UKC

Interesting letter - maybe counter-intuitive to some:

https://www.theguardian.com/society/2025/feb/02/men-concerned-about-prostat...

This seems like an opportune moment to mention an ad I have seen on TV regarding this subject.  A older man appears next to a younger man.  I'm sure the older man, with gey hair and grey beard, is a climber I have met at some time in the distant past but I can't recall a name. I have a very good memory for faces but apparently not names.

Also interesting that quality of life was never mentioned in treatment/management discussion, only mortality. Nor any mention of the false-positives raised by PSA testing that can cause anxiety. Sobering reminder that there isn't a clear and simple testing and treatment pathway and so much is "it depends .."

Hopeful for further advances in treatment and diagnosis, since this is an all too common condition.

Had quite a few relatives (on both sides of our family) who've battled this... including prostatectomy leading to full remission >25 years in a couple of cases so early diagnosis and treatment can work, despite the somber tone of the article/letter.

All European counries are moving ti a prostate cancer screening programme. The info in the letter is outdated. There are loads of big trials going on including in the uk. The main way is psa with mri. It is a scandal there isn't a screening programme already in place with the numbers that die. 

Never mind prostate cancer. We're currently failing almost all our cancer patients. 

From Today's Guardian;

https://www.theguardian.com/society/2025/feb/03/england-essential-cancer-tr...

TBF I haven't studied screening for prostate cancer but I have studied the principles of screening programmes and the benefits of screening programmes are not necessarily as clear cut as their promoters would suggest. Amongst other issues  are the problems created by false positives, (primarily stress for the potential victim and his/her family, and issues arising from unnecessary interventions; the issues caused by false negatives (victims becoming complacent and not responding in a timely manner when they start to experience symptoms); and the problem of simply measuring whether 'early intervention' as had a positive outcome on life expectancy. And the side effects of early intervention for prostate cancer (that the patient may not in fact have ever died from) can be particularly unpleasant, including impotence and incontinence.

(I've just done a cursory google, and I'm not sure how out of date that letter is, the US National Cancer Institute for example is still saying that 'PSA-based screening for prostate cancer is not recommended for individuals 70 years and older.' while the NHS launched the Transform RCT last year, I'm not sure when the results of that are expected.) 

How are you on prostates, Gaston?

This is the standard individual vs societal risk position.
The important statistic is the chance of a false negative is 15%.  - your choice! 

Seems familiar, but he can't quite put his finger on it

I've had several PSA tests (offered to all men over (I think) 60 in France). Both my GP & the urologist I was referred to  made it clear that a single result didn't mean much & stressed the importance of looking at trends.  I had a PSA over the threshold a little over a year ago & had a follow up test 3 months later which was a little lower but still over the threshold (possibly lower due to skiing rather than cycling in the winter). At that point I saw a urologist who organised an NRM scan which suggested a swollen/enlarged prostate but no cancer. After a drug treatment for a few months which didn't make much difference, he recomended an operation to reduce the size of my prostate which I had done in November. No real side effects, need to pee much less often (eg rarely need to get up in the night now). A biopsy on the bit removed confirmed no cancer but I'm scheduled for another PSA test later this year.

My Guardian subscription has run out so I can’t read the letter, But:

Last year I persuaded my GP to let me have a PSA test ( when I was 65) despite not having symptoms after a previous GP refused a test a few years earlier. The PSA result was very high and I was quickly referred to hospital where I had a digital exam, urine flow test and most importantly a scan, all on the same day. This indicated cancer which was confirmed by a biopsy two weeks later. My stage 3 is too advanced to be operable but hormone treatment (testosterone blocker making one weak, fat and over emotional) and radiotherapy has a high probability of curing it.

It is very true that PSA tests in themselves can be inconclusive, not simply green or red but lots of amber where there can be false positives. A perineal biopsy is not a fun way to find you are a false positive.  In my opinion the game changer which supersedes a lot of the  previous reluctance for widespread PSA screening is the recently much easier and prompt access to sophisticated scans ( although this is a bit of a post code lottery) which should correct many of the false positives avoiding need for a biopsy. I understand that the major NHS study in progress aims to clarify this amongst other factors.

My recommendation would be for all men late 4Os and older to badger your GP for a PSA test.

There's an interesting recent Inside Health that discusses the benefits and risks of broader screening in absence of symptoms.

https://www.bbc.co.uk/sounds/play/m0024vtd

In summary (from memory) a mildly elevated PSA doesn't tell you much, benign prostatic enlargement is pretty much physiological once you reach a certain age, many prostate cancers are low-grade and slow-growing (and you'll likely die of something else) and the side effects of surgical intervention are relatively common (including the one you immediately thought of).  Early testing of the worried well is not risk-free.

