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PSA testing suggested for over 50s

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User
Posted 21 Jan 2023 at 06:52

Hi All. I came across this article regarding PSA testing for those over 50.

https://www.pulsetoday.co.uk/news/clinical-areas/cancer/all-men-over-50-should-ask-their-gp-for-a-psa-test-leading-urologist-urges/?utm_source=newsletter&utm_medium=newsletter&utm_campaign=pulsedailynewsletter

Please have a look at the comments section, it is interesting reading and may explain why it is so hard for people to get a PSA blood test with their 'doctor'.

User
Posted 23 Jan 2023 at 04:32

At the age of 46, I attended, quite by chance, a screening event hosted by the Lions Club of Maidenhead.   I had a PSA of 6.8 and turned out a T3b Gleason 9 cancer.

6 years later, my PSA is undetectable. 

Had it not been for the screening event, goodness knows what state I'd be in.

My GP was clear that he didn't support these mass screening events.

User
Posted 21 Jan 2023 at 18:45
The matter of proactive PSA screening has been raised a number of times since I joined the forum in 2008 and no doubt long before that . The medical profession has been split on what is an arguable subject. I think it was in 2009 that there was what was called 'The Great PSA Debate'. I can't remember the actual wording of the proposition but it amounted to advocating that all men of 50 or 45 if in a more at risk group should be offered a PSA test as part of national screening. Four eminent doctors spoke for and against the proposition (one of them was mine from the Royal Marsden who voted against). The vote was put to patient representatives and involved bodies etc. The vote was very much in favour of the proposition but was not accepted by the Government/NICE. It also resulted in many comments on the forum which was on the former format.

I think most of us are familiar with the arguments for and against testing. Unfortunately, there has not been much progress in developing a relatively cheap and reliable test although various possibilities are being investigated. But what needs to be easily determined is what cancers really need to be treated and those that can be left. Gene type may be part of the answer.

Notwithstanding the foregoing, from a practical aspect the additional time required by GPs to do this and DRE's and discuss pros and cons on such a wide scale with men at the prescribed age, yet alone on an annual or other time basis would not be possible. It's difficult and takes time to get appointments with GPs for quite pressing problems as it is in many cases. Then there is lack of scan capacity and trained radiographers and radio oncologists. They are already working weekends in some hospitals. So whatever some would wish, it just aint happening, at least in the short to medium term.

Barry
User
Posted 21 Jan 2023 at 20:59

I just found the original article interesting in terms of suggesting PSA testing. The attacks from those commenting were an eye opener. Putting funding and payment issues aside, on an individual level surely some of these professionals can see the benefit from testing. A lot of the comments were about not being able to refer patients into secondary services. GPs fund secondary services. In terms of not having access to imaging and interpreting scans that surely shows the healthcare system is not fit for purpose...

User
Posted 22 Jan 2023 at 00:09
Gur, you might be interested to read an article written a few years ago about 4 of the top urologists in this country diagnosed with PCa. Three of them did not have regular PSA tests. We used to have a member here on the forum who was a GP - did not support screening. I think it is Chris whose brother is a GP and refused to have a PSA test despite his brother being diagnosed and now incurable.

I reckon for every professional you find who supports screening, there will be another who does not.

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

User
Posted 23 Jan 2023 at 00:07

I find it very interesting that reports say PSA testing would cause unnecessary further testing and that it isn't particularly accurate for diagnosis.  However, as soon as you are diagnosed, PSA seems to be the principal way the cancer is monitored!

If there had been regularly screening, I might not have advanced prostate cancer.

 

User
Posted 24 Jan 2023 at 03:13

Yes good point about MRI but DRE also important too. I have managed to find the post of RalpV which was posted on 2nd Jan 2011 at 18-42 to which I alluded in my previous post. He made additional comments further on. This is in a very long thread which not only contained the views of some of those in favour of screening but also some of those against and gave Government reaction to testing. If you have the time and are interested you can find it here. As the thread was in the old forum format it is read only. https://community.prostatecanceruk.org/posts/t5225-Experts-scrap-prostate-screening-proposal

 

 

Edited by member 24 Jan 2023 at 04:38  | Reason: to highlight link

Barry
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User
Posted 21 Jan 2023 at 12:57

Yes those comments are interesting. About half of them make valid points about the efficacy of screening, but a worrying amount are GPs saying that's too much work for me.

Dave

User
Posted 21 Jan 2023 at 13:11

I notice the GP's are all men.

I have observed it's the older male GP's most likely to refuse PSA testing. Female GP's and younger GP's tend to be more up-to-date and proactive.

User
Posted 21 Jan 2023 at 13:16
I don't think they were necessarily saying it's too much work; their point is it is too much work that the NHS won't pay them for. GPs are paid to do routine cervical smears for women, undertake an asthma review with an asthmatic patient, offer smoking cessation support to smokers or (I think) to prescribe statins. PSA counselling and testing for asymptomatic men isn't covered in their contract. I think we still have a couple of members here who are GPs and will hopefully correct me if I am wrong?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Jan 2023 at 14:59

I'm involved in designing a scheme in an area with poor cancer outcomes due to late diagnosis (a significant number of diagnosis in A&E) and referral rates which haven't recovered after COVID (which they have now in some of the country). The GP's will be paid to get their high risk patients in and PSA tested. They are usually paid for any add-ons like this. They do sometimes choose to subcontract them out to a specialist healthcare company.

