Prostate Cancer

I've been an advocate of PSA testing for a very long while and I have a family history of prostate cancer. My two uncles and my father; and then my elder brother came to see me because he had been unwell for the last, previous 18 months. Rather surprisingly he had been diagnosed as having hypertension with angina because he was getting chest pain after a meal, but he was going very steadily downhill. And he didn't usually consult me about his medical problems but we have a regime here and so we did everything for him, all the standard tests and it turned out that his PSA was very high. And in fact, the pain he was getting in his chest after meals was because he had secondaries in his sternum and ribs and so when his abdomen became distended by his lunch, then not unnaturally it became painful. And so I thought, 'Well my patients all have a PSA done every year if they are over 50, I had better go and get mine done too.' And that came back positive, not very high, 7.2. So I really referred myself to the laboratory and then referred myself to a radiologist who does trans-rectal ultrasounds and biopsies.
 

I really didn't discover a problem myself because my condition was what I would describe as benign. I go to France annually and when I am there I have a check-up with a doctor in France. And over a three, I think, a three or four year period the doctor noticed that my PSA, this is the Prostate Specific Antigen test that she does routinely, that it had gone up from something like 2 or 3 to 7.

May I just ask, before the doctor did the test, the PSA test did she explain what it meant and what the implications were?

Oh yes, yes I mean she said that anybody over the age of 50 and certainly I'm more than that, ought to have an annual PSA test which she does routinely for elderly people, men anyway in her practice in France.

But at that stage did she explain that if the PSA level was unusually high and if cancer was found what the options would be, did she explain at that stage?

No, no at that stage there was no question of discussing whether my condition was cancerous or not. It was a matter of monitoring the PSA level and to see whether any malignancy would occur. And I understood it to be a routine test, a sort of monitoring test and if the situation warranted it, like the PSA went up some alarming amount then other tests would follow, because it would be an indication that that the prostate was malignant.
 

Right, perhaps I could start by asking you how you first thought there was a problem, what first made you seek treatment?

Well that's rather unusual because I didn't have a problem. I felt unwell, nothing led me to believe it would be prostate. I went to the doctor who did a blood test and initially it showed that, he then sent it back for a different blood test, trying every avenue and my PSA was only 3.9 which was borderline. 

When you say you felt 'unwell' just general malaise or any specific symptoms?

I'd felt very weak, felt very you know very lethargic, which is not like me. The PSA was only 3.9 but he said he'd do another one in 6 months. I went back in 6 months and it had leapt to 5.4. So he then asked me if I would go and see a doctor at the local hospital.
 

Before you had the PSA test did you know what it meant or what the implications were or why it was being done?

No only very vaguely and I knew nothing in detail about it. But I only knew that there was an agent produced that could be detected within the blood that would give an indicator whether there was activity in the prostate gland that was irregular or maybe cancerous. So the prostate specific antigen was high in my case, it was 13. 

I'm just quite interested in what people are told before they have the test. Did the GP ever discuss with you what might be done if you had a high PSA test or it was diagnosed as cancer?

No, no at that stage the interest really was to find out what the course of the problem was. I didn't push to find out what could be done. The knowledge of this side of things evolves as time goes on. But certainly at that stage, as far as I can remember it's a little while ago now there was no indication that this & I knew yes it was a test to determine if there was cancer, I knew that, but we did not discuss where we would go if it were. Subsequently it doesn't necessarily mean that it is cancer it would seem because the PSA test is one of those tests that's a little bit vague.
 

It was basically explained to me to see why the urinary flow was so slow in the mornings. It didn't affect me at any other time during the day but certainly it did in the morning. The surgeon that I saw at the time basically said to me 'There's nothing at all wrong with you that we can find,' and they put it down to an emotional problem because prior to that, a year or so prior to that I'd lost my oldest daughter, she'd died. After leaving the hospital, it must've been a week or two later, I went back to the GP who confirmed the hospital's results but did point out that my PSA reading was about the 4 mark, but said in the same sentence &..

Was what the mark?

About 4, about a level of 4. Now PSA at that time meant nothing to me and being rather naive I didn't ask him to explain the significance of PSA. But he did say it was a totally unreliable form of test and it wasn't worth thinking about, gave me some tablets for prostatitis I think.
 

Is this the PSA test?

The PSA test... it was around the 200 numeral Okay, which is high, denoting some cancerous activity in that area. Then as the injections took hold, somewhere after the first injection, may be towards the second injection, the count dropped to 5, from 200 to 5, I couldn't believe it when he said this you know, 'Is that so?', and he said 'Yes it's good news, it's down to 5.' Then the last time I went, a few weeks ago now, the count had dropped again to 1.8.

Oh that's good.

So the injections are working! You know they go alternatively left of your stomach, right hand of your stomach and I've had 3 of those now and the count is down to 1.8. Now this was told to me as I say a few weeks ago, and the doctor said that is very good indeed, good news, the count is normally between 4 and 1, you know, well at 1.8 I'm obviously down at the good end of that.