Interesting view on having PSA test

[Happy happy]

Men concerned about prostate cancer should think before asking for a PSA test | Prostate cancer | The Guardian

[Sheryl]

The reference -- to which you failed to post a link -- is not to an article by the Guardian but rather a letter in its letters volumn. Which contains outdated content.

 

The Guardian as a paper does not recommrnd against the PSA test.

 

PSA is a useful screening tool but not in itself diagnostic. 

 

 

[Lorry]

The content is not so much outdated (the referenced studies are fairly recent) as debated. 

As for the usefulness of PSA, German guidelines discuss PSA on 10 pages,  without any conclusive result. A bit too much for this forum.

Sweden (and Norway) obviously recommends the Stockholm3 test, which is also used by the university hospital of Zurich.

[Happy happy]

14 hours ago, Sheryl said:

The reference -- to which you failed to post a link -- is not to an article by the Guardian but rather a letter in its letters volumn. Which contains outdated content.

 

The Guardian as a paper does not recommrnd against the PSA test.

 

PSA is a useful screening tool but not in itself diagnostic. 

 

 

Sheryl:

 

I think u being a bit harsh on me.

 

I thought I was posting a link when posting the reference.

It is clear reading the article that it contains an opinion from a letter to the Guardian and IS NOT the view of the paper.

I agree the content is possibly dated.

 

I have regular PSA testing as recommended by my doctors.

All I am saying is that the article is interesting.

 

I would further be interested to know if anyone agrees that they should think twice before having a PSA test and if so why.

 

[Easterneye]

Regardless of the inns and outs of the Gaurdian if your over 45 go get yourself a PSA blood test ,, this alone won’t determine prostate cancer ,, but an elevated PSA will lead you next to an mri scan which will deffo indicate cancer if it’s there then the extent of the cancer will be determined by the dreaded transperenial biopsies under local anaesthetic , plus a full body CT scan looking for any secondaries along the way .

Had mine done annually the last 11 years all well within PSA range , elevated up two years ago and went through a year of diagnosis and treatments .

Now the worrying bit  LIKE THOUSANDS AND THOUSANDS OF OTHER MEN I HAD / HAVE ZERO SYMPTOMS 

Get tested , don’t let the silent killer get away with its deadly work inside you before it’s too late 

[CallumWK]

Although I have no reasons to believe I have prostate issues, I have been reading up on PSA tests recently, and found more sources that advised against such a test.

Main reason was that such a test is not conclusive, and often gives false positives, and when people decide to do a biopsy becaue of the results, it actually may make things worse.

[Sheryl]

50 minutes ago, CallumWK said:

Although I have no reasons to believe I have prostate issues, I have been reading up on PSA tests recently, and found more sources that advised against such a test.

Main reason was that such a test is not conclusive, and often gives false positives, and when people decide to do a biopsy becaue of the results, it actually may make things worse.

Nowadays biopsies are not done based on PSA test alone.  If indicated, there are additional blood tests that can be done and  special MRIs.  Urine cultures can also help  rule a prostate infection in or out.  In some individual cases, if there is a high index of suspicion for prostatitis, a doctor might opt to treat presumptively for infection first and then repeat the PSA later.

 

A PSA result is not a positive or negative, it is a number on a scale. This number must be viewed in the clinical context. For example, a mildly elevated PSA in an older  man with known BPH is an altogether different matter than a very elevated PSA in a younger man. Ditto a highre PSA in a man with risk factors for infection. The rate of rise in a PSA is also of significance.  A stable PSA that is just a bit elevated is very different from a steadily rising PSA...especially since the aim is not to find all prostate cancers but rather to find clinically significant prostate cancers (i.e. aggressive cancers as opposed to slow growing) , a very different matter.

 

PSA just screens and potentially signals the need for additional tests. Has to be interpreted in the overall patient context: age, known prostate conditions, trend in PSA level, findings on digital exam etc.

[Sheryl]

A post referring source of inaccurate information has been removed, as has a post on moderation.

[Happy happy]

1 hour ago, scubascuba3 said:

As i said further up, yes think twice, look at Dr John McDougall who has an article about this

Many thanks to scuascuba3. I watched the video by Dr John Dougall (searched and found it on Google) and it is certainly thought-provoking. 

[Sheryl]

3 minutes ago, Happy happy said:

Many thanks to scuascuba3. I watched the video by Dr John Dougall (searched and found it on Google) and it is certainly thought-provoking. 

Be advised that this video was misleading at the time it was made and is now more than a decade out of date.

