Prostate – tests, checks and concerns

I just I thought I’d open up a seperate thread as there has been some inevitable drift on the Chris Hoy thread.

I’m sure I’m not alone in finding myself thinking about Hoy family a lot in the last 24 hours. Partly such a devastating update for such a lovely chap, partly in awe for his positive outlook completely devoid of self pity. But……I’ve got confess there is a little bit that has also been thinking about this from a selfish perspective too. The poor guy discovered his situation because he had a sore shoulder.

From what I’ve read there is no age related screening in the UK unlike some other cancers. And I’m assuming this is for a good reason. A lot of ‘survivors’ say – “just get yourself tested”. But how? I’m guessing this means hassling your GP for a PSA test…which don’t sound that accurate – which is I assume why there is no national screening programme. Lots I’ve read in the last 24hrs suggest you might want to discuss “the pros and cons” of doing this prior to the blood test. I can only assume for there to be any cons there must be a lot of false positives that leads to unnecessary angst. Can’t think of a ‘con’ otherwise.

So what are the obvious signs….other than being in your 50s and a bloke? Who needs to get up 2 or 3 times a night for a piss….and has a sore shoulder…..Should the worried well be descending in their millions on their GPs asking for tests for no specific reason or is that just selfish?

It sounds like we have a few on here who have been through or are going through prostate related issues. You have my sympathies. But do you have any pearls of wisdom for the rest of us too?

What the OP said.   Been reading all the Chris Hoy stuff with sympathy, and re-reading some of Stanley’s content also.   For weeks now I have had a “feeling” down there.  No idea what it is, not a pain or an itch but like there something there that shouldn’t be that hasn’t gone away, perhaps a little like the very early feeling of “needing to go”.  All other bodily symptoms are fine, but this makes me think I should get a check up despite being quite reluctant to do so.   The recent news has made me nervous.

My experience.

Went to the docs because I get times when I either need to pee ‘a lot’ or can’t go despite feeling like I need to, so took the IPSS test and GP suggested that we get it checked. She did a finger up the bum – By the way; every doc I spoke with from the GP to the Urologist wanted to stick their finger up my arse, joyous. Anyway bloods came back with PSA of 6, so MRI scan to look to see if prostate was enlarged- which mine was not, so I’ve another blood test and PSA measurement for next March to see if it moves at all. – which I’m not expecting it to.

Single PSA measurement in of it self isn’t really much of a thing, and finger up the bum is inconclusive. The bit that was at all useful was the all clear from the consultant urologist.

So yeah, take this test.  get yourself booked in with GP,talk frankly about your symptoms if you have any.

Around here, you get asked in for a ‘finger’ test after you turn 50. It used to be 40, but, you know, cutbacks.

After a thread on STW started by someone who sadly was diagnosed with prostate cancer recommending people request a PSA test, I did just that. They booked it in pretty quickly and did both types of test.

Nationwide screening would throw up lots of false positives because the PSA test alone is not a foolproof test. All those false positives would create anxiety and possibly overload the NHS.  However, if you have a concern because of your age, family history or symptoms* get a test. A high PSA alone doesn’t necessarily indicate cancer, but will prompt follow-up tests which might (or will rule it out).

I have a prostate cancer diagnosis. Mine is a small volume,  low grade (1) and I have opted for active surveillance than treatment. I have 3 monthly PSA tests and an MRI every 18 months or so to see if it remains stable.

*Prostrate cancer mostly has no symptoms. Mine was found “accidentally” when I had an unrelated urine infection which was quickly treated with antibiotics but I did some tests including a PSA which led to biopsies and a diagnosis. Most of the urinary symptoms people think of are caused by an enlarged prostate which happens to most men as they age and does not necessarily mean cancer.

most of my points were in the other thread :

I was diagnosed at same age as Sir Chris is now, 48. Thankfully mine was caught at Stage 2 and was still contained in the prostate, which was removed 10 years ago next month and so far I remain cancer free.

There are a few GPs on here who will be along shortly, they usually are, to say that the PSA blood screening test is not much good and will only be applied by your GP if you have other risk factors, which is about right unfortunately.

In mu case, I was at the doctor anyway, on the back of a bad bike tumble, and mentioned that I was up at the loo a few times most nights, so he suggested checking my PSA as a precaution.  It was elevated and they retested it a month later and it was the same, so that led to more tests and I had surgery a few weeks later.

