Age for DRE, Biopsy Re-Read, & Perineural Invasion | Answering YouTube Comments #68 | PCRI

Alex asks Dr. Mark Scholz questions from our CZcams comments on the appropriate age to begin annual DREs, the process of getting a second opinion on a biopsy report, the danger of Gleason 7 with perineurial invasion, and whether color doppler ultrasound can detect lesions that are missed by MRI.
0:09 At what age should men start to get digital rectal exams?
2:35 What is the process like for getting a second opinion on a biopsy/pathology report? Do you need to get a second biopsy?
4:35 How dangerous is Gleason 7 cancer with perineurial invasion?
6:20 Can lesions that are missed on MRI be seen on color doppler ultrasound?
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[@ThePCRI]

If you have questions about prostate cancer and need help from our Helpline team, you can email us here: [e-mail]

[@johngroll2704]

My doctor found my cancer from a digital exam. My psa was below 4.

[@lindafleming3978]

My husband had a 3+3=6 10% of 1 core in Jan 20 in Feb 21, he was diagnosed with MRI which biopsy at that point showed 4+3 in several cores including the targeted area.
Active surveillance had been the only option due to Covid, but this shows that we should not assume 3+3 should automatically mean AS.

[@robgerety]

Thank you for your good work. Where the pathologist has 12 cores, some graded 3+4 and some graded 4+3, does the pathologist report a single gleason score? How is it determined?

[@jeffostendorf9881]

I've been diagnosed with prostate cancer. 12 biopsies with the right 1/2 showing 0 of the 6 biopsies showing cancer and all 6 on the left 1/2 indicating Gleason score off 4+3 and 4+4 and 4. The surgeon says in order to get the margins needed, he will that nerves leaving me with ED. Im not read to give up my sex life at age 60. Radiation will also cause ED and I'm not wanting to take hormones either. What else is there?

[@randgraham1]

Thank you for this information. In 2020 I was a Gleason 7 3 + 4 with PNI and a PSA of 10.25. Why would a doctor insist that I needed Robotic nerve-sparing surgery if the nerves were affected? I have just received my first recurrence PSA of point 0.07 and don't understand why if a patient has PNI they're not told not to have robotic radical prostatectomy surgery? One last question , If this has been in my nerves for 3 and a 1/2 years how far has it spread or do you think that it still might be localized in the prostate bed?

[@maxjones494]

You should ask for PET MRI Scan, that will let you know if Cancer has spread.