Prostate cancer

[endofthelinefinally]

I am so sad about poor Bill Turnbull.
AIBU to push dh to have a blood test done?
He has never visited his GP in the last 30 years.

The only reason he is being seen tomorrow by the consultant is because our MP is involved and I called him to ask why my father had not had a follow up appointment. Turns out they marked him as dead in the system 'obviously by accident'. Thank goodness I was 3000 miles away. I asked to speak to their manager only to be told they of course aren't available and can't call foreign numbers back.

Worst part is I've been calling them for two weeks and our solicitor was told today by hospital management that no one will speak to me because they aren't legally allowed to speak to someone who has a different last name to the patient.

Efrig Sorry to be blunt, but tell him to stop being so fucking selfish and cowardly. Ask him which is worse, a few minutes of embarrassment with a doctor, or a shorter life, because he’s so bloody stubborn. If you have to lag on the emotional blackmail, do it,

My dh died at 54, from prostate cancer, after two years of agony. I wouldn’t wish what he went through on anyone. He didn’t have a single symptom until he took sepsis, then serious problems from then on. It’s one of the easiest cancers to cure if caught in time.

What are the warning signs and symptoms?

Symptoms listed here: prostatecanceruk.org/prostate-information/about-prostate-cancer/prostate-cancer-symptoms

My DH has volunteered at football matches before for Prostate Cancer UK, you collect donations at the game & then get to see the match. He really enjoyed it and it’s great way to volunteer if anyone is interested in signing up details are here: prostatecanceruk.org/get-involved/matchday-volunteering

I'm not sure that looking up ovarian cancer would be useful for the prognosis for bone metastasised prostate cancer.

(And I must have been reading about GBBO in a very dusty room)

My FIL was diagnosed with prostate cancer two days ago, they found out about the cancer because he had a bone scan which seemingly showed cancer of the bone, and explained that bone cancer is secondary, when his prostate results came back (which he already had a test on as he was in hospital with urinary problems some 4 months ago- not caused by a UTI or anything)
So it’s not looking good, there’s some talk of it having spread to nearby lymph nodes.

It doesn’t sound good, I don’t know much but it’s pretty scary.
Prostate cancer seems to be very common nowadays. The man across the street from the in laws had undergone prostate cancer treatment in the past few months, as has FILs friend, now FIL, and there are so many headlines about the same cancer at the moment.

Sympathies with anyone else going through this with friends and family at the moment. It’s an awful situation to be in.

Whilst I completely understand how emotive the topic is if you have a loved one with prostate cancer, there are strict criteria for introducing a medical test as a screening test and the PSA does not meet them.
New screening tests are introduced once their value is proven and the benenfits outweigh the risks at a population level - like the relatively new bowel screening test for example.
It's very, very important that men make themselves aware of the symptoms and see a dr ASAP if they develop them.
If they have additional risk factors they should discuss screening with their GP.
One of the main issues with introducing PSA testing is the risk of harm. Of course there are people who would have the disease caught earlier and survive as a result. But many more would have invasive testing which leads to anxiety, impotence and incontinence for example.
The patient UK leaflet linked in the first page is a good one. If a patient asks me for a test I will never refuse it but it's important to be aware of the potential risks involved - it's not 'just' a blood test.

I know the PSA test isnt always reliable, but the finger test is usually done and the Dr can tell if the prostate feels lumpy or has bumps on it as it should be smooth,and further tests or biopsies usually follow,
Why men are so embarrassed i dont know,it could save their lives,after all we womwn have smear tests which are not pleasant,but neccessary
My partners was found after he got a urine and prostate infection, then sepsis, but as i said all the markers pointed to cancer, they first found an enlarged prostate, but it took months of tests before it was found, after just seeing a shadow on his perineum, and i have to say our hospital has been brilliant,

What is the likelihood of having PC but no elevation in PSA levels?

raspberry Studies show the risk from elevated PSA is that there is a good indication of prostate cancer. The major problem with PSA testing is that they don't start early enough so don't have an individuals basline.

cant Attitudes like yours is why the NHS is failing with regards to the public having confidence in the care provided.

All men should have the test after 50

There was an article in the paper this morning saying screening does more harm than good. I'm rounding the figures a little, but apparently to prevent one man dying of prostate cancer you have to screen 1500 and treat 50 for cancer. That means 49 men will receive treatment for something that wouldn't have killed them, treatment that could leave them incontinent or impotent.

That wasn't the main statistic, the article was actually about new research that showed there is no difference in the death rate from prostate cancer between men who are screened and those who aren't.

I wish they would come up with a more reliable screening test (and one for ovarian cancer whilst they are at it). Meantime if men want a PSA they shouldn’t be denied it.

I insisted on a Ca125 test recently.

to prevent one man dying of prostate cancer you have to screen 1500 and treat 50 for cancer.

Yes, the situation is similar for breast cancer - around 4,800 women per year are diagnosed with ductal carcinoma in situ (DCIS) per year through standard mammogram screening. DCIS is a type of stage 0 cancer where there’s no guarantee whether it will progress or stay the same, and at the moment all women diagnosed with it are given radiotherapy or undergo mastectomies (or both), despite the fact that about 50% would never have been in any danger from their DCIS.

2,400 unnecessary mastectomies every year, it’s pretty terrifying. But also terrifying to live with what could become a time bomb in your breast... I don’t know what the answer is.

Studies show the risk from elevated PSA is that there is a good indication of prostate cancer.

The problem is that it nearly always (98% of the time?) does more harm than good to have a diagnosis.

There needs to be a lot more money spent on research to try to identify which tumours are slow growing and unlikely to be harmful. These patients could avoid the unpleasantness of surgery, radiotherapy and chemo.

