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PROSTATE CANCER SUPPORT ASSOCIATION (CENTRAL ENGLAND) (Registered Charity 1092547) |
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| Patrons: George Baker, Don Maclean M.B.E., K.Prasad F.R.C.S.I.; F.R.C.S.Ed., Ken Taylor, Peter Wildblood. | ||||
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HELPLINE 07855 286264 09:00 - 19:00 daily THE P.S.A. TEST (U.K.) The P.S.A. (Prostate Specific Antigen) test is a simple test used to indicate if a man has prostate cancer. The test involves giving a sample of blood, usually taken from the arm. The sample is sent away for analysis where the amount of PSA is measured and, in a normal healthy young man, would be less than 1. An older man of 60 - 65 might have a result of about 4 and not have prostate cancer. Such a simple test has its drawback and with the PSA test it is the number of positive and negative results it often yields. For example, it is possible for the test to yield a result of, say, 4 in a 65 year-old male and yet he has prostate cancer. Conversely, another 65 year-old could have a result of, say, 16 (an arbitrary figure) and not have prostate cancer. It is this uncertainty which has made the general practitioners very cautious about sending patients for the test. The Government has sent out a circular to all GP ’s giving them advice. Very simply it is that if a man asks for a PSA test he must be counselled. He must be told of the uncertainty of the test and that an elevated result (above about 4) is not conclusive evidence of prostate cancer. There is concern about the psychological effect a positive indication could have on a patient. The GP should also ascertain the following:Before having a PSA test has the patient: 1. an active urinary infection? 2. ejaculated in the previous 48 hours? 3. exercised vigorously in the previous 48 hours? 4. had a prostate biopsy in the previous 6 weeks? (Although the GP would normally be aware of this) 5. ridden a bicycle within the previous 48 hours? (Note: The last one on the above list does not appear in the guidelines and I have added it to the list because I have heard of instances when a PSA reading has been high but subsequent readings have been normal). The Association fully endorses the above procedure but it does not always work out in practice. Personally I had three PSA tests before my operation but I was not asked any of the listed questions. Also I have been told by several men that when they asked for a PSA test the doctor had asked a number of questions in such a way as to dissuade them from continuing with their request. This should not be so. The purpose of the counselling should be to inform the patient of the uncertainty and tell him the procedure in the event of a high reading. Another test the doctor can do is a Digital Rectal Examination (DRE). This involves a finger being inserted into the rectum and the doctor can feel the size, shape and texture of the gland through the wall of the colon. An elevated PSA result and an enlarged and knobbly gland is a more positive indication of the presence of cancer in which case the patient should be sent to a Urologist for more specialist checks. Prostate cancer is one of those cancers that is relatively easy to treat and, if caught early enough and given the right treatment, results in an excellent prognosis. I am living proof of that having had my operation in November 1999. The Association ’s advice is that if you decide to ask for a PSA test you should not be put off by the doctor. Every man over the age of 45/50 has the right to ask for a PSA test and even more so if prostate cancer is in the family.
QUESTIONS PATIENTS COULD ASK THEIR CONSULTANT/GP 1. DREIs the prostate enlarged? Is the groove distinguishable? Are there any knobbly areas? Is there asymmetry? Is there adhesion to other tissues? 2. PSA Value What is the value of my PSA reading? Is that reading what you expected? What is the significance of the result? Which methodology was used to measure the value? (Total PSA or Complex PSA) Which laboratory was used? Will the same laboratory be used for subsequent readings? 3. Additional Lab Analysis Are there any other PSA tests of relevance? Are there any other biological results of relevance? (Gleeson or ‘T’ scores) 4. Biopsies Which parts of the prostate have been sampled? How many samples were taken? How many were found to be cancerous? What stage is the cancer at and what does that mean? How was this measured? What is the significance of the result? Is the tumour still contained within the prostate? Do you follow a nomogram? What is the prognosis? Are the seminal vesicles affected? 5. Treatment What treatments are available for my condition? If a) Surgery (ie involving removal) Which type of surgery would be appropriate: Suprapubic (incision in the abdomen)? Laparoscopic (keyhole surgery)? Perineal (via the back passage)? Transurethral (through the penis)? Robotic? What is the object of this treatment? How many of these operations have you conducted and what is your success rate? How long does the procedure take? What precautions will be taken to ensure I do not catch an infection such as MRSA? How long would I be in hospital? What would be my recovery time? What is my life span likely to be as a result of this treatment? If the treatment is not successful what is the alternative? What follow up is instigated and how long will it be when I receive notification? Is there any dietary requirement I need to be aware of? If b) Radiation Therapy Please explain the following procedures: Conformal external beam radiation? Brachytherapy? What is the object of this treatment? How long does each treatment last for? How long would I be in hospital? What would be my recovery time for each? What is my life span likely to be as a result of this treatment? If the treatment is not successful what is the alternative? What follow up is instigated and how long will it be when I receive notification? Is there any dietary requirement I need to be aware of? If c) Cryotherapy Please explain this form of treatment. Questions as for b) Radiation Therapy. If d) HIFU (sound waves) Please explain this form of treatment. Questions as for b) Radiation Therapy. If e) Hormonal Therapy How does this treatment differ from others? How effective is it compared to other forms of treatment? What is the object of this treatment? How is it administered (tablets, injections)? How long does the treatment last for? Is there a maximum length of time for which I can take this treatment? If the treatment is not successful what is the alternative? Will I have to attend hospital (inpatient, outpatient)? If inpatient, how long would I be in hospital? Will I suffer from ‘hot sweats’, breast pain and swelling? What will be the long term side effects on my general health? What is my life span likely to be as a result of this treatment? What follow up is instigated and how long will it be when I receive notification? Is there any dietary requirement I need to be aware of? 6. Medication For my chosen form of treatment will I require short or long term medication? What form will this medication take? Will I be able to obtain this free of charge? Will there be any side effects? Is there a general supportive treatment I could have? Is there any dietary requirement I need to be aware of? 7. Active Surveillance Why are you recommending me for Active Surveillance? How frequently will I be monitored? What procedures will be undertaken? At what PSA value would you expect to introduce further tests? Are there any other procedures which could be suitable to my condition? Has my case been discussed at a multi-disciplinary team meeting (MDTM). If so, what was the decision, did all the members agree and if not, why not? What are the side effects for each form of treatment? Urinary incontinence (temporary, permanent)? Faecal incontinence (temporary, permanent)? Impotence: a) Will I be able to ejaculate? b) Will I be able to have a normal erection and if not, can I get medical help? c) Will I be able to have an orgasm? d) How will it affect my sex life? 8. Who will give me and my family psychological support should we need it? Name:........................ Tel No: ..................... 9. Whom may I contact regarding any worries I have during my patient journey? Name: ................................ Tel No: ...................... IT IS IMPORTANT TO REALISE THAT WE ARE ALL DIFFERENT AND THE RECOVERY TIMES AND SIDE EFFECTS GIVEN BY THE CLINICIAN CAN BE A GUIDE ONLY. Note: You should ask: What is my Gleeson score? (How aggressive or fast the tumour is growing). ‘T’ score or TNM (Tumour Nodes Metastases) (Gives an indication as to how far the cancer has spread).
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