If you have any concerns it is best to have a proper chat with your GP, and be aware that they may reluctant to do a PSA blood test if you have no other indicators of risk.

and some of the story here :

Prost-8 Riders Aim High For Prostate Cancer UK

Better to be told that you have been worrying needlessly than to die of embarrassment. Treatment if caught early is pretty successful. I seem to recall most men die with it, not because of it.

I got tested a few years ago after a few issues with flow rate and a bit of dribbling. Luckily the poor lady doctor had small thin fingers and after a inserting one up my bum determined that my prostate was enlarged but had no signs (or my symptoms) to indicate something more sinister, and prescribed Tamosulin(?) to help with the symptoms.

I can only assume for there to be any cons there must be a lot of false positives that leads to unnecessary angst.

Even a ‘true’ positive isn’t really as informative as you’d imagine

I think the biggest factor in terms of  broad measures to test and screen is that  as a condition prostate cancer is a very inexact condition. Lots of people die from prostate cancer but also lots of people live with it. Identifying its presence doesnt really do much to inform what steps to take next – its difficult to determine whether its better to treat it or leave it alone in that the outcome of ‘successful’ treatment isn’t without consequence and can leave you in a worse condition in general health terms than no intervention at all. It seems to be something that at present you just can’t really formulate a winning strategy for in public heath terms.

I can only assume for there to be any cons there must be a lot of false positives that leads to unnecessary angst.

But.. a screening where you got a PSA at 40, 50, and then every 5 years would be useful to track what’s happening.

As it is, your first test is when you think something might be up… and the medical pros have no past personal baseline to compare to.

If you have any concerns or suspicions then don’t hesitate to contact your doctor, even if only for a chat to see if it is worth following up. Don’t wait, especially if it is causing any anxiety.

I had real concerns earlier this year with a weeks long episode of hematospermia (google it). I have also always needed to pee in the night which has got much more frequent (up to 5 times), and had a grandfather with prostate cancer on his death certificate, even though he was 82. Cue lots of tests, which were all inconclusive. Then a few months later another episode, this time with blood in the urine. This prompted more tests including MRI and Cystography (that will make your eyes water) and another PSA. Still nothing found of any concern.

And so I carry on with less anxiety and will probably get annual checks now if nothing changes in between. Currently there is nothing happening with my body other than some nights needing to pee multiple times. The conclusion to my episodes in the absence of any other medical explanation has been some sort of traumatic cycling induced episode.

Thanks for the IPSS test link…I’ve just score high enough (though have sneaky feeling the majority of men above 50 might too) to justify an appointment.

And so I carry on with less anxiety and will probably get annual checks now if nothing changes in between. Currently there is nothing happening with my body other than some nights needing to pee multiple times. The conclusion to my episodes in the absence of any other medical explanation has been some sort of traumatic cycling induced episode.

Had similar. Peed blood a few years ago and GP sent me to the urologist for camera insertion. He was a cyclist and said if I’d have come to him directly he’d have told me off for not drinking enough water on rides and sent me home. But if you see the GP you’re getting the camera. All was clear thankfully. That was ten years ago and it happened again a few weeks ago. It’s bloody alarming but yes I’d done my usual of a long ride barely drinking plus was probably dehydrated anyway after a “hectic” weekend.

But.. a screening where you got a PSA at 40, 50, and then every 5 years would be useful to track what’s happening.

As it is, your first test is when you think something might be up… and the medical pros have no past personal baseline to compare to.

You know there are healthcare economists who spend months pouring over data and understanding the true accuracy of these tests and variability of the population to work out if screening, and at what age / interval would be useful.   Or if all the follow up appointments actually delay patients with the condition being able to access expert advice.   There’s plenty of people willing to fund those studies too – because if they do recommend a screening programme there are people who supply the test technology and the early interventions who will benefit!

Screening tests….

Screening every man for prostate cancer is a waste of everyone’s time and cash. As the saying goes, nearly every man dies with either prostate cancer or an enlarged prostate, very few men (relatively) die because of it. Take the IPSS test, if it comes back with a high score, then go make an appointment, and do the thing. Take some responsibility for your own health. Don’t just sit there and do nothing and expect some-one else to take the time to contact you about something that you can act positively about if only you could be arsed*

*insert your own pun (or finger, whichever) here.

Go check it out the moment you are dripping or having flow issues or you find lumps on your body.

Some have no symptoms until the very late stage.

