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PSA tests - should they be routine.

User
Posted 21 Jul 2020 at 08:26

2 years ago, I had the good luck to have an appointment with a Doc who I had not seen before, with a tummy upset, caused by the heatwave & dodgy Aldi beetroot! He gave me a blanket blood test, which included the PSA test - which was at 27,with little or no symptoms for a 69 year old. I have had the HT & RT treatment & am hopefully in remission with a PSA of 0.02

My question is, should as standard, all men have a PSA test of a certain age? (Like the ladies have their 2 tests)

I had previously had about 4 "Finger" tests, with nothing unusual found - as my tumour's were at the front.

THOUGHTS, please.

User
Posted 25 Jul 2020 at 22:12

Lyn i so agree with your comment on communication to wives and partners. My wife nagged me after seeing a Bill Turnbull interview. I didn’t have any symptoms but to shut her up I had a blood test at my annual MOT. Guess what 6 months later I had no prostate - initial result PSA 13 leading to a biopsy Gleason of 3+4 and stage T2, histology after surgery Gleason of 9 and T3B grade. Marsden surgeon said I was months away from spread into lymph nodes.

And I thought I didn’t have any symptoms- thank god for my nagging wife (and Bill Turnbull). I am soooo lucky!!!

User
Posted 25 Jul 2020 at 23:16

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member

 

I agree. If you develop PCa before 50, you'll almost certainly need treatment at some point. Early screening might have saved me from SRT and possible problems further down the line. As many specialists argue and I think Barry implied, the real question is not whether to screen but how to manage treatment, ie when to do watchful waiting etc.

 

About 50% of men in their 50s have some prostate cancer cells so I think it is more precise to say "if you are diagnosed with PCa before you are 50" rather than "if you develop ..."

The vast majority of men with prostate cancer will never know, or not until they are old enough to die of something else - men diagnosed in their 30s & 40s tend to have a more aggressive and persistent strain that radical treatment does not resolve. 

 

 

Edited by member 25 Jul 2020 at 23:20  | Reason: Not specified

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

User
Posted 26 Jul 2020 at 12:15

Originally Posted by: Online Community Member
But 226 men die each day from heart and circulatory diseases (49.3% of 460. UK population 49.3% male)

There's an error in your (unwritten) assumption there - just because 49.3% of the population is male, does not mean that 49.3% of those suffering from heart and circulatory diseases are split the same way. In fact, men are slightly more likely than women to die from CVD (85,897 deaths vs 81,219 in 2018), mostly because they are much more likely to die of coronary heart disease (40,395 vs 23,737).

User
Posted 26 Jul 2020 at 14:40

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
But 226 men die each day from heart and circulatory diseases (49.3% of 460. UK population 49.3% male)

There's an error in your (unwritten) assumption there - just because 49.3% of the population is male, does not mean that 49.3% of those suffering from heart and circulatory diseases are split the same way. In fact, men are slightly more likely than women to die from CVD (85,897 deaths vs 81,219 in 2018), mostly because they are much more likely to die of coronary heart disease (40,395 vs 23,737).

OK. Thanks. I have no problem with that. But two points arise...

1) I showed where my data came from so you were able to 'peer review' it and correct me (thank you πŸ˜€)
2) Your correction strengthens my underlying point that prostate cancer is not "the biggest killer of men" (thank you πŸ˜€) since even more men die of cardiovascular disease than my primitive calculation assumed

What I couldn't let slip by was the uncontested gross error in the above statement. People come here to find out about Prostate Cancer. They're worried/scared and often don't know much about it. I think we should try to make sure we're not propagating scary exaggerations which are so easily disprovable. But I think you probably agree with me about that. πŸ˜€

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 26 Jul 2020 at 21:06

Originally Posted by: Online Community Member
I did word it wrongly, I meant to say, Prostate Cancer is the biggest Cancer that kills men.

Not sure that's true either though. If you google the phrase "which cancer kills the most men in uk" it takes you to a Guardian article from 2018 https://www.theguardian.com/society/2018/feb/02/prostate-cancer-now-kills-more-people-than-breast-cancer-uk-figures-reveal 

Online Community Member wrote:

The top cancer killer in the UK is lung cancer, which claimed 35,486 lives in 2015, followed by colorectal cancer, with a toll of 16,067 people.

However, new figures reveal that 11,819 men died in the UK from prostate cancer in 2015, overtaking breast cancer, which resulted in the deaths of 11,442 women. While not included in the data, about 80 men are also thought to have died from breast cancer in 2015.

