Information on the 'gentlemens gland'

[daffy]

I would not disagree with any of the findings illustrated in your post RG, but I would quote from the link I gave above:

Angela Culhane, chief executive of Prostate Cancer UK said the latest figures were a "stark reminder" that efforts to tackle the disease needed to be redoubled.

She said: "By 2030, prostate cancer is set to be the most commonly diagnosed of all cancers in the UK. Before we reach this point, we absolutely must ensure that as many of these men as possible have their prostate cancer caught early and successfully treated, so their lives are not cut short by the disease."

Those "latest figures" show that over 12,000 men died of Prostate Cancer in 2017.

At present, poor as it is in giving a good indicator of malignant cancer, the PSA test is the best first line of investigation we currently have. As my visit this evening to the MRI Suite of my local hospital has shown, a next step need not be invasive and has practically no side effects but can detect tumour and help determining further steps, should any be in fact required. After all, this evenings scan may show I have nothing to worry about and be unlikely to join the next annual crop of those who succumb to this killer. But if I am to undergo further treatment I'm certainly happy to have started the process with a simple blood test, and maybe quite thankful for that.

It is of course for all men to decide their own action re their prostate, and in all the links given in this thread so far there is ample factual and learned information from various reputable sources that can help each one in that decision.

[Railwaygun]

I agree, in principal, with what you are saying Nick @Railwaygun . The PSA test is only an indicator - it can give false positives, it can miss something. A 'normal' biopsy does not necessarily find anything. It is only, certainly in my case, a needle taking 12 tissue samples. As it was explained to me, the gland is divided into 4 imaginary quarters and three samples taken from each quarter. I had two of those and nothing untoward was found. The specialist was not satisfied, so I had a MRI scan, This showed a small 'dark' area so I had the Template Biopsy, which targets the 'dark' area. Still nothing was found and all the specialist could say, (and having researched him on line, he is a Professor who was renowned in the UK for his ability in the mens health field, (don't know why he came to Ireland  ), it 'probably' was not cancer.

It could be said that I had five years of not knowing what was wrong for nothing, but I still say that it is better to get ones PSA checked even if it does lead to a false positive. At least that way, your GP can keep an eye on things. Since the specialist put me on my daily tablet, my PSA has been near 'normal' levels for a couple of years now.

Cancer can be found with a biopsy, but without the initial test, it might not be ever found.

the problem is that False positives lead to over investigation and unnecessary reeatment, associated with morbidity.

I write  as a generalist rather than a Specialist.

I can't comment on your case, but the NHS has to work on best evidence, rather than "its a good idea". Even the USA has stopped PSA screening, and they get paid per test!

please let us all encourage symptomatic male friends & those at risk, to discuss testing with their GP/urologist.

[Chris Morris]

The problem is that the symptoms described are not far from what naturally happens as you get older. I didn't have any of the symptoms, just a slight discomfort in my side.

The process seems to be very sensible and logical. For me this was as follows:-

1. PSA test which led to hospital appointment
2. DRE by specialist and further PSA test which gave enough cause for the specialist to require further tests
3. MRI scan. This shows up where the prostate may have a problem and in my case they could see quite a problem but I didn't know at the time.
4. Biopsy. This was the first invasive test and is the one required for medics to know exactly what the situation is. I had mine under full anaesthetic because they wanted to take lots of samples. Because there is so much stuff close together down there there is a risk of infection following a biopsy of this kind. I was fine and all of my friends who have been through the same were also fine.
5. The biopsy showed I had a problem but I was not informed at this point. I did however get cordially invited for more tests which kind of told me they had found a serious problem.
6. CT scan - makes you feel hot and that you have we'd yourself. This is done to look for cancer around the body and see how close it is to any organs.
7. Bone scan - you get an injection of something radioactive and are told to keep away from young children for the rest of the day! This is to check whether cancer has spread to your bones.
8. Meeting with consultant to discuss findings and further treatment.

The reason for not saying anything to me before meeting the consultant was so that they he could give me a full picture of where I was and what he recommended next. The point is that it is a logical sequence of events. The PSA test being just a start point to kick off further investigations and these investigations only continue if the previous one gives cause to continue. So far as I am concerned I am very pleased that my GP decided that a PSA test was worth doing even though my one slight problem (and it was very slight) was not a symptom of prostate cancer. I'm also pleased with myself for going to my GP because the normal bloke reaction would be to just ignore such a small problem.

The PSA test did good for me.

[rob_au]

One message that I hope others take from this thread is the importance of being aware of men's health issues and being forthright and courageous enough to discuss these with your family doctor. I state this from experience being almost five years post-surgery and (multiple rounds of) chemotherapy for testicular cancer.

My experience stated with a simple observation that one testicle didn't feel the same as the other - At the earliest opportunity (as I was travelling overseas for business when I first noticed this in the shower one day), I visited my local doctor. My doctor assured me that it was probably nothing, but gave me a referral for an ultrasound - I arranged this for during my lunch break on the same day and afterwards continued on with my day, unperturbed and reassured by my doctors' calming words. As such, I was very surprised when my doctor called me later in the afternoon. The conversation went almost like this verbatim:

"I have received your ultrasound results and while I don't normally do this, I have made an appointment for you with a specialist tomorrow, which you will attend"

What followed was an appointment with one surgeon, who while he couldn't get me on his operating schedule for a number of weeks, sent me for blood and CT tests and referred me through to another surgeon who would see me the next day.