User
Posted 21 Jan 2023 at 15:29
Yes, isn't that what happened in Devon & Somerset? The Primary Care Trust outsourced all biopsies and MRIs to a private company?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Jan 2023 at 17:58

This morning Amanda Pritchard, Head of NHS, said they were looking at pharmacies doing blood tests.  Whether it would be psa is questionable but GPs doing jabs of any kind always appears a distraction.

At our GP blood tests are done at 8am one day a week and there's a big queue at 7.45.

Edited by member 21 Jan 2023 at 18:00  | Reason: Not specified

User
Posted 21 Jan 2023 at 18:45
The matter of proactive PSA screening has been raised a number of times since I joined the forum in 2008 and no doubt long before that . The medical profession has been split on what is an arguable subject. I think it was in 2009 that there was what was called 'The Great PSA Debate'. I can't remember the actual wording of the proposition but it amounted to advocating that all men of 50 or 45 if in a more at risk group should be offered a PSA test as part of national screening. Four eminent doctors spoke for and against the proposition (one of them was mine from the Royal Marsden who voted against). The vote was put to patient representatives and involved bodies etc. The vote was very much in favour of the proposition but was not accepted by the Government/NICE. It also resulted in many comments on the forum which was on the former format.

I think most of us are familiar with the arguments for and against testing. Unfortunately, there has not been much progress in developing a relatively cheap and reliable test although various possibilities are being investigated. But what needs to be easily determined is what cancers really need to be treated and those that can be left. Gene type may be part of the answer.

Notwithstanding the foregoing, from a practical aspect the additional time required by GPs to do this and DRE's and discuss pros and cons on such a wide scale with men at the prescribed age, yet alone on an annual or other time basis would not be possible. It's difficult and takes time to get appointments with GPs for quite pressing problems as it is in many cases. Then there is lack of scan capacity and trained radiographers and radio oncologists. They are already working weekends in some hospitals. So whatever some would wish, it just aint happening, at least in the short to medium term.

Barry
User
Posted 21 Jan 2023 at 20:59

I just found the original article interesting in terms of suggesting PSA testing. The attacks from those commenting were an eye opener. Putting funding and payment issues aside, on an individual level surely some of these professionals can see the benefit from testing. A lot of the comments were about not being able to refer patients into secondary services. GPs fund secondary services. In terms of not having access to imaging and interpreting scans that surely shows the healthcare system is not fit for purpose...

User
Posted 22 Jan 2023 at 00:09
Gur, you might be interested to read an article written a few years ago about 4 of the top urologists in this country diagnosed with PCa. Three of them did not have regular PSA tests. We used to have a member here on the forum who was a GP - did not support screening. I think it is Chris whose brother is a GP and refused to have a PSA test despite his brother being diagnosed and now incurable.

I reckon for every professional you find who supports screening, there will be another who does not.

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

User
Posted 22 Jan 2023 at 07:48

https://ec.europa.eu/commission/presscorner/detail/en/ip_22_5562

  • Prostate cancer testing in men up to 70 on the basis of prostate specific antigen testing, and magnetic resonance imaging (MRI) scanning as follow-up.

  • To support the implementation, EU guidelines on cancer screening and treatment will be developed with the financial support of EU4Health on lung, prostate, and gastric cancer. Existing EU guidelines on breast, colorectal and cervical cancer will be regularly updated.

    Next Steps

    Once adopted by the Council, the Recommendation will replace the current Recommendation on cancer screening from 2003.

 

The EU Commission has issued a new recommendation on prostate cancer screening in September 2022.  They have looked at the latest science and concluded that screening is beneficial within the defined screening criteria. 

So it looks like the scales are tilting in favour of screening. But implementation will probably take many years as you are then into all the discussions about resources and costs.  Obviously the UK is not part of this but one would imagine the same science will be used in any UK review.   

User
Posted 22 Jan 2023 at 20:03

This is a  no brainer. Was I lucky that my gp readily agread to annual psa tests from age 60? Good job as my psa shot up to 28 just over a year ago. Referral pdq for mri etc resulting in starting treatment (HT/RT) 5 weeks later.

This should be standard. I am amazed that health professionals deny the obvious. I guess I wouldn't be here but for a forward looking gp.

Peternigel

User
Posted 22 Jan 2023 at 21:07

Hi Peter

Yes you are lucky 4 months before I was diagnosed with APC with a psa of 2100 I went to my GP surgery with pains in my stomach and a lump in my groin,I was told it was an inguinal hernia,I've had an official complaint going with NHS England for over 7 months,rang them last week for a progress report and there still waiting for info for them to give me there answer why I wasn't given a simple bloodtest for my psa reading.