Now admittedly that data is somewhat all over the place in terms of timing and mixed sexes, but it does strongly infer that lung cancer might well kill more men than prostate cancer. And I expect a second google search might reveal some more precise figures from a more trusted source. But I'll stop there. I'm not trying to be an a******, but it's so easy to check facts these days we should really do it before repeating stuff we've heard from unauthoritative sources.

Originally Posted by: Online Community Member

I'm not saying it should be a screening program, but the tests should be readily available to men from their GP.

That is exactly how it's meant to be right now though. I looked through the guidelines Lyn linked to and happy to report that my GP followed them to the letter.

Originally Posted by: Online Community Member

I'm sure on a suffering basis alone, a PC caught & treated early, is far more desirable than all that Chemotherapy.

Totally agree πŸ˜€

Originally Posted by: Online Community Member

The longer term costs of care & treatment, are another factor.
But it seems, the medics only care about Covid19 at the moment.

I think the medics would really like to get on with their jobs, but politicians and pandemics get in the way. 😒

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

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User
Posted 21 Jul 2020 at 10:32

The PSA Test is not particularly accurate with a relatively high number of 'false results'. I am not sure that the test process is robustness enough at this time to support a routine, 'all embracing' monitoring programme. 

I have been through the process myself with a climbing PSA (11.0 whilst taking Finasteride) leading to a MRI Scan, Bone Scan & Transperineal Biopsy during the Covid-19 'peak'. I am one of the lucky ones in as much as no evidence of cancer was found - my problem is attributed to a 'patchy chronic inflammation'. I am 'glass half empty' sort of person & spent a number of months convincing myself of the worst - I am all for routine testing once a more reliable testing mechanism is in place.

User
Posted 21 Jul 2020 at 11:40

Originally Posted by: Online Community Member

My question is, should as standard, all men have a PSA test of a certain age? (Like the ladies have their 2 tests)

No. But all men should be ABLE to have a PSA test without having to fight for it if they ask for one at a certain age. Currently this age is 50 in the UK (in theory). But should probably be lowered to 40 - at least for people in higher risk groups.

PSA screening is "a bit crap". My Urologist at tele-consult told me "at 50 with PSA between 4 and 10 there's a 27% chance you have prostate cancer" and then told me I'd need an MRI and biopsy.

I was hoping to be in the 73% of false negatives, but I wasn't willing to bet my life on it (I might have for a 5% chance).

An MRI might be a better bet, but that's not likely to happen because of the cost.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 21 Jul 2020 at 11:56
Men often perceive that women have a blanket screening test for breast cancer but that's not the case. We get a letter telling us we are due, with a leaflet explaining the high rate of false positives and false negatives plus the risk of over treatment - the leaflet then says that if we still wish to go ahead, we should contact the number to book an appointment. The only real population screening programmes in this country for adults are the cervical cancer smear test (about 70% take up on a good year but falling) and the bowel cancer home test (which the NHS is talking about cancelling). Obviously, screening of new babies is very successful with almost 100% take up but babies don't really have the opportunity to give or decline consent.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Jul 2020 at 12:00
PS I meant to say that I would campaign strongly against prostate cancer screening with the current tests available but I think all men over 50 should periodically get a leaflet like the one about breast cancer. I also think it is brilliant that there are prostate cancer posters in the ladies' toilets up and down the motorway network - if you want a man to get tested, persuade the women in his life that it matters!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Jul 2020 at 12:24

Talking to a consultant friend he said best way to view PSA is it’s a good indicator the prostate isn’t happy. Velocity is probably a better marker of something more sinister going on. Better tests are coming but PSA, DRE and mpMRI then move to TPM biopsy if necessary are the gold standard at the moment. No test is perfect but they are very useful tools if the data is handled well by a skilled urologist. Plus I’m mindful that in ~45% of cases cancers are usually upgraded during histology. Post RARP mine went from low grade Gleason 6 to medium grade Gleason 7(3+4) so AS wouldn’t have worked out well for me.

Edited by member 21 Jul 2020 at 17:03  | Reason: Not specified

User
Posted 21 Jul 2020 at 12:51

Originally Posted by: Online Community Member
Talking to a consultant friend he said best way to view PSA is it’s a good indicator the prostate isn’t happy. 

My prostate is probably the happiest it's ever been sitting in a pot of alcohol in the path lab πŸ˜‚

(If it hasn't been incinerated yet).

