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 theres 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.

Have you thought at all about the causes of prostate cancer?

I’ve read a little bit about the causes, they’re extremely unclear, very contradictory and quite often a bit idiosyncratic I think. This is an area that clearly you know is not tried and tested yet to the point where I think anyone would come up with conclusions. When you read stuff like that you tend to be swayed by whichever factors are closer to your own lifestyle [laughs]. I mean the fact that I’m white, that I’m vegetarian that I don’t you know indulge in kind of you know extremes of diet, that I don’t work with, what were the other indications, I don’t work with powerful magnets, I don’t live under a pylon and all those kind of things. I mean you know you tend to take from those, I guess some solace in the fact that you know that’s pushing me towards a category of lower risk. That may be illusory but I think going through that kind of process is probably quite important and quite useful to people, it does help them make their mind up.

And thinking back can you remember the main pros and cons of having the test from that all that information?

I think the main, the main pro of having the test would be that if there was a sign that there may be cancer obviously it would, could lead to earlier treatment and that would clearly be the main pro of having it is that it could lead to diagnosis and may be sort of catching the problem at an early stage. So it’s the other side of it that I think was more interesting really because it did seem to me, from what he [the GP] told me and what the leaflet said that there is a huge amount of uncertainty in this test and it isn’t anything like as certain as some other tests for various cancers or other illnesses. And I forget, I think something like is it something like even like two thirds of the cases cannot be accurately pinpointed? I got this figure two out of three from somewhere and I can’t quite remember what that’s, what that’s related to [laughs]. Anyway it seemed that in some cases it could suggest that there was a problem which may not be cancer and that could lead to further exploratory tests and treatment which could be actually quite sort of I don’t know sometimes painful and other times uncomfortable. It could also lead to a sort of a mental, I’ve lost the word there, can I just come back to that mental word;

Worry?

Yes, I suppose, yes, anxiety, yes. So there was that side of the argument that it, and the other side of the argument is that it could actually miss, miss the cancer anyway and so I decided that with all that sort of uncertainty around it and my symptoms not deteriorating that for the time being I wouldn’t proceed to the next stage of having the test. My doctor gave me a sort of very brief examination in so far as he was capable of doing which he said suggested no obvious abnormality although I understand that’s a fairly.

It was a rectal examination?

That’s right yes, is a fairly sort of imprecise thing but it did again sort of put my mind at rest for the moment that, but as I say I remained very uncertain about whether to go ahead and have the test or not. I may well yet do so.

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 theres 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.

So having read all that information what sort of message did you go away with?

Well I think what I came away with was the fact that this is a quite finely balanced thing for men of my age as to whether, as to whether this should be something that I would A do myself or B whether the Government should do as a routine part of the National Health Service. And I did kind of mull that over and I’m, probably I think my position changed, having sort of read the stuff and reflected on it after a while. But having made up my mind I think my mind is now made up, and I’d be a person who would not think that at the moment routine testing, screening was something that the NHS should provide, although I wouldn’t you know deny people the freedom to pay for it if they felt that it was important to them.

Would you mind spelling out your reasons?

Because I think the test is not good enough to be perfectly honest. I mean it’s not a test which is a, you know has a one to one relationship with giving you information that you can reliably act on. It’s only an indicator and the indicator is itself on a scale and you know what happens if you are borderline and so on. It seems to me that the testing would need to be so periodic for people who came out with a borderline result of an antigen that it would kind of just loom too largely in their life really compared with all the other, the other comparable conditions that could be screened and tested for. I mean if you’re not careful you know you could, you could be having yourself routinely tested for such a variety and array of things that you turn out to be some kind of neurotic Woody Allen figure or Howard Hughes at the worst extreme and I don’t want to live with that really.

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.

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.

Is there any history of prostate cancer in your family?

Well my father, among the many conditions that he had very late in life was actually diagnosed with prostate cancer but as I say that was in conjunction with 32 other things which an 86-year-old man had. What that suggested to me is that, is actually a counter indication if anything because he wasn’t aware that he had prostate cancer and he may well have had it for 30, 35 years without knowing. As far as I know he had no urinary problems that were associated with, with prostate cancer. So if anything the fact that he had it was a counter indication for me that the test would be good.

