Interview 30

Age at interview: 66

Brief Outline:

No urinary symptoms, but he asked for a PSA test because a friend had prostate cancer and because of media coverage. PSA found to be slightly raised. In 2004, after a biopsy, cancer was diagnosed, and treated with hormones and then brachytherapy.

Background:

Occupation' Consulting engineer (semi-retired). Marital status' married. Number of chidlren' 2. Ethnic background' White British.

Having considered all the many treatment options he chose to have brachytherapy.

When I went back, the consultant was very positive and obviously explained that the prostate cancer had been found, but it was in its early stages and very treatable and then he explained the options open to me. One thing he did mention was that as a result of their findings he did explain that prostate cancer tends to be very slow growing but he did explain that they, they still don't really know for sure how the type of cancers behave relative to whether they were aggressive or not. 

So he then went on to explain the options available which was radical prostatectomy which is removal of the prostate, radiotherapy, which in this particular hospital they carried out 3D conformal beam therapy which tends to be more accurate than the older methods used. And he wrote to confirm to my GP that that's the diagnosis and advice given to me and that further appointments would be made to go through the various options, with both himself and his team of assistants, surgeons and oncologists.

Did he mention that just active monitoring was another option?

He did mention that which he called watchful waiting. In fact in some ways he did put quite a bit of emphasis on that by saying that this would be done by doing regular PSA tests and if they remained of a similar reading to what was apparent for the diagnosis it was thought the cancer would be relatively quiet, and not causing immediate problems.

And he said that certainly I would be a suitable candidate for brachytherapy but unfortunately they don't do that at my local hospital in [the local city] but they had a tie up with another hospital and that could be arranged. But anyway it was a possibility and I would make the decision when I'd spoken to the oncologist and gone through the various options. I also had an appointment with the surgeon who performed radical prostatectomy and basically on that appointment I had interviews with the oncologist and the surgeon and they explained their procedures for total removal of the prostate or 3D conformal beam therapy directed at the prostate. They also explained what brachytherapy was which was basically a form of radiology but by injection of radioactive seeds into the prostate. Having considered all the options and the various side-effects applicable to all the options and also having read the Prostate Cancer's [Charity] toolkit I was leaning very much towards brachytherapy and on the next appointment with the consultant when it was basically decision time although he did emphasise that there was no hurry and I didn't have to decide as a matter or urgency, nevertheless I felt that due to my age I, and knowing the cancer was there I felt something should be done about it rather than taking the option of making a long time to make my mind up or go for the watchful waiting option.
 

His thinks his GP did a PSA test as part of a routine 'check-up'. He had no symptoms.

My first test was given on the advice of my GP but he didn't tell me it was specifically called PSA he just explained that he was going to check my prostate. And I agreed to this and he gave me a digital rectal examination and then he said I also would need a blood test. He found the examination satisfactory but again he didn't say what the blood test would reveal in terms of PSA or anything else, he just

Was that because you had symptoms?

No I didn't have any symptoms at all, he purely offered it to me voluntarily as part of my check-up.

So you went along for a check-up. You asked for a check-up?

No, no I was having a general check-up for blood tests, cholesterol and other things and he said he would check my prostate at the same time. But again he didn't mention the word PSA so I was totally in his hands with regard to the reasoning behind the test.

So you had a PSA test without really knowing that you were having one?

Correct.

And he didn't give you any written information?

No

About the PSA?

No he didn't give me any information at all he just said it was a prostate check.

Did, are you sure that you had a PSA test the first time you had the medical in 2000? You said that the doctor said that everything was fine with your prostate? 

I wasn't sure no.

So you don't...

Because I didn't know what PSA was all about at that stage.

Did he mention the fact you'd had a blood test that would indicate if anything was wrong with your prostate?

He indicated to me that all was well but he didn't specifically say, 'Nothing is wrong with your prostate,' he just said the results of the blood test, all was well with regard to the prostate check.

The death of a friend, local radio, and articles in magazines and newspapers also influenced him to have the PSA test.

Much more awareness was made.

Oh that's interesting would you mind just summarising that, you decided to have, starting by saying why you decided to have a PSA test at that stage, all the influences, the things that influenced you?

