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PSA Test?

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User

Posted 27 Feb 2018 at 14:32

Hello everyone,

I'm a 56 year old white male with no family history of prostate cancer, however, I have had some symptoms of benign prostatic enlargement for around 18 months now. The symptoms have not worsened over time and they involve slight difficulty starting urination and a weak urine flow. I do not need to get up during the night because of it.

There has been much recent media coverage about men like me getting checked, which usually means having a PSA test.

My question is, why should I have a PSA test? It is well known as being unreliable because it produces both false positive and false negative results, leading to overdiagnosis and overtreatment. As a consequence it is not recommended as a national screening programme by the NHS. When I discussed it with my Doctor, he did not think that it was a good idea.

It seems quite possible that I could receive an erroneous high PSA reading after the test which would then probably result in an unpleasant and possibly unnecessary biopsy, with all that entails.

What are the benefits of having a PSA test when the results cannot be relied upon?

Thanks,

Arturo

User

Posted 27 Feb 2018 at 20:26

Hello Arturo.

Of course you are correct in that the PSA test by itself is not very accurate for detecting Prostate cancer but doctors would only use the result together with other factors before you would need a biopsy. Have you actually been diagnosed with an enlarged prostate or are you assuming this is the case due to your symptoms. You probably already know these symptoms can also be the the same as for Prostate Cancer.

Has your GP confirmed you have an enlarged prostate by doing a rectal examination.

My husband had an enlarged prostate with the accompanying symptoms for many years before being diagnosed with Prostate cancer. Over the years he had regular PSA and DRE tests. Had it not been for the PSA tests we would not have seen the gradual changes then sudden increase together with the GP feeling something in his prostate that alerted us to proceed with an MRI then a biopsy once there was areas of concern on the MRI.

He has subsequently had a Prostatectomy and hopefully has had all of the cancer removed so we would never say that his biopsy was unnecessary.

You could of course carry on as you are hoping your symptoms are just from an enlarged prostate but how would you feel later on down the line if you left it too late and ended up incurable.

The PSA test is controversial but sadly for now it's all we've got until a better test becomes available.

Regards

Ann

User

Posted 27 Feb 2018 at 21:12

Within a range of 2.0 to about 40 the PSA isn't reliable on its own but if your PSA comes back as 100, 1000 or 10,000 you can be sure that it is reliably telling you something bad is happening.

It is good that your GP agrees with your thinking - he could be partly motivated by the fact that he will have to pay for the PSA test and, if you are subsequently diagnosed, any prescriptions etc will also come out of his budget.

My husband was 50 and diagnosed with a pSA of 3.1 - it had already spread to his bladder so we were lucky that the GP knew PSA could be unreliable on its own. My father-in-law died with metastatic prostate cancer and a PSA of 1.6 so I complete agree with you that the PSA test is unreliable - the big question then is '"if you were diagnosed, would you have treatment or would you want to take your chance" .... if you would reject treatment due to the test being unreliable, you may as well save your GP a few quid now.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 28 Feb 2018 at 11:32

Hi Arturo,

If you are happy with your doctors diagnosis then fine maybe he is thinking of your health and not his budget,but just because you are in your 50s does not guarantee you will not have Prostate cancer.

I had a low PSA of 2.19 after having a private medical for renewing 7.5 ton driving that i paid £140 for and a microscopic trace of blood was found in my urine and my doctor said i should have further tests that found cancer confined to my prostate with no bone or other cancer breakouts.

Thinking back on it all my Doctor could have had my well-being at heart or the fact that i was paying Privately for it just to fill in some DVLA paperwork.

It turned out with the PSA 2.19 a Gleason 3+4=7 and 5 out of 12 cores positive I was able to have the option of a full radical prostate removal or Brachytherapy,I had the Brachytherapy.

I am 70 and 17months on from the procedure and doing well.

Good luck John.

User

Posted 28 Feb 2018 at 11:54

Hi Arturo,

As you say PSA is not perfect, but it is the best indicator we have at the moment.

With no history of cancer in the family, both parents alive at 93 and being fit, I was found to have PSA rising from 4.6 to 9.6 in 12 months.

The oncologist said it was strange that I had PCa as I had no indicators.

I would definitely recommend a PSA test, especially if I had BPE, just for peace of mind.

User

Posted 28 Feb 2018 at 16:01

I was (and still am) symptomless apart from a raised PSA test, my GP checked my PSA regularly and referred me to the specialist when it started to rise. I had an MRI with "nothing found" followed by a biopsy. The biopsy found my cancer and it is confined to the prostate. I am on active surveillance only.

My point is, that without a PSA test there would have been no chance of finding my PCa at this early stage. As regards overtreatment, you have the choice of treatment, in my case none.

John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2

Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23 <0.01

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