 

It's contents are not factual.

 

Many lives can be, and are, saved through early diagnosis and treatment of aggressive prostate cancers. Prostate cancer is the second leading cause of cancer death in men. And a particularly painful type of death. It is well worth avoiding this. Considerable advances in diagnosis and treatment have occurred i nthe past decade and PSA is just an initial screening test. It does nto immediately lead to biopsy.

[Happy happy]

18 minutes ago, Sheryl said:

Nowadays biopsies are not done based on PSA test alone.  If indicated, there are additional blood tests that can be done and  special MRIs.  Urine cultures can also help  rule a prostate infection in or out.  In some individual cases, if there is a high index of suspicion for prostatitis, a doctor might opt to treat presumptively for infection first and then repeat the PSA later.

 

A PSA result is not a positive or negative, it is a number on a scale. This number must be viewed in the clinical context. For example, a mildly elevated PSA in an older  man with known BPH is an altogether different matter than a very elevated PSA in a younger man. Ditto a highre PSA in a man with risk factors for infection. The rate of rise in a PSA is also of significance.  A stable PSA that is just a bit elevated is very different from a steadily rising PSA...especially since the aim is not to find all prostate cancers but rather to find clinically significant prostate cancers (i.e. aggressive cancers as opposed to slow growing) , a very different matter.

 

PSA just screens and potentially signals the need for additional tests. Has to be interpreted in the overall patient context: age, known prostate conditions, trend in PSA level, findings on digital exam etc.

Thank u Sheryl:

What you say more or less corresponds with the advice given to me by doctors in Thailand.

 

[placnx]

1 hour ago, Sheryl said:

Nowadays biopsies are not done based on PSA test alone.  If indicated, there are additional blood tests that can be done and  special MRIs.  Urine cultures can also help  rule a prostate infection in or out.  In some individual cases, if there is a high index of suspicion for prostatitis, a doctor might opt to treat presumptively for infection first and then repeat the PSA later.

 

A PSA result is not a positive or negative, it is a number on a scale. This number must be viewed in the clinical context. For example, a mildly elevated PSA in an older  man with known BPH is an altogether different matter than a very elevated PSA in a younger man. Ditto a highre PSA in a man with risk factors for infection. The rate of rise in a PSA is also of significance.  A stable PSA that is just a bit elevated is very different from a steadily rising PSA...especially since the aim is not to find all prostate cancers but rather to find clinically significant prostate cancers (i.e. aggressive cancers as opposed to slow growing) , a very different matter.

 

PSA just screens and potentially signals the need for additional tests. Has to be interpreted in the overall patient context: age, known prostate conditions, trend in PSA level, findings on digital exam etc.

After reading the post mentioning the Stockholm3 test, I looked it up, and it seems quite interesting: 

https://www.stockholm3.com/

 

After having a few friends die of prostate cancer, and myself having procrastinated when my doc recommended a biopsy, I definitely believe in regular PSA testing. Some friends have done brachytherapy (radioactive seeds implanted in the prostate), but their cancer was detected early.

 

If as good as claimed, the Stockholm3 test seems to be an excellent diagnostic alternative in conjunction with PSA testing.

 

 

[WDSmart]

I have a complete exam every year, and it includes a PSA test and score. I'm 79, and my PSA count is right at the limit. However, I was advised several years ago by several of my friends in the USA who are doctors that anyone my age should not really consider having their prostate removed, even if there is evidence of cancer. They told me that type of cancer is very slow growing and should not become a problem unless I lived above 100. 

[MangoKorat]

There was no significant difference in the risk of dying, or dying of prostate cancer, between the three treatment options. Three‑quarters of the men in the active-monitoring group experienced growth or spread of the cancer and needed subsequent treatment, but a quarter of the men were alive without having received any form of treatment.
Reginald Hall
Retired urologist, Newcastle upon Tyne

 

As someone who's had Prostate Cancer (PC) for 10 years and who's illness is in currently in remission but not necessarliy cured, I am shocked at the attitude of a 'Professional' towards this disease.  He should know very well that you can't lump men who have low grade PC together with those who have a more aggressive type.  Although its the same basic disease in terms of outcomes, there is a vast difference. 

 

Most people who have low grade PC are simply monitored as the disease often does not get worse or spread. The reason for the monitoring is just to confirm that.  What is it they say? You die with it, not of it.

 

However, aggressive PC spreads and must be treated if the subject is to have a chance of survival.  Once PC spreads to other parts of the body, there is no curative treatment, it can only be slowed down.

