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As a comparison, my DRE only showed an asymmetry on first presentation; PSA was about 2. The biopsy showed only a few samples with little involvement; Gleason was 3 3. I'm surprised at your husband's high PSA and Gleason score with an unremarkable DRE.
Sorry to hear of your husband’s diagnosis, but welcome.
What you report is unusual, but as the late Aubrey Pilgrim used to say “The Golden Rule of prostate cancer is that there are no rules.”. There are many forms of the disease, it occurs in different parts of the gland, takes a variety of forms, all of which makes it very difficult to be certain about any aspect, from diagnosis to treatment choice.
I think it is important to bear in mind that it is very difficult to actually reach the gland, so in the first place, the doctor’s probing finger has to feel through both the glove and the bowel, both of which reduce sensitivity. Then there are the physical aspects of both the doctor and the man being examined. Doctors with small hands might be what the man feels is a plus, but they may not be able to reach the gland, which may in any event not be as close to the bowel in some men as in others. Then there is the positioning of the tumour or tumours. If they are in the part of the gland that cannot be reached by the doctor’s digit, they simply don’t register – this is compounded where the condition known as BPH (Benign Prostate Hyperplasia) is involved because the enlargement of the gland can ‘hide’ the tumours.
As a matter of interest, when my BPH started giving a good deal of trouble, I had a better scan than I had nine years earlier and everyone was shocked to find that my gland had grown in a most peculiar fashion – almost vertically, and of course no one could feel that part of the gland. This meant that the doctor who had been examining me regularly had estimated my gland as large – about 70 gm – but it was in fact very large – about 120 gm, which explained to a great extent part of the gradual rise in my PSA levels.
Hello Jennie,
I had a PSA of 4.0 and neither my GP nor urologist could feel any abnormality. Biopsy revealed Gleason 4 3=7. The prostate when removed weighed in at 32 grams (which should give it a volume of about 32cc)Post surgery pathology revealed two separate tumours involving quite a large amount of the gland. They could not be felt on DRE because the were located to the front of the gland top to bottom and so could not be felt from behind.
Bill