I had the blood test a while back after some symptoms (turned out to be nothing). The GP was clear that the blood test wasn’t hugely accurate & could easily throw up false positives & false negatives; his approach was to do a digital exam regardless of blood test results (although I gather that this only checks for enlargement).

Screening every man for prostate cancer is a waste of everyone’s time and cash.

Except for the ones whose lives are saved and their family & friends. I don’t know the numbers (or how prostrate cancer testing/outcomes compares with say, cervical cancer screening) but currently I’m seeing a lot of posters up in male loos about prostrate cancer & encouraging men to be aware of symptoms & to go for tests.

It seems odd to be encouraging men to go for tests if they’re not cost effective and if they are, then surely screening is the way to go (I think I got offered a “poo in a box’ bowel cancer screening test out of the blue – presumably because of my age).

Interestingly I’ve just this minute come off of the phone after booking my annual review with the surgery. It seems to be offered to all over 50s and involves a face-to-face appointment & a reasonably thorough exam & blood/urine tests. I would imagine that it wouldn’t be impossible to train the clinicians here (although they may be low band HCAs)  to do a digital exam if requested; it would probably only add a few minutes to the appointment time.

Anyway, it seems well worth doing if you have the slightest concerns and at no point was I made to feel that I was wasting any ones’ time.

For me, I had a regular blood test because of some medication that I take.

The nurse said that I might as well do a PSA test whilst I’m at it.

Results said I had a high reading so come back in a few weeks for another test.

PSA down and doctors are happy with the reading. Great news for me, or so I thought!.

Also under a constant and he wanted to change some medication but wanted me to see the uroligy dept just to confirm all was ok.

After an MRI scan and then a biopsy session where everyone said all looks good and nothing obvious. It turns out that I have level 2 prostate cancer.

So what I am saying is getting checked out is not as black and white as you would hope for.

But for the sake of a blood test, it’s worth giving it a go.

Peed blood a few years ago and GP sent me to the urologist for camera insertion. He was a cyclist and said if I’d have come to him directly he’d have told me off for not drinking enough water on rides and sent me home. But if you see the GP you’re getting the camera

Lucky you, maybe. I had a bloody pee incident just now and all I got was a phone consultation with a Nurse Practitioner who diagnosed UTI and prescribed antibiotics. Separately from that I have 6 monthly PSA tests following a very elevated level which resulted in multiple MRIs and 2 biopsies that were negative. PSA has now subsided to a lower stable level.

My dad, exactly like Chris Hoy, has had his prostrate cancer spread to his bones (spine, pelvis and jaw). However, he’s a lot older and not as fit as Chris Hoy, so has just been given 2-3 months to live. We’re all very much still processing this bombshell

I’m booked in for a prostrate exam and blood test later this afternoon as I’m now in the ‘at risk’ group

If you think you’re at risk, go and get checked and don’t be a bloke and just cross your fingers and hope everything will be fine

John Holmes Says the C-Word on the iPlayer. Very good. Mate had a biopsy after high PSA results and likened it to having his perineum repeatedly attacked with an industrial nail gun…

https://www.bbc.co.uk/sounds/brand/m0020s52?partner=uk.co.bbc&origin=share-mobile

But do you have any pearls of wisdom for the rest of us too?

I’m not sure that I do!

The usual symptoms of prostate problems are: reduced urine flow, increased frequency, not finishing properly (rogue drops) and not emptying fully. Any of these could indicate an enlarged prostate or prostate cancer. An enlarged prostate does NOT mean it will become cancerous.

Increased risk factors include: age, family history, weight, diet and ethnicity (increased risk in black men),

Most prostate cancers occur in men of around 70 years of age and are slow growing. Hence, men dying with it, not because of it. Obviously that changes if you are a younger man with a faster growing cancer!

Caught early it is fixable although that isn’t without its own challenge (as I’m sure @iainc will attest to). Once the cancer has spread beyond the prostate then curative treatment is less likely. It usually becomes incurable when it has spread to tissue further away from the prostate (usually bones or lymph nodes).

Treatment depends on stage: cutting, burning or poisoning… I mean: surgery, radiotherapy and chemotherapy. Lots of other drugs can be used too; these usually inhibit testosterone production which then slows cancer growth.

