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PSA tests - should they be routine.

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 😀)
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 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 😀

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
User
Posted 27 Jul 2020 at 10:42

I think the conclusions of the trial Chris Parker referred to in 2009 may have changed somewhat in that the benefit of screening was underestimated (see https://drcatalona.com/ for some discussions). Doesn't mean he changed his mind about universal screening though. 

I major problem seems to be that many GPs misunderstand the PSA testing controversy and ignore NICE guidelines, mine for example ignored my PSA of 5.68 (but referred me when it reached 32 six years on, when the lab noted "CALL PATIENT"), and the man I shared a hospital room with after my RP was initially refused a PSA test even though he had clear symptoms and various risk factors (he went to a different GP which likely saved his life). 

User
Posted 27 Jul 2020 at 13:14
Of course we are all biased here...

Cheers, John.

User
Posted 27 Jul 2020 at 13:28

I was diagnosed at 56 with localised prostate cancer and have recently received my brachytherapy treatment, shortly after my diagnosis a 72 year old friend who I had told about my diagnosis went for tests, biopsy etc. and was told he had Gleason 4 +4 Prostate cancer where it has moved to his bones he would have loved to have been diagnosed early like me and seeing what he is going through I am glad I was diagnosed early and that all started with a PSA test.

User
Posted 27 Jul 2020 at 15:53

Originally Posted by: Online Community Member

I was diagnosed at 56 with localised prostate cancer and have recently received my brachytherapy treatment, shortly after my diagnosis a 72 year old friend who I had told about my diagnosis went for tests, biopsy etc. and was told he had Gleason 4 +4 Prostate cancer where it has moved to his bones he would have loved to have been diagnosed early like me and seeing what he is going through I am glad I was diagnosed early and that all started with a PSA test.

That is a very good illustration of the GP problem - that is some seem reluctant to "Do their job properly"
Probably because of the "Blame culture" EG It is difficult to prove negligence with this subject. Of course, GP common sense, went out the window a long time ago, in the main they just do what the "Rules" & their computer, instruct them to do.

User
Posted 27 Jul 2020 at 16:11
Almost every time I've had a serious illness the GP has initially diagnosed me with something less severe (flu instead of meningitis, piles instead of colitis, IBS instead of a hernia). With PCa it was only an unrelated blood test that picked it up. Perhaps I'm being unfair, but I get the impression that GPs feel that the public are a feckless bunch of skivers who only go to them to get sicknotes (or worse) and therefore always assume the patient is overstating things.
User
Posted 27 Jul 2020 at 17:42

Originally Posted by: Online Community Member
Almost every time I've had a serious illness the GP has initially diagnosed me with something less severe (flu instead of meningitis, piles instead of colitis, IBS instead of a hernia). With PCa it was only an unrelated blood test that picked it up. Perhaps I'm being unfair, but I get the impression that GPs feel that the public are a feckless bunch of skivers who only go to them to get sicknotes (or worse) and therefore always assume the patient is overstating things.

There is probably some truth in that Peter, of course the other side of the coin, is many badger their GPs, with very minor ailments, such as cut fingers, sprained ankles, pimples & other things, they should sort out themselves.

User
Posted 27 Jul 2020 at 18:22
GPs are self-employed, and GP practices are businesses. There will be as many great doctors as dreadful ones.

Is it still the case that if a patient needs a hospital referral, the cost comes out of the GP's budget?

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

User
Posted 29 Jul 2020 at 12:35

Not sure about screening. I believe there should be more testing.

My GP surgery has those advertising screens and they were displaying a message inviting men over 60 (!) who had symptoms to have a PSA test. I thought that strange, especially as I had no symptoms and was under 60 and was given a test without a problem. In fact my GPs were amazingly good last year, I could not have asked for better. I fear for people being forced to wait for symptoms.

Right now though some tests and some overdue appointments would be very welcome.

Rob

User
Posted 29 Jul 2020 at 13:34
😱
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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