TESTS & SCREENING METHODS
PSA & DRE at the GP
most men will need no more
MRI & BIOPSY at a
hospital urology department
Mancheck encourages men to challenge these statements that you might hear from GP's
- PSA Refusal -
- The PSA tells me nothing -
- It's your age, don't worry about it -
- Every man gets prostate cancer but they don't die of it -
- You're drinking too much caffeine and alcohol (yeah!..but no but) -
- PSA tests are no use because they give false negatives and false positives -
- We will let you know if there is a problem (call your GP, ask for and record your results) -
- Your results are fine, nothing to worry about (but your GP fails to encourage regular future checks) -
PSA @ GP
BLOOD TEST for Prostate Specific Antigen
IMPORTANT NEWS MARCH 2016: NEW LOWER BENCHMARK. All MEN AGED 50-69 with PSA 3.0 (ng/ml) and higher SHOULD TRIGGER A GP REFERRAL TO A HOSPITAL UROLOGIST.
The PSA test still gets negative press from many quarters; some GP's, charities, health professionals and the NHS, not helped by a now discredited study in the USA. This PSA blinkered negativity and 'denial' by many has done untold damage to a clear way forward to combatting this serious health issue; leading many to think
I've heard about prostate cancer, a relative and friend
died from it but there's nothing I can do
- it's a health lottery
The PROBLEM IS NOT THE PSA TEST, an EXTREMELY USEFUL & ORGAN-SPECIFIC BLOOD TEST, but how the results are interpreted and what they can lead to. Any self-respecting GP should deal with patient anxiety and urology department avoid over treatment, two common arguments against PSA testing. Raised PSA levels invariably lead to BIOPSIES that expose patients to the risks of SERIOUS INFECTION and SEPSIS, the only significant concern for TARGETED MASS PSA SCREENING. Infection risk can be minimised by using the Trans Perineum Template Biopsy method which also gives more detailed results. Furthermore, using 'patient anxiety' as a reason or excuse to not deal with this serious men's health issue is a shallow and unacceptable argument.
Surely the priority for men is to have a risk-benefit choice?
- The choice to avoid being one of the 330,000 living with advanced disease.
- The choice to avoid end-of-life palliative care.
- The choice to avoid becoming one of the 12,000 UK men dying from prostate cancer.
NB: during the 48hrs before giving a blood sample you should NOT have: exercised vigorously, cycled, ejaculated, had a DRE, had prostate stimulation, a urinary infection. These can raise PSA temporarily, your GP can advice.
KEEP YOUR OWN PERSONAL RECORD OF ALL YOUR PSA TEST RESULTS & DATES for comparison year-on-year and discussion with your GP or urology consultant. A few days after your PSA test call your GP or surgery to ask for your ACTUAL PSA LEVEL and RECORD IT. Learn about how PSA generally rises with age, along with prostate size, for both BENIGN (ok) and MALIGNANT (bad) reasons. A 33% or 0.75 increase in PSA level over twelve months warrants further investigation. LARGER PROSTATE = HIGHER PSA.
Many men have 'normal' PSA levels of between 0.2 and 1. There is evidence that men with PSA 0.2 to 0.7 are highly unlikely to die of prostate cancer so if no symptoms appear this LOW PSA GROUP of men might extend the interval between check-ups, talk to your GP.
MEN AGED 40-49 having a marker (baseline) PSA test for future comparisons
The age-specific median value for men aged 40-49 years is only 0.7 so men in this age group with a PSA over 1.0 should keep-on-the-case, especially if it rises to 1.5, 2 and 3. Men from age forty might want to have a PSA test at suitable intervals (ie. 40-45-50) to set a baseline to compare future tests, however the NHS will not normally fund PSA tests for men under 50, black men under 45. Interestingly, the new Consensus Statement No.9 from PCUK says: ‘Asymptomatic men at higher than average risk of prostate cancer who have a PSA test between the ages of 45 and 49 should be referred for further investigations if their PSA level is higher than 2.5ng/ml. There are likely to be GP's unaware of this 'low' PSA referral level for higher risk men such as black Afro-Caribbean and those with a family history.