Me? Aged 53 at diagnosis (probably had it for years though). No family history, I’m white, fit and not overweight. No symptoms other than fatigue (and maybe the odd rogue drop), GP took a while before considering DRE and PSA (no blame whatsoever). PSA came back at 374 (not a misprint).  Initial prognosis was that I was unlikely to live 5 years. Treatment took me to hell and back but I’m quite well at the moment. I try and exercise every day (100 days of exercise until Christmas), eat healthily and consume a cocktail of supplements. I have no testosterone owing to hormone therapy, so loads of menopausal symptoms :-/

My advice would be: Consider your risk factors, monitor your urine flow/frequency and chat with your GP if concerned. There is loads of information out there: Prostate Cancer UK, Prostate Cancer Research, Macmillan, etc.

Some of my history here https://adventureswithprostatecancer.com/  see “cancer life” tab, although I’ve not updated for some time.

Contact me for a chat if you like and… try to live a little more each day 🙂

Who needs to get up 2 or 3 times a night for a piss….and has a sore shoulder…..

Me. But only after a few beers on a Frid/Sat night and I fell of my bike a few months ago, shoulder hasn’t been quite right since.

Think I’ll get a check up.

Thanks for the IPSS test link…I’ve just score high enough (though have sneaky feeling the majority of men above 50 might too) to justify an appointment.

Just to provide a second data point, I only scored 3 on that test and am mid 50s. So if you score higher, then it may well be a wake up call to get some more tests done.

It seems odd to be encouraging men to go for tests if they’re not cost effective and if they are, then surely screening is the way to go (I think I got offered a “poo in a box’ bowel cancer screening test out of the blue – presumably because of my age).

there’s a difference between encouraging men with symptoms to go for a test and encouraging all men to go for a test.  The predictive power of a PSA test in men with symptoms is better than in the whole population.  But it’s not even as simple as saying – one symptom some of the time – hence the little IPSS questionnaire.  You see we all start to think it’s just part of “natural aging process” but it’s more variable than that.

I’m not sure if this has been posted up in the Chris Hoy thread, but the BBC have a page up on prostrate cancer following Chris Hoy’s announcement.

https://www.bbc.co.uk/news/health-62755001

I seem to remember reading somewhere that cycling can cause problems down there as well? Probably from the constant impacts. I know that after riding my hardtail it seems like I can have a bit of trouble peeing. Or am I just not remembering correctly?

Taken me a long time time to see the clever name of the I-PSS test.

I seem to remember reading somewhere that cycling can cause problems down there as well? Probably from the constant impacts. I know that after riding my hardtail it seems like I can have a bit of trouble peeing. Or am I just not remembering correctly?

Cycling can put pressure on the perineal area (in-front of bum hole to behind ball bag). This contains lots of nerves and delicate tissues. Pressure in this area may cause numbness and other symptoms. Best avoided! So get a saddle that relieves pressure in that area! Cycling can also slightly raise PSA for 24 hours, but it doesn’t cause cancer or make it worse (according to the research I have read).

Just to provide a second data point, I only scored 3 on that test and am mid 50s. So if you score higher, then it may well be a wake up call to get some more tests done.

Thanks.

Convert – score 27.

On BBC News now.

We can opt in (salary sacrifice) for skin, bowel and prostrate cancer checks via a workplace benefit with these people: https://www.check4cancer.com/

I must admit last year and up until today, although I’d signed up (and effectively paid for it) I hadn’t actually gotten around to requesting the kits (I did a couple of years back when I first signed up). I’m over 50 now so probably qualify on the NHS but given it’s cheap and easy enough to sort privately I’m happy to.

I got diagnosed with a benign enlarged prostate at 48 – I was informed by the consultant that as I was under 50, treatment options were limited, so he put me on Tamusolin for a few months to see if it made any difference. It didn’t. Roll on 11 years, I had another PSA earlier this year and it was above the threshold so off for an MRI – it’s the size of a lemon (not walnut) but not cancerous.

I’m nowon a 6 month cycle of PSA tests and daily Solefenacin – the biggest difference however has been a daily supplement of cranberry powder in terms of reducing the urge and frequency of needing to go.

Screening every man for prostate cancer is a waste of everyone’s time and cash….
Except for the ones whose lives are saved and their family & friends….

Well this is the issue with thinking on an individual “one by one” basis, as opposed to national medical screening criteria basis.

Firstly – I’m a GP

Secondly – cancer and other illnesses are a terrible disease, and of course if you can catch them earlier, generally the outcome is better. I’m extremely sympathetic to those who ahve been troubled by prostate cancer, and grateful treatments are available for those of us who get it.

