PSA Screening Rejected

prostate_logo Sometimes what I read in reported articles makes me weep. I don’t know whether it is inaccurate/over-simplified reporting or the attitude of experts that causes my weeping. I’ve had a vested interest in this one. Here are snippets from the relevant BBC article.

UK experts have recommended against a screening programme for prostate cancer, saying its potential harms would outweigh any benefits. … PSA screening has been contentious because of concerns about over-diagnosis.

Potential harms? Of a blood test? Over diagnosis? What crap is this? This particular article doesn’t elucidate on the “potential harms”. As far as I know, the blood test is perfectly safe and nobody, as far as I’m aware, diagnoses prostate cancer based upon PSA levels alone. We know full well that there are other causes of increased PSA levels and that some with prostate cancer do not exhibit increased PSA levels. It’s just one of the few tools at our disposal. If you have restricted urine flow, look further. if you have increased PSA levels, look further.

… a normal PSA test result does not guarantee that a man does not have a tumour. It can miss cancer and provide false reassurance.

Complete bollocks! A PSA test doesn’t look for cancer, the biopsy that may subsequently be performed does that. PSA tests, along with DREs (Digital Rectal Examinations) are used as indicators as to whether a biopsy might be advisable.

I am confident that this is the right decision.

– screening committee director Dr Anne Mackie

Said she, who either is or will be treated to both regular mammograms to screen for breast cancer and cervical smears to screen for cervical cancer.

Men should speak to their GP if they have any concerns.

– Professor Julietta Patnick, director of the NHS Cancer Screening Programmes

No shit, Julietta [Ed: who will also be treated to regular mammograms and cervical smears]. Brilliant! For a glaringly obvious statement such as this you needed to be a professor? How are men supposed to develop their concerns when you’ve rejected screening? They are left only with their toilet habits and we know how aware and open most men are of those.

Although this decision is not a surprise, the announcement is extremely disappointing. While the evidence points to the potential risk of over diagnosis and over treatment through large scale PSA testing, we also know that for some men with aggressive prostate cancer, but no symptoms, the PSA test will be the only early indicator of the cancer at a time when effective treatment can be offered.

– John Neate, chief executive of The Prostate Cancer Charity

Not that a male would know anything about prostate problems, of course.

The quoted article above links back to an April article headed, “Warn men of prostate test distress, study urges”.

If a man has high levels of the protein PSA, a biopsy is carried out, which in most cases shows there is no cancerous growth at all. A British Journal of Cancer study found for 20% this was a distressing process, and that for some these feelings continued even after a negative result.

When I began PSA tests about 5 years ago, I was told that, of the biopsies that returned negative results (no cancer), ~30% were “false negatives”. i.e. cancer was actually present. That’s why I chose not to have one originally. Why go through that discomfort when you could have no faith in a negative? Maybe any continued stress might have been due to the inaccuracy? In those days, cheapskate Britain took only 8 biopsy samples while other European countries took 16 (or thereabouts). We now take 14 in an attempt to reduce false negatives.

We found that in some men, the psychological effects lasted even after the men were told their biopsy was benign. It’s essential that doctors know about this, and that men are fully informed of the psychological challenges they may face during and after a PSA test.

– Professor Kavita Vedhara

Thanks professor – more mixing up of the PSA test and the biopsy. Post biopsy stress, even when benign, will be a result of inadequate testing leading to too many false negatives. Thus the negative is effectively unbelievable. This is not the fault of any PSA test, it’s the biopsy test that was inadequate.

I’ve been having PSA checks for 5 years and, of course, there is a little stress waiting for a result. Will it have increased? How much? It varies by about 30% naturally, anyway. Waiting for the result of any test is stressful. Waiting for A-level results is stressful. That’s life! I’d expect stress levels to increase waiting for the result of a cervical smear or a mammogram. Have they found a mass I didn’t feel? Did that stop anybody screening using smears and mammograms? No certainly not. Did anyone spout this nonsense about stress levels caused by the screening offered to females? I doubt it.

Ultimately, what is more stressful, waiting for a test result or finding out, after it’s way too late, that for the last 10 years you’ve been developing an aggressive prostate cancer that is now too advanced to be excised and it’s going to kill you?

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