to think Prostate Screening is too bloody hard to get?

[PoleAxed100]

I just want to raise awareness. Please read.

My lovely husband decided, with all the awareness about cancer screening in mind, to get his prostate screened. Turns out there isn't a screening process , his Gp surgery weren't interested and neither were his work health insurers. I'd heard of charities doing something but we couldn't find a current program. So my 57year old went to his Gp and asked fairly firmly for a prostate screen and while she was at it could one of his moles be looked at; it wasn't big, it wasn't dark it is just that it had changed shape a little. She was persuaded to refer for both issues but said she really didn't think he had cancer (yup said exactly that.

On Thursday last week at 2 different appointments he was told in the morning he had Melanoma and in the afternoon that he had prostate cancer. Both totally unrelated issues. The melanoma has been caught early, he needs more tests for the prostate.

Screening is really necessary. There were no symptoms at all for the prostate cancer and very little for the skin one.

Should've thought of a catchier title and been less wordy.

MN towers can move it/change title for you if you report your OP.

Maybe to AIBU & title about how it should be easier to get prostate screening?

Good luck with both things (the fact he had no symptoms is a good sign I hope)

There's no screening process? Isn't it one of the most dangerous types if not seen in time?

Sorry for your husband’s health problems.

There isn’t a good prostate screening test to roll out on a population level. Rolling out one that doesn’t do the job properly can do more harm than good.

I hope your husband’s treatment goes well.

Isn't it one of the most dangerous types if not seen in time?

No, prostate cancer isn’t usually one of those.

A man dies of Prostate cancer every 45 mins in this country but if caught early has a good prognosis. But we are notoriously bad in this country at catching cancers early. It is too expensive for the NHS and causes too many unnecessary tests and anxiety is the reason I think.

Thank you for Good wishes.

I too was amazed that there wasn't actually any screening process and diagnosis has to wait till symptoms appear.

Best of luck to him, OP. How lucky that he got himself checked out.

IAmRubbishAtDIY

There's no screening process? Isn't it one of the most dangerous types if not seen in time?

Are you thinking of pancreatic?

Hi all,

We're moving this one (and editing the title) the OP's request.

All the best to you and DH, OP

Thank you Sophie and GiantKitten for the suggestion.

Could your husband go back to his GP and ask for a PSA bld test? Not sure what the situation is in the UK but it is a fairly standard bld test here for males.

Thing is you need a screening process that works on a population level. I don't know if there is one for prostate cancer. The PSA blood test can be a bit ambiguous and with men I imagine there would be issues with uptake for routine prostate exams.

I'm sorry for your situation though.

Other purple, the PSA isn’t a good screening test. There was a big study that reported earlier this year.

www.google.co.uk/amp/s/scienceblog.cancerresearchuk.org/2018/03/06/why-a-one-off-psa-test-for-prostate-cancer-is-doing-men-more-harm-than-good/amp/

This is helpful in explaining the problems with the PSA as a screening test.

It's a very readily available test in the UK. When I worked in the labs I remember GPs were always adding them on to men over 50 having bloods just in case but it's not a test that gives a yes or no answer.

Sorry you and your husband are having such a difficult time.

PSA testing is not a good screening tool for prostate cancer (which is something the NHS website explains surprisingly well). It is neither particularly sensitive (some men with prostate CA won't test positive) nor specific (a positive test doesn't necessarily mean the man has cancer). There is therefore a risk that using it as a screening tool may not spot people who actually have cancer and may expose men who don't have cancer to the unnecessary risk of invasive testing (and the risks of prostate biopsy are not insignificant).

I think a rectal exam is necessary in any screening process. Collecting PSA results over time would also show if it is rising. My DH and DSs have had it done in the past as routine annual screening provided by Company Medical cover. Which is why we were so surprised how hard it was to access now.

My grandad got prostate cancer a few years ago after my aunt bugged him into getting the PSA test done. Then she made my dad do it, he also has it and wouldn't have lived to my grandads age. Their half brother, not related to my grandad, also has it.

Apparently it's really common in Afro-Caribbean men (my family are A-C).

It is the same for bowel cancers. Screening starts at 60 when you are sent a simple poo sample test. My husband died at 59 no symptoms until it was too late and he died only 3 months after diagnosis.
Had we lived in Scotland he would be alive today as they start screening at 50.

I was astounded older at thereally high rate in A-C men (my husband isn't). Familial incidence is also a risk factor. My BIL couldn't get his GP to test but hopes now that his Brother (my DH) has a diagnosis that he can persuade GP.

In my area, there's loads of posters encouraging men to go and get checked and what symptoms they should look out for, though I appreciate the latter didn't apply for your DH.

Wonder if it's area dependant (so the postcode lottery all over again)

In my area, there's loads of posters encouraging men to go and get checked and what symptoms they should look out for, though I appreciate the latter didn't apply for your DH.

That’s a different thing though. It’s right that men know the symptoms of prostate cancer to go in and get checked out as soon as they develop them. Screening symptomless individuals on a population level means you need a test with very specific requirements for it not to end up inadvertently doing more harm than good.

The trouble with prostate testing is it causes over treatment and that in itself carries risks. Most men with prostate cancers are elderly and will die with rather than from prostate cancer. Dependent on biopsy scores, most urologist offer a watch and wait with regular psa monitoring and biopsy again if results aren’t stable. Routine screening is likely to cause more problems than it cures within a population. Most men over 55 will have some signs of prostate cancer.
The screening via biopsy is unpleasant and carries real risks of infection and haemorrhage. The treatment can leave men impotent and incontinent. Long term it can wreake havoc with mental health and relationships because of ongoing problems.

I do get the arguments against population screening but obviously I can't agree that it is worth more deaths to avoid increased anxiety with over diagnosis. The biopsy on my DH wasn't undertaken until mpMRI indicated it necessary. He was reassured that the antibiotic protocol to prevent infection after biopsy has been improved since the hospital last had a serious infection as a result of the procedure and it certainly was different to what websites and handout stated.

"The debate over prostate cancer screening has raged for decades. Two large randomised studies tested whether screening reduces prostate cancer mortality and, while the US trial reported no benefit, 1
the European (ERSPC) trial noted a significant reduction in mortality. 2
In The Lancet, Fritz Schroder and colleagues 3
now report 13-year mortality data from the ERSPC study. At 9 years, screening appeared to reduce prostate cancer mortality by 15% (rate ratio 0·85, 95% CI 0·70–1·03); this reduction was 22% at 11 years (0·78, 0·66–0·91) and 21% at 13 years (0·79, 0·69–0·91). Importantly, the number needed to invite to be screened to prevent one death fell from 1410 at 9 years to 781 at 13 years; the number needed to detect cancer fell from 48 to 27, showing continued improvement in the absolute effect of screening. "

from The Lancet www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61008-4/fulltext