Yes well obviously my friend's own illness and suffering of prostate cancer and unfortunately he passed away last year, 10 years after his original diagnosis and treatment for those years. And it was just coincidence at the same time all this was happening there was a lot of publicity on the local radio about the disease and in fact some interviews have been carried out with men who'd been diagnosed with the disease.

Was there any prostate cancer in your family?

Not to my knowledge but again that's another thing and obviously one is told about the disease, it can affect many men and they can have the disease and go through life without necessarily dying from it because it tends to be a disease associated with older men, although I understand men in their 50s now are being diagnosed with it, probably because of the fact that more PSA tests are being done. So I think the general awareness that's been published, and there's also been a number of articles in both national and local newspapers on the disease, it's sort of come to have this much greater publicity given to it which I feel must be good thing for the future.

Is there any particular national newspaper that you both, in which you've read articles about it?

I think there was something in the Independent some while back and I think there's also been, because we take the SAGA magazine.

Oh yes.

There have been a couple of, which obviously is an organisation designed for the over 50s anyway [laughs] there have been several articles on it there and I think. I think also the Telegraph, or the Sunday Telegraph have had some articles on it. 

After he moved house and changed his GP a friend encouraged him to have a second PSA test.

I met a friend who was quite close to us, in fact we had been on holiday with them and he had already been diagnosed with prostate cancer some years previously. And he was a person who was quite prepared to talk about his problem and he basically asked me if I'd had the necessary prostate test and I mentioned I'd the normal examinations and then he said, 'Did they tell you what your PSA was?' and of course that was total strange language to me and I said,' Well what is a PSA?' and he explained it all to me, as a result of which during my next medical visit to the GP I actually asked for a PSA test to be done.
 

The doctor at the hospital told him not to ride a bicycle just before his PSA test.

Yes then I, then I went to see the consultant and he had a surgery at the hospital that day and one of his assistants examined me further, did another digital rectal examination and found no problems there, he said it was smooth on the outside. But he did explain that sometime cancers can develop inside the prostate and just because the gland was smooth it wouldn't necessarily indicate there was no cancer. But because I'd only had one PSA test at that time he suggested I had another one just in case it was a hype in the system. I also explained to him I had been riding my bicycle before the test and he just said that riding your bicycle can sometimes raise the PSA. Which again I didn't know that was the situation.

So nobody had told you not to ride a bicycle?

No.

Before the test?

No.

Right.

It's just one of those things, apparently it can activate the prostate and cause a possible leap in your PSA reading.
 

He finds it worrying that cancer may be present even if a man's PSA level is within the 'normal' range.

I think the main thing that, and this will probably come out during my routine check-ups, there hasn't been a full explanation of what one would expect the PSA reading to be, during the check-up periods, relative to the time after treatment, there seem to be varying opinions on this and in fact if you go on the various websites available on the Internet on PSA readings what they should be before and after, before and after treatment, I feel there's still a bit of a way to go in terms of, it may be because the precise figure on PSA can vary from patient to patient relative to the type of treatment they've had and therefore they are hesitant in publishing more accurate figures. But there does seem to be quite a variation.

A lack of clarity?

Yes on what one should expect. Because I, in fact strangely enough when I went for my first check-up I was a little concerned because it had gone up from .4 to .8 which you know in pure mathematical terms is double but I was assured there was nothing to worry about at this stage and it was probably partly due to the hormone treatment wearing off slightly. But I think one of the, looking at it from a logical point of view I think for my age before the treatment and anyone who actually got, or been diagnosed with prostate cancer for my particular age a normal figure is anything from 3 to 4.5 and one assumes that if it's in this range there's no cancer present. But it has been proven that this is not necessarily the case, that cancer can be there even when the so-called normal range of PSA is shown in your blood test. I find that to be slightly worrying.

The uncertainty?

Yes because one would sort of read into that that whatever your PSA reading you should still have a biopsy but obviously the implications of carrying that out in all cases would be considerable to the Health Service and they could be doing biopsies that weren't necessary. So I think it is quite a thin dividing line between these readings as to what is normal and what isn't normal, especially at the lower range of the figures.