I'm interested in conversations about and I want to talk about

Know exactly what you want?

Show search

Notification

Error

PSA tests - should they be routine.

Email this conversation Print this conversation

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

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

But 226 men die each day from heart and circulatory diseases (49.3% of 460. UK population 49.3% male)

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 😀)
2) Your correction strengthens my underlying point that prostate cancer is not "the biggest killer of men" (thank you 😀) 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. 😀

_____

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 😀

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.

Show Most Thanked Posts

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 😂

(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

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

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 😂

(If it hasn't been incinerated yet).

😂 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 🤷🏼‍♂️👀🤔

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

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

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

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

Email this conversation Print this conversation

Join the online community now.

Click through to become a member and gain access to support, information and real time replies.