How One Wrong PSA Test Can Harm a Man's Life - Professor Freddie Hamdy

Perhaps the question aught to be posed differently at the start of diagnosis where a surgeon is not the first port of call and a better explanation of the situation should be discussed.

I was “lucky” not to be asked in that fashion because surgery was not an option for me as my prostate cancer had already emptied into the bones. So the panic was a different panic. “Get it out” is not the option when your skeleton is the problem.

I feel the discussion is already lost at the point that there’s a patient that is feeling that all is not well.

Cancer is not an alien; an entity that it’s possible or necessary to remove from one’s body. But most people think it’s an alien that is going to kill them, when with a better explanation and discussion, the cancer could be lived with for a while or maybe forever.

The public perception of cancer is still universally skewed and brings on an unnecessary panic — this needs to change. Not all cancer will kill you now.

As for screening, there’s a growing number of public now more aware of prostate cancer and its tests to determine whether you have the cancer — more work on information is needed to make the public more aware. The screening can come later, first let everybody know what it is and how to ask for help. 

I have friends for whom the phrase "get it out and have done with it" turned out to be less than the truth. 

Radiotherapy is often seen as second best, whereas there is a good argument that it is at least equal to surgery. Combined with hormone therapy it may even be better. 

The problem is that it is a long drag. The urge to "get it out" combined with what appears to be a quicker process is attractive in our time. 

Perhaps we need to teach everyone that there are occasions where slower is better, or at least less damaging.

Very true, I often read 'just want to get it out/get rid of' when there is no guarantee it won't come back although obviously a lot of the time it doesn't come back.

I think though that PSA test very important, my journey started when PSA went up to about 4.  Mri followed.

PSA and MRI most important bits in my mind u can tell so much from those two.

Yes potentially bad side effects from surgery, warm people about potentially what to expect and possibly advise for RT.

Steve 

If caught early,  low PSA, Gleeson and smallish tumour size they should try more treatments with RT and no HT, then potentially a doddle.

Steve 

I can identify with what Prof Hamdy says in the article.

When I was diagnosed with a small Gleason 6 tumor in 2017 my first reaction was get it out. But then I read many posts on this website and I realised that it's not like having a tooth out. So I chose active surveillance. 

I've been on AS for 9 years and it has been stressful. As Prof Hamdy says, at the slightest glitch I question if I should be having treatment. I've seen many consultants over the years (mostly private) and I've been offered a range of treatments, which I declined.

I saw one very eminent urologist who said bluntly that the only thing I qualify for is active surveillance. That was very helpful. 

I'm wondering if I should stop AS altogether. I should be more worried about high blood pressure. My father died of that aged 54.

Thanks Rob for pointing to the excellent article.

Hello All

It's all here - in the NICE guidelines, what should be discussed before any treatment:

NICE Guidelines - Recommendations - Treating Prostate Cancer.

So go on, tell me who had that discussion with their team????? Yes Mr xxx you have prostate cancer now here's a list of the treatments and possible side effects.

Oh by the way you may suffer sexual issues and urinary issues, but not to worry - let me get my knife out!!

Let's not forget we are all human and have choices in this life BUT the NHS needs to get it's act together and take the time to go through the options.AND the side effects. People don't realise it's major surgery and you just don't "get it out" and it's done and dusted.

My personal opinion (and not Macmillan's) is Surgery should only be offered in certain circumstances where the cancer is 100% contained in the gland and is either aggressive or cribriform pattern or there are other medical reasons that prevent other treatments. To me it's like taking a hammer to crack an egg. Having said that I am more than happy to give my full support to anyone who has had surgery and needs help and advice after the event. As most of you know surgery wasn't an option for me and looking back it wouldn't have been my choice either.

Let me finish my post by saying two things:

* My personal opinions do not stop me supporting anyone who is a member of our Community, whatever cancer or treatment they have.

* I am 100% in favour of Prostate Cancer testing for every male 50 over regardless of race, medical history or risk factor.

So take care out there and have a brilliant day.

Best wishes - Brian.

Hello Steve (Grundo) 

Grundo said:

PSA and MRI most important bits in my mind

Don't forget the prostate biopsy is very important too - PSA is an indicator but can be very inaccurate at times.

Thanks for your continued support throughout the group.

Best wishes - Brian.

Wow that's some time on AS David

Suppose staying on it solely depends on PSA and possibly more importantly what the MRI says , are tumour (s) staying the same size or just growing very slightly.

Best wishes 

Steve 

I agree with that Brian as regards your points on surgery 

Steve 

Yes Brian I know biopsy important but in mind MRI says it all or nearly all IE, where the cancer is , is it contained, tumour size in mm, 

And then if all looks ok via MRI but PSA highish then further bone scans probably.

But yes I know biopsy important 

Best wishes 

Steve 

By the way I think that there is a lot they still don't get right, perhaps they could get advice from people on here