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 21 Jul 2020 at 12:58

There are roughly 12 million men between the age of 40 and 70 in the UK, could the NHS cope with blood testing 12 million men a year and all the follow up appointments.  I think covid has shown what we can do , but at what cost. I know cost should not be a factor and one of my first posts on here was saying  we should have a screening system.

Thanks Chris

User
Posted 21 Jul 2020 at 13:00

I'm also in the NO brigade. The test is just not accurate enough. The false positives are bad, but also the detection and treatment of low grade cancers which would never have developed.

I know it sounds hypocritical as I and pretty much everyone on this forum has benefitted from psa tests, but some things in life are not black and white. 

Dave

User
Posted 21 Jul 2020 at 15:02
There's also the point that the majority of men with prostate cancer will never know that they have it, will never require treatment, and will die with it, not from it. Screening would result in massive over-treatment, much of it completely unnecessary. I'm also in the "No" camp.

Cheers,

Chris

User
Posted 21 Jul 2020 at 16:21
As above. Current test is too unreliable leading to many many men undergoing life changing treatment and untold stress when it may not be needed at all

If life gives you lemons , then make lemonade

User
Posted 21 Jul 2020 at 20:14
My friends in America have an annual DRE and PSA blood test over the age of fifty, and their medical insurers who pay for the tests evidently think that is prudent cost-wise.

I think men should have a PSA test at age fifty, and then repeat tests every two or three years, preferably annually.

They say the test is not very accurate, what with false positives, etc., but if you have a PSA of two and the next time the GP bothers to test you seven years later and it’s sixteen, obviously something untoward is going on.

In my case, stage T3a prostate cancer...

Anyway, still breathing without ventilator assistance,

Cheers, John.

User
Posted 21 Jul 2020 at 20:30

False positives and negatives are a fact of life with any test. Yes they may be higher than would be liked with PSA but that is well explained when asking for a test. The problem with not making them routine is surely that many many will wait too long and then present with situations that are much more difficult to treat. A high PSA level on it’s own is not going to lead to radical treatments so would it not be preferable to have tests routinely? Certainly there is an increasing number of Urologists who think it was a mistake to stop them

Edited by member 21 Jul 2020 at 20:31  | Reason: Not specified

User
Posted 21 Jul 2020 at 20:45

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
Talking to a consultant friend he said best way to view PSA is it’s a good indicator the prostate isn’t happy. 

My prostate is probably the happiest it's ever been sitting in a pot of alcohol in the path lab πŸ˜‚

(If it hasn't been incinerated yet).

πŸ˜‚ I was hoping for the footage from my surgery but the video feed wasn’t available. I was gutted as had the romantic Sunday matinee all planned out for the good lady 🀷🏼‍β™‚οΈπŸ‘€πŸ€”

User
Posted 21 Jul 2020 at 20:52

Originally Posted by: Online Community Member
False positives and negatives are a fact of life with any test. Yes they may be higher than would be liked with PSA but that is well explained when asking for a test.

That's all true, but if all men aged 50 and PSA 4-10 are sent for MRI & TRUS biopsy when only 27% have prostate cancer, that not only means a lot of people will be put through the mill mentally, but it's also very expensive and fully 73% of those biopsies will have been unnecessary.

I agree with Lyn. I think there should be a large-scale awareness campaign (including really good explanations of symptoms that gradually creep up on you so slowly you don't notice, like frequency and dribbling etc.) and then leave it to people to decide if they want to get tested or not.

 

Edited by member 21 Jul 2020 at 20:56  | Reason: adding info

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 21 Jul 2020 at 22:14

Originally Posted by: Online Community Member

False positives and negatives are a fact of life with any test. Yes they may be higher than would be liked with PSA but that is well explained when asking for a test. The problem with not making them routine is surely that many many will wait too long and then present with situations that are much more difficult to treat. A high PSA level on it’s own is not going to lead to radical treatments so would it not be preferable to have tests routinely? Certainly there is an increasing number of Urologists who think it was a mistake to stop them

I think that is my feeling, the unreliable part mainly comes from men needing to desist from any sex activity for a week before & if you have had a tummy upset it can effect the result. You would need to postpone the test, until you were better. I believe personally on balance, the advantages of the PSA test, outweigh the disadvantages.

But thanks for all your thoughts, keep them coming.....