 

'However, men should think very carefully and consider the evidence before asking their GP for a PSA test.'

 

If my GP hadn't sent me for a PSA test, I wouldn't be here now.  I went to see my GP on a totally different matter. It was only when I mentioned a few symptoms I was experiencing, one that isn't usually associated with PC, that my GP said "I think we'd better do a blood test. She didn't even mention PC but PSA was, as it turned out, one of the tests she'd requested.

 

Two days later I received a phone call asking me to visit the surgery immediately. The results were a PSA of 189, my GP said she suspected PC and was requesting an urgent appointment with the Urologist at my local hospital. A subsequent biospy confimed PC and the resultant scans identified tumours occupying 60% of one lobe of my prostate and 100% of the other. I was given a choice of removal or radio therapy and told the 10 year outcomes were about the same - I opted for radio therapy. I asked the Oncologist to be brutally honest about my chances (as everyone was referring to my PSA count being massively high) and she told me I was only just within the criteria for curative treatment and she thought there was a 70% chance the disease would return as it was a highly aggressive form. 

 

The tumours had broken through the capsule of my prostate but there was no evidence of it anywhere else. At that time I was told that I was having the maximum dose of radio therapy and if it wasn't successful, any subsequent treatment would only be to slow the spread of disease down.

 

Fortunately I responded to the radio therapy (+ hormone therapy) better than anyone expected.  My PSA began to rise again 5 or 6 years later and the oncologist I saw then said he thought it was more likely that we hadn't quite 'got' the disease the first time around than it had returned.  Things had moved on in treatment pathways during those 5 or 6 years and my response had been good. I had a PET scan to map out exactly where the cancer was active and it was still within my prostate. I could not have further beam radio therapy but I could have a more targeted version in the form of HDR Brachytherapy, better still should that not be succesful, other treatement options were now open to me.  The HDR Brachytherapy was given in 2 sessions, 1 month apart and to date, my PSA has settled to a constant 0.70.

 

Had I not mentioned my (few) symptoms to my GP or if she was one of those that is opposed to too much PSA testing, I would not be writing this post, I'd have been 6ft under a long time ago.

 

The suggestion that:

 

'men should think very carefully and consider the evidence before asking their GP for a PSA test.'

 

is ridiculous.  Are we doctors?  There is only one way to identify the likelihood that PC is the cause of any symptoms you may have and that begins with a PSA test. There is no other way.

 

The old reasoning of false positives and the risk of infection though a biopsy is long gone.  In many countries the next step after a high PSA reading is a newer form of MRI scan which, I believe can identify the presence of potential tumours and help urologists make a decision on a biopsy.

 

I met my original oncologist in the hospital coffee bar recently when I was at the hosipital on a different matter and I asked he what she thought would hatve happened if I my PC had not been diagnosed when it was. She told me that it was very hard to say but she suspected that if I had not been diagnosed until 3 months later than I was, I would not have fitted the criteria for curative treatment......."and remember, yours was highly aggressive". I don't think there is a chance in hell that I would still be here now.

 

I don't care what this man says, there is no other way to identify the possibility of PC and I tell everyone I know to get tested every year once they reach 50. You don't always have the usual symptoms, some people that have been diagnosed with PC had no symptoms at all.

 

I apologise for the length of my ramblings but the debate of whether to test or not really stirs me up.  Perhaps by reading what happened to me, men reading this will be convinced that regular testing is an absolute must.

[soalbundy]

20 hours ago, Sheryl said:

The reference -- to which you failed to post a link -- is not to an article by the Guardian but rather a letter in its letters volumn. Which contains outdated content.

 

The Guardian as a paper does not recommrnd against the PSA test.

 

PSA is a useful screening tool but not in itself diagnostic. 

 

 

I believe the NHS doesn't do them anymore, too many false and negative positives, there is a new highly accurate test out now, Episwitch PSE 94% accurate.

[MangoKorat]

4 hours ago, CallumWK said:

Although I have no reasons to believe I have prostate issues, I have been reading up on PSA tests recently, and found more sources that advised against such a test.

Main reason was that such a test is not conclusive, and often gives false positives, and when people decide to do a biopsy becaue of the results, it actually may make things worse.

And just how does it make things worse?  The excuse usually presented is the risk of infection from biopsy's. As had been stated by many people in this thread, PSA tests are now, in most cases, followed up by an MRI scan.

