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

Hi Sandberg 

From the above comments I accept that I was very lucky in the way that my diagnosis and subsequent treatment was handled.

My consultant, who was on the surgical side, gave us (my wife and myself) a reasonably good explanation of the process and probable side effects of both surgery and radiotherapy and at the same time prescribed hormone therapy. He then strictly instructed us to go away, discuss the options plus do whatever research we desired before making a decision. He also told us that in his opinion and in my particular instance both scenarios should be equally successful, a curative pathway!

Time alone will confirm or deny that last sentence but I opted for RT.

Please feel free to read my profile by clicking on my avatar above if you wish to read my whole protracted journey to date. 

Rod

Hi David 

Just wondering if your psa tests have remained stable over the 9 years you’ve been on a/s 

As you may know I’ve been on a/s for nearly 4 years now with relatively stable psa tests albeit on the high side every 3 months but the last one was 11.1. 
My consultant said this could be due to a very enlarged prostate so waiting for the next one. 
Did you ever have a higher one that was different from the norm? 
All the best Roy. 

Hi Roy

My PSA has roughly doubled over 9 years.

I have had 2 spikes during that time and they were probably due to flare ups of prostatitis.

It's normal for your PSA to rise steadily as you get older. It could be due to prostate enlargement, liver and kidneys becoming less effective at removing PSA, or other factors.

All the best 

David 

I can understand the "pros and cons" with regard to universal screening. I was reminded of some UN reports following the 1986 Chernobyl disaster which highlighted one rabbit hole waiting for the unwary. I would think, that to some extent, the same could apply to prostate cancer. 

"In 2000 the United Nations Scientific Committee on the Effects of Atomic Radiation, and in 2006 also the UN Chernobyl Forum, stated that, except for thyroid cancers, in the highly contaminated areas no increase in the incidence of solid cancers and leukaemia was observed."

“As for the thyroid cancers, the increased discovery is due to a screening effect. In normal populations there is a very high incidence of "occult" thyroid cancers (with no clinical symptoms), which is naturally up to 28% in Japan and 35% in Finland, which is a hundred to a thousand times higher than the incidence of "Chernobyl" cancers. After the accident more than 90% of children in contaminated areas started to be tested for thyroid cancers every year. It is now obvious that such vast screening resulted in finding the normally undetected occult cancers.

(Wiki states: "Additionally, approximately 20,000 cases of thyroid cancer were reported among those exposed as children or adolescents at the time of the accident".  Possibly an accurate figure, but it actually tells you nothing.)

The number of cancer deaths predicted as a consequence of the Chernobyl nuclear power plant accident has been revised downward, from tens or hundreds of thousands to 4,000. The actual mortality for the accident has now reached 56, according to a United Nations report.

The 4,000 future cancer cases are just a theoretical construction, based on the linear no-threshold (LNT) theory for estimating radiation damage. In fact, it is quite likely that the Russian population will actually experience a cancer deficit as a result of Chernobyl. The liquidators—firemen and emergency workers—around Chernobyl have so far the same cancer incidence as the average Russian population (the rate is somewhat lower, but the difference is not statistically significant).”

I’ve found that a bit of a surprise post but I’ve always been curious about the health benefits of radiation. When I say health benefits I mean that there’s not the horrendous scary mass killing that was predicted. My feeling as a kid of the 70’s with leaflets telling me how to survive the nuclear holocaust.

Time will tell.

Hamdy’s caution is well-grounded in the evidence and ethics of screening: PSA screening "en masse" risks converting many healthy men into harmed patients. But his view shouldn’t be read as “no one should ever be tested.” The most defensible current path is informed, risk-stratified testing and investment in better diagnostics and organised programmes so that men who stand to benefit can be identified without mass over  diagnosis.

That said, rejecting universal screening isn’t risk-free either. Some of the arguments for PSA (when done thoughtfully) remain: there are men whose prostate cancer is aggressive and would go undetected until too late. For those men, early detection via PSA — especially when combined with follow-up imaging — can save lives or reduce the severity of disease. Indeed, analyses of large trials have shown a reduction in prostate-cancer mortality in certain screened populations. It was only a PSA test that began my journey of prostate cancer and the later biopsy revealed a very aggressive cancer. Perhaps the good professor should acknowledge that as with most things there is nuance and one size rarely fits all.