The controversial PSA test .. prior to diagnosis.

User

Posted 06 Jun 2019 at 10:20

My local GP surgery discouraged me from having the PSA blood test.

Just by chance I had to see a Junior doctor out of county. While talking about my general health issues, he encouraged me to have the PSA test done.

My GP that I have had for the last 18+ years was visibly disappointed when I told him that I was going to take the advice of this Junior doctor.

The result came back as 67 and the rest is history.

I will never know if my treatment options could have been greater, or my life expectancy longer if I had the PSA test 14 months earlier when I first went to my GP with concerns. Also we don’t know what the PSA result would have been, but a big part of me feels that they may have done some further tests (eg. MRI scan/Bone scan etc) earlier to see if I could potentially have cancer if the PSA test had come back with a high score. A lot of if’s here!

I appreciate that I can’t change the past, but thought I would check with the community as to your thoughts.

I do appreciate however that the PSA test for diagnosing cancer is not great, but interestingly seems to be fine for measuring if treatment is working or not.

Thanks

User

Posted 06 Jun 2019 at 16:25

A PSA test is very effective for diagnosing prostate cancer. The reason there’s no screening programme is that prostate cancer is an almost inevitable side-effect of the ageing process for a man (the % goes roughly in line with age, so about 70% of 70-year-old men have it), but most cases of prostate cancer don’t require treatment, and men die with it rather than from it, generally not even knowing that they have it. A screening programme would put immense additional pressure on the NHS and would result in enormous numbers of men being told that they have cancer who quite frankly don’t need to know.

Of course the downside of that is that very often those men who do require treatment don’t find out that they have PCa until it starts showing symptoms, which can be when it’s reached an advanced stage. It’s really a no-win situation: test everyone and the result will be massive over treatment; test late and the disease isn’t caught early. There’s no obvious solution.

Many of us here (me included) were diagnosed with PCa when totally free of symptoms, it being found as a side-effect of some other treatment.

Best wishes,

Chris

User

Posted 06 Jun 2019 at 17:06

Originally Posted by: Online Community Member

A PSA test is very effective for diagnosing prostate cancer.

Actually, it's not in most people. If you come out with PSA 10 or more, that's quite clear that investigation is needed, but the vast majority are at levels where no one can be sure, and then it's difficult to know what to do. A significant improvement on "A PSA test" is to have periodic PSA tests and look for rate of rise. We had someone here a month or two back who reported a very low PSA (< 2), but I flagged up that even though it was very low, it had increased 4 fold in 18 months, and that's certainly a trigger for further investigation. That would be missed by a single test. PSA is not a good test, but it's all we have at the moment. There is research work going on to find a better indicator of PCa.

Your point about many cases of PC not needing treatment is very valid. Chances are quite a number of the people here who think they've got significant life threatening PCa don't, but we can't tell which those are, and they go through treatments which significantly reduce QoL unnecessarily.

I believe the current NICE guideline is that you should be sent away from your GP with a leaflet to read first time you ask for a PSA test. Various of the PCa charities are challenging this, and it's one of the topics at Tackle's AGM next week. The two senior urology consultants I was talking with yesterday said a significant problem is that GP's who do this front line diagnosis usually know very little about urology in general, and prostates in particular. Urology as a whole accounts for 1/3rd of all hospital operations, but GP training only has 2 weeks allocated to it, yet there is a move to push increasingly more front line diagnosis to GP's because it's much cheaper than hospital referrals.

User

Posted 06 Jun 2019 at 17:13

If there are 11,000 deaths from prostate cancer each year, one wonders how many of them may have been avoidable with early diagnosis.

I would advocate a PSA test for all men aged 50 and subsequent ones at say, 55 or 60, and if there is an increase in their PSA level, clearly something is going on, and then further investigations might need to take place.

I had no symptoms, and a GP at my practice refused to do a DRE on me despite me being in my underpants on his couch for something else! Luckily, a different GP later thought I might need a PSA, which was 16.7!

I am still here and cancer-free, thanks to symptom-free testing.

The cost is immaterial, considering how much the government squanders on so many other projects.

Cheers, John.

User

Posted 06 Jun 2019 at 18:44

I wasn’t thinking simply of cost, John (although it’s certainly a consideration) but of available resources. There are only a certain number of urologists and oncologists available, and literally millions of additional cases every year (most of whom would not actually need treatment) would completely overwhelm the system, and have a serious adverse effect on those patients who did actually need urgent treatment. It might very well cost lives rather than saving them.

Best wishes,

Chris

User

Posted 06 Jun 2019 at 19:32

‘My friends in America’ whom Matron will be sick of me referring to, have an annual PSA test and a digital rectal examination.

Bearing in mind, their medical cover is insurance-based, the insurance company must feel it is cost-effective to have these tests sooner rather than pay out for prolonged treatments and palliative care later.

If one of my GPs hadn’t ticked the PSA box ‘by accident’, as they had never done in the preceding seven years, I might be riddled with cancer and looking at a terminal prognosis.

As it is, I have a 98% chance of surviving for fifteen years, which will do for me.

PCa screening for men? Yes, all the way.

Cheers, John.

User

Posted 06 Jun 2019 at 23:32

FWIW, I would suggest that a PSA test CAN BE very good at diagnosing PCa. And equally, may not be?

A friend of mine at 68, has been having regular PSA tests, all at less than 1.7. He has PCa. He'll have HIFU later this year.

Nobody can tell you that a test is generally statistically worthless if it helps you?

6 years on, I still have PSA tests about 6 monthly. I don't give a tihs about guidelines or norms or common practice etc etc. I do what I need to do for me, and my wonderful GP practice support me.

The thought of going to annual testing knowing that the moment after I have had a test PCa could be rampaging through my body, and do so undetected for 11 months 30 days and 23 hours and 59 m minutes?? Does not placate me.

atb

dave

All we can do - is do all that we can.

So, do all you can to help yourself, then make the best of your time. :-)

I am the statistic.

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