Interview 10

Age at interview: 59

Brief Outline: He has not had any urinary symptoms. Has looked at information about the PSA test and has decided that he would only have a test if he developed symptoms.

Background: Occupation' Writer. Marital status' married. Number of children' 3. Ethnic background' White British.

Thinks that screening for prostate cancer might cause unnecessary anxiety.

Would you like to comment on the fact that there isn't a national screening programme then for men, for prostate cancer like there is for women with breast cancer?

Well I know there's a lot of issues about breast cancer and whether the, how useful it is but I would've thought that if the PSA test were a categorical black and white test then I would think it would be recommended for everybody because it would be completely clear. But since it's so contingent it seems and it's, the information it gives is conditional in some way I don't know that it would be the right test to offer for everybody because yet again it would only cause possibly unnecessary anxieties.

He found the information about the PSA test useful, particularly a booklet from Cancerbackup.

And what sort of information have you looked for, have you been, were you sent any leaflets or booklets from the university?

Yes I was, in fact there was one particular one, I think it was Cancerbackup, which I found the most helpful. What none of them actually did in fact, which I would loved to have seen happen, would be, in a way, just simply draw up a flow chart of the decisions that you make, the decision tree. I mean at what point do you actually decide to have the test, and then at what point do you decide from the results of that test whether you go on to a biopsy, let's say, and so on.

You mentioned the Cancerbackup booklet?

Yes

Was that about the right amount of information?

I thought it was extremely well laid out, it took you through the, it described the background, it described the issue and then it presented the question of a PSA test in a very balanced way, what the pros and the cons were and then it left you with questions that you had to ask yourself about whether you wanted to do it, if so what you would do with the information. I think that's the most important thing.

I mean if you take your car to the garage and they say it needs I don't know a new clutch or something then it's quite clear you have to do that but here it isn't so clear because the, the information is not clear cut.

Worries that the PSA test is unreliable and may give false positive and false negative results.

But it's a question I suppose really of whether one does have as it were a prophylactic kind of test and just testing to see whether one does have this antigen. Part of the reason is that I also have to say rather doubt how useful the test actually is, what the information, how useful it is for oneself, what one would do with it. There seems to be... a lot of people who do have high levels of the antigen, in fact don't have cancers. I think I read a statistic somewhere saying that even though it's with symptoms only about 1 in 14 of those in fact were shown to have cancers. And this can I think be a very anxious, a very fearful experience and unless there's a real reason which symptoms showed up, I'd almost rather not expose myself to the possible fear. And then, and there are huge uncertainties obviously, when you suspect that you might have something like this then you think of all the implications in your own life and how it will affect your family and so on and I think these are, I rather think, I like to think, that are unnecessary, unless of course there are clear symptoms which made one have to address the problem.

You mentioned false positives and false negatives?

Mm.

Was that something that came through in the literature that you read?

Yes mostly there were cases where the tests had shown, had read normal but there were, was in fact a cancer. But on the other hand you could argue that those would be picked up by a second PSA test so I suppose once you have had one, I mean it seems to me what you would do, for me the decision flow would be as follows. Wait until there were symptoms, if there were symptoms see how, how serious they were. If they were sufficiently serious take a PSA test, but only that, and see the results. 

He thinks he is not at high risk of prostate cancer and would be disinclined to have a test without symptoms.

Yes well I'm in my late 50s, I'm 59 and so I think I'm at that age where I should be taking this issue seriously. I don't see myself as one of the high risk groups in that there's no experience, no history of that in my family or in any close relative, and I'm not in one of the ethnic groups which I see are at high risk. And so I'm, but I'm nevertheless aware of it, I have a lot of friends of mine do it, have a test quite regularly on, may be on an annual basis. I tend to look at these issues rather on the way of a car in a sense I mean some people like taking their cars in for regular maintenance, I'd rather not have something fixed unless it's broke and my general inclination would be to wait until there were symptoms before I acted. And I think, I may be wrong, but again not knowing a great deal about it but just through what we all pick up at our age, it's fairly clear what the obvious first symptoms would be, difficulty or pain in urinating, frequent urinating during the night, more than one has experienced in the past. So I suppose if those things became serious or of course if there was any actual pain then I would go and take this a bit more seriously.
 

Says that a raised PSA result may lead to an unnecessary biopsy. Prefers to live life in an 'optimistic way', having a test only if really necessary.

Now if the results were normal or slightly increased antigen levels then probably again do nothing, and just wait and see, and take another PSA test, possibly in 6 months time after that. And if things have gone, if the levels have gone much higher then, then, and I think also a digital rectal examination would be a first step to have. I don't, well I wouldn't like to have, to have to have a biopsy, obviously it's painful but again because I'm not entirely sure what the information would do and as I understand it something like 70% of the results, well 70% of the cases of biopsy show there isn't a cancer. So that is reassuring but then it's also to say 70% of people needn't have gone through it.

So one of the main reasons for not having a PSA test at this stage is unnecessary anxiety?

I think that's true. I mean a lot of people who live their life in fear and want to insure against everything and one of the minor, they have sort of an anxious attitude towards life and I think that, I have a sort of sense, this is completely ridiculous really but I sense that this actually can create the condition or very largely and I'd rather live life in a more optimistic way and only take action when it's clearly necessary.