Literally within two and half days of the visit to my local doctor, it had been confirmed that the disparity that I observed, which could have just as easily been ignored or dismissed for lack of want to deal with the possibilities it represented, was testicular cancer which had spread to both my gut and my lungs. I was then scheduled for surgery exactly a week after I had first visited my doctor, starting a cascade of life changing events.

I am however now in the clear, but had I not have been prepared to speak to my doctor, the outcome of this story could be very different.

So, please, I implore everyone to not be backward in coming forward.

[daffy]

Really glad to hear of the successful outcome of your timely treatment Rob.

Stay well.

[dannyboy]

Like daffy, I am glad to hear of how things turned out Rob. And thank you for sharing your experiences. 

[daffy]

I'd just like to add here that from a UK perspective, or at least for me here on the Fens of Lincolnshire, the process may have only just begun, but the speed with which the various offices of the NHS has reacted to my condition is to be applauded.

My UTI first symptoms were on December 12th last.
A&E visit catheter fitted, and antibiotics given December 14th.
Catheter removed one week later.
Earliest meaningful PSA test blood-letting was two weeks later, Friday 3rd January, with result the following Monday.
Second PSA test exactly two weeks later, with result on Monday 20th January.
Referral for MRI scan by GP saw appointment arranged by hospital Thursday 23rd January.
MRI scan done Friday 24th January.
Urology Consultant appointment already confirmed by post today for MRI results on Thursday 30th January.

In my opinion this is tremendous care and efficiency from our often much maligned, under-staffed and over-worked NHS.

It also goes to show how seriously they take the whole prostate issue, and whatever the future holds for me I will remain thankful for all that they do, and have already done.

[Chris Morris]

Hope it all goes well from here Mike.

For me the MRI scan could not say there was definitely a problem bit it gave enough evidence to go on to the biopsy stage. If you do have to have a biopsy you will get a Gleason score and that will guide any treatment.

[daffy]

Thanks Chris.

They used a contrast dye during my scan to highlight any growths so I guess my 40 minutes lying motionless on a noisy vibrating table (listening to the radio at the time seemed somewhat surreal) will be well worthwhile.

At this stage I'm hopeful that cancer is not present, but if it is I shall endeavour to copy the attitude of a woman I met last year who had, three months before, just completed chemo for aggressive ovarian cancer. We, along with her elderly parents, were walking high in the Alps together on a number of days last August. She had the most positive and indomitable  spirit I have ever found and I was so very pleased to hear about a month or so later that she had been declared free from the disease.

[Chris Morris]

Yes the MRI scan isn't great. It's a big piece of kit but the hole you go into is rather small and what feels like a comfortable position becomes far less comfortable over 40 minutes. The machine is noisy, I kept expecting it to break into a bit of heavy metal riffs based on the noises it was making. Still these machines do a great job, as do those who review the scans.

[Chris Morris]

The biggest challenge I have had so far is being told my bladder was too full for a process and I needed to pee out just a cup full. Now that was a new challenge but I managed to stop after a cup and a half.

[dannyboy]

The machine they used for me was extremely noisy - especially as the operator did not switch the music until a couple of minutes had passed!  . To me, it sounded like a non-stop pneumatic drill.

[daffy]

Just back from seeing the Urology Consultant following the MRI scan.

Although he was careful to ensure I knew that any scan cannot be definitive, he told me there was no evidence of any cancer in my prostate or the surrounding area, including spinal bones.  Another DRE was done too, and he was happy to report he found nothing to give him any concerns. He did not feel an empirical biopsy was necessary at all. He said that the size of my prostate was not unusually large for someone of my age, but would monitor my PSA levels, hoping to see a decline in time.

He concluded the visit by telling me that he would take me off the treatment Cancer Pathway, and prescribed a two week course of antibiotics to help reduce any inflammation, followed by another PSA test shortly after, then a further blood test prior to seeing him again in about three months time.

All in all his opinion seems to be that my enlarged prostate is probably due to prostatitis of a non-problematic nature and inner inflammation by bacteria may have caused the initial blockage.

Rather oddly, although I am much relieved by all this, at the moment I'm not as ecstatic as I thought I'd be with the news that I am most probably cancer free. Maybe it's just because I'm very tired, perhaps a reaction after the release of both conscious and hidden stress and anxiety.

But now I do feel that I can get on with my life!    Just have to take it steady with the antibiotics as the Consultant said I should avoid hard exercise or sport, like cycling, tennis, golf etc, as one of the side effects, rare as it may be, can be snapped tendons!

A stressful 50 or so days, and some near sleepless nights as the mind dwelled on all manner of possible future scenarios, but I'm so glad my GP took the time and care to initiate the tests I've had done.

Right, now to set up the holiday insurance for that walking holiday in the Austrian Alps in August!

Life goes on.

[dannyboy]

That is brilliant news  daffy - so pleased all you have ended up with is, like me, a watching brief. Long may it continue.  Like you, when I was told that I probably did not have cancer, I did not feel ecstatic, more a case of 'thank goodness for that'. I have an excuse now to try one of the miniature whiskies I got for Christmas.

[daffy]

Many thanks David.

We brief watchers must stick together. 

I'll join you with a cup of tea in place of the whisky as alcohol makes me ill.