Prostate Cancer

What's your opinion about doing routine testing for PSA for men?

Well I think it is invaluable, in spite of the fact that there is contrary opinion now that it's not a good indicator of the level of malignancy or level of tumour that one can have. I think it's essential and certainly I would argue from my case that it's the change in the reading that is significant and therefore if it's done routinely one would see or recognise the change in the system. However if it's only done once and then not again for another couple of years or so then there is no comparative effect, but if it's done regularly then this to me is utterly vital.

I think it would be a really good idea to provide screening for prostate cancer on a regular basis because it is the change in the PSA level that would indicate that something is going wrong. And it's, it's no good to my mind going to your GP and him saying that you know it's a fact of life that the prostate is enlarged, and you know we'll wait and see, and not do anything about it, because there are things that one can do about it and it would be advisable I think.
 

Do you want to say a little bit about your views of PSA testing then?

Well, I think that my own view about PSA is that it is a highly political subject and I can understand why it is a political subject. But when we look at it dispassionately, although it's not perfect, in fact it is imperfect, it is more perfect than many screening tests or diagnostic tests which are used and trusted implicitly by the medical hierarchy and by the patients.

My key point about PSA testing is that it has been badly presented, both to the medical profession and through the medical profession to the general public. PSA testing is a better diagnostic test than the cervical smear, it is a better diagnostic test than mammography, there is only one standard diagnostic test, colonoscopy, only one diagnostic test colonoscopy, which is better, and then only when you have a very good rectal surgeon doing it, or rectal physician. The trouble with PSA testing is that you get a lot of false positives. The problems of false positives have been exaggerated. The average patient isn't very disturbed; they have to wait 10 days or so to find out whether the tests are truly false positive or whether they are satisfactory. It is trying for him but it is not devastating. I mean you ought to really see ways in which we can get this done faster, not give up the test.

And you say the main reason, [for not doing PSA testing] you think, is the financial one?

And I think the main reason is a financial one because although the actual PSA test is very cheap, the follow-up test for everybody who is positive is expensive. It is expensive in terms of actual costs of materials, in costs of the time of the radiologists, cost of time of the laboratory and it blocks the radiologist's couch for half an hour or so. And furthermore, if all those false positives were not false positives but actual positives, the theatre, the trouble on theatre time would be very considerable indeed. The urological clinics and lists would be chock-a-block. Instead of being honest with the world, and saying we can't afford this but we've got to find means of affording it, we tell the doctors and the doctors tell the patients that the test is a bad test. A bad test is a test which gives rise to a great many false negatives and the PSA testing gives rise to fewer false negatives than all those other diagnostic tests which have Government support and Government approval. It's cash and the men are being allowed to die because people are saving money by allowing them to die.