The figures that may chill the marrow of many men are the estimates of the side effects of prostate surgery: urinary incontinence 8-65% short term, and 5-15% longer term; erectile dysfunction of 50-90%[1]. It is data like these that drive some men to try to use the prostate specific antigen (PSA) test, with all its drawbacks, to diagnose prostate cancer as early as possible in order to avoid the more heroic treatments.
In 1993, by some quirk of personality, I began paying to have a yearly PSA estimated. It was a fairly boring self-indulgence until 2001: Feb 2001 PSA 4.3 ng/ml, May 2001 4.0, Feb 2002 6.1. Biopsy gave a Gleason score of 6/10, and the symptomless cancer was treated with brachytherapy in July 2002, which meant only one week away from work. My most recent PSA in July 2011 was 0.1.
It seems to me that a distinction needs to be made between a national PSA screening programme and allowing individual choice. Understandably, I am not enamoured of Nick Wilson's social engineering suggestions that include charging more for all PSA tests [2}.
Rapid Response:
Re: Disinvesting from prostate cancer screening
The figures that may chill the marrow of many men are the estimates of the side effects of prostate surgery: urinary incontinence 8-65% short term, and 5-15% longer term; erectile dysfunction of 50-90%[1]. It is data like these that drive some men to try to use the prostate specific antigen (PSA) test, with all its drawbacks, to diagnose prostate cancer as early as possible in order to avoid the more heroic treatments.
In 1993, by some quirk of personality, I began paying to have a yearly PSA estimated. It was a fairly boring self-indulgence until 2001: Feb 2001 PSA 4.3 ng/ml, May 2001 4.0, Feb 2002 6.1. Biopsy gave a Gleason score of 6/10, and the symptomless cancer was treated with brachytherapy in July 2002, which meant only one week away from work. My most recent PSA in July 2011 was 0.1.
It seems to me that a distinction needs to be made between a national PSA screening programme and allowing individual choice. Understandably, I am not enamoured of Nick Wilson's social engineering suggestions that include charging more for all PSA tests [2}.
[1] New Zealand Parliamant. Inquiry into early detection and treatment of prostate cancer, 2011. www.parliament.nz/en-NZ/PB/SC/BusSum/4/0/1/00DBSCH_INQ_9159_1-inquiry-in....
[2] Wilson N. Disinvesting from screening. BMJ 2011; 343: 919-920.
Competing interests: No competing interests