PSA test - men

Just remember that a finger is smaller than a Richard III...
 
omens said:
The PSA test is poor as a screening tool for prostate cancer, largely down to specificity and sensitivity. The infographic posted by @Alastair explains this well. You could have a normal PSA (and a normal prostate exam) and still have prostate cancer. Even TRUS + biopsy might not find cancer if they've not been taken from the right areas. MRI is more useful but we still don't have a good easy screening tool for prostate cancer.
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Agreed.
I had prostrate cancer 12 years ago. I had surgery, and I'm fine now.
It was a very difficult time for me, exacerbated by the fact that I'm terrified of surgery and all things medical.
Post-surgery, I had all sorts of stuff through the post telling me that I needed to monitor my health with PSA tests and physical exams, but when I had my post-op with the surgeon who had fixed me up, he told me that the tests, including the PSA tests, throw up a lot of false positives, leading to unecessary stress, and so many false negatives that, in his opinion, they caused more problems than they solved.

I followed his advice and have never had any of these tests.
 
Garry Edwards said:
Post-surgery, I had all sorts of stuff through the post telling me that I needed to monitor my health with PSA tests and physical exams, but when I had my post-op with the surgeon who had fixed me up, he told me that the tests, including the PSA tests, throw up a lot of false positives, leading to unecessary stress, and so many false negatives that, in his opinion, they caused more problems than they solved.

I followed his advice and have never had any of these tests.
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It is well known it's not a definitive test, however if your readings are high it's a pretty good indicator that their is something amiss that needs further investigation. If the readings are medium it's a difficult decision as to whether to go any further, namely biopsy etc. If the readings are normal /low it's no indicator that you are definitely in the clear but it's a good indicator and if their are no other symptoms you might well be correct in not bothering to worry. In your case having had cancer and had it operated on I'm sure your decision based on your Docs advise was a good choice (for you).
Personally I had a test a few months ago and it came back very low, I intend to have the tests repeated regularly so I can monitor any changes and then decide what I want to do about them.

In general I would say a PSA test is worthwhile so long as you dont stress about either the test or the result.
 
Well, further to my post above the blopsies confirmed the worst. Next step an MRI scan followed by hormone therapy and radiotherapy. Not sure if it's all worth it at my age but
hey ho!
 
Sorry it's not all good news, but my understanding is that generally old age will kill you before prostate cancer, especially at your age :)
Not that I am a long way behind you on that score.
 
Al1944 said:
Well, further to my post above the blopsies confirmed the worst. Next step an MRI scan followed by hormone therapy and radiotherapy. Not sure if it's all worth it at my age but
hey ho!
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Chatting to a prostate cancer patient on holiday, he reckons that the hormone therapy has done him more good than any of the other options he has had, including radiotherapy and chemo. All the best for the future, whichever route you take.
 
A few years ago I went to the doctor with "waterworks" symptoms and had a PSA test as part of the diagnosis. The results showed that I have "elevated" PSA levels. Following on from that I had various scans followed by two biopsies. It was discovered that I have an enlarged prostate and an elevated PSA level is my normal (the biopsies were clear and the enlarged prostate is a contributory factor in my waterworks problem).
I now have annual PSA tests which can be compared to the previous results to show if anything changes.

Yes, the PSA test is known to be a bad indicator and yes, mine was a false positive, but if future PSA tests show a dramatic rise in levels then I know something is changing and needs looking into further. In that respect the PSA test is useful to me even if it is a poor indicator on it's own as a one-off test.
 
anwa said:
Yes, the PSA test is known to be a bad indicator and yes, mine was a false positive, but if future PSA tests show a dramatic rise in levels then I know something is changing and needs looking into further. In that respect the PSA test is useful to me even if it is a poor indicator on it's own as a one-off test
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Is it a 'bad indicator' or is there a lack of knowledge as to how these antigens are created within the world of the GP?

I had a test done because my father died from prostate cancer - the results returned a level of 27.6 which is not good (a 60 year old will, generally, have a natural level of around 4). The GP (a different one of which I'd made the request) asked if I had been sexually active in the previous 4 days; had I been cycling (I resisted writing 'riding a bike'); had I been involved in vigourous exercise? It would seem that all of these activities will elevate the PSA in the blood. Any of these could be seen as producing a false negative - in my case it wasn't (another story).

