Prostate Cancer.

I have been  wanting to compose a post on the topic if Prostate Cancer, but 

Thanks both.

Thank you Abbey and Steve, you are both absolute gentleman,  and this is what makes Scarletfever  special .

Kentexile wrote: Prostate cancer isn’t just the most common male cancer it is the most common cancer  and also the biggest cancer killer full stop and the response last week was wholly inadequate. If there are issues with false positives then the priority should be to see what can be done to deliver better testing. As I have posted before I was diagnosed with advanced melanoma in 2021 and had 3 lots of surgery but the game changer was an immunotherapy drug which had recently been licensed to treat melanoma and whilst there were some side effects I have been in remission for  2 years and my last scan a couple of weeks back again came back clear so I  had the” good fortune” to be diagnosed when there was a viable treatment. Two sad things  - the first is the drug I was treated with was first made in 2008 but was only commercially developed and tested about 10 years later - if there had  been the money and will to take it forward sooner thousands of lives could have been saved or extended. The second was waiting for my first treatment the man in the next treatment chair saw I was nervous and looked to put me at ease. Over the next hour or so whilst we were receiving our treatment he mentioned he had been diagnosed with pancreatic cancer which had killed his mother about 35 years and was himself nervous that he was receiving exactly the same treatment she had done then which had a success rate in single figures which put what was happening to me in perspective.

That’s quite a story, Mark.

Diagnostics all comes down to money. We found that governments would issue dictats for blanket testing on certain diseases. When we asked who was funding it, we were told it had to come from within our budget. If a test’s maginal cost (the cost to do one more test rather than full cost which includes staff, electricity and analyser costs) is £5, adding an extra 1000 tests a month means my budget would have to fund that £5,000 cost implication. All this when budgets and staffing are squeezed.
In Wales, the Welsh Government set up the Welsh Screening Services which are fantastic labs. Bowel Screening has been very successful.
As for better and more accurate testing (other than the Prostate Specific Antigen), these are generally genetic tests and far too expensive to run as a screening rather than diagnostic service. It’s a cost restraint that I actually agree with.
Pathology diagnostics are way ahead of what we were doing when I started as a junior scientist back in 1985. The array of diseases we are able to better diagnose and manage is astounding. As an example, with leukaemia, we had to perform complex cytochemical staining on microscope slides containing patient bone marrow aspirations (to obtain this requires a very painful procedure). The whole process took a couple of days. Today, the same blood sample taken by the GP in the first instance can be put through the immunophenotyping analysers and a diagnosis sufficient to start treatment can be ready within 2-3 hours. This is just one example. AI digital microscopes can find many cancers (breast, bowel amongst others) far quicker than the human eye so more patients are entering the cancer treatment pathway quicker than before. They are entering it possibly quicker than the NHS can cope with, if truth be told. This is one of the main reasons the NHS is struggling is that we are diagnosing quicker and better and people are living longer but not necessarily better.

great post sir, i hope you are well. your honesty openess and bravery is an example to us all, i would urge abyone over 50 (like myself) to get an annual bowel and prostrate check

Abbey wrote: Diagnostics all comes down to money. We found that governments would issue dictats for blanket testing on certain diseases. When we asked who was funding it, we were told it had to come from within our budget. If a test’s maginal cost (the cost to do one more test rather than full cost which includes staff, electricity and analyser costs) is £5, adding an extra 1000 tests a month means my budget would have to fund that £5,000 cost implication. All this when budgets and staffing are squeezed. In Wales, the Welsh Government set up the Welsh Screening Services which are fantastic labs. Bowel Screening has been very successful. As for better and more accurate testing (other than the Prostate Specific Antigen), these are generally genetic tests and far too expensive to run as a screening rather than diagnostic service. It’s a cost restraint that I actually agree with. Pathology diagnostics are way ahead of what we were doing when I started as a junior scientist back in 1985. The array of diseases we are able to better diagnose and manage is astounding. As an example, with leukaemia, we had to perform complex cytochemical staining on microscope slides containing patient bone marrow aspirations (to obtain this requires a very painful procedure). The whole process took a couple of days. Today, the same blood sample taken by the GP in the first instance can be put through the immunophenotyping analysers and a diagnosis sufficient to start treatment can be ready within 2-3 hours. This is just one example. AI digital microscopes can find many cancers (breast, bowel amongst others) far quicker than the human eye so more patients are entering the cancer treatment pathway quicker than before. They are entering it possibly quicker than the NHS can cope with, if truth be told. This is one of the main reasons the NHS is struggling is that we are diagnosing quicker and better and people are living longer but not necessarily better.