User
Posted 22 Jul 2020 at 02:44
Reasons have been given why the PSA test should not be regularly offered, mainly on cost, logistical undertaking and due to stress, particularly where a person is not found to have PCa. However, unless I have missed it, one of the main reasons for not offering a PSA at say 50, or earlier to more at risk of PCa groups is not to do with any of these reasons. It is because the PSA test leads many men who subsequently are diagnosed with PCa to have treatment for a cancer that would not have been a problem to them. Thus no matter how reliable a PSA test could be made, it would not not alter possible over-treatment. What is more urgently needed is a test to determine whether the PCa detected in a man really needs treatment and if so how soon.

But we are where we are with the science and tests and many men who clearly do need treatment because their cancer has advanced or spread are likely to be glad they did have a PSA and may wish they had been offered a PSA or whatever test earlier. OK, there will be a few who in hindsight will have wished they had never had the treatment due to adverse side effects of it but these are going to be a minority.

All things considered, it is probably right that as things stand at present men wanting a PSA test are told or given a leaflet on what this may lead to so the individual can decide whether he wishes to proceed. Where a GP considers a man presents complaining of problems that could be attributed to PCa, he/she should inform the patient what is suspected and does a DRE. I must say I was glad my GP suggested I had a PSA test when he did, as I am convinced that ensuing treatment seriously delayed the advance of my PCa

Barry
User
Posted 23 Jul 2020 at 09:18

Many have mentioned that the PSA test is not an exact science and it's true.  If they'd gone by PSA alone I would still be sitting here today blissfully unaware of Gleason 6 low risk, and Gleason 8 high risk, tumours in my prostate.  I had (and have) no symptoms, my PSA has never risen above 3.2, and all DREs have been clear.

Perhaps all men of a certain age should be offered the option of a test, but with the caveat that a positive result does not necessarily mean that you do not have PCa and that you should remain alert for any other signs.

User
Posted 23 Jul 2020 at 10:54

Originally Posted by: Online Community Member
Perhaps all men of a certain age should be offered the option of a test, but with the caveat that a positive result does not necessarily mean that you do not have PCa and that you should remain alert for any other signs.

In theory, any man >=50 can ask for a test, but some GPs make it difficult. Mine didn't, but warned me about false positives, biopsies etc. I went ahead anyway. (Glad I did).

Lyn's idea about an awareness campaign with a leaflet every once in a while (coupled with something to incentivise GPs to not get in the way) would probably bridge the gap between what you suggest and the current situation.

I think the population in general is horribly ignorant about the prostate. I didn't even know what it did until I was diagnosed. It just never occurred to me to wonder or care. I suspect most people are similarly ignorant.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 23 Jul 2020 at 11:59

Originally Posted by: Online Community Member

Many have mentioned that the PSA test is not an exact science and it's true.  If they'd gone by PSA alone I would still be sitting here today blissfully unaware of Gleason 6 low risk, and Gleason 8 high risk, tumours in my prostate.  I had (and have) no symptoms, my PSA has never risen above 3.2, and all DREs have been clear.

Perhaps all men of a certain age should be offered the option of a test, but with the caveat that a positive result does not necessarily mean that you do not have PCa and that you should remain alert for any other signs.

I suspect an MRI scan, would be a better test - but I expect money & demand is the major factor.

User
Posted 23 Jul 2020 at 14:37
But then that is an issue in it's own right - some prostate cancers simply don't show up on MRI scans. John was diagnosed with an assumed T1a because his scan was clear but when they got in, they found that the cancer was present throughout the gland and into his bladder neck. Even with the more modern mpMRI, and choline / gallium / F18 / 18F there are men like CJ whose scans remain clear despite there obviously being active cancer. For true PCa screening, every man would need to be offered regular PSA and DRE with follow up mpMRI and biopsy in any circumstance where the PSA was at all elevated, the DRE was suspicious, the man was symptomatic and / or any other risk factors were present. I suspect, as suggested, the country simply cannot afford it.

My biggest worry (call me a cynic) is that we will see less diagnostic testing in the next few years, not more. COVID will almost bankrupt us as a country - I think we will see ED treatments withdrawn, projects like the innovation fund withdrawn, a stop to the roll out of SpaceOar, cancellation of the plans for two more proton centres, etc. We have seen on here the impact of the privatisation of urology services in the South West, where a group of GPs now hold the contract for all PCa diagnostics and men can go through hell just trying to get onto the books of a specialist.

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

User
Posted 25 Jul 2020 at 14:00

I tried to read up on it a bit but it is complex. If I'm not mistaken, prostate cancer surgeons (including famous ones such as Walsh, Catalona, or d'Amico) tend to think regular PSA screening should be done routinely (eg here or here). In contrast, Richard Ablin, who is usually credited with discovering the PSA molecule, is strongly opposed to screening. Screening tends to be recommended from 45 or even 40. This young age is more to establish a baseline PSA level than to detect PCA. 

