Prostate CA: Sy grows a 'tache and KF grows half a beard

[Steve A]

All the best to you Geoff sounds like they have your situation in hand
I’ve had the finger but can’t get the blood test done

[GeoffSmith]

There is new NHS guidance so if you're over 50 and you (manage to get to) talk to your GP then you can get a PSA test. I'm not sure whether it is country-wide but Bristol (after research with UCLA and others reported in January 2017) have introduced MRIs within 2 weeks of an abnormal PSA result. I think that one of the problems in the past has been due to biopsy being the next step in the process - I can understand this as the biopsy is not to be undertaken lightly and can miss cancer sites but the MRI should help rule out false positive PSA results and target the biopsy to maximise the efficacy.

[Saltire]

At least you have a GP/Surgery/Whatever that will happily entertain your condition......

completely. My (also rural) GP surgery operates exactly the same system, so much so that I’ve pretty much given up trying to contact them. Last November I developed a couple of lesions on my legs. Not painful, but unsightly and needing checked. It took me three weeks of daily 08:00 phone calls to get an appointment with a trainee doctor. She prescribed some cream - which had no effect, and said “come back in a week”. This time, it took a month of phone calls.

Repeat twice more, and eventually they decided to do a biopsy, which was straightforward by comparison. When I rang to enquire the results, I was told they were “inconclusive”, and I’d have to see a specialist. And the earliest he can see me is . . . . February 2020. November 17 to February 20 - good job it’s probably not serious

The NHS is broken. And money alone won’t fix it. Just to cap it all - and back on topic - my GP practice has a page on its website telling you that they won’t give you a PSA test so not to bother asking.

Interestingly, a private GP service has recently opened in Tetbury, the next door town, and it’s heavily oversubscribed.

[Giniw]

November 17 to February 20 - good job it’s probably not serious

Oo
Appalling!
It's bad here, but not to that extent though — yet.

[GeoffSmith]

…my GP practice has a page on its website telling you that they won’t give you a PSA test so not to bother asking…

The website of a typical GP's practice near you has a page on PSA testing and link to the NHS PSA pages. The GP's page was posted on 8th March 2016 when (thanks to Wayback Machine) the advice was:

Should I have a PSA test?
Because the results of the PSA test are not as reliable as doctors would like, other tests and investigations are needed to diagnose prostate cancer.
A PSA test cannot identify prostate cancer on its own, and changes in PSA levels alone are not a good reason to start treatment.
If you are thinking about asking for a PSA test, it is important that you first discuss whether it is right for you with your GP so you understand what the results might mean.
The Prostate Cancer Risk Management Programme has information on the risks and benefits of the PSA test to help you decide whether or not to have it.

The advice is now:

Should you know your PSA level?
Instead of a national screening programme, there is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.
If you're a man aged 50 or over and decide to have your PSA levels tested after talking to your GP, they can arrange for it to be carried out free on the NHS.
If results show you have a raised level of PSA, your GP may suggest further tests.

Of course it's always useful to read the GP's crib sheet.

[Saltire]

That’s very interesting, Geoff. I raised it last in Feb or March of this year, and the (verbal) story coming from the practice (which you identify correctly, btw) was that they’d be swamped if all their male patients in the target age group asked for test - so they were encouraging people not to.

Amusingly, I took Bentley (my dog) to the vet yesterday for his regular Cushings disease check up. I had to take a urine sample with me (not mine). They took blood as well at 11:30, and by 4pm the they’d done full bloods, haematology, and urine, and the vet was on the phone discussing the results and recommending treatment. And that costs me less than £30/month to cover all conditions across Bentley’s lifetime. Furthermore, I can ring the vet and get an appointment with a named vet any time to suit me over the next few days. If it’s an emergency, someone is available as soon as I can get there.

Matt Hancock, watch and learn.

[woody]

Thanks Geoff, that is very helpful.
Having had my DRE, I have now been referred to the Hospital for further tests.
My GP found the prostate was smooth, and round(no nobbly bits), but slightly enlarged, and together with the raised PSA levels, he felt it needed further investigation.
I should get an appointment next week, the hospitals here in Nottingham are very good.
Cheers,
Woody

[GeoffSmith]

Someone asked me about the relevance of the MRI scan so I thought I should share: These are my own thoughts and may be a load of bollocks…

Until recently, an elevated PSA required a biopsy to investigate matters further: Given that the PSA levels can be increased by a multitude of activities (exercise, cycling, sex [particularly anal sex as the nurse told my wife and I ] etc.) immediately prior to the test, the risks associated with the biopsy, the possibility of missing a cancer and the irrational nature of some people who have never had to problem solve a Lotus, then I can see why GPs may appear less than enthusiastic about agreeing to a PSA test. I am lucky that Southmead urology are at the forefront and were actively involved in the study with University College London that recommends MRI as the next stage of an investigation into an elevated PSA test. Other health authorities may be implementing similar protocols but perhaps they don't yet fully appreciate the benefits.

