Oncologists aren't being mean when recommending not using mass screen on g for prostate cancer....

[mids2019]

https://www.dailymail.com/news/article-15859537/Health-Secretary-mass-prostate-cancer-screening-men-death.html

I work in radiotherapy and it's use in prostate cancer is non trivial. There are radiation risks to rectum and bladder which can deal to life long complications as well as erectile probllems. There are similar issues with chemptherapy.

prostate screening has been shown to result in an unacceptable level of false positives due to inaccuracy of diagnosis currently and also the slow growing nature of many of the tumours.

what worries me about this is that we seem to have cancer screening policy dictated by exper ts but by campaigners and celebratories. I hope prostate cancer screening is not introduced ed as routine and we can be reassured our health policies aren't driven by solel y emotion.

Your post is so accurate! Unfortunately daily mail readers don’t see the full picture…I worked in a similar field to you and have seen what radiotherapy & radical prostatectomies can do…experts know a lot more than Stephen Fry & Dodgy David Cameron!

I both do and don't agree.

I noticed my DP, aged 57, was taking a long time to pee, and getting up in the night to do so, which he never had before. That was his one and only symptom. He's a man, and he would NEVER have gone to the GP for that if I hadn't made him. He got tested and his PSA was 33. That led to MRI and CT and PET scans and a biopsy. Diagnosis of prostate cancer, Gleason 7, T3b, escaping the prostate and in the seminal vesicles but crucially it had not yet spread. He had a radical prostatectomy last November and he took until late January to feel normal-ish again, but the doctors hope/think he will be OK.
Whilst I agree that routine screening would identify a lot of early and slow-growing cancers that were never going to become problematic, causing a lot of extra expense and worry needlessly, I do think that PSA test probably saved my partner's life. The doctors were unequivocal that surgery or radio/hormone therapy was needed and this was not a case for watching and waiting. It is so lucky that I made him go to the GP, but we have since met a few men who found out too late and are now Stage 4 in their 50s, when regular PSA testing would have spotted the issue earlier.
I definitely think black men and those with a family history should be screened automatically - they shouldn't have to ask. My FIL had it and now my partner - I shall be telling my boys to get screened from about age 40 onwards.

On the whole I agree with you. But I was a bit disconcerted to read that those with the BRCA2 gene mutation are considered at higher risk and so should have regular checks but there's no effort to find out who has that gene.

I really worry about health policy being dictated by those who we well meaning but with very little knowledge on oncology or medical statisics. These are very difficult subjects at their core and so decision making should be led by experts. Any cancer death is tragic obviously but as a society we need to make judgments about what is best for the population as a whole. There are obvious resource implications in our decisions as well....Maybe it would make sense in a perfect world for all the population have twice yearly MRIs to detect brain rumours but there obviously isn't capacity.

I think the point here about health awareness/someone awareness and male engagement with healthcare.
Ideally your DH shouldn't need a wife to identify his symptoms and make him go to the doctor.

If men won't even go to the doctor with active symptoms are they really going to consistently engage with a screening programme anyway.

I think the thing is, if you have any concerns (or even none), you can go to the GP and ask for a PSA test.

It’s that simple for men. No grilling for symptoms, no suggestions it’s anxiety. You just walk in and ask for it. My dad did it over the internet. He got it within three days.

Introducing it as standard will lead to worse outcomes. I think it’s fair enough.

My husband was found to have prostate cancer in January following a blood test at the hospital following an accident. No symptoms whatsoever. His PSA was 25 which is five times higher than it ought to be. A prompt MRI showed an advanced T3b tumor, surgery is generally not advised at this level. At the moment there is no sign of spread, but he’s waiting on a more sophisticated scan which will tell us more. He’s currently on ADT (basically chemical castration) and will have radio therapy at a later date. Yes there are associated risks, but RT is much better these days and permanent damage is less common. He’s 63. If he had been called for routine screening at 60, as in many other countries, things might have been different. We screen women for both cervical and breast cancer, and in some cases women have treatment that isn’t always needed. A PSA test is a simple blood test, takes two minutes and doesn’t require any expensive equipment or training. Prostate cancer is the second highest cause of cancer deaths in men. If a man is found to have a normal PSA level that’s it, come back in a few years time for another check, if it’s low but higher than it should be it can be monitored regularly, this would mean men wouldn’t be diagnosed with a psa level of 25, or 100, it would be found early and monitored yearly.

