Getting to the bottom of the Great PSA Controversy

pa_kelvin says:

05:07am | 26/11/12

There’s been a lot of talk this Movember, some good, some not so good. As some –one with Prostate Cancer I read most articles with interest. Movember is not just about men’s physical health, but also supports men’s mental health issues and supports other organisations such as Beyond Blue a men’s help line similar to Helpline or Lifeline.
I was first diagnosed with Prostate Cancer in November 2007 [age 48] after a routine blood test [not related to any symptoms of any Prostate problems] confirmed a high PSA reading, a further blood test was taken which confirmed the initial high PSA count after which a referral to a Urologist was made. During this appointment a rectal exam [reeeaaalllly uncomfortable] was performed ,at which time I was found to have an enlarged Prostate, further tests involving a biopsy were undertaken the following week ,which confirmed the presence of aggressive Prostate Cancer.
I sent my GP flowers with a card attached worded   *Thanks to you I’ll be growing Roses, not pushing up Daisys*
On December 11 th 2007 I had my Prostate removed {Lucky I’m in Private Health] during which I remained in hospital for 6 days [morphine good] until being allowed home ,still with a catheter for a further 2 weeks before having it removed.
All was good until Feb 2011 until I started having extreme pain in my lower back which was put down to sciatic nerve problems, but which further MRI scans, and a blood-test showed that the Prostate Cancer had Metastasized [transferred] to my bones
A normal PSA blood count should be below 4, mine at that time was over 1300. Bone scans showed tumours in over 65% of my bones [the only area NOT affected are my legs and arms] ,at which time a course of treatment was started immediately.
Treatment for Prostate Cancer is undertaken using Hormone therapy consisting of a 4 monthly injection and a daily hormone tablet the major side effects being similar to a woman going thru menopause [hot flushes, sore boobs, irritability etc.].
Hormone Therapy works to kill the Testosterone. Prostate Cancer feeds of Testosterone, so no testosterone to feed on means a type of remission, but no testosterone no sex life as it’s a chemical castration.   
Most Radical Prosectomys cause impotence due to nerve damage during surgery .A healthy sex life can still be achieved with the use of Viagra, or similar tablets, or in some cases injections [tried but painful] which can be very frustrating and do lead to a lack of “spontaneity”, but with the Hormone treatment diminishes any desire or urges completely.
Over time the daily Hormone tablets lose their effectiveness, this could take years, or as in my case 14 months. When monthly PSA checks show a rise the Oncologist takes you of the daily tablet, which then slows the PSA rise….. In my case it hasn’t….
Recent bone scans have shown no new growths of tumours on my bones , but my PSA levels are still rising , so it looks as if Chemo , for me , will start sooner ,rather than later… not something I’m looking forward to ,and which to be totally honest scares the crap out of me.
The Prognosis for some-one with my current symptoms 5 years ago would have been a death sentence ,but with new treatments available I should be around for years….This is in part due to funds raised by organisations such as Movember…
I have good days and bad days, mostly good days with a little bit of discomfort in *hotspots* of my bones, sometimes cant pick-up the grandkids when they visit ,I tire easily and cannot physically handle the workload of my small business that I was doing prior to Feb 2011, which is in itself very frustrating.
I occasionally break down in tears thinking *what if* and *why me* ,but as I’ve said to family and friends I am not going to lock myself in a dark room and become a complete blubbering mess and I’m determent to be around for a long time yet.
I have a Loving and supportive wife , 3 daughters and 7 grandkids [6 boys , 1 girl] all of whom are affected by my illness and who all need their Husband , father and grandfather .
All but 1 of my Grand-children is too young to understand what my condition is, but know Pa isn’t 100%. My daughters like any others with parents going thru what I am wait for the results of my monthly tests, and I know stress as much as I do. My mo website is below to donate.
http://mobro.co/4851509

acotrel says:

05:25am | 26/11/12

If I have cancer, I’d like to be aware of it early, and not left ignorant because of some cost-cutting exercise.

Old Fogey says:

05:30am | 26/11/12

Being in my mid 60’s and with an enlarged prostate which has been inconveniencing me for years, I really would appreciate a proper set of national guidelines.  In the past I have been sent for PSA tests but have been advised at the time that the test is unreliable.  Why bother?

Chris says:

05:35am | 26/11/12

What’s PSA?

Gregg says:

08:18am | 26/11/12

” So what is the point? The point is that PSA testing is a disorganised mess. There is currently no clear guidance about who might benefit from testing and who would not; no guidance on how frequently men should be tested; and no guidance on what represents a “positive” test result that should be followed up with a prostate biopsy – the only way to diagnose the presence of cancer. In short, there is no guidance on how to maximise the benefits of testing and treatment and minimise the harms.

Collectively, we are doing the Australian community a huge disservice by letting the present situation continue. “

Sometimes you have to make decisions yourself and even then having a bit more help would not go astray.

I think it was coming up for about five years ago that after continual headaches which I had initially put down to perhaps too long out in the sun and not enough fluids, I eventually went to our local GP and explained the symptons so he organised a scan which initially was alarming in that it showed something of possible significance which was later cleared with a second scan.
The GP was at least a bit proactive in that he said you’re at the age where we ought to do a full thorough examination as like most blokes when you’re reasonably healthy it is something not too readily thought off and any blood testing etc. had been some years previous so it was early in the year when I had my blood sent off.