aber-fan wrote: Abbey wrote: Diagnostics all comes down to money. We found that governments would issue dictats for blanket testing on certain diseases. When we asked who was funding it, we were told it had to come from within our budget. If a test’s maginal cost (the cost to do one more test rather than full cost which includes staff, electricity and analyser costs) is £5, adding an extra 1000 tests a month means my budget would have to fund that £5,000 cost implication. All this when budgets and staffing are squeezed. In Wales, the Welsh Government set up the Welsh Screening Services which are fantastic labs. Bowel Screening has been very successful. As for better and more accurate testing (other than the Prostate Specific Antigen), these are generally genetic tests and far too expensive to run as a screening rather than diagnostic service. It’s a cost restraint that I actually agree with. Pathology diagnostics are way ahead of what we were doing when I started as a junior scientist back in 1985. The array of diseases we are able to better diagnose and manage is astounding. As an example, with leukaemia, we had to perform complex cytochemical staining on microscope slides containing patient bone marrow aspirations (to obtain this requires a very painful procedure). The whole process took a couple of days. Today, the same blood sample taken by the GP in the first instance can be put through the immunophenotyping analysers and a diagnosis sufficient to start treatment can be ready within 2-3 hours. This is just one example. AI digital microscopes can find many cancers (breast, bowel amongst others) far quicker than the human eye so more patients are entering the cancer treatment pathway quicker than before. They are entering it possibly quicker than the NHS can cope with, if truth be told. This is one of the main reasons the NHS is struggling is that we are diagnosing quicker and better and people are living longer but not necessarily better. Thank you for your exceptionally informative and well balanced post on this. To declare an interest: I was diagnosed with chronic lymphocytic leukaemia in 2011 and - despite being told that it often didn't need treatment - had an aggressive form and had chemo less than 6 months later in 2012. I was very lucky - the treatment worked and the CLL has never returned (yet) though I am checked annually. The only point of yours I'd disagree with concerns bone marrow aspiration - reading and commenting on a CLL forum for 10 year or more convinces me that it's only painful if done by less able specialists - mine was brilliant - there was a degree of discomfort, but no big deal. Same as blood tests - some nurses leave you with a big painful bruise, others you hardly know they were there. It's a knack - some have it, some don't.  So, I have some experience of cancer (I had a second, less relevant, requiring 3 surgical interventions of around 5h each under general anaesthetic..) I may also possibly also have prostate cancer. Quite a while ago, I developed a problem with having a wee, needing to go several times to fully empty my bladder. A check showed that my prostate was very swollen. PSA results were way above normal... BUT it's my understanding that the key figure here is PSA density - which is PSA divided by volume of prostate. This figure was just about within bounds. Two MRI scans (one private, one NHS) showed a small "ambiguous area" which is probably cancer, but if it is it's not changing quickly. I am monitored every 6-12 months.  The only way to be sure is a biopsy, which involves putting a needle into the prostate and collecting samples. My specialist told me that, with such a swollen gland, it would lead with 99% certainty to urinary retention - in which case, they'd whip out the prostate whether it needed it or not.  Prostate removal can lead to incontinence and impotence. So, risk and reward. You would not want to take those risks without being pretty sure you have an aggressive cancer. I've seen it said that most men die 'with' prostate cancer, but only a few die 'of' prostate cancer. It's extremely common to have it in some form - what is needed is to find those with the aggressive forms. It's for this reason that certain groups should be targeted for screening, rather than subjecting everyone to unnecessary worry in many cases. As time moves on, I believe that the costs associated with the more accurate tests will come down significantly... in the meantime, it makes sense not to test everyone. All who are genuinely worried can ask their GPs, and those over 50 have a right to a test.  It's a tricky balance and a difficult decision for politicians, health experts - and individuals. Get checked if in doubt, though! And inform yourself as well as possible of the options.

I should have made it clear that when I started, bone marrow aspirations were taken from the sternum (chest) whereas today they are taken from the iliac crest (hip). Today’s procedure is far less painful.