Clinical trial data on the effectiveness of screening are hard to interpret, for example, it turned out in one trial supposedly showing ineffectiveness of screening that many men in the control group had received PSA tests anyway, skewing the results against screening. 

Personally, I'm persuaded by the arguments for screening in spite of the fact that overtreatment will occur. Note that compared to breast cancer, in terms of "years of life lost", much less is to be gained screening for prostate cancer than for breast cancer, see here, here and here.

User
Posted 25 Jul 2020 at 16:28

Wicher

I’d definitely be in favour of earlier screening. Verification of prostate health can only be a good thing given the number of guys developing prostate cancer early to mid 40s. Really opened my eyes up as time from initial symptoms and elevated PSA to biopsy was 4 years. I’m lucky that I had symptoms as I would have been none the wiser with potentially a bad outcome had I not acted quickly and had treatment.

TG 

Edited by member 25 Jul 2020 at 23:04  | Reason: Not specified

User
Posted 25 Jul 2020 at 17:57
I wonder, how many cases are like mine, with the tumours at the front & not detectable with a doctor's finger - as a percentage?
User
Posted 25 Jul 2020 at 18:13
Mine wasn't detected by the finger test either. As I'd had a high PSA for some time and a previous negative biopsy, it was only a chance blood test (I was being tested primarily for bowel cancer, which was thankfully negative) that picked up that the PSA had risen significantly since the previous test.
User
Posted 25 Jul 2020 at 18:35
John had a PSA of 3.1, no symptoms, a small soft prostate and a clear MRI - thank god for the instincts of a young doctor who decided to refer him to urology anyway, and for the now vilified TRUS which managed to pluck out a cherry of G7. Post-op, the cancer was shown to be in every segment of his prostate and had invaded the bladder neck.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 25 Jul 2020 at 19:24

Originally Posted by: Online Community Member

Wicher

I’d definitely be in favour of earlier screening. Viability of prostate health can only be a good thing given the number of guys developing prostate cancer early to mid 40s. Really opened my eyes up as time from initial symptoms and elevated PSA to biopsy was 4 years. I’m lucky that I had symptoms as I would have been none the wiser with potentially a outcome had I not acted quickly and had treatment.

TG 

I agree. If you develop PCa before 50, you'll almost certainly need treatment at some point. Early screening might have saved me from SRT and possible problems further down the line. As many specialists argue and I think Barry implied, the real question is not whether to screen but how to manage treatment, ie when to do watchful waiting etc.

 

User
Posted 25 Jul 2020 at 19:58

Originally Posted by: Online Community Member
John had a PSA of 3.1, no symptoms, a small soft prostate and a clear MRI - thank god for the instincts of a young doctor who decided to refer him to urology anyway, and for the now vilified TRUS which managed to pluck out a cherry of G7. Post-op, the cancer was shown to be in every segment of his prostate and had invaded the bladder neck.

Why is TRUS villified or is that just non-targeted TRUS?

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 25 Jul 2020 at 20:16
Just non targeted, some argue a template biopsy is the gold standard now.
User
Posted 25 Jul 2020 at 21:25
Both types made me pretty ill, so I would prefer other methods. They may exist, but not much money is being spent on them.
User
Posted 25 Jul 2020 at 21:33

Originally Posted by: Online Community Member
Both types made me pretty ill, so I would prefer other methods. They may exist, but not much money is being spent on them.

Agreed. Something non-invasive would be infinitely preferable, but as we've seen, not all tumours show up on even mpMRI. But even MRI is horribly expensive. We had one done privately on my wife's knee and it cost £500. Pretty sure my gadolinium mpMRI would have been even more. It's far too expensive for a screening test.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 25 Jul 2020 at 22:12

Lyn i so agree with your comment on communication to wives and partners. My wife nagged me after seeing a Bill Turnbull interview. I didn’t have any symptoms but to shut her up I had a blood test at my annual MOT. Guess what 6 months later I had no prostate - initial result PSA 13 leading to a biopsy Gleason of 3+4 and stage T2, histology after surgery Gleason of 9 and T3B grade. Marsden surgeon said I was months away from spread into lymph nodes.

And I thought I didn’t have any symptoms- thank god for my nagging wife (and Bill Turnbull). I am soooo lucky!!!

