My urologist was still doing the DRE at 4 years from surgery.  Recently, he has usually had a medical student with him, so I guess the student gets a chance to see what it feels like if no prostate is present. While he is doing the DRE, he is also checking for abnormalities in the rectal wall, which is one other purpose of the exam. Thanks again, Ron B. Chicago

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Hi Ron:     As you can see, the ng is working today.  Tomorrow, who knows?     Not sure about the half life.  You make a good point.  I have always been told that it takes a long time for the PSA to go down, so that is why most doc’s wait a few months to do the first post op PSA.     The DRE is in the category of ask five and get four different answers. Some do.  Some do not.  The uro hasn’t asked me to drop my pants since the staples came out.  My primary care says it is not necessary.  In one of the many books I read while preparing for the surgery one author said that it is done to make sure there is nothing showing up in there that shouldn’t.  If the prostate is gone, organ contained disease, clear margins, etc., what would be there to feel?  For that matter, if the margins were not clear that does not mean that there would be something that could be felt with a DRE, right?  Not sure what the point is after the surgery except maybe for an initial follow up.  I am just glad that I walked away from this experience with one thing that I can gladly forget about.  No more DRE’s for me.  And, no more colonoscopies for another decade.  I swear the prep for that damn exam was worse than the RRP.  I still can taste that stuff.     Have a good weekend group.  Hope you are getting dryer by the day Ron.     Thank you. David S.

– Hide quoted text — Show quoted text – Thanks for the advice on my earlier post. As I was studying for tomorrow’s PSA test as Alan suggested , I thought of these 2 questions: From Walsh’s book…the PSA half life is about 2-3 days…so wouldn’t the first post-op PSA test be OK at almost 5 weeks? (33 days) My doc usually does them at 4 weeks…I don’t know why, I’ll ask him in 2 weeks when I see him. (A nurse does the blood draw early tomorrow and I see him 2 weeks later…where they can draw it again if needed.) And two: Walsh ALSO mentions a post-op DRE. (digital rectal exam). What do they feel for after the prostate is gone? Thanks again, Ron B. Chicago

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no more colonoscopies for another decade.

I’d never wait that long. The recommendation is every five years past the age of 50, and — anecdote alert — I went from clean coloscopy to metastasized (lymph nodes) colon cancer in three years. I swear the prep for that damn [coloscopy] exam was worse than the RRP.  I still can taste that stuff.

Chill it, hold your nose, and gulp it down. I.P.

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