But the charity themselves have said that screening is not needed!

Which charity said that?

Prostate Cancer UK seem quite disappointed about the decision - https://prostatecanceruk.org/get-involved/donate/dm/national-screening-committee-decision

The GP does discourage you though, my husband asked for one six months before he was diagnosed. They wouldn’t give him a test unless he had symptoms, which he didn’t, they said he’d need a doctors appointment first, but of course getting a doctors appointment for a non urgent issue is virtually impossible, I think they said there were no appointments available and to try again in a few weeks.

They don’t. My dad literally said on his form “I’ve seen it on TV and I’d like one”, and got it within three days.

@drinksdilemma that’s good that was his experience but my husband had a very different experience and had to fight for the test - despite a very strong family history.

The experts of course know more, but both Stephen Fry and David Cameron have both had prostate cancer, so probably know more about it than the average Daily Mail reader.

I’m glad your dad got one promptly, I’m just telling my lived experience. Our surgery said they’d only test if he had symptoms or if there was history in his family. They said he could come and discuss with a doctor but currently there were not any appointments available. Obviously different surgeries have different policies.

Agree with OP.
People want to believe that all modern medicine is a miracle. And that a simple easy cure exists for most problems.

My dad is living with Prostate cancer that hasn't spread. "Being monitored".

Dad became disabled about 5 yrs ago after treatment for a different problem; i believe that treatment for him fell into the category of over-diagnosis. It's not anyone's fault, everyone made the best decision they could. He hates being disabled. Am glad no one is trying to rush him into treatment for the P-cancer with all the risks that could have of making him even more disabled.

The way I see it is that if all men were screened very few men would end up with metastatic prostate cancer which is a devastating thing to deal with, my 62 year old neighbour died of this, 18 months after being diagnosed. If he had been screened at 55 it would probably have been discovered long before it spread into his bones.

But that’s not what the evidence suggests.

What it suggests is a lot of men would end up being diagnosed with and treated for something that’s not actually causing them any harm.

Of course they're not. All screening has risks (and personally I am wary of it) but, for some reason, people seem to see it as some kind of universal panacea - is it just through fear? Whilst I have long been full of admiration for Sir Chris Hoy (fabulous athlete and gentleman), his own personal experience has led him to lose his objectivity. The same can be said of other "celebrity" campaigners. They are, of course, entitled to their opinions but policy, ultimately, has to be guided by actual experts.

Exactly.

We may have an unfortunate woman that was diagnosed with aggressive breast cancer in her early thirties which would be rare. The family would advocate for mammograms from perhaps 25 but if course you would be picking very very few new cases with an additional massive health burden and needless worry for milllions. Medical statisticians and oncologists have spent years studying the pros and cons of screening and are in a position to make sensible recommendations. We should trust them.

There is a danger in having heath policy overly influenced by celebratories with a disease or charities with large amounts of cash seeing that as there is not an immediate golden bullet for cancer in the near future then they pivot towards virtuous but I'll advised campaigning for screening so they can be seen to do something.

I think you are absolutely right OP.

@mids2019

Have they done any of these studies for women? Because I feel as if the screening programmes for us are a similar risk, but I obviously don't have statistics.

If a man presents with a very high psa level (>50) then something is clearly wrong. I’d imagine that most men with that level would have active prostate cancer. Lower levels can just be monitored not necessarily treated.

Isn't one of the issues that offering mass screening only becomes cost effective if there is sufficient take up on it ? And men are traditionally less willing than women to respond to these screening invitations.

I've had bowel cancer, which was only discovered by me doing a routine FIT test sent to me in the post. Apparently only around 60% of those sent out are returned.