Last year I was diagnosed with prostate cancer after a routine PSA test. It had not spread, and the doctor decided to adopt a six-monthly blood and prostate examination. Had I not had the PSA test I feel I would have soldiered on in blissful ignorance. But receiving no treatment sends my mind into overdrive.
Mr W McBryde, Dumfries
Your worry is understandable. Most people diagnosed with cancer are keen to have treatment as soon as possible to get rid of all signs of it.
But with prostate cancer, all is not what it might seem. One of the most important things to point out is that this type varies greatly in how aggressive it is: prostate cancer is mostly something you die with, not of.
Since the arrival of PSA testing — which measures a protein called prostate-specific antigen — there have been more prostate cancer ‘diagnoses’.
But PSA levels can be raised for other reasons, too (such as an enlarged prostate or even recent sexual activity), and a biopsy is needed for confirmation.
Besides the fact that the prostate biopsy carries risks (it is painful and can trigger a potentially life-threatening infection in a tiny number of cases), it may lead to a diagnosis of cancer in men who would otherwise have remained unaware of the illness, and lived on for years, only to eventually die of something else.
Many men have cancers that will not progress significantly if left alone. For these, treatment — which may involve prostate removal surgery, and radiotherapy or chemotherapy — may be unnecessary and not worth the complications, such as incontinence and impotence.
The difficulty is in deciding which confirmed prostate cancers are the less aggressive, semi-dormant ones that will not shorten life. The key is a measurement called the Gleason score, given by the pathologist who examines biopsy tissue samples.
The lower the Gleason score (two or three is considered low, six to eight is high), the more favourable the outlook. In such circumstances the specialist would typically advise watchful waiting, the recommendation you have.
The research is complex, but I will quote you one 20-year study involving 1,300 men with Gleason scores below six. They were deemed to be at low risk of dying from their prostate cancer.
They were followed in the same way as you, with PSA tests, digital rectal examination and prostate biopsies when a change was noted. In that time, 49 died, 47 of them from causes other than the cancer. More than 90 per cent of the group were…