That being said, I have to put my medical hat on and agree with the scientific basis of NOT having a screening programme for prostate cancer.

Note – screening is when you apply a test to PEOPLE WITHOUT SYMPTOMS. As soon as you have symptoms it’s not screening, but “investigating symptoms”. This is key, because if Mr X has no symptoms and a random PSA of 7 (technically elevated), his chance of having prostate cancer is (on a population basis) significantly less than Mr Y who has poor urine flow, peeing 5 times a night, and a bit of dribbling, AND a PSA of 7.

Thus, Mr Y is justified going through further invasive testing (and the complications that arise from it) to see if he has cancer. Mr X less so.

many people get emotive about this subject because, of course, cancer is terrible. And of course, there’s always going to be someone who incedentally has a cancer picked up via random testing, and of course they’ll be grateful that THEY had the test. But on a population level, more men will be harmed/alarmed by random testing. But you never hear from them on social media etc etc.

This is a useful leaflet i give to chaps to spend a bit more time pondering over the decision:

https://www.gov.uk/government/publications/prostate-specific-antigen-testing-description-in-brief

It’s a similar thing with cervical screening in women – there’s many groups out there saying “it’s a crime we don’t do cervical screening from 16 years old… NHS saving money blah blah blah”, but if they actually understood the science, rather than believe it’s a ‘money saving cut’ they’d realise the cancerous changes that screening is looking for in the 25-64 year olds, can be ‘mimicked’ by the NATURAL CHANGES that pubescant and adolescant women’s cervixes go through. THUS… you’d end up ‘detecting changes’ in all those women (/girls) and have to send them for biopsies and loop excisions etc, and cause potential fertility and birthing issues. And you wouldn’t detect any more cancers in asymptomatic women.

Anyway – it’s certainly worth speaking to a GP if you’re getting older, peeing more, slow flow, dribbling etc etc, as THEN you have symptoms, and warrant further testing.

DrP

The usual symptoms of prostate problems are: reduced urine flow, increased frequency, not finishing properly (rogue drops) and not emptying fully.

Adding another data point, I went through testing for those sorts of symptoms in my late 30s/early 40s.  Started out with the finger and PSA tests and as mentioned above, once one doctor has done the finger you can bet that everyone you see along the diagnosis chain will want a go too.

Anyhow the initial tests found I had a normal prostate and I ended up having a bunch more tests, some of which made the finger look pleasant. The conclusion was that my detrusor muscle is just a bit crap at its job. All good but it means that any warning signs about prostate cancer are going to be much harder to notice.

The GP was clear that the blood test wasn’t hugely accurate

The reason for this is that the briefing for you before the test is missing or given improperly.

One should not: have sex, ride a bike or run for around 72 hours before the test. (I found this out by accident from the MacMillan Nurse Practitioner at the hospital). This gives a better baseline for your numbers.

My consultant was all for doing a test at a follow-up appointment but on being told I had cycled the day before and got lucky that morning he conceded that this would not be accurate.

I am currently low-risk prostate cancer as the two early biopsies took the cells from my prostate and the follow up biopsy and MRI’s have been clear. 6 monthly PSA tests aer now order of the day with urology only involved if the number heads towards 20. Fingers crossed I will die with an enlarged benign hyper-plasia prostate and not from stage 4 cancer that has metastised though my body.

I get my PSA checked every couple of years ago. Only had the finger test once, but that was before surgery to fix a knackered bollock from ‘the snip’. I’m on Testosterone so have to be checked every couple of years. PSA slightly raised, although last test it had come down. Hasn’t changed in years.

As someone under surveillance who has regular PSA tests, I can absolutely confirm cycling within a day or so before can elevate the result. In my case although alarming, it droped to my baseline on the next test when I avoided it on the lead up. No-one in the GP practice or my urology department told me this was a thing, I only found out by researching it myself. Some sources say any heavy exercise can do the same. I am a regular runner and gym goer, but I now give myself at least 48 hours rest from exercise before my blood test.

I fortunately knew the PSA can be raised from cycling, and TBH, I’ve usually been cycling the day before my test. So long as results don’t keep climbing.

I pay privately for psa and other routine blood tests.  Nothing found and I cycle to appt, I m aware of false positives but thats a further challenge, i d prefer that to a false negative.  I m having a routine NHS health screen next week so will ask if they ll do a psa.

Going private is a bit of a luxury, you get seen when you want, have a nice chat about football or rugby, results discussed next day.