[CallumWK]

3 minutes ago, MangoKorat said:

And just how does it make things worse?  The excuse usually presented is the risk of infection from biopsy's. As had been stated by many people in this thread, biopsy's are now, in most cases, followed up by an MRI scan.

 Because with a biopsy you risk having bleedings.

 

I believe that a bleeding not only can cause infections, but also may spread the cancer

[TigerandDog]

as a prostate cancer survivor I definitely recommend an annual PSA test for ALL men over the age of 40.

 

In my case I was having annual PSA tests and was always within range, BUT towards the high end. My GP always said everything was ok and nothing to worry about.  One morning I woke to find blood stained sheets. went to my GP who did another PSA test and the result came back just below the high end of the so called safe range. My GP, as a precaution, sent me for a biopsy and was firmly of the opinion that it would come back showing no cancer.  To her surprise the result actually came back as localised malignant cancer. Treatments followed and I am now cancer free.

 

The main point here is that PSA tests are ONLY an indicator, BUT they can lead to a patient being referred for further testing that DOES indicate whether a patient has cancer, and if treated early on, such patient can live a long and cancer free life afterwards. 

 

Even though I am now cancer free I still have an annual PSA blood test as it is possible for the cancer to return, even if you've had a radical prostatectomy, as it did with my brother-in-law. Several years after his prostatectomy his PSA levels started elevating rapidly, and further testing showed that the cancer had returned and was in his lymph nodes. He did not survive the retuning cancer.

 

So guys don't be wimps when it comes to visiting the doctor, and get tested annually.

[MangoKorat]

1 minute ago, CallumWK said:

 Because with a biopsy you risk having bleedings.

No, you have a risk of infection but read what I and others have said, in many cases, there is no need for a biopsy in many cases these days unless an MRI scan suggests the presence of PC.  Biopsy's are then used in order to identify the size, location and nature of the tumours

[MangoKorat]

13 minutes ago, soalbundy said:

I believe the NHS doesn't do them anymore, too many false and negative positives, there is a new highly accurate test out now, Episwitch PSE 94% accurate.

That's something new, things are changing fast. Anything that identifies this horrible disease can only be good.

[scubascuba3]

27 minutes ago, soalbundy said:

I believe the NHS doesn't do them anymore, too many false and negative positives, there is a new highly accurate test out now, Episwitch PSE 94% accurate.

Interesting, I hadn't heard of that, no one has mentioned it here before. From Gemini AI 

[soalbundy]

I personally think its a question age whether testing is a good idea or not, my father was diagnosed with prostate cancer at 78, he didn't bother with treatment and died of a heart attack at 83. I'll be 77 this year, that's already a reasonable age where death wouldn't be unusual, getting tested and getting treatment if cancer is diagnosed at that age I find to be exaggerated clinging with ones fingers on the edge of a precipice. Death comes to us all through a myriad of means, desperate clinging on isn't very dignified or helpful.

[TheFishman1]

Yeah I’m agreeing 100% with Shirley

[MangoKorat]

14 hours ago, placnx said:

Some friends have done brachytherapy (radioactive seeds implanted in the prostate), but their cancer was detected early.

Just to clarify - not to argue. There are different types of Brachytherapy - the seeds that your refer to and HDR which is done in conjunction with a PET Scan. With HDR the therapy is carried out through what I can only describe as large needles inserted through the Perineum and guided into an exact location through computer mapping informed by the PET scan.

 

HDR is sometimes said to be only 30% effective but my oncologist disagrees in cases like mine where it appeared that previous Radio Therapy had 'missed' a small area.  One of its main advantages is the precision that it can achieve. In my case the residual tumour was right in the centre of my prostate on one side only.  The needles, were guided into the exact spot by imaging  using the map obtained through the PET scan. So far there has been no return but this was a secondary treatment following Radio Therapy a few years earlier.

 

I am not sure, as I didn't have a low grade of PC (I wish I did) but I believe the seeds are used with lower grades of the disease and in cases where 'watchful waiting' (monitoring) has taken place over an extended period and the cancer is now becoing active.

 

There appears to be several new treatments around and on the horizon at the moment but the key to it all is to catch it early and that is why a PSA test is so important - or maybe one of the newer tests somebody mentioned above.  It doesn't matter really if it turns out you don't have PC.

 

This is one of those diseases that can either take years and years to become really active (if at all) - or it can romp through your body very quickly.

 

What the naysayers need to consider is that once the disease breaks out of the Prostate Capsule, the pathways used by UK hospitals (I can't speak for other countries), do not include curative treatment. They can (will) only use measures that will slow the disease down.

