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.

That’s an old study.

This is from the one I linked to earlier..,

Findings In this randomized clinical trial comparing men aged 50 to 69 years undergoing a single PSA screening (n = 189 386) vs controls not undergoing a PSA screening (n = 219 439), the proportion of men diagnosed with prostate cancer was higher in the intervention group (4.3%) than in the control group (3.6%); however, there was no significant difference in prostate cancer mortality (0.30 per 1000 person-years for the intervention group vs 0.31 for the control group) after a median follow-up of 10 years.

Meaning The single PSA screening intervention detected more prostate cancer cases but had no significant effect on prostate cancer mortality after a median follow-up of 10 years.

I get that single PSA screening isn't that useful but regular testing and rectal exams might well be, it is what private medicine offers. We just won't afford it on the NHS. The mpMRI seems a game changer too.

I can't pretend to understand which study or interpretation is 'right' but I did find very recent dissent from the National Federation of Prostate Cancer Support Groups (NFPCSG) at the BMJ's anti screening stance.
In particular noting this sentence "we should expect the BMJ to provide balanced reporting on the benefits of screening which now appear to outweigh the harms. We should not forget that over 11,800 men die from this thoroughly unpleasant cancer and UK cure rates languish below most other advanced countries."

www.bmj.com/content/362/bmj.k3966/rr-3

I can't agree that it is worth more deaths to avoid increased anxiety with over diagnosis.

That's not the risk. Not even close. The risk is many men who either wouldn't have developed the cancer, or would have died of other causes before it ever really affected them, being rendered impotent or incontinent by treatment and testing, or suffering badly from cancer treatment. About two thirds of men over 70 who die are living with prostate cancer which hasn't caused a problem. Detecting it is not really the point.

It would be nice to believe that there is a straightforward equation of more screening equals more cancer caught "early"/"in time" equals better outcomes, but in fact it's far far more complicated than that. The same is true for population screening of breast cancer under the age of 50. It does more harm than good.

That does sound more flippant than i meant, I meant the anxiety of overdiagnosing leading to what you say. Wouldn't early detection followed by monitoring be preferable to later detection folowed by monitoring? Certainly for the fast growing cancers? It certainly seems to be preferable in our individual circumstance. And we are in this relatively fortunate state purely because of a pre symptom screen.

Wouldn't early detection followed by monitoring be preferable to later detection folowed by monitoring?
If it doesn’t change the survival rates, no. It isn’t worth it.

That’s what the big recent trial found-earlier detection using PSA didn’t lead to a longer survival.

So we need a better screening process, everyone does seem agreed that single PSA isn't good enough. But other advances which haven't filtered into studies may well be helping the monitoring process.

Wouldn't early detection followed by monitoring be preferable to later detection folowed by monitoring?

If survival was the only thing that mattered, yes.

However, living with the knowledge that you have a cancer that needs monitoring does have a rather negative impact on life quality.

But do we need a better screening test? That’s the fundamental question. With some cancers, it makes a huge difference if you detect them before symptoms start. Others it doesn’t. Breast cancer spreads early so the benefits outweigh the risks. Prostate cancer isn’t necessarily one where a national screening programme would help more than a national education programme educating men on the signs to look out for so they can be seen ASAP by their GP and swiftly seen by urology.

If survival was the only thing that mattered, yes.

Research has showed that diagnosis of prostate cancer through screening doesn’t actual affect survival.

I totally agree OP. My DH (aged 56) has stage 4 prostate cancer. He will not live into his 70’s & die from an unrelated illness unless medicine advances at a much faster rate. He will likely die before he is 60.
His PSA was sky high at diagnosis & other than a backache he was relatively symptom free. Sadly he had had a PSA test a couple of years which was misfiled. Earlier intervention would have led my husband to a much longer life expectancy. Interestingly the consultants he has seen have told him this.
It is widely known that the PSA levels can change with something as simple at riding a bike but levels could be checked for doubling rate & in conjunction with a rectal examination do give an idea. Prostate cancer actually isn’t something men live happily with either. The treatment destroys so much & at a later stage prostate cancer is like any other - bloody awful & a killer.

Sorry OP I meant to say I do hope your husband recieves reassuring news & that you are okay. It is a truly terrible time :(.

However, living with the knowledge that you have a cancer that needs monitoring does have a rather negative impact on life quality It does hugely, I agree. I'm sorry if this is your situation too But I don't know how that can be squared with promoting early detection . UK cancer survival rates are below other comparable countries' and it seems late detection is held responsible. And this is always described understandably as a bad thing.

Perhaps I'm not the one to be discussing this dispassionately. I am too grateful to have discovered DHs early (I hope also early stage).

Thank you Diangled I am sorry for you and your DHs situation and I wish you all the best. X

I can remember when there were, Well Men Clinics, rolled out nationwide.

After about six months, they stopped doing them, because no-one was going to them.

I know a few Men whose Fathers etc have died from prostrate cancer, yet they wouldn't have the screening/tests offered to them.

We think my DH's (died 2005), cancer started in his prostrate, but he ignored all his symptoms.

Here in Liverpool, we were one of the first to offer breast screening to Women over 45 and other screenings, which have continued because the uptake was nearly 100 %.

It would be interesting what the uptake is, if they offered a full screen for prostate cancer. They could start with one health authority.

OP I totally agree.

My DF this week had his prostate removed following a prostate cancer diagnosis. He had to persuade his GP to check his PSA, his GP didn't want to 'open a can of worms'. Thank goodness dad persisted because they've caught it at a good stage.

I am all for prostrate screening . I lost my DF to prostrate cancer earlier this year .My DF had put the slight incontinence down to his age he was 65 ,but i was suspicious and got him to get his prostrate checked and his psa was sky high .By the time he was diagnosed it had bone metastasis .He live for around 4 1/2 yrs after being diagnosed. He was never one for going to drs and would never had gone for a check even if offered .OP i wish you and your DH all the best .And Diangled i am so sorry you and your DH are in this situation ,it is a cruel illness

My husband's father died of prostate cancer last year. Husband is in his mid-50s to went to the GP to ask if he could be tested. He was told there is no test until you show symptoms.

Thank you for all good wishes, I feel for all of you in a shit situation. Gosh Cowes that gives me the shivers, his dad dying of PC is one risk factor. Do you think you could try a different GP or go private?

FTR, it's "prostate". One 'r'. "Prostrate" means lying flat on your front.

Men who actually have symptoms should be checked. That's agreed by everyone, including the NHS. But the data just does not support the idea that screening asymptomatic men will save any lives, whereas it will definitely do harm. And the problem is that once you find something you can't unfind it, so there is going to be a lot of treatment that won't actually make lives longer.

PoleAxed100, FIL was nearly 90, so no doubt his age had something to do with his ability to fight. I'm so sorry to hear of your news, but caught early enough the prognosis is very good. FIL's brother had his prostate removed in his early 70s and enjoyed a further 20 years of good health, cancer free.