Prostate cancer expert explains how one wrong PSA test can harm a man’s life.

Prostate cancer screening for most at risk men has been rejected in Britain and one of the country's top surgeons has explains how one wrong test result can "snowball"

 Oxford University professor Freddie Hamdy CBE has told how slow growing tumours may never cause men a problem in their lifetime - but the consequences of treating them can have a devastating impact on their quality of life.  The Professor of Urology is a member of the UK National Screening Committee and told a media briefing how a simple PSA test can quickly end up with frightened men unnecessarily going under the knife to just "get it out". As a result, they often become incontinent and suffer erectile dysfunction.

 Professor Hamdy explained: “Men need to be really well counselled and informed before the snowball starts. It starts with a blood test and then it snowballs. Before you know it, you are on an operating table having your prostate removed.

 “Most men once told they have prostate cancer by clinics are terrified. You give them options, and most men will say ‘I want it out’. They don’t care if the tumour is deemed ‘significant’ or not. We explain to them the side effects… the leakage, loss of sexual function and they’ll say, ‘it doesn’t matter, I just want it out’. So, the prostate comes out.

 “They come back and we see them a year later and they say they’re having a problem. It’s about loss of sexual function and leakage. They wish their sex life was better. It can lead to difficulties in couples’ marriages. The harms are things we don’t see up front because of that diagnosis of cancer. These harms are hidden until a while later, including from the patient.

“The diagnosis of prostate cancer in a healthy man is a hugely disruptive event with the potential to reduce quality of life very significantly for many years. It cannot be done lightly.”  The UK National Screening Committee report contained anonymous comments from prostate cancer patients. One said: "It really changed my life. I couldn't go anywhere. I'm always thinking 'what if I wet myself?'"

Another man said: "Knowing I might not ever have sex again, I try not to think about it because it does crack me up. I've been married for 36 years, and we've just got to the point now where we avoid the situation."

 The committee's recommendations outlined the “lifelong harms” from unnecessary surgery. They include urinary incontinence such as leakage when coughing, exercising or lifting, where incontinence pads may need to be worn”.  It continues: “Erectile dysfunction – the inability to have or hold an erection due to nerve damage. Other surgical complications could arise include bleeding, infection, blood clots or damage to nearby organs such as the bladder or rectum. All of these can cause harm that significantly affects someone’s quality of life: physically, emotionally and psychologically.”

 The committee decided that the prostate specific antigen (PSA) test is not accurate enough to justify inviting otherwise healthy men to be checked with it.

 Evidence suggests PSA levels can rise for many reasons, including simple infections, and 75% of people with a raised PSA do not have prostate cancer. A raised level means men can be referred for unnecessary biopsies or MRI or treated for tumours that may never cause harm.  Some people diagnosed with a form of prostate cancer after a PSA test go on “active surveillance” but the committee’s panel of experts explained how this can also cause significant harms to mental wellbeing.

 The media briefing in central London on Friday heard data showing that after three years some 25% of prostate cancer patients initially placed on active surveillance have opted for treatment. After 10 years this is 50% and after 15 years has increased to 60%.  Prof Hamdy said: “I'll give you the clinical scenario of the man who is on active surveillance. He's fit and well but been diagnosed with prostate cancer. We do regular PSA tests, MRI scans and repeat biopsies.

 “The slightest glitch in any of these, even if it is a PSA result which goes up only sporadically, the man is so sensitive to the possibility of disease progression that he will ask for treatment. And we find out after surgery from testing that the vast majority of these operations were unnecessary.”

 Story by Martin Bagot for the Mirror.