Did your GP check for increase in PSA scores?

NICE's guidelines only apply to men with symptoms. (Same with BAUS's guidelines.) Did you have symptoms?

For men without symptoms, the guidelines were published by NHS England (PCRMP), and the limit was a PSA of 3 regardless of age. This is the same limit which is used across the EU and by the TRANSFORM trial too for men without symptoms (which is the definition of screening). So assuming you had no symptoms, your GP used the wrong PSA reference scale, but so do most GPs.

With the removal of the right to screening (even on request), the PCRMP has recently been withdrawn, so the NHS no longer publishes PSA thresholds for men without symptoms. You can find the last copy here [Wayback machine].

With regard to using PSA velocity in screening, no screening program in the world uses that. It adds complexity, and although research shows it can find cancer earlier, there is no evidence that it improves outcomes.

Your campaign to take account of PSA velocity would need to find some data which showed it improved outcomes. Again I'm assuming you had no symptoms, in which case using PSA velocity would need to have been in the PCRMP in your case rather than (or in addition to) the NICE guidelines, but as the document where it would have needed to be has now gone, so your campaign would need to start with reintroducing that, i.e. offering screening, even if not a national screening progamme.

This area is now a complete shambles in the UK, and will directly result in more deaths. The US stopped screening on request in 2012 just like we have just done, and had to reintroduce it in 2018 because of the increased numbers of men diagnosed later stage. Mathematical modeling suggests this change will have increased the deaths from prostate cancer in the US by 13% to 20%.

But for prostate cancer, while PSA of no concern (perhaps 3 or less) and high PSA (perhaps 10 or higher) might be correctly identified there will be an awful lot of results in between where the patients hopes for something to be done when there might not be a risk sufficient to undergo a treatment which has a high probability of having life-affecting side effects.

It needs a more sophisticated approach if any sort of screening is to be helpful. The obvious one is to do repeat measurements on patients in the "can't be sure" range after 3 or 6 months which can indicate an active cancer, and prioritising those with other risk factors such as family history or experience of infections likely to be associated with urinary retention. Unfortunately that doesn't fit with the traditional idea familiar to GPs of a screening test being a one-shot yes/no answer.

I believe Peter 2016 is correct. My GP's nurse told me that the 'Normal - no action' comment on my PSA test reports were added by the lab but of course the lab doesn't know my history (no prostate) . My GP never raised a red flag. 

My opinion now is that those not offered a PSA test, that can afford to pay,  have an anual PSA test anually. Any sudden rise in PSA should be reported to your GP.

Hi Jules,

Do you think that cell Gleason grades change with time or that the higher grade % of the total lesion increases being faster growing? I've long thought Gleason would keep constant seeming to be genetic. 

The seminal and lymph nodes would be more effected with time.   regards Peter