IIRC GP examining prostate via rectum is a fairly reliable way of detecting a swollen prostate and seeing if there is suspected cancer (rough surface). This is is very quick and mildly uncomfortable.

The PSA level is almost meaningless by itself the first time but does provide a useful baseline for a later second test, because it is an Increase in levels which gives a suspicion of cancer.

Sorry Kevin, your post arrived as I was typing.  Yes, scans very much a good idea, and should be universally available...  

You don't need a subscription to read it.

You do if you’ve used up your ration of free reads. 

No. Not for the Guardian.

I eventually went to the GP after a couple of years of minor symptoms. A digital examination suggested an enlarged prostate and a PSA test was done - this was 4.4, high but not too bad. I was referred to a consultant who examined me and thought there might be a cancer but a scan would tell.

The scan was inconclusive so they did a biopsy. That returned negative but the hospital said they would keep monitoring me with PSA tests. These consistently got higher until 18 months later they were over 8 and they took a second biopsy that confirmed cancer 2 days before Christmas in 2020. It was 7 on the Gleason scale, at 6 they would have monitored me but because over 50% of the cells were fairly aggressive they suggested immediate treatment.

3 months hormone treatment and a month of radiotherapy followed by another 3 months hormones and my PSA dropped to virtually zero. It's nearly 4 years since the treatment and I'm discharged back to the GP for 6 monthly monitoring with a PSA roughly 0.3 each time. The side effects of the treatment were awful but the other option would have been worse. I'm pretty much side effect free now.

PSA isn't infallible, and in my case the first biopsy wasn't either but the trend rather than the number on a PSA is what to look for. Having sex within a day or 2 of the test can give a higher reading and anything that irritates the prostate will increase it too so 1 high reading on its own isn't conclusive but can be a pointer. If anyone thinks they might have symptoms then an investigation plus PSA test is a good starting point and don't put it off.

I think that’s just in the app isn’t it? It’s all free in a browser. 

The guardian is free to read… you just need an account. I did relent last year and pay them a small amount but it’s not needed to read the paper.

Can we get back on topic?

Thanks for sharing Rick. My initial PSA was 36 on testing a year ago, biopsy showed Gleason 9. The hormone treatment has been hard but pleased that PSA now down to 3.4 I’m about to start my 4 weeks of radiotherapy then HT until summer ‘26. I’m really pleased it won’t be going on longer (PSA tests willing). How long did it take for the side effects to diminish after you finished HT?

As for the disliker on my initial post: F*** You!!

All the best with your treatment, Kevin 

The hormone side effects were just hot flushes which were ok and disappeared soon after I finished the therapy. The side effects of the radiotherapy was the problem. I would wake in the night bursting for a piss but be unable to get anything out, more painful than I'd like to go through again, but my mate had the radiotherapy without those effects so you can't tell how it'll be. I was also needing the toilet up to 20 times a day and that probably lasted about 6 weeks after the treatment and it was then a few months before I could safely get more than half an hour away from a toilet but I'm pretty much ok now. Your PSA and Gleason are much worse than mine were so I suppose that's why your hormone therapy will be so much longer - I only had 6 months in total. Good luck with it.

Thanks Rick. Actually my 2 years total on HT is pretty good, many have 3 years and some for life

+1 here for PSA tests despite the possibility of false positives. 16 years ago (at age 53) I had a routine set of well-man tests which included blood tests. These showed elevated PSA (5-6?). I had no symptoms whatsoever but my GP sent me for investigation.

As this was in the days of Gordon Brown's "waiting list to go on the waiting list", I opted to use private heath care. Prostate cancer was confirmed by biopsy and I then had brachytherapy (radioactive implants) which killed off the cancer.

I still have 6-monthly PSA tests which now register almost 0. I'm not sure I would be here today without the initial test (no symptoms remember). As I understand it, a key metric is how quickly the PSA level is increasing.

You need to be very careful in interpreting these studies...and even more careful with interpreting newspaper interpretation of the same.

Firstly, the study relates entirely to screening.  If men present concerned with any other connected symptom - usually, but not always, urinary flow restriction - then the numbers move significantly in favour of further investigation.

Secondly, the pathway from a raised PSA doesn't go directly to intervention, but rather to an experienced "finger examination" and monitoring and then to biopsy.

