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Routine testing - the guidance isnt clear

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User
Posted 08 Dec 2022 at 16:26

I am a healthy active 65 yr old.  I have no obvious prostate risk factor other than age.  I have high cholesterol and have been treated for this with statins for the past twenty years.  I have had a couple of psa tests in the past ten years.  Last one i think was more than two years ago.

I had to have a blood test for cholesterol recently so asked the nurse if i could have a PSA test while i was at it.  She checked with my GP and the answer was no.  As i was low risk and had had a test not so long ago it wasn't necessary - 5 years interval for someone like me.

I have carefully read the guidance on here and the NHS consensus doc and its not clear.  Cannot see any reference to 5 years anywhere.

Other friends get theirs checked annually alongside cholesterol.  They were surprised when i said GP said no. But then its hard to argue with ones GP when the guidance to the public is woolly. Mo

Is my GP correct?? Am i just one of the 'worried well'?

User
Posted 08 Dec 2022 at 20:45
The basic problem is that a PSA test isn't actually a terribly reliable way of knowing whether or not a man has prostate cancer. A level of around 3 or 4 is normal for a man in his 60s, but if someone gets a test and it comes back as 10 or 20, that may well be due to a urinary tract infection, or lots of other things. The only way to know for sure whether or not someone has prostate cancer is to do an MRI scan and, if that shows something suspicious, a biopsy to confirm, and a biopsy is not something anyone would do for fun, believe me!

So basically, men tend to get tested if they have suspicious symptoms such as having to go to the loo six times a night, and lots of cases are found by chance when something else is being investigated (that's how mine was found), but there's no screening programme and, as you've discovered, many GPs are reluctant to test without cause.

Cheers,

Chris

User
Posted 09 Dec 2022 at 20:12

I suppose there's a risk that frequent testing could cause anxiety but just as an example, I was tested every year, with one key exception and over a 6 year period and my psa rose steadily from 3.6 to 11. A series of results can paint a more accurate picture than a single test every 5 years or so. I think mine was left way too late and could have been picked up 2 to 4 years earlier which might have been before I developed mets in several lymph nodes. Luckily I'm fine. I've been amongst the first people in this country to have had RT that directly targets lymph nodes at the same radiation level as is used for the prostate ... makes sense, cancer is cancer and low level treatment is less likely to work.

I don't want to generalize but it seems that Drs really don't want to have to tell you there's a chance you've got cancer and perhaps because psa results can be so variable as to whether they indicate a problem or not, they tend to be hopeful rather than real. There's always a chance that a person with a really high psa doesn't have cancer but also that a person with a low psa does. I understand there's some different and better blood tests being developed that are more definitive for the presence of cancer but for now psa is all we've got before going to MRI [mine was inconclusive] or of course biopsy.

I'd say there should be annual psa tests and good conversations between Drs and patients if the psa level rises above what are accepted figures in the guidelines.

Jules

Edited by member 09 Dec 2022 at 20:31  | Reason: Not specified

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User
Posted 08 Dec 2022 at 18:47
I'm sure you know that at your age the odds are that you do have prostate cancer? It's an inevitable part of the aging process for a man and the percentage incidence is pretty much in line with age, so at 65, roughly 65% of men have it. If a man lives into his 80s, essentially every man has it.

The problem - and the reason there's no routine screening - is that most cases will never require treatment. Most men die with prostate cancer, not from it. So the question that you need to ask yourself carefully, is do you really want to know? If the answer is "yes", then I would have thought that you do have a right to be tested. If all else fails, you could always have a test done privately. Please don't rush in to it, though. Knowing that you have cancer is no small thing and, as I commented above, most men don't need to know.

All the best,

Chris

User
Posted 08 Dec 2022 at 19:39
Thanks Chris. Yes was aware that prostate issues affect many men of a certain age. But I know a football mate who had a prostectomy following symptoms/tests which concentrates the mind.

I get your point about most men having PC but not dying from it. My daughter is a GP.

