SIUSLAW NEWS | SATURDAY, MAY 29, 2021 | 9A
Community Voices
Us TOO Florence — It is not time to ‘Say Goodbye to the DRE’
By Bob Horney
Us TOO Florence Chapter leader
Having been an “of-
ficial” prostate cancer
survivor since my rad-
ical prostatectomy on
Jan. 30, 2002, I have
seen numerous med-
ical advances come
along to assist urolo-
gists and their patients
in the effective diag-
nosis and treatment of
that disease.
Even with these ad-
vances, one key ele-
ment necessary to take
advantage of them is
for men to commit to
and present themselves
for regular prostate
cancer screening. As
urologists report, and
we in Us TOO Florence
have seen with our own
eyes, when men ne-
glect screening, pros-
tate cancer can — and
often does — get an
insurmountable head
start that urologists
can’t catch.
So, it is a bit surpris-
ing to read an article
co-authored by a cou-
ple of MDs who title
their work: “Time to
Say Goodbye to the
DRE for Prostate Can-
cer Screening.”
The authors are Jus-
tin Dubin, MD, chief
urology resident and
Sanoj Punnen, MD,
MAS, associate profes-
sor in the department
of urology; both at the
University of Miami
Miller School of Medi-
cine in Miami, Fla.
Their opening com-
ment states, “Com-
pared to the illuminat-
ing information we get
from an MRI, the DRE
is merely a finger in the
dark.” They go on to
acknowledge, “Screen-
ing and assessing for
prostate cancer (PCa)
is a major component
of a urologist’s practice.
For most urologists,
part of this process in-
cludes the digital rectal
examination (DRE).
“The DRE entails
using a finger to enter
the rectum and feel a
patient’s prostate. The
DRE enables physi-
cians to make rough
estimates of prostate
size and identify ab-
normalities suggestive
of PCa.
“It is the first physi-
cal examination urol-
ogists learn because
for a long time DREs
were the best and only
means to screen for
and detect PCa. The
DRE is ingrained in
urology culture.
“In the 1990s came
the discovery of the
prostate specific anti-
gen (PSA) blood test,
which could help phy-
sicians identify PCa
earlier in its course.
Imperfect and some-
what
controversial,
PSA testing has be-
come the gold standard
for PCa screening. But,
since the adoption
of PSA into urologic
practice, other major
advances in PCa de-
tection have become
available, such as 4K
score test or multipara-
metric magnetic reso-
nance imaging (MRI)
of the prostate.
“These newer tools
help urologists decide
which patients should
move on to a prostate
biopsy and which ones
can avoid it.”
However, they go on
to say, “Despite these
advancements,
most
urologists and even
general practitioners
continue to perform
DREs on men seeking
PCa screening. Many
physicians are adamant
that it is still their re-
sponsibility to do so.
But does the DRE pro-
vide helpful informa-
tion for decision-mak-
ing or is it an obsolete
practice perpetuated
by historical dogma-
tism?
“We believe it is the
latter and it is time to
say goodbye to the DRE
for PCa screening.”
In continuing to
build their case, they
highlight (and in my
estimation), exagger-
ate the pain associated
with the DRE, claim-
ing it drives men away
from being appropri-
ately screened for PCa.
(Not sure what they
mean by “appropriate-
ly” screened).
When men complain
to me about the dis-
comfort of the DRE
exam, I always suggest
they should under-
go their wife’s pelvic
exam.
The authors also as-
sert that when assess-
ing the value of any
medical examination,
the deciding factor is
whether it can help
guide medical deci-
sion-making.
Plus, for any exam-
ination to be useful, it
must be accurate.
I have a personal re-
sponse to their last as-
sertion — as do many
other prostate cancer
survivors. That is, a
lot of this depends on
the skill of the “finger”
doing the DRE.
In my case, when
the late urologist Peter
Bergreen examined my
prostate in December
2001, he noted some
subtle
irregularities
that no PCP had ever
noted (might not have
been there yet).
Even at that, he didn’t
suspect any malig-
nancy (cancer), espe-
cially that had already
escaped the prostate
(which it had).
So, I ask the authors,
was Dr. Bergreen’s ex-
amination accurate?
ABSOLUTELY!
Did it help guide
medical decision-mak-
ing? ABSOLUTELY!
Twelve needle-biop-
sy…PROSTATE CAN-
CER!
Did the PSA help?
Nope!
December 2000 was
4.1; December 2001
was 4.1.
Note:
Responses
to their earlier asser-
tions (and others) next
month.
BECAUSE SAFETY IS KEY,
PLEASE DON’T
DRINK AND DRIVE!
I
t probably comes as no surprise that
more traffi c fatalities due to drunk
driving occur during the holidays
than any other time, but of course,
you should never drink and drive. With
your safety in mind, these community
sponsors urge you to review these
important tips for hosting or attending a
safe celebration!
Memorial Day is coming, bringing much
celebration and the start of the summer.
Special occasions with good friends
mean good times and free-fl owing
libation — so party on hearty, but leave
driving alone. We want to see you get
safely home!
“Key” Strategies For A Safe
Memorial Day weekend:
WITH BEST WISHES TO EVERYONE FOR
A SAFE Memorial Day Weekend!
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541-991-4400
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541-514-4991
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Florence
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• Plan an alcohol-free celebration – Host a fondue
or “make your own” ice cream sundae party as a fresh
alternative. Add some fun party games to keep guests
entertained without drinking!
• Check your keys with the host – This is an
effective strategy for giving the host some control
over inebriated guests.
• Keep the number of a taxi company handy –
A good tip for both party guests and hosts alike.
• Offer to drive a guest home – Start the
Summer off right by performing a good deed
and help keep drunk drivers off the road.
• Appoint a designated driver – Use the buddy
system and you can return the favor next time.
• Provide lots of snacks to party guests –
Drinking on an empty-stomach rapidly
increases alcohol’s debilitating effects.
• Post transportation info on party invites –
Include information for public transportation,
car pools and taxi company phone numbers.
• Don’t let a friend drive drunk – Take the car keys
away or use one of the strategies above to see your
friends safely home.