Guest guest Posted November 10, 2004 Report Share Posted November 10, 2004 , There are some studies that show that DRE (Digital Rectal Examination) can affect the PSA levels. It is a simple mechanical issue - the manipulation of the gland can literally squeeze some of the PSA, which is meant to be contained within the gland, into the bloodstream. Of course, as you will have discovered by now, there are other studies that say it doesn't matter and that a DRE doesn't afftect PSA levels. Since there is no absolute clarity on the issue, the recommendation is DO NOT have a DRE befpre taking blood as it MAY affect the result. Quite simple Here is a study reference you may wish to use: The following listing of physiologic conditions and manipulations that affect PSA serum levels is a from S Yox: " To Screen or Not to Screen? The Controversy Over Prostate Cancer. " Laboratory Medicine V29, No 8. Aug/98. Condition/Manipulation Increase Effect on PSA Level Persists Up To Acute bacterial prostatitis 5-7 fold 6 weeks Acute urinary retention 5-7 fold 6 weeks Exercise - bicycle 0-3 fold 1 week Prostate biopsy Very Variable 6 weeks Prostate massage Variable 6 weeks Ejaculation Variable 2 days Transurethral Prostatic Resection Very Variable 6 weeks All the best Terry Herbert in sunny Kalk Bay, South Africa Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. June '04: TURP. Sep '04 PSA 7.45 fPSA 42% My site is at www.prostatecancerwatchfulwaiting.co.za It is a tragedy of the world that no one knows what he doesn't know, and the less a man knows, the more sure he is that he knows everything. Joyce Carey Update & Question We decided to go to an Urologist to see if we can get a repeat of the cPSA or the PSA. I'm still trying to undersrand all the PSA stuff. Anyway, this doctor stated that it didn't seem right that Kurt's cPSA (3) 2.1 the cutoff on the high end... was so abnormally high when compared to a ten year history of (0.5 - 1.1) of PSA testing at Methodist Hospital in Houston. So he is repeating the test with a PSA as he has had in Houston at Methodist. Now my question...I have read numerous times, in searching information, that the blood test should be performed BEFORE the digital exam. This doctor didn't do that!! My husband questioned him about it and he said it really didn't matter with him. Only matters with certain people...I don't quite understand the answer but, maybe I can put two and two together. Is it true that the blood should be drawn before the digital exam? Will it make a big difference in results? The doctor said that if the test comes back and it has not increased like the cPSA then we'd do nothing and just repeat the test in 6mo. If it indeed comes back looking more like the cPSA testing then he'd have to go for a biopsy. So we sit for a week...biting our nails and praying...until we get the new results. I hope everyone is doing well, K Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2004 Report Share Posted November 10, 2004 , Whatever you do, do not suffer from PSA anxiety. I assume your husband is middle aged so it is not unusual for a man of that age to have a raised PSA probably because of prostatitis. You didn't say if he had any symptoms, getting up during the night or trouble when starting to urinate etc. I believe that it is common knowledge that the PSA test should always be done first because the DRE can cause a rise in PSA. If your husband has no symptoms, then the PSA test is indeed a screening test, if on the other hand your husband has symptoms, then the PSA test is indeed a diagnostic test. No point in getting yourself stressed out over something that may never happen :-) Regards We decided to go to an Urologist to see if we can get a repeat of the cPSA or the PSA. I'm still trying to undersrand all the PSA stuff. Anyway, this doctor stated that it didn't seem right that Kurt's cPSA (3) 2.1 the cutoff on the high end... was so abnormally high when compared to a ten year history of (0.5 - 1.1) of PSA testing at Methodist Hospital in Houston. So he is repeating the test with a PSA as he has had in Houston at Methodist. Now my question...I have read numerous times, in searching information, that the blood test should be performed BEFORE the digital exam. This doctor didn't do that!! My husband questioned him about it and he said it really didn't matter with him. Only matters with certain people...I don't quite understand the answer but, maybe I can put two and two together. Is it true that the blood should be drawn before the digital exam? Will it make a big difference in results? The