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  • doing DRE after radiation therapy.

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    Old 06-28-2020, 12:25 PM   #1
    efang
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    doing DRE after radiation therapy.

    I want to know that I have done radiation therapy and the PSA is quite low. How often do I have to do digital rectal exam (DRE)again?

    Thanks!
    __________________
    treated prostate cancer by SBRT on 12/2018 PSA. 3.80, 2.60 , 1.16 , 0.88 , 1.36 , 0.50。
    HBAiC around 6.0.
    Dilatation of the descending thoracic aorta ( 2.7X 2.9 cm), but the blood pressure is normal

     
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    Old 06-28-2020, 07:22 PM   #2
    IADT3since2000
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    Re: doing DRE after radiation therapy.

    Hi efang,

    Dr. Charles "Snuffy" Myers told me during an exam after my radiation that he would not be doing a DRE because the tissues needed to fully heal after the radiation. He had done a DRE prior to the radiation, part of the staging process to determine if I was eligible, along with sophisticated imaging.

    I don't believe I've ever had a DRE since then either over the past seven years. Maybe I would have had DREs if my PSA and other labs suggested a concern, but my PSAs have been great. I'm curious about what others have experienced.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured. (Current T 99 6/5/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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    Old 06-29-2020, 04:45 AM   #3
    efang
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    Re: doing DRE after radiation therapy.

    Hello Jim,

    I am so happy to see you again, I agree with you , I think my radiation oncologist will not ask me do this now because my PSA still is OK, but if I go to see a urologist , he may requires me to do, but I am interested to listen other people's experience.

    Thanks,

    Efang
    __________________
    treated prostate cancer by SBRT on 12/2018 PSA. 3.80, 2.60 , 1.16 , 0.88 , 1.36 , 0.50。
    HBAiC around 6.0.
    Dilatation of the descending thoracic aorta ( 2.7X 2.9 cm), but the blood pressure is normal

     
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    Old 06-29-2020, 08:06 AM   #4
    Terry G
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    Re: doing DRE after radiation therapy.

    I have not had any DRE’s since treatment. My family Dr. has not suggested one and my guess is he would not have as much experience examining an irradiated prostate as an RO might. Since my post PSA numbers have not been alarming and I was very low risk my RO has not suggested a DRE.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
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    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3

     
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    Old 07-02-2020, 10:49 PM   #5
    HighlanderCFH
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    Re: doing DRE after radiation therapy.

    With my prostate having left the building since my 2011 surgery, there is nothing left to DRE and Mayo Clinic said there is no reason to do one now as long as my PSA remains zero.

    It's an interesting thought, though, on whether the same thing applies to an existing prostate after radiation treatments.

     
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    Old 07-04-2020, 07:20 AM   #6
    JustBrandon
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    Re: doing DRE after radiation therapy.

    Quote:
    Originally Posted by efang View Post
    I want to know that I have done radiation therapy and the PSA is quite low. How often do I have to do digital rectal exam (DRE)again?

    Thanks!
    Not sure, but it would definitely need to be done by a well versed urologist, as an irradiated prostate is going to have some structural changes to it. Might be hard to tell the difference between radiation effect or suspicious abnormality unless the urologist has experience doing DREs after a patient has recieved radiation.

     
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    Old 07-04-2020, 11:24 AM   #7
    guitarhillbilly
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    Re: doing DRE after radiation therapy.

    I completed 42 rounds of IMRT over 2 months ago and my PCa care is now back in the custody of my UR who performed the Biopsy -fiducial markers - Gel.
    All my UR has done so far post IMRT is my PSA Test and a 6 month Lupron Injection [2ND ONE]. UR was pleased with my PSA Test results and did not do a finger wave [DRE] .Scheduled for another PSA and Lupron with office visit in 6 months.
    __________________
    T2a / Gleason Score 8 / PSA at Diagnosis 6.9 /
    1-5 aggressive score : 4
    12 cores= 4 positive
    NBS = Negative
    Pelvic CT= Negative
    Pelvic MRI= Negative
    Age at Diagnosis= 60-65 age group
    Completed 42 IMRT Sessions
    Lupron scheduled for 2 years [Started DEC 2019]

     
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    Old 07-04-2020, 11:46 PM   #8
    HighlanderCFH
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    Re: doing DRE after radiation therapy.

