Hi Garry,
I initially went to my GP, who imediately gave me a DRE, and then took blood for a PSA test.
At some stage in the proceedings she turned away to do something or other, allowing me to 'shoulder surf' and look at what she had written on her computer, I saw that she had recorded my DRE as 'smooth' and I took solace from that as I had read smooth prostates are more frequently benign than malignant.
Incidentally the PSA then came back as 30.1
The next step, back in 2007, was to have a TRUS biopsy, which came back as Gleason 9, T stage 2a.
Now the problem is that the TRUS biopsy does a fair bit of damage to the prostate, as most of us know the TRUS is followed by days often weeks of blood in urine and semen, God knows what is actually going on inside us.
So in those days they had to let things settle for 4 - 6 weeks before doing an MRI, as if they did it too soon all of the internal bleeding would cloud the scan. I've heard it likened to ariel photography in wartime, if they take pictures too soon after bombing the smoke obscures the target and they can't see what was hit?
So in my case when the MRI was finally done, about 4 weeks later, I was upgraded to T3b.
Now I often wonder, and probablly will never really know, were those gradings accurate and had my tumour really grown from T2 to T3 in those intervening weeks, or were they anxious to get the MRI scan done too soon and was it internal bleeding/bruising or 'bomb damage' that they were looking at when they upgraded the 'T' score?
So, sorry to ramble, these days they try and get over these difficulties by doing MRI tests before the TRUS, but even then with the best will in the world, all of these tests, DRI, PSA, TRUS, MRI etc are each imperfect in their own way, and the competent Consultant uses their knowledge and experience to take all test results into account before giving a final score.
Incidentally when I then went back last year for 'salvage' template biopsy, I asked about the Gleason score, T stage etc and was told none of that applies to irradiated prostates, which are well ravaged bomb sites, they just went back and gave further radiation to whatever looked like cancer, no numbers were quoted whatsoever.
In the final analysis there are really two main categories of results that you get from these tests, either the cancer is contained within the capsule and treatable on a curative basis, or it has already escaped and you are left with a paliative alternative, so far it looks good for you?
:)
Dave