doctor said that if the test comes back and it has not increased like the cPSA then we'd do nothing and just repeat the test in 6mo. If it indeed comes back looking more like the cPSA testing then he'd have to go for a biopsy. So we sit for a week...biting our nails and praying...until we get the new results. I hope everyone is doing well, K Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2004 Report Share Posted November 15, 2004 Hi , I'm catching up on posts, and am not sure if you have had a reply, so hear goes. It is established practice to take blood before a DRE just to be safe. However there is plenty of evidence to show that the procedure has little effect on PSA in blood drawn immediately after one. Inevitably there will be evidence out there to show that it does have an effect. Here are some abstract "conclusions" that show little or no effect on PSA if the blood is drawn after DRE. If you want to read the full abstracts, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi and search using the PMID number. . We showed that the DRE had no clinically important effect on PSA values twenty-four hours later. The mean PSA rose from 1.57 to 1.62 ng/mL, similar to the controls. PMID: 7684542 Based on these data we believe rectal digital examination has no effect on PSA serum levels. PMID: 7536380 Based on these findings, physicians should be confident that the serum PSA concentration in the immediate post-digital rectal examination period is accurate and does not compromise clinical use of the tumor marker. PMID: 1377290 Although the effect of DRE on PSA levels does not appear to be clinically significant, in order to prevent any confusion, it may be the best approach to perform DRE after obtaining serum for PSA analysis. PMID: 8791045 The interval of time between the two assays in our study indicates that in everyday clinical practice, for both inpatients and outpatients, digital rectal examination has no effect on prostate specific antigen and that subsequently there is no need to delay assay. PMID: 8657671 We showed that the DRE had no clinically important effect on PSA values twenty-four hours later. The mean PSA rose from 1.57 to 1.62 ng/mL, similar to the controls. PMID: 7684542 Based on these data we believe rectal digital examination has no effect on PSA serum levels. PMID: 7536380 Based on these findings, physicians should be confident that the serum PSA concentration in the immediate post-digital rectal examination period is accurate and does not compromise clinical use of the tumor marker. PMID: 1377290 Although the effect of DRE on PSA levels does not appear to be clinically significant, in order to prevent any confusion, it may be the best approach to perform DRE after obtaining serum for PSA analysis. PMID: 8791045 The interval of time between the two assays in our study indicates that in everyday clinical practice, for both inpatients and outpatients, digital rectal examination has no effect on prostate specific antigen and that subsequently there is no need to delay assay. PMID: 8657671 -----Original Message-----From: maryks_55 Sent: Thursday, November 11, 2004 1:53 AMTo: ProstateCancerSupport Subject: Update & QuestionWe decided to go to an Urologist to see if we can get a repeat of the cPSA or the PSA. I'm still trying to undersrand all the PSA stuff. Anyway, this doctor stated that it didn't seem right that Kurt's cPSA (3) 2.1 the cutoff on the high end... was so abnormally high when compared to a ten year history of (0.5 - 1.1) of PSA testing at Methodist Hospital in Houston. So he is repeating the test with a PSA as he has had in Houston at Methodist. Now my question...I have read numerous times, in searching information, that the blood test should be performed BEFORE the digital exam. This doctor didn't do that!! My husband questioned him about it and he said it really didn't matter with him. Only matters with certain people...I don't quite understand the answer but, maybe I can put two and two together. Is it true that the blood should be drawn before the digital exam? Will it make a big difference in results?The doctor said that if the test comes back and it has not increased like the cPSA then we'd do nothing and just repeat the test in 6mo. If it indeed comes back looking more like the cPSA testing then he'd have to go for a biopsy. So we sit for a week...biting our nails and praying...until we get the new results.I hope everyone is doing well, K Quote Link to comment Share on other sites More sharing options...
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