User
Posted 25 Jul 2020 at 23:16

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member

 

I agree. If you develop PCa before 50, you'll almost certainly need treatment at some point. Early screening might have saved me from SRT and possible problems further down the line. As many specialists argue and I think Barry implied, the real question is not whether to screen but how to manage treatment, ie when to do watchful waiting etc.

 

About 50% of men in their 50s have some prostate cancer cells so I think it is more precise to say "if you are diagnosed with PCa before you are 50" rather than "if you develop ..."

The vast majority of men with prostate cancer will never know, or not until they are old enough to die of something else - men diagnosed in their 30s & 40s tend to have a more aggressive and persistent strain that radical treatment does not resolve. 

 

 

Edited by member 25 Jul 2020 at 23:20  | Reason: Not specified

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

User
Posted 26 Jul 2020 at 07:16

Originally Posted by: Online Community Member

Lyn i so agree with your comment on communication to wives and partners. My wife nagged me after seeing a Bill Turnbull interview. I didn’t have any symptoms but to shut her up I had a blood test at my annual MOT. Guess what 6 months later I had no prostate - initial result PSA 13 leading to a biopsy Gleason of 3+4 and stage T2, histology after surgery Gleason of 9 and T3B grade. Marsden surgeon said I was months away from spread into lymph nodes.

And I thought I didn’t have any symptoms- thank god for my nagging wife (and Bill Turnbull). I am soooo lucky!!!

As Prostate cancer, is the biggest killer of men, there should be screening, be it PSA or other methods. I would suggest, from the age of 55 - earlier, if there are symptoms. Better to catch it early, than end up like Bill, with chemotherapy wrecking your life.

Edited by member 26 Jul 2020 at 07:17  | Reason: Not specified

User
Posted 26 Jul 2020 at 09:33

Originally Posted by: Online Community Member
Mine wasn't detected by the finger test either. As I'd had a high PSA for some time and a previous negative biopsy, it was only a chance blood test (I was being tested primarily for bowel cancer, which was thankfully negative) that picked up that the PSA had risen significantly since the previous test.

Obviously a rubbish negative TRUS biopsy, I expect?

Cheers, John.

Edited by member 26 Jul 2020 at 09:38  | Reason: Not specified

User
Posted 26 Jul 2020 at 09:37

All the doctors and oncologists who specialise in PCa I have spoken to are in favour of testing.

Cheers, John.

Edited by member 26 Jul 2020 at 09:38  | Reason: Not specified

User
Posted 26 Jul 2020 at 09:44

Originally Posted by: Online Community Member

As Prostate cancer, is the biggest killer of men, there should be screening, be it PSA or other methods. I would suggest, from the age of 55 - earlier, if there are symptoms. Better to catch it early, than end up like Bill, with chemotherapy wrecking your life.

That already exists for men 50 or over. I agree with you that screening is desirable for those who want it - preferably for men >40.

The problem with trying to force screening on people is that many will not want it. You can't impose your world-view on people without the political power to do it and the economic power to pay for it.

I think also there is a real "don't drop the soap" stigma about having a finger shoved up your bum. Certainly it was very offputting to me and I was surprised how much of a non-event it actually was. My mother-in-law, mum and wife started badgering me when a year or two ago and I said "when I'm 50". In the end I only waited 3 months after turning 50. Blood test, no problem. Finger up bum - offputting.

Not only that, but the GP's DRE didn't detect anything.

Online Community Member wrote:
All the doctors and oncologists who specialise in PCa I have spoken to are in favour of testing.

Are they willing to give up their Porsches to help fund it? πŸ˜†

Edited by member 26 Jul 2020 at 09:45  | Reason: Not specified

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 26 Jul 2020 at 10:19

Originally Posted by: Online Community Member

As Prostate cancer, is the biggest killer of men

The above premise would appear to be incorrect. 

Heart and circulatory diseases cause more than a quarter (27 per cent) of all deaths in the UK; that's nearly 170,000 deaths each year - an average of 460 people each day or one death every three minutes.

https://www.bhf.org.uk/-/media/files/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf 

 

  • Prostate cancer is the most commonly diagnosed cancer in the UK.
  • More than 47,500 men are diagnosed with prostate cancer every year – that's 129 men every day.
  • Every 45 minutes one man dies from prostate cancer – that's more than 11,500 men every year.
  • 1 in 8 men will be diagnosed with prostate cancer in their lifetime.


https://prostatecanceruk.org/prostate-information/about-prostate-cancer

 

So 32 men die in the UK each day of prostate cancer (11500/365)
But 226 men die each day from heart and circulatory diseases (49.3% of 460. UK population 49.3% male)

Edited by member 26 Jul 2020 at 11:38  | Reason: correcting my own calculation error

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 26 Jul 2020 at 11:57

Originally Posted by: Online Community Member
Obviously a rubbish negative TRUS biopsy, I expect?