This was where things did go astray for hearing nothing back from the medical centre I assumed all was OK and so on I went with life, still being reasonably active even if finding some things a bit on the tiring side at times, just the weather and getting older I thought.
Something else I cannot remember came up for me to attend the GP again much later in the year and as would have it he calls up the previous record and says ” Oh yeah, you might be a diabetic ” ( and this from results some nine months previously ) , we better do a blood sugar reading and bloody hell it’s 23! and that’s bloody high with diabetes and normal blood sugars are around 5 and 23 is well on the way to about 33 when you can apparently become comatose!

So I got injected with something immediately and he put me on to medication to bring the sugar level down fairly rapidly and then it’s a case of reading up on all you ought to do.
Sugar level is fine these days and all this co-incided some with a local meeting on mens health with concentration on Prostates and we had a guest speaker who had previously been detected early enough and so seeing as I was to go on to having regular roughly six month blood tests because of the diabetes, it was a simple enough decision on my part to add in PSA testing and I actually even add it in myself to the doctors referral for the blood test.

Touch wood and it is always in the low low end of the readings but like with all they can test for it is the trends to be aware of whilst for now all is pretty well OK on all matters I still keep each regular set of results so I can go back and check for trending if need be and maybe I ought to get smart enough to set up a few graphs for key areas.

As to who would benefit from regular testing, I would say that anyone where a trend developed would and as in pa_kelvins situation, he may not have had to be reliant on a test he was getting for something else.
And then as for what would be considered a ” positive ” result warranting further testing/biopsy, kelvin’s doctor was certainly on the ball and quite likely would have been as well if there had been a trend determined.

There are a lot of medical afflictions that become more dominant with age and regular blood testing, including for PSA is not really a big deal and not all that costly yet it could reveal so much, save many lives and so much in greater costs and grief.

I fully recommend everyone past 45 start getting regular medical examinations with blood testing included.
And make sure you follow up because some GPs may not!

Shane* says:

08:55am | 26/11/12

“So, the great big PSA testing controversy is missing the point. It’s not about whether men should be tested or not, because they are, and will continue to be, tested.”

That’s because you keep telling them to!

Simple really - The PCFA and Urological Society are the only two organisations who keep this up.

Mr Lowe, you need to stop telling men they should be tested! It’s half the problem.

Unfortunately the current mindframe of most men is that they “have” to get tested. Because the DRE made for highbrow comedy gold throughout the last 20 years, the assumption is that we all need to have the test once we hit a certain age. And that’s demonstrably not the case.

Robert S McCormick says:

02:14pm | 26/11/12

Just as there is an on-going debate about Climate Change - some scientists say it is real, some say it’s not & others say the jury is still out.
Is Humankind solely responsible? Are cows & sheep responsible because they fart methane all day, every day? Is it just Nature doing it’s thing? or is it a combination of the lot? The issue has been so politicised no-one is really 100% sure now.
We can all do our bit to cut down on what we contribute to those emissions & the pollution we strew around without a thought.
As with Climate Change so too with Prostate Cancer.
“To do the PSA test or not?” That question has been argued for decades.
My GP recommends it be done once a year. If the results remain static then we do nothing. If the results show a large change in the figures he recommends it be investigated further. My count, never high, dropped a few points about 5 years ago & since has not remained static ever since.
Yes, it kills more men per annum than breast cancer does women. The question is, & the stats which should be published, what is the average age of the 3000 men who die of Prostate cancer every year?  What is the average age of the women who die of breast cancer?
Compared to what Prostate Cancer gets, Breast Cancer gets far more coverage, far more Government Money. Or, at least, that is what we are told.

There is year-round emphasis on Breat cancer.
Poor old Prostate Cancer gets the publicity only during November. I worked as a volunteer in a small Sunday Morning Coffee Shop. Ostensibly this was set up to raise funds for Breast Cancer Research. It was staffed by equal numbers of females & males. If it’s not ironic it’s something else for when November came around we males suggested that for the 4/5 Sundays in November the proceeds should be donated to Prostate Cancer Research. That would have left Breast Cancer with getting the cash for the other 48 or more Sundays.
We got howled down. Why? Aren’t Men’s Health Issues every bit as important as Women’s? That little Coffee Shop was clearing between $100 & $150 every Sunday. We did not think that for it to donate between $400 up to $720 a year to Prostate Cancer was asking too much. Breast Cancer Research would still be getting anything from $4800 up to $7200 per year.
The result? The men, understandably, stopped volunteering for we believed that we were considered less deserving than the women in the group.
Our GP says there are, other than genetic reasons, lots of other ones which can possibly lead to Prostate Cancer.
There are also a number of things we can do to keep that PSA number down.
Not least of which are:
(1) Exercise! Yuck? Maybe but try it! It works! You’ll never have that “Body to die for” and it is almost addictive once you get used to going to that gym.
No time? Most open around 6.00am. What are you doing then? Asleep? It only takes about an hour or even less 3 times a week to strip off a heap of that blubber - the visible stuff & the stuff inside.
(2) Low-Fat-but-Not-No-Fat” diets.
(3) Limiting, but not necessarily eliminating, alcohol intake.
(4)  Weight Reduction - if you can’t see “It” without a mirror or, worse still, reach “It” you need to lose a vat load of lard, boys!!
(5) Naturally, Tobacco is off the menu!
JZR, sounds like our GP & if not is a very sensible, intelligent person.