 

A lot of guys avoid testing because they have heard that if they are found to have the disease, the subsequent treatment will put them out of action in the bedroom department.  That is not always the case these days and there is a lot that can be done to help.  Yes, its a 'big thing' for a bloke, it terrified me, I was relatively young on diagnosis but it doesn't always happen and sometimes, function can return several months or even years after treatment.

 

I don't keep up with the latest developments in dealing with PC as I'm (hopefully) past that now but there's always some news on the subject, usually good. The one thing I do know that remains key, is to get tested and regularly.  I wish the UK government would stop their nonsense and introduce a sceeening programme for men over 50.  I don't care how many false positives there are - the alternative can be deadly. Far too many men are dying of a disease that, in most cases, is readily treatable in its early stages and a bonus is that early treatment is normally less invasive in many cases.

 

To be totally brutal on this, the most common areas for the disease to spread to are the bones, lungs and brain and it doesn't stop. As Sheryl says, it can be an agonising death.

[John49]

This thread is complicating what for me, was a straightforward issue – based on my personal experience.

 

For many years, my PSA was about 4 - i.e. on the limit when you are supposed to show concern.

I ignored it for years, as I understood that the rate of change of PSA (above say 4) that is the warning light.

 

Recently, my PSA stated to creep up to 5, then 6, then 7.

I had a prostate MRI that was inconclusive.

This was a mistake, the wrong test, as this test lacks accuracy.

I followed up with the more accurate mpMRI – cancer indicated.

Followed up with transperineal biopsy, done under sedation.

That was a breeze with no after affects.

 

Subsequently, had 5 shots of external beam radiotherapy – that was not a breeze – tedious over several days with some painful urination.

 

My story lacks detail – as it was relatively straightforward – easy decisions, obvious or reasonable – that I hardly remember it.

As for ‘dying with it’, rather than ‘dying from it’ – up to you (and your doctor as someone will surely chip in) – depending on your age and health.

[simon43]

We all have different experiences.  Sheryl knows my history:

 

Mild BPH with elevated but steady PSA (6) for many years.  PSA then rose to 14 and an MRI at Bumrungrad indicated 2 'lumps' that the doctor considered highly likely to be PC.

 

I returned to the UK for a biopsy and the skilled prostate doctor looked at the MRI scans from Bunrungrad and said that he wasn't so sure that it was PC.  Had a 24-needle biopsy under local anaesthetic, including targeted at the lumps and no PC found - they were benign calcium stones, and my high PSA was exacerbated by UTI/prostatitis etc.

 

The doctor did tell me that most of the prostate biopsies that he performs find no cancer, which is good news for those worried by an elevated PSA.

 

I'm not a doctor (well, I do practice surgery on my sex doll..), but an elevated but steady PSA could be caused by UTIs, calcium stones in your prostate etc, whereas a slowly rising PSA that keeps going up is worthy of urgent investigation.

 

Whatever, but with a raised PSA,  I certainly can't see any reason for not having a biopsy (after MRI investigation), UTI checks etc, unless you are at an advanced age where the chances of PC killing you is less than you dying of old age... than

 

 

[Ben Zioner]

I was diagnosed in 2018, with a tiny Gleason 3+3 lesion. I flatly refused the radical treatments my doctor proposed. Last month's MRI showed that my cancer wasn't any different from 7 years ago.

 

Pr. Ablin , the discoverer of PSA has always vehemently opposed its use for screening, while he didn't deny that it was an excellent tool to monitor cancer treatment. 

 

Using a marker that gives a large proportion of false positives, as well as some false negatives, seems preposterous if not driven by the lure of profit, sadly. And this is even more so our days where MP-MRI is readily available.

[jerrymahoney]

Per the OxfordBiodynamics website:


Which doctor can order the PSE test?

-- In the UK, EpiSwitch PSE can only be ordered by a private doctor at this time. The test is not yet available on the NHS.

-- In the US, any healthcare provider (HCP) can order EpiSwitch PSE.

https://www.94percent.com/

So, for Thailand as of now, the most accurate test is PSA + DRE.

[Sheryl]

8 hours ago, jerrymahoney said:

.....
So, for Thailand as of now, the most accurate test is PSA + DRE.

Followed by Free PSA if the PSA is elevated.

 

Culture of urine or (preferably) orostate fluid  if prostatitis  suspected. 

 

Then mpMRI if indicated by alk thd above findings.