I've had to indure kidney failure 2 weeks in hospital tubes coming out of my kidneys peeing into bags for 5 months,emotions everywhere sex life with my wife for 28years gone and left with an incurable disease that I'll probably die of,life's a b****.

Regards Phil 

User
Posted 23 Jan 2023 at 00:07

I find it very interesting that reports say PSA testing would cause unnecessary further testing and that it isn't particularly accurate for diagnosis.  However, as soon as you are diagnosed, PSA seems to be the principal way the cancer is monitored!

If there had been regularly screening, I might not have advanced prostate cancer.

 

User
Posted 23 Jan 2023 at 04:32

At the age of 46, I attended, quite by chance, a screening event hosted by the Lions Club of Maidenhead.   I had a PSA of 6.8 and turned out a T3b Gleason 9 cancer.

6 years later, my PSA is undetectable. 

Had it not been for the screening event, goodness knows what state I'd be in.

My GP was clear that he didn't support these mass screening events.

User
Posted 23 Jan 2023 at 22:31

I am very grateful to my GP at the time who suggested he add a PSA test to bloods he was requesting for an unrelated matter. The result was variously reported at 17.2 and 17.6 but difference not of real importance. This and suspicious DRE led to standard biopsy resulting in gleason 3+4 and T2A which was subsequently upgraded to T3A after MRI. Even at this point the surgeon who reported the outcome of tests told me he doubted he could remove all the cancer and personally escorted me to an Oncologist to initiate radiation treatment.

There must be many men whose PCa would have been found before it became advanced had they been PSA and DRE tested as part of a National Screening programme, albeit some would not be found to have cancer and would have undergone tests and treatment unnecessarily, as even where tumours are found, not all tumours  develop to cause early death.

There was an invitation for all men to be screened in part of Austria many years ago and follow up has shown that this resulted in a great reduction of men dying of PCa. Also, probably due to pressure from Insurance companies, a far higher proportion of men in the USA have their PSA tested and more regularly, so cancer is picked up earlier. Links to this with references were provided by a very well informed American who used to contribute to the forum. I will delve back into the old forum and try to find a link.

There was a petition on screening and the response to this is in this link https://community.prostatecanceruk.org/posts/t3845-Government-response-to-petition-AICRPSACampaign

It was stated by a member that no country had a policy of National screening. Does anybody know if this is still the case?

Edited by member 23 Jan 2023 at 22:36  | Reason: to highlight link

Barry
User
Posted 24 Jan 2023 at 00:37

Originally Posted by: Online Community Member

...However, as soon as you are diagnosed, PSA seems to be the principal way the cancer is monitored!...

I think a one off PSA test is fairly useless, but change overtime is much more useful. I think many in the NHS are only capable of ticking boxes. With such a massive organisation, drilling people army style is probably the best way to train them. I genuinely believe taking two readings several months apart and calculating a PSA velocity is beyond the ability of any system in the NHS.

I think 10years ago going straight from PSA to biopsy was standard practice. Now an MRI sits between those and has reduced the number of unnecessary biopsies, so the science and technology may be advancing such that PCa screening is now viable.

Dave

User
Posted 24 Jan 2023 at 03:13

Yes good point about MRI but DRE also important too. I have managed to find the post of RalpV which was posted on 2nd Jan 2011 at 18-42 to which I alluded in my previous post. He made additional comments further on. This is in a very long thread which not only contained the views of some of those in favour of screening but also some of those against and gave Government reaction to testing. If you have the time and are interested you can find it here. As the thread was in the old forum format it is read only. https://community.prostatecanceruk.org/posts/t5225-Experts-scrap-prostate-screening-proposal

 

 

Edited by member 24 Jan 2023 at 04:38  | Reason: to highlight link

Barry
User
Posted 24 Jan 2023 at 15:26

Hi Phil. I am so sorry to hear about the experience you had. It is also very concerning that they are not dealing with the compliant quickly as that professional is still out there seeing patients, they need some feedback at a minimum to prevent this happening to someone else. I had to contact NHS England to get a PSA test when my father presented with a 2 month history of urinary frequency and the GP practice had requested a PSA test 6 weeks later. The request was expedited and unfortunately it came back very raised. Not sure what kind of training some of the 'clinicians' receive.  

User
Posted 24 Jan 2023 at 16:49

Hi Gur007 

I was and still am extremely very angry in how long my gp practice/nhs took to diagnose me,I'm not saying they could have caught it in time but it would have been caught at an earlier stage and perhaps gave me a few more years,the problem is I am still under the same practise so it feels like I'm biting the hands that feed me but on the other hand stuff em they've destroyed my life!!

Yet I must say once diagnosed my local hospital was very good in treating me and more than likely saving my life due to aki (acute kidney failure).

Regards Phil 

User
Posted 25 Jan 2023 at 07:04

I can't imagine how you must be feeling about it. The surgery shouldn't alter the care they provide in the future because you gave raised concerns about the treatment you have received. At a minimum they need to acknowledge their mistake and learn from it. 

 
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