    Quote:
    Originally Posted by guitarhillbilly View Post
    I completed 42 rounds of IMRT over 2 months ago and my PCa care is now back in the custody of my UR who performed the Biopsy -fiducial markers - Gel.
    All my UR has done so far post IMRT is my PSA Test and a 6 month Lupron Injection [2ND ONE]. UR was pleased with my PSA Test results and did not do a finger wave [DRE] .Scheduled for another PSA and Lupron with office visit in 6 months.

    Good luck, GH. And I hope you never have to undergo a DRE again.

     
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    Old 07-05-2020, 06:38 AM   #9
    guitarhillbilly
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    Re: doing DRE after radiation therapy.

    HighlanderCFH: Thanks.
    __________________
    T2a / Gleason Score 8 / PSA at Diagnosis 6.9 /
    1-5 aggressive score : 4
    12 cores= 4 positive
    NBS = Negative
    Pelvic CT= Negative
    Pelvic MRI= Negative
    Age at Diagnosis= 60-65 age group
    Completed 42 IMRT Sessions
    Lupron scheduled for 2 years [Started DEC 2019]

     
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    Old 07-05-2020, 10:23 AM   #10
    Southsider170
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    Re: doing DRE after radiation therapy.

    Quote:
    Originally Posted by HighlanderCFH View Post
    Good luck, GH. And I hope you never have to undergo a DRE again.

    I never understood the complaints about the DRE. Its sort of annoying, but I've had a lot worse. Sigmoidoscopy is a whole lot worse.

    The last time I was at the doctor, last summer, he apologized in advance. I told him I'd rather be on the receiving end that on the giving end.

     
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    Old 07-18-2020, 05:55 PM   #11
    wtdedula
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    Re: doing DRE after radiation therapy.

    I assume you're referring to radiation as the primary Pca treatment. This I can't answer. But I thought I'd respond because I had RP Surgery and shortly thereafter, my primary care doctor wanted to do a DRE and I let him. Though after he did it, I wondered what purpose it would serve. I asked the forum at that time and I think most who opted for RP were not offered DREs though perhaps a few were.

    I am not sure of the protocol for Radiation Only. Since those who only underwent radiation still do have a prostate, perhaps there is still some benefit to having a DRE done.

    Tim
    __________________
    Age = 57 at diagnosis - PSA 6.11
    5/8/17 Biopsy - 6 (out of 12) cores positive, 4 cores are 3+3, 2 cores are 3+4 (In each core pattern 4 represents 5% of core)
    8/1/2017 Robotic assisted Surgery with Dr. Andrew Stephenson at the Cleveland Clinic Main Campus (Ohio)
    Final Pathology: 3+4 = 7 (Grade Group 2) -, % of prostate involved by tumor = 10%, Positive margin = 1mm, Gleason pattern at positive margin = Pattern 3, EPE - Cannot be determined due to + margin, Bladder neck: Neg, SV: Neg, 4 Lymph nodes : Neg
    PSA History: 7/25/17: 6.11 (Pre-surgery),9/14/17:

     
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    Old 07-19-2020, 05:51 AM   #12
    Terry G
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    Re: doing DRE after radiation therapy.

    Unfortunately doing a DRE post treatment might be just a money issue? The Doc’s get paid for each procedure and a glove and lube are cheap. Drop your drawers, bend over and it’s done. Very little risk of being sued for missing something. I hope I’m wrong.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3

     
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    Old 07-19-2020, 06:31 AM   #13
    efang
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    Re: doing DRE after radiation therapy.

    Right now I just want to know that if my Radiation oncologist doctor doesn't ask me do DRE, I can just don't ask as well, but my primary doctor regularly will do DRE once a year, how should I do? in other words, has any side effect of doing DRE?

    Thanks,
    __________________
    treated prostate cancer by SBRT on 12/2018 PSA. 3.80, 2.60 , 1.16 , 0.88 , 1.36 , 0.50。
    HBAiC around 6.0.
    Dilatation of the descending thoracic aorta ( 2.7X 2.9 cm), but the blood pressure is normal

     
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