For those who have more aggressive tumours these treatments can be life saving.

My dad has advanced prostate cancer and a side helping of Alzheimer’s. His dad also died from prostate cancer. My FIL on the other hand has the slow growing kind and has no treatment at all now.

With the results of screening they are talking about treatment for the slow growing type. Saying treatment is worse than no treatment is ignorant. Best practice in both Denmark and America is for progress to be monitored and when it reaches stage 3 use the radioactive pellets to control the cancer so it doesn't advance to stage 4.

My Dad has Prostate cancer. He was diagnosed after visiting the doctor as he used to find it uncomfortable to sit down, he said it was as if he was sitting on a small stone.

His PSA level was slightly high but not enough for concern. However, the GP decided to do a rectal examination and felt that the Prostate was lumpy. A referal to a consultant followed where he had another rectal examintion and a biopsy.

The biopsy results were positive.

My Dad had 8 sessions of chemotherapy followed by radiotherapy every day for 3 weeks. He also has hormone injections every three months. PSA is checked regularly.

He is 76 and has coped with it all really well. He has the attitude 'what will be, will be'. He remained very active throughout the treatment and has never let the cancer 'get to him'. He just carries on as normal.

I urge everyone to persuade any men in their life to get checked.

My FIL was also diagnosed with Prostate cancer but fortunately it was slow growing so he received no treatment but was monitered. He has since passed away but not because of cancer.

Firesuit/Supermum....

So if the evidence suggests that elevated PSA is a good indicator of possible PC,,what is the normal level of PSA in the blood stream? Is it Zero?

Is the 3ng/ml a good trigger point for further investigation/action??

My current strategy as someone who is non symptomatic and apparently not in one of the main risk categories is ;

a) Be watchful of symptoms
b) carry out annual or maybe 6 monthly home tests which flag at the 3 ng/ml level

I am confident at being able to initiate the home test successfully.

Don't shoot the messenger. Cant is entirely correct - Times article (paywall, sorry) on how a recent study has shown that antigen tests on men who are asymptomatic show precisely... nothing at a population level:

"UK researchers looked at whether a one-off test could avoid some of these issues in a trial of 400,000 men, half of whom were invited for checks. After a decade, prostate cancer death rates in both groups were identical, at 0.3 per cent, it was reported in the Journal of the American Medical Association. PSA screening missed two thirds of lethal cancers, but was more likely to pick up low-grade tumours than waiting for men to report symptoms."

Radio 4's Inside Medicine also covered this today (and their podcast isn't behind a paywall, obviously!)

You're much better off learning (or encouraging the men in your life to learn) the symptoms of prostate cancer. This is from the NHS website:

Symptoms of prostatitis can include:

pain in the pelvis, genitals, lower back and buttocks.
pain when urinating.
a frequent need to pee.
difficulty urinating, such as problems starting to pee.
pain when ejaculating.
pain in the perineum (the area between the anus and scrotum), which is often made worse by prolonged sitting.

If your DH, OH, dad, uncle... has these symptoms, they should go to the doctor, not bury their head in the sand and hope it'll all go away.

Today's inside Health on radio 4 at 3.30 was about this very topic. It available on iplayer.

I wonder if anyone has information on prostate screening strategies in other European countries?

hairy My dad went to the doctor with pelvis pain and issues with urination starting and stopping. Was repeatedly told this was normal part of getting old and he would probably need a hip replacement soon. He was refused a PSA test or any other type of exam to identify the cause of the issues. The GP surgery fobbed him off for years. He got his blood work done privately and PSA levels were elevated. The GP agreed to refer him. It was only when he was desperate after being passed around 3 trusts that he let us get involved. I complained to PALS and I got a waffled response and no real change in treatment so I complained to our MP. We hired a solicitor to track all the complaints and failures so they could deal with PALS.

Read Jeffrey Archers article in the DM. None of that happened to my father. He had to go private to get a simple blood test. We had to involve an MP to get him infront of a urologist. He never got physio and was told to go private.

All fine and good saying the PSA test isn't good when asymptotic but most going to the doctor have symptoms. That is why they are going to the doctor. Also it's important to track the changes. Doing a one off test doesn't help that is why Denmark and US both test annually from a relatively young age. My FIL was recently checked out because his PSA levels increased but were still within the normal range. He has stage 2 prostate cancer and they assume it's non aggressive. They have him on a 3 month PSA check now and will do another biopsy in a year to check progress. If it's progressed more than expected they said they will do surgery to insert the radioactive pellets.

Want2bSupermum thanks for that. It's not my 'attitude', it's the evidence base. And if you take the care to read my post I was very clear that I never refuse a request for the test but ensure the patient has the opportunity to make an informed decision about whether to go ahead with it.
Had your dad seen me and requested a test while asymptomatic, discussed with me and still wanted to have it then he would have had it. As I clearly said in my post. Although you say your father was symptomatic which is an entirely different situation to asymptomatic screening anyway. Obviously I cannot comment on the care he did or did not receive as I wasn't there.
Anecdotal evidence, whilst emotive, is not population based. I am very sorry that your father has had a bad experience though, it is obvious that it is very upsetting for you.

I found out my dad has prostate cancer recently. His only symptom that made him go to the doctor was wee problems and he thought he had an infection or something. It’s already spread to nearby lymph and bone.

I’m now very much aware of the importance of routine tests. 1 in 8 men will get prostate cancer. Get him to have himself regularly checked if he is of the age.

Oh please don't let this turn into a bunfight

My grandfather has stage 4 prostate cancer while my grandfather-in-law has it at an earlier stage. It scares me how common it seems to be and I do hope that if one good thing comes out of Bill's diagnosis it's that more men go to the doctor with their concerns sooner.