Not obvious at all. It was several years earlier and my PSA levels were less than half of when the biopsy was positive.

User
Posted 26 Jul 2020 at 12:15

Originally Posted by: Online Community Member
But 226 men die each day from heart and circulatory diseases (49.3% of 460. UK population 49.3% male)

There's an error in your (unwritten) assumption there - just because 49.3% of the population is male, does not mean that 49.3% of those suffering from heart and circulatory diseases are split the same way. In fact, men are slightly more likely than women to die from CVD (85,897 deaths vs 81,219 in 2018), mostly because they are much more likely to die of coronary heart disease (40,395 vs 23,737).

User
Posted 26 Jul 2020 at 12:37

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member

Lyn i so agree with your comment on communication to wives and partners. My wife nagged me after seeing a Bill Turnbull interview. I didn’t have any symptoms but to shut her up I had a blood test at my annual MOT. Guess what 6 months later I had no prostate - initial result PSA 13 leading to a biopsy Gleason of 3+4 and stage T2, histology after surgery Gleason of 9 and T3B grade. Marsden surgeon said I was months away from spread into lymph nodes.

And I thought I didn’t have any symptoms- thank god for my nagging wife (and Bill Turnbull). I am soooo lucky!!!

As Prostate cancer, is the biggest killer of men, there should be screening, be it PSA or other methods. I would suggest, from the age of 55 - earlier, if there are symptoms. Better to catch it early, than end up like Bill, with chemotherapy wrecking your life.

 

That already exists in England and Wales. I think part of the problem with threads like this one is that people say 'screening' but mean something quite different. 

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

User
Posted 26 Jul 2020 at 14:40

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
But 226 men die each day from heart and circulatory diseases (49.3% of 460. UK population 49.3% male)

There's an error in your (unwritten) assumption there - just because 49.3% of the population is male, does not mean that 49.3% of those suffering from heart and circulatory diseases are split the same way. In fact, men are slightly more likely than women to die from CVD (85,897 deaths vs 81,219 in 2018), mostly because they are much more likely to die of coronary heart disease (40,395 vs 23,737).

OK. Thanks. I have no problem with that. But two points arise...

1) I showed where my data came from so you were able to 'peer review' it and correct me (thank you πŸ˜€)
2) Your correction strengthens my underlying point that prostate cancer is not "the biggest killer of men" (thank you πŸ˜€) since even more men die of cardiovascular disease than my primitive calculation assumed

What I couldn't let slip by was the uncontested gross error in the above statement. People come here to find out about Prostate Cancer. They're worried/scared and often don't know much about it. I think we should try to make sure we're not propagating scary exaggerations which are so easily disprovable. But I think you probably agree with me about that. πŸ˜€

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 26 Jul 2020 at 15:24

Originally Posted by: Online Community Member

All the doctors and oncologists who specialise in PCa I have spoken to are in favour of testing.

Cheers, John.

Well John, about 10 or so years ago there was held a large meeting where many interested groups, individuals, and professionals debated PSA testing and a motion that men aged 50 or earlier if in a more at risk category be PSA tested.  One of the eminent doctors opposing the motion was Chis Parker of The Royal Marsden who you have quoted as a leading light in another context. 

If I recall correctly it was called something like 'The Great PSA Debate'. I will try to find a link. It came as no surprise that there was a sizable majority in favour of testing.  However, on considering professional advice and doubtless also logistical and cost implications of testing at aged 50, the Government have not been persuaded to make the change and it seems most other countries have taken the same line. 

  

Edited by member 26 Jul 2020 at 15:28  | Reason: Not specified

Barry
User
Posted 26 Jul 2020 at 16:56

It was at the annual national uro-oncology conference, I think.

Neither PCUK or Cancer Research UK support the introduction of a screening programme - see here for PCUK's rationale https://prostatecanceruk.org/about-us/projects-and-policies/consensus-on-psa-testing

If all GPs followed the NICE PCa guidelines, it would help. I would like to see every GP that fails to do so referred to the GMC but patients are rarely cross / aware enough to do so.

Not only has the gov not been persuaded to introduce a national PCa screening programme, but they are proposing to withdraw the bowel screening programme.