What I'm suggesting is if screening is to be considered a way forward to promoting good, male health outcomes then more knowledge is required for GPs. If you have a chloresterol check you're required to fast prior to the blood test. Likewise, if a PSA test is being performed then desisting from activities which will elevate PSA will provide a more accurate result, ie, reduce false positives.

Going back to the positives of breast cancer screening capturing only 8% - I bet the women in that 8% are glad they were screened.

Bear in mind 1 in 9 men will contract prostate cancer at some point in their life - agreed not all die from it - but those that do would've no doubt liked to have the opportunity to have it treated and live!
 
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I think this is a great thread to help bring about more awareness of prostate cancer because it's not a case of if you get it it's a case of when you get it. My Granddad had it & just after my Dad retired at 55 he was diagnosed with prostate cancer which was a bit of a shock, luckily my Dad responded very well to the treatments & has had the all clear for 15 years or so & is back to enjoying life but still goes for check up's as it could return at some stage. Because of my family history regarding the condition it had been playing on my mind so at 43 I went & got myself checked, had blood taken to check the PSA level but the labs messed up the results as my Dad had his done the same day so there was only one option left & that was to go for an examination & thankfully got the all clear but I will be going back in around 5 years because if it develops I would rather catch it early when treatment is far more effective. Get yourselves checked out guy's as it's better to be safe than sorry
 
Sw33ty said:
I think this is a great thread to help bring about more awareness of prostate cancer because it's not a case of if you get it it's a case of when you get it. My Granddad had it & just after my Dad retired at 55 he was diagnosed with prostate cancer which was a bit of a shock, luckily my Dad responded very well to the treatments & has had the all clear for 15 years or so & is back to enjoying life but still goes for check up's as it could return at some stage. Because of my family history regarding the condition it had been playing on my mind so at 43 I went & got myself checked, had blood taken to check the PSA level but the labs messed up the results as my Dad had his done the same day so there was only one option left & that was to go for an examination & thankfully got the all clear but I will be going back in around 5 years because if it develops I would rather catch it early when treatment is far more effective. Get yourselves checked out guy's as it's better to be safe than sorry
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If there's a family history of prostate cancer then a PSA test is well worth the trouble. In fact, it has crossed my mind that NHS records should be noting family histories - but this will lead to data protection and other controversies!

My father had it, his two brothers had it and I've got it (hopefully surgically removed now so non-existent) my son needs to get tested!
 
My GP was on the ball when I went to see her for an unrelated problem last year! Have been on hormone injections since October which reduced the PSA level dramatically. Started radiotherapy treatment on Tuesday - 5 days a week for seven weeks or so.
 
There is a lot of difference between PSA screening and PSA testing! It has always been known the efficacy of PSA screening can be counter productive to successful outcomes. The image above shows this. The knock-on effect of this screening failure is is a lack of awareness of prostate cancer.

Look at it from this angle - more men die from prostate cancer than women die from breast cancer. This fact alone should make men (and their relatives) more acutely aware of the dangers of undiagnosed/untreated prostate cancer. Nobody complains that breast cancer screening is inefficient - screening continues and awareness is constant.

It is without doubt understood that a more reliable prostate cancer screening process needs to be adopted. There is a study ongoing in Stockholm to this end. Until such times we only have PSA testing to indicate the possibility of cancer. Stockholm Trial

The usual recourse these days from a positive PSA indicator is to perform other tests, some of which is painful, invasive biopsy others are simply "Watchful Waiting"

So, screening is not the complete answer we would like it to be. In the meantime we should all become more aware of Prostate Cancer and its signs and symptoms. Being more acutely aware will help reduce this Cancer from Killer it is to something more benign or, hopefully, eradicated for ever!
 
chuckles said:
There is a lot of difference between PSA screening and PSA testing!
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I think the scary thing is that you can have prostate cancer, have no symptoms and have a normal PSA. My own GP thinks that annual testing for rapid changes might be more useful than "spot check" PSA. I think that higher risk (eg family history) should have some form of screening.

