March is Prostate Cancer Awareness month

[Andrew Gabriel]

Most of the members here are going to be of an age where prostate health could be an issue. As someone who's gone through this mill, I thought it might be useful to explain it.

Most importantly, it is helpful to understand your risk.

In the UK, 1 in 8 men get significant prostate cancer (and Cancer Research UK suggest this is increasing to 1 in 6 men born from 1960).

The risk increases with age from age 50, although there are more younger men being diagnosed in recent years.

If your father or brother had prostate cancer, your risk is 2-2½ times higher.

If your mother or sister had breast cancer below age 60, your risk is also increased.

Black African and Black Caribbean men are at twice the risk, with 1 in 4 getting significant prostate cancer, and it tends to be more aggressive and at an earlier age.

Prostate Cancer UK have produced a 30 second risk checker for NHS England, to help you understand your risk, and decide if you should ask for a PSA test.

Most men diagnosed with locally curable prostate cancer have no symptoms of the prostate cancer, and even some men diagnosed with advanced incurable prostate cancer have no symptoms.

The best test we currently have is to request a PSA blood test. PSA is the main chemical the prostate manufactures, but it isn't meant to go into the blood. The disorganised cells resulting from most prostate cancers cause increased levels in the blood, but so does aging, infections, enlarged prostate (which is nothing to do with prostate cancer), sexual activity, and some exercises (bike and horse riding), so although PSA is the best quick check we currently have, there are many other reasons PSA can be raised. 15% of prostate cancers don't raise PSA at all. A digital rectal exam associated with a PSA test can also be useful, but is also not a definitive test. In the event of any suspicious findings, you will be referred to hospital for an MRI scan to image the prostate.

All men from age 50 have the right to a PSA blood test from their GP. Unfortunately, many GP's are reluctant to do this because they are way out of date on the prostate cancer diagnosis pathway. There was a time when this could lead to an unnecessary biopsy, but the current diagnosis pathway will always result in a scan first to avoid an unnecessary biopsy. Never allow yourself to be dissuaded from having a test because you have no symptoms - most men diagnosed have no symptoms. Men at higher risk should ask before age 50.

The pandemic has seen far fewer men go to their GP and get checked for prostate cancer, and as a result, there are over 14,000 men in the UK who would normally have been diagnosed and treated, but instead have no idea they have prostate cancer. These men are going to end up being diagnosed at a later stage, with increased chance of being incurable.

Don't die of ignorance or embarrassment. Andrew

[Andy Burns]

Yes, just before the pandemic, a schoolfriend and my father were both diagnosed and I put getting tested on my list, unfortunately it's still on the list, so thanks for the reminder ...

[Tim Lamb]

A timely reminder for our age group. I manage to tick all your risk factor boxes apart from enhanced PSA reading! My surgery put me forward for tests and monitoring. A biopsy found a small amount of cancer in one of 12 samples. Covid has interrupted hospital visits but they do still ask for 6 monthly PSA checks.

Currently the biggest inconvenience is daytime piddling: every hour or so! Luckily, I only get up once at night and there is usually a convenient tree or tractor wheel during the day:-)

Get yourselves checked.

>

[Harry Bloomfield Esq]

It happens that Andrew Gabriel formulated :

They flagged up my PSA levels, following a not associated blood sampling. That was followed by an ultra sound scan, an MRI and the the digital exam plus questionnaire, but no biopsy. The outcome was just natural prostate enlargement with age, no problems.

I am on the watch list, for increased PSA levels and they recently were in touch again, because they had reduced the trigger levels nationally for PSA concerns. I was able to confirm nothing much had changed and I had zero issues.

[Bob Eager]

Indeed.

And me, about 15 years ago. I had three biopsies; the third one put me in hospital with sepsis, which they had trouble treating, so I was in for ten days. They stopped for a while after that.

They then (a few years on) put me in for a template biopsy, which is an operating theatre job. Had to go to a different hospital (Maidstone) where the consultant said my flow rate was 'rubbish' and offered to fix that at the same time as the biopsy. In and out in a day, 1 overnight stay. All clera so far and the PSA readings are fine.

Often not even that now. My wife gets up more than me.

Fun bit from the ten day stay. I was on a particular antibiotic that had to be closely monitored (blood test at noon to determine next does at

1800) every day. I was fine but bored. Was just having final check with the consultant (who had an attractive junior doctor, called Claudia, with him); he wanted a blood pressure reading before he'd let me go.

It came out rather high, but he said he'd subtract a bit from that and discharge me. The subtraction was due to what he had observed, constantly, as the "Claudia effect" on male patients.

[Dave Plowman (News]

Quite. At age 73, I saw some blood in my pee. Only once. But contacted my GP. She immediately arranged for a hospital appointment - had it 3 working days later. This was 4 years ago, pre-Covid.