Edited by member 26 Jul 2020 at 17:04  | Reason: Activate hyperlink

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

User
Posted 26 Jul 2020 at 20:14
I did word it wrongly, I meant to say, Prostate Cancer is the biggest Cancer that kills men.

I'm not saying it should be a screening program, but the tests should be readily available to men from their GP.

I'm sure on a suffering basis alone, a PC caught & treated early, is far more desirable than all that Chemotherapy.

The longer term costs of care & treatment, are another factor.

But it seems, the medics only care about Covid19 at the moment.

User
Posted 26 Jul 2020 at 21:06

Originally Posted by: Online Community Member
I did word it wrongly, I meant to say, Prostate Cancer is the biggest Cancer that kills men.

Not sure that's true either though. If you google the phrase "which cancer kills the most men in uk" it takes you to a Guardian article from 2018 https://www.theguardian.com/society/2018/feb/02/prostate-cancer-now-kills-more-people-than-breast-cancer-uk-figures-reveal 

Online Community Member wrote:

The top cancer killer in the UK is lung cancer, which claimed 35,486 lives in 2015, followed by colorectal cancer, with a toll of 16,067 people.

However, new figures reveal that 11,819 men died in the UK from prostate cancer in 2015, overtaking breast cancer, which resulted in the deaths of 11,442 women. While not included in the data, about 80 men are also thought to have died from breast cancer in 2015.

Now admittedly that data is somewhat all over the place in terms of timing and mixed sexes, but it does strongly infer that lung cancer might well kill more men than prostate cancer. And I expect a second google search might reveal some more precise figures from a more trusted source. But I'll stop there. I'm not trying to be an a******, but it's so easy to check facts these days we should really do it before repeating stuff we've heard from unauthoritative sources.

Originally Posted by: Online Community Member

I'm not saying it should be a screening program, but the tests should be readily available to men from their GP.

That is exactly how it's meant to be right now though. I looked through the guidelines Lyn linked to and happy to report that my GP followed them to the letter.

Originally Posted by: Online Community Member

I'm sure on a suffering basis alone, a PC caught & treated early, is far more desirable than all that Chemotherapy.

Totally agree πŸ˜€

Originally Posted by: Online Community Member

The longer term costs of care & treatment, are another factor.
But it seems, the medics only care about Covid19 at the moment.

I think the medics would really like to get on with their jobs, but politicians and pandemics get in the way. 😒

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 27 Jul 2020 at 05:05

This is what I was alluding to -

Dr Chris Parker, our final
speaker, oncologist from the Royal
Marsden, explained his own
personal view, which forces him to
reject the motion. He prefers to
accept a small increase in risk of
death through not knowing his
PSA rather than the very much
larger increase of risk of
unnecessary treatment. He
illustrated graphically how the
recent European trial had showed a
20% reduction in mortality, but at
expense of massive over-treatment.
He outlined a number of other risk
factors that would be more
effective than a screening
programme in reducing death
through early detection..

Extract from The Great PSA Debate

https://www.tackleprostate.org/uploads/files/ProstateMatters_7.pdf

Apart from improvements in MRI, we don't seem to have made significant progress in finding a better marker for testing than PSA in the years from 2009 and there are still some GP's who are very reluctant to authorise a PSA test for men at 50.

Edited by member 27 Jul 2020 at 05:23  | Reason: Not specified

Barry
User
Posted 27 Jul 2020 at 07:54

Originally Posted by: Online Community Member

This is what I was alluding to -

Dr Chris Parker, our final
speaker, oncologist from the Royal
Marsden, explained his own
personal view, which forces him to
reject the motion. He prefers to
accept a small increase in risk of
death through not knowing his
PSA rather than the very much
larger increase of risk of
unnecessary treatment. He
illustrated graphically how the
recent European trial had showed a
20% reduction in mortality, but at
expense of massive over-treatment.
He outlined a number of other risk
factors that would be more
effective than a screening
programme in reducing death
through early detection..

Extract from The Great PSA Debate

https://www.tackleprostate.org/uploads/files/ProstateMatters_7.pdf

Apart from improvements in MRI, we don't seem to have made significant progress in finding a better marker for testing than PSA in the years from 2009 and there are still some GP's who are very reluctant to authorise a PSA test for men at 50.

Maybe he’s changed his mind since then. I saw him around eighteen months ago.

Cheers, John.

User
Posted 27 Jul 2020 at 08:03
Or he still supports testing but still rejects mass screening?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 27 Jul 2020 at 09:56
Test and be damned
 
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