So I’m more confused. What’s the point of tests? If they spot a higher risk which then leads to a positive diagnosis is that then just ignored? What’s the point in being aware of symptoms associated with an enlarged prostate etc if when you then get a positive diagnosis everyone just looks concerned and wring their hands!

It seems odd.

User
Posted 08 Dec 2022 at 20:45
The basic problem is that a PSA test isn't actually a terribly reliable way of knowing whether or not a man has prostate cancer. A level of around 3 or 4 is normal for a man in his 60s, but if someone gets a test and it comes back as 10 or 20, that may well be due to a urinary tract infection, or lots of other things. The only way to know for sure whether or not someone has prostate cancer is to do an MRI scan and, if that shows something suspicious, a biopsy to confirm, and a biopsy is not something anyone would do for fun, believe me!

So basically, men tend to get tested if they have suspicious symptoms such as having to go to the loo six times a night, and lots of cases are found by chance when something else is being investigated (that's how mine was found), but there's no screening programme and, as you've discovered, many GPs are reluctant to test without cause.

Cheers,

Chris

User
Posted 08 Dec 2022 at 21:38

5 years between psa tests seems a bit long to me. A lot could happen in that time and an opportunity to deal with cancer early could be lost.

Yes, even with a rising psa Drs can be inclined to dismiss the results. It took blood in my urine and semen for my Dr to take the next step and at that point I was Gleason 9, with a few mets, so as men with "potential" we often have to push our GPs, firstly for psa tests and then for follow up. I'd had yearly psa tests up to that point so action should have come sooner.

Jules

Edited by member 09 Dec 2022 at 02:36  | Reason: Not specified

User
Posted 09 Dec 2022 at 10:07
Thanks Jules and hope you are ok.

Reading your response and Chris’s I am confused.

Is it good to test or not? And with what frequency? There’s a lot of hooha about men and prostate health but the medics cannot offer clear simple guidance on testing necessity/frequency.

It seems wrong that we should have to push our GP. This always works against the less articulate/assertive.

Mark

User
Posted 09 Dec 2022 at 20:12

I suppose there's a risk that frequent testing could cause anxiety but just as an example, I was tested every year, with one key exception and over a 6 year period and my psa rose steadily from 3.6 to 11. A series of results can paint a more accurate picture than a single test every 5 years or so. I think mine was left way too late and could have been picked up 2 to 4 years earlier which might have been before I developed mets in several lymph nodes. Luckily I'm fine. I've been amongst the first people in this country to have had RT that directly targets lymph nodes at the same radiation level as is used for the prostate ... makes sense, cancer is cancer and low level treatment is less likely to work.

I don't want to generalize but it seems that Drs really don't want to have to tell you there's a chance you've got cancer and perhaps because psa results can be so variable as to whether they indicate a problem or not, they tend to be hopeful rather than real. There's always a chance that a person with a really high psa doesn't have cancer but also that a person with a low psa does. I understand there's some different and better blood tests being developed that are more definitive for the presence of cancer but for now psa is all we've got before going to MRI [mine was inconclusive] or of course biopsy.

I'd say there should be annual psa tests and good conversations between Drs and patients if the psa level rises above what are accepted figures in the guidelines.

Jules

Edited by member 09 Dec 2022 at 20:31  | Reason: Not specified

User
Posted 13 Dec 2022 at 15:32

I just checked record and my one and only psa test was three years ago and was 0.52.

According to info I have read this is the high side of normal for a 65 yr old.  

I am due another blood test in February- should I request once again a test and be assertive with it this time?  

User
Posted 13 Dec 2022 at 17:24
Spakkaman is the 0.52 reading a typo? Should it read 5.2. At age of 62 a reading of 5.4 started my PC journey.

Rgds

Dave

User
Posted 13 Dec 2022 at 19:40

For a man in his 60s, anything over 4.0 ng/ml is considered abnormal. 0.52 is definitely NOT high.

Best wishes,

Chris

Edited by member 13 Dec 2022 at 19:46  | Reason: Not specified

 
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