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Finally my Dad agreed to get checked but ...

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User
Posted 05 Feb 2019 at 18:41

Whilst I was visting my Dad recently (he is near 80), I nagged him to get checked out as A) I'm have it and B) he has had on and off back ache.

He is a stubborn bugger and kicked back at the time but admitted today that he went to  his GP. He had a symptom screening chat, a DRE and a urine test on the grounds that the GP claimed that if you have Prostate Cancer you will have blood in your urine.

As far as I know, haematuria is only a *possible* marker for advanced PCA not early stage (abscence of blood does not rule out PSA and presence of blood may not be PCA).

I asked him about the usual symptoms and none were apparent apart from backache but he has been replacing his kitchen so that is a likely cause.

She said he was fine to have a PSA test if things change.

I had to rewrite this several times as the first few drafts were me venting at the possible utter stupidity of my Dad's GP. On reflection, I thought it better to err on the side of generosity as I wasn't there and don't know what was actually said. I love my Dad but he is stubborn and may not have actually asked for the test.

I was a bit "wtf?" to him and nagged him a bit about getting the actual test but he was "what the Dr said" and my "do not push it radar" kicked in.

On one hand, he is at risk as I have it but on the other, he does not present with much. I'm wondering whether I should leave it a while and try again regarding the test. Any advice from others with fathers in the same boat? I do not want him to go through what I have.

It shows how hard it is dealing with loved ones when it comes to this bloody disease even before it arises

User
Posted 05 Feb 2019 at 20:30
Personally I would leave well alone. If your main concern is familial risk then you were diagnosed about 30 years before him so he either a) doesn't have it or it is a very slow burner or b) you both gave it and you could have avoided treatment and still been here when you are 80.

My father-in-law was diagnosed at 79. It ruined his really, really happy life. My dad has recurrence at 81 - having recovered from the op 20 years ago he has no desire to have treatment and ruin his life a second time.

Your dad's DRE was apparently (allegedly) normal. Why not leave it a few months and then next time, go with him.

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

User
Posted 05 Feb 2019 at 21:37

Thanks

My objectivity is a bit off because I’m due test results on Tuesday and I can’t bear the thought of my dad going through this as I love him, grumpy old sod that he is.

You are right about the age thing - maybe if I live a bit longer I’ll develop some patience.

PP

User
Posted 06 Feb 2019 at 03:03
I am often amazed at the ignorance of GPs regarding this disease. ‘You would have blood in your urine if you had cancer’, ‘You don’t need a PSA test if you have no symptoms’, ‘We don’t do DRE’s these days’, ‘Do you still ejaculate? (after prostatectomy)’, all spring to mind from personal experience and from correspondents here.

Cheers, John.

User
Posted 06 Feb 2019 at 07:18
The problem is that a lot of older men don’t challenge them it do research because that was not how they were brought up.
User
Posted 06 Feb 2019 at 07:25
One Dr. (Not my usual) on two occaisions told me that "Pca is nothing to worry about, my Father has had it for twelve years and he's fine" A youngish Dr which is even more alarming!

Cheers

Bill

User
Posted 06 Feb 2019 at 07:30
Between that, NICE’s refusal to sanction PSA screening and the fact that breast and cervical screening is standard for women .... agh I was about to get VERY political there 😤
User
Posted 06 Feb 2019 at 07:56
Unfortunately guys research has proven that PSA is about as useful as a chocolate teapot as a screening tool. You only have to look at the variety of initial PSA test results on this site to realise anything up to 80? Might not be cancer, while results below 2 are subsequently proven to be cancer.

To be a useful universal screening tool a test needs to deliver more benefit than harm, experience in the USA has proven that general PSA screening does more harm than good.

So what is PSA good for? Well it was invented as test of the success of radical and systemic treatment - it's good at that. It is also useful in the hands of knowledgeable GPs who can assess risk effectively and the likely hood that a PSA test may deliver individual benefit - best of luck with that last one!!

User
Posted 06 Feb 2019 at 08:00

MBut it is better than nothing as an initial diagnostic screening. The whole over treatment thing is down to what happens after the test and that is a matter f training and access to other diagnostics.

It may give rise to false positives and negatives but enough people get caught using it that it warrants use.

Put it this way, I’d be far further down the road to being rubber ducked if my GP had not decided to do the test so it had my vote.

My take on why it is not standard is far more cynical.

Edited by member 06 Feb 2019 at 08:04  | Reason: Not specified

User
Posted 06 Feb 2019 at 11:22
Not if you get the all clear but die of sepsis following a biopsy. Or you have radical treatment and end up with life changing side effects that are worse than the cancer would have been.

The statistics on PSA testing do not lie. Even in the USA PSA screening is no longer recommended due to the harm it has caused in the past.

User
Posted 06 Feb 2019 at 12:10
Typing “PSA Controversy” into Google gives just that - a lot of controversy. There are two main opposing studies that give different results. More research into screening is needed until we get a better tool. Until then I’m glad I had mine...
User
Posted 06 Feb 2019 at 13:06

Originally Posted by: Online Community Member
Even in the USA PSA screening is no longer recommended due to the harm it has caused in the past.

My English friends in America (the US Virgin Islands to be precise) aged 62 and 81 have had annual PSA tests and DRE’s since they were 50, as part of their medical insurance plan.

They implored me to have the same: ’They don’t test properly in UK’, said the 81 year old friend whose brother-in-law died of PCa in England.

I was refused a DRE by a GP: ’We don’t do that these days’, and went seven years between PSA tests, despite having an annual ’full blood count’ test which was far from comprehensive and did not include PSA.

And I ended up with T3aN1M0 cancer. I’m ’cured’ now of course. I am only slightly jaded, Matron.😉

Cheers,  John.

User
Posted 06 Feb 2019 at 13:12
Like I said - controversial ....
User
Posted 06 Feb 2019 at 13:54
Bollinge your USA friends would now get the same treatment you had as the guidelines changed recently in the state's too - no PSA screening without counselling first.
User
Posted 07 Feb 2019 at 07:38

Originally Posted by: Online Community Member
Bollinge your USA friends would now get the same treatment you had as the guidelines changed recently in the state's too - no PSA screening without counselling first.

Hot off the press @AmericanCancer 2019 #cancerstats: “Prostate cancer mortality up for 1st time since early 1990s, likely due at least in part to plummeting screening rates. Incidence ticking back up a bit, so maybe we're finally heading toward a "smarter screening" consensus”

User
Posted 07 Feb 2019 at 08:20
And the NHS has just announced that the bowel screening 'poo sticks' programme is being withdrawn.

And the mythical breast screening programme that men seem to think exists isn't actually a true screening programme - it is a regular letter reminding women of the opportunity and then pointing out the risk of false negatives, false positives, infection from biopsy, overtreatment, etc. The national rate of take up is (unsuprisingly) falling.

I will not support screening while it is dependant on PSA. Once they have identified a more reliable tool I might move position.

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

User
Posted 07 Feb 2019 at 08:28
If you don’t screen people you don’t have to spend money on treatment of larger cohorts is one perspective. Cynical or realistic? You decide....
 
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