They did blood and urine tests. Ultrasound scan. CT scan with contrast. And a cystoscopy - all in the same day. And on the cysto screen I was shown what they said was likely bladder cancer. A red spot about the size of a 50p piece. The camera also showed some parts of the prostate. Said to look fine, but slightly enlarged.

The same day was booked in for a TURBT two weeks later. That is done under a general anesthetic using rigid cysto. Removing the tumour and doing a biopsy to find out what sort of cancer. Had a second one a month later, followed by BCG. Squirted into the bladder to help the immune system fight the cancer. 15 in all over a year. Have had 3 monthly cystos for the next year, then 6 monthly, since all was well.

Do *not* ignore blood in the pee etc ever. The sooner a cancer is treated the better chance of success.

Even at my vast age, I only need to pee once at night - usually about 6 am. Despite taking plenty fluids.

[Tim+]

That?s the kind of experience that rather puts me off going for a PSA. If I could be sure that in my area that they *didn?t* dive in with a needle biopsy I?d be happier about getting a PSA test. Guess I need to ask my doctor what happens locally.

It?s far from being a minor safe test and I?ll need some convincing to undergo one.

Tim

[Tim+]

Not all blood in urine is due to cancer though. I?ve had it but was perfectly happy not to be investigated as I had a reason for it that I was aware of.

For the general population though it good advice to recommend speaking to your doctor about it.

Tim

[Andrew Gabriel]

Most hospitals do an mpMRI scan first nowadays. This change was rolled out during 2018/2019. In many cases, this gives a clean bill of health and no biopsy is needed. If a biopsy is needed, it will be guided by the mpMRI scan to sample the suspicious areas, as well as a few other random samples. Before mpMRI scans, biopsies were "blind" (not guided by imaging), and sometimes missed significant cancer.

Also, biopsies are not done transrectally any more (known as TRUS). It was impossible to clean the rectum sufficiently, and around 3% resulted in prostate infection (in spite of a large prophylactic dose of antibiotics), and some of these became sepsis. The infection rate had been increasing steadily due to anti-biotic resistance, and became unacceptable. Biopsies are now all done transperineal, even the outpatient ones (known as LATP - Local Anesthetic Transperineal). The infection rate with these is extremely low (many hospitals have never had a single case). Many hospitals allow patients to request the biopsy under general anesthetic instead, but that will always add delay to get you onto the operating theatre list.

If you find your hospital isn't doing mpMRI before biopsy, or you're offered an old TRUS biopsy, refuse and ask your GP or the hospital to refer you somewhere else instead.

Cheers Andrew

[Tim+]

Thanks. That?s useful to know.

Tim

[Dave Plowman (News]

True. It could be just a urinary tract infection. But with cancers there is often no pain etc in the initial stages, just some blood.

Likely because of my age, my GP immediately sent me for specialist investigation.

[Andrew]

Or compost heap :-)

[Bob Eager]

The PSA is just a blood test, not a biopsy.

[Lawrence]

5 years ago my flow rate was so low that I had to have a permanent catheter fitted while I waited for an op and further investigation. Two years before I'd had a biopsy that was declared clear. The op kept getting put back and eventually I moved on to self catheterisation. Three and a half years ago I had a turps op and 80% of my prostate was removed. This was biopsied and declared clear. Seven weeks ago I had blood in my pee. Within 5 days I'd had an ultrasound scan and flexible cystoscopy and told it didn't look like cancer but a PSA test showed very high levels. Three days later an MRI showed that my prostate had regrown but there was no cancer. I'm now on a regular PSA watch with higher than normal trigger levels. I consider myself to be lucky. The NHS stepped up to the task of looking after me. I forgot to mention that 8 months ago I had a heart attack and had a bypass to sort that out as well.

[Tim+]

Or trauma/mechanical abrasion.

Tim

[Tim+]

Of course, but if a high level automatically leads to a biopsy?

Now I don?t know what happens in my area (yet), but I?m in no hurry to have a biopsy.

Tim

[Ian Jackson]

You can always say "No".

If something might be amiss, then not having the precautionary tests and procedures isn't going to make it go away!

[Tim+]

Indeed, but having an invasive test with a high complication rate isn?t necessarily going to do you any good if you don?t have prostate cancer.

Now, as I?ve said, I?ve not kept abreast of what happens following a raised PSA in my neck of the woods but false positives and the morbidity (and occasional mortality) associated with invasive testing needs to be considered before making a decision.

Tim

[Tim Lamb]

The ability to piddle over the *top* of anything ceased a long while ago. There seems to be an unusual form of gravity involved as, no matter how far over the toilet bowl I aim, there are invariably splash marks on the rim near my knees!

[williamwright]

Vigorous sex.

Bill