chuckles said:
Look at it from this angle - more men die from prostate cancer than women die from breast cancer...Nobody complains that breast cancer screening is inefficient - screening continues and awareness is constant.
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There's always been more money pumped into breast cancer. I decided to see if there's an infographic for breast cancer too:

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I agree that it's amazing that breast cancer screening is more effective at saving lives than prostate cancer screening and there needs to be a better test. I'll have a look at the Stockholm trial.

chuckles said:
The usual recourse these days from a positive PSA indicator is to perform other tests, some of which is painful, invasive biopsy others are simply "Watchful Waiting"
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I have friends and acquintances who've had complications from just the biopsy. That's after they've had an MRI to guide the biopsy. One is in continual pain as a result and wished he'd never had the biopsy in the first place.

chuckles said:
So, screening is not the complete answer we would like it to be. In the meantime we should all become more aware of Prostate Cancer and its signs and symptoms. Being more acutely aware will help reduce this Cancer from Killer it is to something more benign or, hopefully, eradicated for ever!
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Well breast cancer hasn't been eradicated. I imagine it'll be the same even when there's a good prostate cancer screening test - more lives will be saved but some people will still die from prostate cancer.
 
When it comes to female health, women tend to view health differently than men - they tend to more aware and are not in 'fear' or dismissive of visiting GPs etc. In view of that I just wonder how much of an accurate comparison that infographic is. Women are encouraged to self-examine so any 'positive tests' would escape the data gathering for screening - to my mind a false picture.

omens said:
I have friends and acquintances who've had complications from just the biopsy. That's after they've had an MRI to guide the biopsy. One is in continual pain as a result and wished he'd never had the biopsy in the first place.
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The biopsy is pretty gruesome I have to say - the important thing here is what would your friend think if the biopsy showed he had P-Cancer? I think he would be grateful to have the opportunity to have treatment I'm sure.

You get caught between a rock and a hard place with the decision - it sure scared me and I found it worse than the prostatectomy!

But, it has to be faced, Prostate Cancer is a horrible disease - treatment of it is equally as bad but hopefully, at the end of it, you're still breathing! :)
 
Not to put anyone off the biopsy - I was dreading it for weeks. It was slightly uncomfortable but I wouldn't now be afraid to have it done again if the need arose.
 
Al1944 said:
Not to put anyone off the biopsy - I was dreading it for weeks. It was slightly uncomfortable but I wouldn't now be afraid to have it done again if the need arose.
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Fortunately - I no longer have the need!
 
It's difficult, isn't it. We probably all know some somebody who had a prostrate problem which was caught by the screening, but we don't hear so much about the downsides of the false positives.

Here's a summary from the US National Institutes of Health, which is the US government's medical research agency.
The United States Preventive Services Task Force has analyzed the data from all reported prostate cancer screening trials, principally from the PLCO and ERSPC trials, and estimated that, for every 1,000 men ages 55 to 69 years who are screened every 1 to 4 years for 10 to 15 years:
  • About 1 death from prostate cancer would be avoided
  • 120 men would have a false-positive test result that leads to a biopsy, and some men who get a biopsy would experience at least moderately bothersome symptoms from the biopsy
  • 100 men would be diagnosed with prostate cancer. Of those, 80 would be treated (either immediately or after a period of active surveillance) with surgery or radiation. At least 60 of these men would have a serious complication from treatment, such as erectile dysfunction and/or urinary incontinence.
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Full article: https://www.cancer.gov/types/prostate/psa-fact-sheet

Sure, we all want to be that 1 man in 1,000 whose life is saved. But we wouldn't want to be one of those 60 who get serious complications.
 
StewartR said:
  • 100 men would be diagnosed with prostate cancer. Of those, 80 would be treated (either immediately or after a period of active surveillance) with surgery or radiation. At least 60 of these men would have a serious complication from treatment, such as erectile dysfunction and/or urinary incontinence.
Sure, we all want to be that 1 man in 1,000 whose life is saved. But we wouldn't want to be one of those 60 who get serious complications.

