CampaignsHealthcare RationingCancer Screening & TreatmentProstate Cancer and the PSA test: a patient's story Prostate Cancer and the PSA test: a patient's story
By Alan Taylor - 07/06/2007
When I was diagnosed with prostate cancer in September 2000 following a random Prostate Specific Antigen (PSA) blood test I knew very little about the disease. However, I soon discovered that prostate cancer, which is the most common cancer for men, is complex and unpredictable. The statistics for the disease are alarming.
Each year 32,000 men are diagnosed with prostate cancer and 10,000 men die from the disease. To put this another way one man dies from prostate cancer every hour. A survey by The Prostate Cancer Charity in 2005 showed that only 1 in 10 people actually know what the prostate gland does and less than half those who took part in the survey knew where the prostate is located.
Early detection of prostate cancer increases the range of treatments available and the chances of a cure. Where detection is delayed the treatment options reduce as does the chance of a cure, although the disease may be controlled. However, for some men there are no symptoms so it is vital that men know they are at risk of getting prostate cancer as they get older, particularly those men who are from African Caribbean origin and those with a close male relative who has had the disease. It is important that men over the age of 45 have an awareness of prostate cancer so learning about this disease now could help save mens’ lives in the future.
The prostate can cause urinary problems, for example: peeing more often, especially at night; or difficulty starting or taking a long time to finish; or feeling that the bladder hasn’t emptied properly.
In 80% of cases these symptoms may be caused by other non-cancerous problems so if a man has any of these symptoms it is important that he visits his GP to find out what is wrong.
Awareness of prostate cancer is increasing and two questions frequently asked are why is there no prostate cancer screening programme and whether or not a man without any symptoms should have a PSA blood test to find out if he has a prostate problem which may be confirmed later as prostate cancer. The first question can be answered more easily than the second one.
Many men feel let down because there is no screening programme for prostate cancer but there are reasons for this. Due to the complex and unpredictable nature of the disease the Department of Health will not introduce a screening programme until there is evidence that screening will bring more benefit than harm. This explanation is more suited to a strategic policy statement and does not help men to understand the problems of screening so let me add a bit more detail to this. The facts are that the World Health Organisation has set out ten criteria which should be met before introducing any health screening programme. For example, the criteria requires among other things, that:
* the condition to be screened is an important health problem;
* its natural history is well understood;
* it is recognisable at an early stage;
* treatment is better at an early stage;
* a suitable and acceptable test exists to identify the disease.
At present only the first condition is satisfied. This is because the prostate cancer is still not fully understood by doctors in the UK and worldwide and there are differing medical opinions on how best to treat local or early prostate cancer. Also, there is a body of medical opinion worldwide which continues to question the value of the PSA test, with its failings, as an identifying test for prostate cancer for use in a national screening programme.
The conclusion from all of this is that there is no evidence that a screening programme would save lives so at present there are no clinical grounds to justify introducing a prostate cancer screening programme.
The second question concerns the option of having a random PSA test, which is the fall back position for men over age 50 but there is no simple or straightforward answer to this question.
Early prostate cancer may not cause symptoms so a man may not know he has prostate cancer until either he has a PSA test which shows a raised PSA level and prompts further procedures or he develops urinary problems and seeks advice from his doctor. It is important therefore that from age 45 men should find out what the prostate gland does and what can go wrong with it.
Learning about prostate cancer now may save your life in later years. From the age of 50 a man can have a NHS PSA test if he chooses provided his GP first explains the limitations, risks and consequences of having a test. If a man chooses to have a PSA test a “one off” test is useful but an annual test will show the pattern of a man’s PSA level over time.
So how can prostate cancer be identified? The starting point is the PSA blood test which measures the level of PSA in a man’s blood. This is not a test to detect prostate cancer but if a man’s PSA level is raised above the normal level for his age this may indicate a problem with his prostate gland. The accepted normal PSA level for men in their 50s is up to 2.8 nanograms per millilitre of blood, for men in their 60s up to 4 ng/ml and for men in their 70s up to 5.3 ng/ml. If the level is raised above the accepted normal level further procedures, for example an internal ultrasound scan and biopsies, may be necessary to confirm whether the increased PSA level is caused by a non cancerous condition or by prostate cancer.
Deciding whether or not to have a PSA test when there are no symptoms may be difficult for some men because of the contradictions when considering the advantages and limitations of the test. This is because the PSA test may give some men a false assurance that they do not have a prostate problem when they actually do have prostate cancer (a false negative result) and others who have a raised PSA level may have further medical procedures which may show that they do not have prostate cancer (a false positive result).
A further complication from a PSA test, which can cause unnecessary anxiety, is that the test may pick up prostate cancer which is not very aggressive and may not cause problems. The man will then know he has cancer and may be kept under long term surveillance but he may die with it rather than from it.
The common view held by many doctors is that the PSA test, despite its limitations, is the best test available as the starting point for investigating prostate problems which, after further tests, may or may not lead to a diagnosis of prostate cancer.
Would I advise men who do not present any symptoms to have a random PSA test? This has to be a personal decision made when a man knows the limitations, risks and consequences of a PSA test. My advice has to be that if you are a man age 45 or over then being aware of prostate cancer now may save your life later. Men over the age of 50 who feel the need for assurance should speak to their GP who can provide clear and balanced advice about having a PSA test and an information sheet. It is only then when a man has all the information and considered this in respect of his personal circumstances can he make a decision about having a test.
So there you have it! Prostate cancer is a complex and unpredictable disease with uncertainty to one degree or another at every stage. This is not helped by a test which has limitations and differing medical opinions on treatment options. But this is not a disease you can ignore and learning about it could save a man’s life now or in later years. For balance, I have to say that many men are diagnosed quickly and receive effective treatment and support from caring healthcare professionals so the news is not all bad.
For The Prostate Cancer Charity’s views on PSA testing when there are no symptoms and screening go to the first link below.
If you have any queries about prostate cancer call The Prostate Cancer Charity's confidential Helpline 0800 074 8383 which is staffed by specialist nurses and open Monday - Friday 10am - 4pm and Wednesday from 7pm - 9pm or visit the second link below.
For the Department of Health’s policy on prostate cancer screening go to the third link below.