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Do Any Countries Offer Routine PSA Tests?

User
Posted 13 Sep 2018 at 12:41

Do any countries with socialised healthcare schemes similar to our NHS, offer routine and regular PSA screening to men over 50?


If so, do their prostate cancer morbidity rates differ very much from our own?


If I was being churlish I might conclude that the fact that women are implored to have mammograms and cervical smear tests on a regular basis, yet men are not offered routine PSA tests at all, amounts to sexual discrimination.


 


 

User
Posted 13 Sep 2018 at 21:19

Probably because the PSA test alone is not that reliable regarding diagnosis


Bri

User
Posted 14 Sep 2018 at 03:33

Originally Posted by: Online Community Member


Probably because the PSA test alone is not that reliable regarding diagnosis


Bri



I take your point, Brian, but I think annual increases in PSA would give cause for concern.


My PSA was tested in 2010, when it was 2.2 but not again until 2017 when it was 16.7. By which time the cancer had spread into the lymph nodes. Good job I had the 2017 test!


Cheers, John. 

User
Posted 14 Sep 2018 at 07:42
Statistics have proven that routine testing of over 50s leads to over treatment and causes more damage than it prevents.

Maybe if all men were tested from 30 it could be more useful??
User
Posted 14 Sep 2018 at 15:41

Agree about just blind testing but I do think that where there is a familial history of PC then PSA  should be at least encouraged in primary care. 

THE CHILD HAS GROWN, THE DREAM HAS GONE
User
Posted 14 Sep 2018 at 15:56
I was at lunch in London this Monday with two guys aged around sixty and sixty-three, and neither had ever had a PSA test to their knowledge.

The father of the sixty-three year old died of prostate cancer!!!

I hope I didn’t put them off their lunch proselytising about PSA testing.

Cheers, John
User
Posted 15 Sep 2018 at 00:32

John,


Your mentioning elsewhere treatment you had in Austria reminded me that there was an experiment done quite a few years ago in the Tyrol in which all men between certain ages were invited to be PSA tested. I can't remember the details without rereading but these links are applicable. I believe the experiment was discontinued.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282002/


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3281998/


https://www.researchgate.net/publication/5531655_Tyrol_Prostate_Cancer_Demonstration_Project_Early_detection_treatment_outcome_incidence_and_mortality



more info as you scroll down this link


 


 


 

Edited by member 15 Sep 2018 at 00:35  | Reason: Not specified

Barry
User
Posted 15 Sep 2018 at 01:16

Thanks Barry, I think this sums it up:


“In the Tyrol region where treatment is freely available to all patients, where widespread PSA testing and treatment with curative intent occurs, there was a reduction in prostate cancer mortality rates which was significantly greater than the reduction in the rest of Austria. This reduction in prostate cancer mortality is most probably due to early detection, consequent down-staging and effective treatment of prostate cancer.”


 

Edited by member 15 Sep 2018 at 01:17  | Reason: Not specified

User
Posted 15 Sep 2018 at 07:07

Originally Posted by: Online Community Member
Statistics have proven that routine testing of over 50s leads to over treatment and causes more damage than it prevents.

Maybe if all men were tested from 30 it could be more useful??


 


I would love to see some sort of screening program, one of my first posts was about the need for one and was met with "arghhh". 


By the time we had caught up with the backlog there would be approximately 16 million men between the age of 30 and 70. If they had a yearly test and based on 250 working days per year that is 64000 tests per day. Then add to that the follow up appointments etc.  Unfortunately I don't think the NHS could cope with that or afford it. 


Thanks Chris

User
Posted 15 Sep 2018 at 10:28

So just let men die?


I refer back to my original post regarding breast and cervical cancer screening. They are spending a fortune on HPV vaccinations for girls and boys to prevent cancer.


Surely, prevention / early diagnosis is better than cure and likely to cost much less?

Edited by member 15 Sep 2018 at 10:30  | Reason: Not specified

User
Posted 15 Sep 2018 at 11:39

In September 2016, at the age of 46, I attended a screening event organised by the Lions Club of Maidenhead.  They organise this every 18 months or so.


When I went to my GP, he was very dismissive of my psa result.  He told me he thoroughly disapproved of this type of event.  Nonetheless, he agreed to retest me.  To cut a long story short - pT3b, Gleason 9, RP, SRT and currently HT (bicalutimide).


My GP told my his practice got 5 referrals from the Lions screening event.  The other four men were significantly older than me.  I was the only one with a raised PSA who turned out to have cancer.


I don’t know if I think a screening programme is the answer.  I’ve read arguments for and against.  In any case, they would probably start at 50 which would have been too late for me anyway.  I suppose I was lucky - right place, right time.


Ulsterman

User
Posted 15 Sep 2018 at 11:45

To Bollinge


That’s the point isn’t it - PSA testing isn’t preventative and early diagnosis leads to over-treatment.


Some of you talk about breast screening like women are getting something different to men. There is no true breast screening programme in England - what women over 50 get is a letter every 3 years reminding us that we can have a mammogram. The letter also sets out the possibility of false negatives and false positives and the latest data on the risk of overtreatment. If a woman wants to go ahead, she can phone her local breast screening department to make an appointment. About a 1/3 of breast cancers are diagnosed by ‘screening’ and the rest (including the aggressive ones) are diagnosed in women below the screening age group or with symptoms. Pretty similar to prostate cancer, when you think of it.


Cervical screening is the only true cancer screening programme in this country for women and that is because the test is reliable and the risk of overtreatment is negligible. But even that isn’t as perfect as you apparently assume. A woman with symptoms has to fight very very hard to get tested if she is younger than the threshold for screening, even if there is a family history.


Bowel cancer screening is the only direct access screening programme that I can think of - the take up rate is only 59% even though the test is actually posted through the letterbox! 


If you want equity with women, campaign for GPs to be required to send leaflets out to men every so often telling them a) how important a PSA test is b) how unreliable the result might be c) how many people are estimated to be treated unnecessarily


About 63% of women actually take up the offer of a mammogram the first time they are invited - about 75% have a mammogram at some point between the ages of 50-70. Based on the stereotype of men being much less likely to go to a GP and much less proactive about their health, I wonder if the %response to a leaflet would be much higher than the current rate of PSA testing.

Edited by member 15 Sep 2018 at 13:12  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Sep 2018 at 13:59
Lyn, erudite and practical as ever. Well said!

AC
 
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