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@StewartR

What's not reported about those 60 men is, by my interpretation, without screening they wouldn't have been diagnosed, therefore not treated and finally die! You could argue 80 lives saved but 60 sadly with (treatable) complications and only in a very few are those conditions permanent.

As a surgeon once stated (about ED) on a Forum with which I am associated, "Sex is great, but breathing is better!" ;)

Don't get me wrong here. PSA screening is controversial there is no doubt of that - but screening is a lot different from testing. Testing would occur because of presenting with symptoms.

We all need to be aware of what a Killer prostate cancer is and be conscious of its signs and symptoms.

If your father, uncle, grandfather had/has prostate cancer; if your ethnicity suggests you're vulnerable; if you have a slow urinary flow; if you feel a sudden urge to pee and it occurs often - get yourself tested. You are at risk!
 
chuckles said:
What's not reported about those 60 men is, by my interpretation, without screening they wouldn't have been diagnosed, therefore not treated and finally die! You could argue 80 lives saved but 60 sadly with (treatable) complications and only in a very few are those conditions permanent.
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Sorry, but I think your interpretation is totally incorrect. You're implying that the screening programme would have saved those 60 lives, but that is explicitly contradicted by the first bullet point.
 
StewartR said:
Sorry, but I think your interpretation is totally incorrect. You're implying that the screening programme would have saved those 60 lives, but that is explicitly contradicted by the first bullet point.
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You could be right Stewart - I did re-read it a few times. It's certainly not clear - to me at least.

Points 1 and 3 seem to conflict - especially as point 2 describes false positives. That implies point 3 is describing true positives. If that is the case then I stand by own original interpretation.

The converse then begs the question - how does the lucky blighter in point 1 come to be defined?

Frankly, being at the sharp end of all this recently I've had my mind focussed and life totally changed - us men need to be more Prostate Cancer aware - it's a killer! Don't let anybody tell you, "Prostate Cancer; if you get cancer, that's the good one to get". Trust me it isn't; it's odious, evil and kills!
 
I have noticed that the awareness of prostate cancer has increased a lot over the past 15 years or so which if fantastic but the attitude of males in general hasn't really changed & the comments like i'm fine there isn't anything wrong with me or no Doctor is sticking their finger up my bum are far to common sadly. The thing is that the cancer can & will spread from the prostate to the bowl & liver if it's not caught in time.
 
"We all need to be aware of what a Killer prostate cancer is and be conscious of its signs and symptoms."

The nasty thing about this is that you might not have any symptoms at all until it spreads outside the prostate.
 
Some few years back I recall there was mention of a more reliable test than the PSA one. Apparently more costly but by comparison to PSA almost no false positives or negatives.

Wracks brains ~ did they say it was used mainly in Scandie countries???

Also, I think they said that not all GP's knew of it but those that did would not justify the cost??? Even if the thinking behind its improved reliability meant (almost?) no need for biopsy or other patient affecting tests!
 
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Tringa said:
Another bit of information/discussion about prostate cancer - https://www.bbc.co.uk/programmes/b086s7jr

Dave
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Interesting read - thanks for posting

Al1944 said:
"We all need to be aware of what a Killer prostate cancer is and be conscious of its signs and symptoms."

The nasty thing about this is that you might not have any symptoms at all until it spreads outside the prostate.
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There's the rub - double whammie!

Box Brownie said:
Some few years back I recall there was mention of a more reliable test than the PSA one. Apparently more costly but by comparison to PSA almost no false positives or negatives.

Wracks brains ~ did they say it was used mainly in Scandie countries???

Also, I think they said that not all GP's knew of it but those that did would not justify the cost??? Even if the thinking behind its improved reliability meant (almost?) no need for biopsy or other patient affecting tests!
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I think it's the Stockholm Trial for which I posted a link - here's another link
 
There is quite a bit of work going on. A couple of years back I was working for a startup developing a DNA damage test based on some research from the University of Bradford, aimed to detect people who were pre-cancerous for prostate, bowel, breast and some other conditions. Unfortunately the test could not be demonstrated to work reliably with the first round of collected samples (boy, was it hard to get blood samples for prostate!) and then the money ran out.
 
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