Jonathan Edwards
Senior Member (Voting Rights)
My understanding would be this.
The real value of 'screening' for me was that I had a Grade 7/10 cancer restricted just about to the prostate identified and removed by radical surgery straight away at age 61 and eight years later have reason to think I will never need to worry about my prostate or the cancer.
I put 'screening' because I asked for the PSA test myself simply knowing that apart from colon cancer (for which I had just had a colonoscopy clear) prostate cancer was the most likely treatable problem for me that might affect life quality and length. Interestingly my prostate was normal on examination so that was a waste of time and the PSA was only slightly raised. So I repeated it and it was a bit higher and asked for an MRI. That was reported by the top uroradiologist at UCLH and a biopsy was recommended which showed the grade.
What is probably important is that all the decisions were based on a sophisticated assessment of risk. I do not have a past or family history to suggest likelihood of other causes of early demise. I was young enough for radical treatment to make sense. Nothing invasive was done until it was established that I almost certainly had a moderately high grade but curable problem. I cannot see how it can have been a bad idea.
What matters most to me is that I don't have to think about the prostate any more. It would almost have been worth having my prostate out even without any cancer. It makes life much simpler. I have a number of friends and relatives with prostate cancer given conservative treatment, which in theory may give as good survival rates but leaves people taking medicines and knowing that they will never be free of the problem.
I strongly suspect that the evidence for no benefit from screening was gathered ten years ago when radical robotic surgery and high quality MRI interpretation were rarely available. In the US there are so many cowboys results will be bad. In the UK the NHS could not afford up to date management. The relevant outcome measure is feeling free of worry ten years later. That is only just becoming a reality now.
The problem I see is that this negative approach to screening became a fashion, and a fashion that suited health services wanting to do things cheap and non-surgical oncologists wanting to get in on the game. Everyone has an agenda.
The difficulty for government run health services is that curative treatment of prostate cancer costs about £25,000 in Europe and more in the US. In the UK there are no resources to cover this. No surgeons are trained up except in the private sector.