Thirdly, because it's usually a slow-growing cancer, age is important.  If you're diagnosed at 80 with a modest-scoring prostate cancer, you will almost certainly die with it, rather than of it.  This dilutes the numbers - but if you are in the 50-60 cohort and have a moderate gleason score, then intervention is important.

I was 53 on diagnosis - I turned up at the GP with reduced urine flow.  Blood test showed raised PSA, monitoring showed progression.  Grid biopsy showed grade 3 gleason 7.  Radical prostatectomy.  Unfortunately this did not clear, so salvage radiotherapy....and again not clear.  So now "living with" for the past 5 years.  I'm told it is likely to be "life limiting", but not soon, so there's no point crying in my beer and I generally don't think about it much other than at monitoring time.

So I'd urge you to get tested if you have any symptoms.  General screening of otherwise healthy men probably isn't best bang for the buck for the NHS right now.

I read something recently about studies and the dangers of drawing incorrect conclusions.

One example given was on prostate cancer. Apparently there were one or more studies on high doses (i.e. 5mg daily) of finasteride for men with benign (BPH) prostate issues who'd been taking finasteride for 9-12 months.

They did some biopsy and they found a small but statistically significant increase of adverse findings in the men on finasteride versus those with BPH untreated by finasteride. This was initially concluded that the drug use carried a small increased risk.

Seems an easy conclusion right? Well apparently the people on the drug had prostate 40% smaller (the purpose of taking it, for BPH!) so if someone had a small cancerous tumor within their prostate it was more likely to be discovered by needle biopsy than the same tumor in a larger prostate. The lesson was that it can be easy to make wrong conclusions from study results if the underlying factors aren't understood properly.

Anyway as it was prostate treatment themed, I though it fitted this thread.

Glad to hear your side effects from the radiotherapy have settled down. I'm a dosimetrist (I kinda design radiotherapy treatments for patients), and I don't really get to hear how patients fare after I've done my bit of the process, so it's always nice to hear a positive outcome. 

Also, I'm enjoying and pleased about this discussion talking about all this, it's a great thing to be doing.

Agree with the Norris above. This stuff needs talking about more, and these forums are over-represented by guys of a certain age, so quite a good place for it.

I'm glad doctors these days are very cautious with PSA tests. Mine will be 2, then 5 three months later, and the same numbers repeat. Not much useful information from that cycle, no trend, etc. Softly, softly approach is to be welcomed.

I have had something wrong with the waterworks since the lockdowns, and am finally seeing urologists in a week, and not before time.

But awareness needs raising for sure. I'd hazard a guess that anyone reading over the age of 50 has lost a couple of friends to it. The more conversations the better. 

I'm sort of jealous of the psa readings in the 2-5 range. My first one at the age of 53 was 21. The GP felt it was worth exploring further! Turned out to be a grade 5 cancer. Oops. 

Morning all. Ive been a bit busy lately so more lurking than posting. This thread has hit a spot though.

I have no symptoms but I'm 50 at the end of this year (gulp) so I suppose I need to start thinking about this as my risk factors increase. 

No idea where to start but I have seen more in the media about various tests and I suppose I should probably get screened soon. Do I go private or can I get this done through a national program?

Cheers 

Richard 

The best way is through your GP, if they are reluctant explain that you fully understand that PSA tests are not always definitive, and the risks and consequences of false positives. Mine relented when I explained a close friend much younger than me had been diagnosed with advanced PC but having no symptoms

What was the outcome?

It's a fair question. I do feel it's probably best to step away from the idea that prostate cancer can be a taboo subject - more conversations needed.  

As it turns out, it had also just crept into the lymph system. So I had the radical prostatectomy, 6 weeks of radiotherapy and 14 months of hormone treatment. To say it was a difficult 18 months may be an understatement. However, it all seems to have worked, and PSA remains undetectable 7 years on. Lots of side effects from the treatment, but at least I have a life to live with them.

Well done Gribble, there’s hope for all of us. How long did it take after HT finished for the side effects to dissipate? 

I don't consider any of this 'taboo' at all. Cancer of any form is a horrible disease, but prostate cancer is probably one of the better ones to get.

Thanks. That sounds like an excellent result.

I wish I could remember! There are many types of HT, I imagine the side effects and duration vary. Mostly, I was just pleased to stop HT. I did stop early, although more recent research shows that with that type, 6 months was sufficient. I was set for 24 months, and could only manage 14!

gp said not had psa since 2007,test score 9.5,pretty high so biopsy mri scan,bone scan now on hormone therapy with radiotherapy soon

i am extremely grateful to my gp