So that reinforced the idea that it would be a bad thing for you perhaps to have a test?

Or a an unnecessary thing to have yeah.

Because he lived happily till he was old without knowing he had the cancer?

Yes, precisely so yes.

And do you remember what the leaflet said about treatment for prostate cancer?

Yeah that it’s, there are various forms of treatment, most of them are unpleasant to some degree and many of them have side effects which you know are quite life affecting. That also is a factor. I mean the problem about all this thing is that there are complexities on all sides it seems to me and prostate cancer itself is quite a complex cancer and I gather a fairly unusual one although I’m by no means an expert in those matters. The fact for example that many men over 50 have, have prostate cancer cells present in numbers that are detectable but not noticeable in terms of every day life and may lie dormant like that for many years to come, is already you know one suggestion that this may be a condition that I don’t think that routine screening would necessarily give me information on which I could make a reasonable operational decision. And then the fact that as I’ve said the PSA test is not a test for prostate cancer as such, it’s a test for one of the indicators of prostate cancer and then the fact that the, the various treatments and their combinations are, quite often do bring side effects which are in very high percentages and those percentages suggest to me that I’d rather play the kind of wait and watch game than go for the first indicator of something that may be an indicator of prostate cancer.

So to sum up at the moment you have no symptoms and you decided you wouldn’t want to have a test at this stage, can you sum up all the different factors that influenced you?

Well I really, I’m the kind of person who, I generally speaking I do want to know whether I’ve got a condition or not but I’m always going to balance that with how clear are the indicators going to be, what are the risks and what’s the prognosis in terms of the effect of treatment and so on. And I think at the moment so many of those are stacked on the uncertain unpleasant or unsure, unsure side of things as far as prostate cancer is concerned that doesn’t persuade me to take a test routinely unless I had quite serious symptoms. I think you know personality and what, the way you think about life philosophically probably plays a part in this. I mean you know I’m not going to be somebody who’s going to cling onto life desperately at all costs. I think I have you know definitions that are quite clear in my own mind about what would be tolerable and what wouldn’t in terms of you know seeking to maintain my life and I think you know unless a lot of the boxes are ticked then I’ll go out and wave people goodbye without going through you know a huge amount of invasive procedures.

Obviously I’ve thought about the PSA test because it’s been in the newspapers and I’ve heard people talk about it at work. And my thoughts go like this. I don’t feel particularly worried about prostate cancer for myself. I wondered what I would do if I got a negative result i.e. the test was clear and I don’t think I’d get any benefit from having an all clear result because I’m not worried about it in the first place. So what I would, if I had the test and got a negative result, which is the most likely, that, you know no gain and a little bit of inconvenience to all concerned, a bit of waste of doctor’s time, laboratory time. If I got a positive result I then, as far as I know, would be facing a number of rather awkward decisions about whether to be treated, whether, what, and going through the further tests that are needed before one gets to the treatment. I’d also be worried, wondering about whether it was a false positive result and was the whole thing necessary or not. So on balance it seemed to me that being tested would cause more trouble than not being tested;

You mentioned the media, do you want to say a little bit more about that?

Yes, the media, I think, is quite prone to pick up a cause like prostate cancer screening, and that’s good many ways but the way I was reading the articles is that they seem to be very one, usually one sided, usually for it. And I automatically would ask the question well, what’s the other side of the argument? And when I found that that wasn’t being very well described or considered in the press I did a bit of reading around for myself and came to the conclusion that there was a down side to being screened, that the test wasn’t very reliable, that even if it’s positive it doesn’t necessarily mean that you’re going to suffer from having a prostate, a lump in your prostate, that you can live okay fine with that, with that but the treatment wasn’t, isn’t foolproof by any means, nor very clear cut and some of it is quite invasive. So it’s not necessarily a good thing to be tested.