My PSA was obviously high and the prostate was smooth but enlarged. I was told that the MRI screened out about 25% of abnormal PSAs (false positives) where no further action was required. As something was found however, the benefit of the MRI is that they knew where to target the biopsy (guided by the ultrasound probe inserted into a suitable dark recess). I had four targeted samples based on the MRI and 9 from across the whole of the prostate. There was one site in each of the sample sets so if I had not had an MRI and if the random samples had been in slightly different positions, my biopsy could well have been a false negative and shown nothing.

If I decide to go down the active surveillance route, they have a baseline PSA, MRI scan and biopsy, so any significant changes in the PSA can be investigated in the first instance with an MRI scan which may do away with the need for a biopsy (there is no denying that the biopsy is not a particularly pleasant procedure, but no worse than a trip to the dentist).

[alan e]

Well i got my PSA tested and it came back a bit high so now i have to pee in a tube and take it to the doctors to be tested have a new PSA test and have my walnut checked
(not looking forward to that).

[Dave Eds]

Guys, with the heaviest of hearts I have to announce my dear friend Dave finally lost his fight for life today. I managed to speak to him yesterday and as he drifted in and out of consciousness he mentioned his wedding to Maxine and clearly knew who he was speaking to. God bless him for everything good he brought in to my life and to the lives of everyone who had the honour to meet him personally or via such communities as this.

Rest in peace my old scouse blagger mate, such a pleasure to have met you and made such good friends.

[HJ2]

Oh wow.... that is sad news indeed. My condolances and all the best in the time to come!

[theelanman]

Dave can you pass on my condolences from myself and my family Dave was one of those guys tou just couldn't fail to love him...... a dangerous wit and an around star will surely be missed
A very sad day....... rest in peace my fine friend

[Steve A]

A very sad day, truly a loverly man

[muley]

Really sorry to hear this.

My condolences to Maxine et. al.



Jim

[Brit-Car-Nut]

Very sorry to hear this.

Dave PM'd me numerous times and his words were more than helpful.

I am sorry for the battle that was against him throughout.

[GeoffSmith]

Thinking of Dave today as I've just had another biopsy. Based on the quarterly PSA results and recent MRI, the little bugger is growing albeit slowly. I've had no dramatic symptoms to date and it was only because of Dave's nagging that I got checked out and it is being monitored by active surveillance. They have refined the transperineal biopsy procedures (I was one of the first batch of 300 in Bristol in August 2019) and it was a lot less uncomfortable than last time. It's still there and I have come to terms with that so hopefully I will continue with active surveillance.

Bottom line is, if you've reached that certain age then get a doctor to poke his finger up your bottom (as Dave T used to say to me) and ask him for a PSA test.

[Saltire]

Glad to hear you’re doing fine, Geoff. Sadly our GP practice will not carry out PSA tests on request, so we are reduced to waiting and hoping . . .

[Dave Eds]

I don't think that has changed much Jonathan.....Dave would always insist that we insist or even demand in the nicest way.....
So I have to insist and demand on behalf of my good mate that we all insist and demand in the nicest but most assertive way, after all our lives may depend on it and his suffering does not mean that any of us should suffer - indeed quite the opposite!

[GeoffSmith]

I said it in 2019 up there ^^^^ and I'll say it again: Assuming you can get an appointment, demand one as you are entitled (unless you are a lot younger than you look). GPs used to have a quandary as the next step after a high PSA was usually transrectal biopsy with associated (comparatively high) risk. The risk has been reduced with MRI and transperineal biopsy follow ups.

BTW I have just been having a discussion with someone on Twitter who, like Dave T, was diagnosed too late. You don't really want to go there.



[EDIT] Well said Spud.

[dapinky]

Indeed, and if pleas go unheeded, add plenty of 'family history' into the conversation.

When we moved to Wales I was told that they don't do PSA testing (even though I had to have annual blood tests for other stuff, so it was just 1 extra test to do, and my records showed the previous PSA results for the preceding 6 years at my old surgery).

I was told that they would only do it if there was a history of problems in my family - it's the only time in my life that I can say I was pleased that my dad had prostate cancer 25 years ago, and it was removed with surgery.

They reluctantly agreed to do it, but I have to ask every year to ensure it continues.