Interview 16

He has not had urinary symptoms, but asked his GP for a PSA test when two friends developed prostate cancer. He decided not to have the test (at the moment), having heard that it is not reliable, and that the biopsy can be painful.

His GP explained that the PSA test is unreliable and that a false positive result might lead to a…

Age at interview 60

Gender Male

It really came to a head because two men I know quite well were diagnosed with prostatic carcinoma and that and I think a combination of a growing awareness about prostate cancer generally, probably the fact that I’m getting older so you just become more aware of things that may cease to function or not function properly. But the two people that developed it, it was a little bit close to home, and to an extent at the provocation of my wife I think, I decided to see if there was a test that could be done.

I think you’ve got to be careful about this because you can become paranoid and get tested for just about anything. So I started in what I thought was a logical place and went to see my GP, who in fact was extremely helpful. And he said, ‘Well you can have what’s called a PSA test, but I should explain it to you. And he did and he explained it extremely well because I think I started out by thinking that it was rather like getting your cholesterol tested or just a blood test, I thought it could be just a routine test but I discovered later on that it’s no such thing.

There is a test and as far as I can make out it certainly is not a definitive test, and he was, as I said very good about it and talked me through it in some depth and he had the figures to back up what he said. And it seems to me that you can have a PSA test but it is not a finite measure and so it became apparent that you can actually have a relatively high PSA reading, without having prostatic carcinoma. I then said, ‘Well it’s, given that you had a PSA test is it more prevalent in older people than say younger people?’ and the answer was, ‘Probably yes, because it tends to occur more in older people. He then went onto explain that if you did have a high reading the next stage would really be a biopsy where they took a sample of the prostate itself. And as I said he was very open and honest about it and he said hed had two patients that had had the biopsy and didn’t actually thank him very much for it because it was an extremely painful procedure and invasive. And he also pointed out that although it was a smaller risk it was possible to take a sample of relatively healthy tissue in a biopsy and therefore not turn up the carcinoma at all.

So he left the decision up to me, which I don’t think was avoiding the issue at all, I think he did exactly the right thing, because he was not in a position to say, ‘Yes that is a definitive test and it will tell you yes or no whether you should proceed to the next stage.

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His GP gave him detailed information which helped him decide not to have the PSA test

Age at interview 60

Gender Male

Could you say a little bit more about the sort of information the GP gave you?

Yes there was a general handout which was a sort of one page flier but he had actually gone to some trouble to isolate more statistics and I think one of the reasons he did that was because of the experiences of these two people that he sent for a biopsy who were not entirely friendly towards him any longer, let’s put it that way. and the charts he gave me were very, very expressive and they broke it down into age groupings and it almost got as far as socio economic groupings. And it broke it down into the incidence of PSA testing and those people that went onto have biopsies and the calculations that were concerned with that so it was extremely useful. The other point that he made which I think is a very good one is that the PSA test is extremely valuable if you are diagnosed with prostatic carcinoma because it will help more definitively to identify whether treatment is working. And it appeared to me that that was one of the major uses of the PSA test but only after the carcinoma had been diagnosed and treatment had occurred which I thought was a very good point.

Did he have all this information waiting for you, did he know you were coming to ask about it?

No he didn’t and initially he ran me through it in, not in a brief manner it was fairly, it was fairly structured but his words were, ‘The decision is yours’, but you need to have enough information to be able to take that decision. And so he actually collected some of this data for me and I think he now has that as a de facto standard for people that come in and it was extremely useful. Certainly the one page flier [PSA Testing for Prostate Cancer] gives you the nuts and bolts of the thing but this was much more definitive and allowed you to arrive at a valued decision.

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Recognises that men may have prostate cancer but die of something else.

Age at interview 60

Gender Male

And when you were at the Gps did he discuss prostate cancer at all or treatment for prostate cancer?

He didn’t discuss treatments for prostate cancer, he discussed to a limited extent the kind of prostatic irregularities that might occur which included hypertrophy which you can exhibit apparently the same symptoms with just straight forward hypertrophy or urinary, urinary tract infection as you can with a carcinoma. So it’s, the more probable case if you are exhibiting symptoms it could be just straight forward hypertrophy rather than anything else. Although having said that and looked into a little bit further the incidence of prostatic carcinoma is much wider than I previously thought. But one of the articles I read and something I remembered from it was that, and it’s a quote from a particular medical dictionary is that a lot, a very high percentage of older men actually have a prostatic carcinoma, but the phrase that rings in my mind is that they die with it rather than because of it. So you then arrive at a situation where you may well have it but you may not die of it.

Does that influence your decision-making?

It does to an extent because if you, if a high percentage of elderly men actually have it you may outlive the thing altogether and in fact that’s apparently what happens in the majority of cases.

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