MEN AGED 50-69
IMPORTANT - FROM MARCH 2016 the Prostate Cancer Risk Management Programme (PCRMP) has set a new LOWER benchmark: ALL MEN AGED 50-69 WITH PSA 3.0 and over SHOULD GET A GP REFERRAL TO A HOSPITAL UROLOGIST. GP's cannot refuse men over 50 (black men over 45) from having PSA tests.
AN EXAMPLE OF EXCEPTIONAL PSA USEFULNESS a.k.a. EFFICACY
NO PROSTATE equals ZERO PSA LEVELS.
When a patient has had a prostate removal (a.k.a. radical prostatectomy) with no expected cancer spread to other parts of the body, that patient should have undetectable 'zero' PSA levels forever. If prostate cancer cells have managed to propagate elsewhere in the body the patient will start to get PSA readings to indicate further treatment required.
It is also worth mentioning that Urologists have access to thousands of PSA results and can use this data to assist in patient diagnosis; not surprisingly Urologists are PSA clever.
DRE @ GP
a.k.a. DIGITAL RECTAL EXAMINATION
A finger up the proverbial, usually very quick and painless - a glove and gel job. Your GP will feel to see if your prostate is enlarged or has a rough surface - small and smooth is better. As previously mentioned, prostates tend to enlarge with age for both BENIGN (ok) and MALIGNANT (bad) reasons, in parallel with increasing PSA values.
Mancheck aims to dispel some of the myths and phobias associated with the DRE. Usually it's very quick and without the slightest discomfort, ...WHERE THERE'S NO SENSE THERE'S NO FEELING !
MRI & the new mpMRI @ hospital
MAGNETIC RESONANCE IMAGING (SCAN)
Although MRI images cannot always detect early 'organ confined' prostate cancer MRI can help the target biopsies towards suspicious areas of the prostate. MRI will detect prostate cancer that has spread (metastasised) to other parts of the body. Currently UK men have limited access to the new mpMRI scanning method, a game changer for accurate detection of agressive (needs to be treated) prostate cancer. mpMRI is already reducing the need for biopsies and a UK roll-out of access to mpMRI is an urgent priority. [edit 2019]
BIOPSY @ hospital
PROSTATE TISSUE SAMPLING
MRI cannot always differentiate between 'organ confined' cancers that are aggressive and require treatment, and low-grade slow cancers that could be left UNTREATED. Biopsies involve the taking of tissue samples from WITHIN the prostate that are then looked at under a microscope by skilled specialists. Any cancers found are then given a Gleason grade dependent on severity.
RISKS: Raised PSA levels invariably lead to BIOPSIES that expose patients to the risks of infection and SEPSIS, especially when using the transrectal ultrasound (TRUS) method through the anus under local anaesthetic.
Some urology departments now only use the 'cleaner' and more targeted TRANS PERINEUM BIOPSY (under the scrotum) in preference to the TRUS biopsy, using MRI images to assist in targeting areas of concern. Unlike the TRUS biopsy, the TRANS PERINEUM template biopsy is often carried out under general anesthetic, although some urologists are using a new technique under local anaesthetic. [edit 2019]
PSA TEST -> BIOPSY -> INFECTION RISK -> OVER TREATMENT -> NEGATIVE OUTCOMES -> INCONTINENCE -> DEPLETED SEX LIFE -> LIFE & DEATH DECISIONS
The NHS is currently sitting on the fence. Targeted mass screening will require funding and extra professionals, some men will have negative outcomes. Urologists will argue they can avoid over treatment and minimise risks so that overall, on balance, there can be a substantial and beneficial reduction in the 12,000 UK deaths from prostate cancer. MANCHECK believes the current situation is a NATIONAL MEDICAL FAILURE and DISGRACE. The UK prostate cancer death rate is double that of the USA despite the USA's large high-risk population of Afro-Caribbean men, and a US prostate cancer mortality rate that has also been increasing over recent years.