Mailbag: More complexity in prostate cancer testing
Norman Swan: So let's go to the mailbag now.
Preeya Alexander: Yes, so I was not here, I was off gallivanting last week, but you've done a story…
Norman Swan: Feel free to criticise what we did. We wouldn't have been so crap if you'd been there.
Preeya Alexander: That's not at all what I was suggesting.
Norman Swan: Olivia was fantastic…
Preeya Alexander: She's always fantastic.
Norman Swan: So a GP has written in about our story on prostate cancer diagnosis and screening, although we didn't use that word. We had Jeremy Grummet on the show talking about the guidelines, because he took umbrage, because…this did involve you, because when you and I were talking about these guidelines that came out when they first came out, I was quite forceful in saying that the PSA blood test was crap. And Jeremy, who's been on the Health Report several times before, took umbrage at this and saying it's not crap with the new guidelines. So anyway, he came on to talk about the prostate cancer guidelines and to correct my image that the PSA was crap.
And this GP who's written in says, 'I found Jeremy's comments to be the untypical, unrealistic comments that urban centric, non-GP specialists are prone to make.' And our correspondent is in fact a general practitioner. So he says, 'It takes a few seconds to tick the PSA request on a form, and that's the easy bit. The Herculean task is then to obtain access to a urologist and a prostate magnetic resonance imaging machine for a rural or regional patient. And let's not forget city dwellers without private insurance who are facing exactly the same problem.'
Preeya Alexander: That's the thing. The blood test, the PSA, is often the easy part, I have to agree with this, and I work in a metropolitan region, but often it's the next steps, it's what do you do with the result, how likely is it to actually cause a problem, and how does the patient access the ongoing either urology input or scanning that they need, because it can be very costly.
Norman Swan: And to be fair to Jeremy, he did talk about this disparity between city and country and this evidence. And Paul also writes in, 'I know this is anecdote, and I've no idea if it's evidence based,' but when he was a GP…we've obviously got more GPs listening to the program now that you're on because they want to check you out here, whether you're sullying the profession. 'I've had a few isolated patients with an extremely low PSA (in other words, under one) which slowly rose to be around about four.' And just to put this in perspective, I don't know if you know this, Preeya, but the original studies that were done I think it was at Stanford University by a urologist there, on PSA, he was suggesting you had a high risk of cancer at a PSA of 25.
Preeya Alexander: I remember you saying this when we did the show several weeks ago…
Norman Swan: And it's crept down. And what Paul's talking about is that this change in PSAs are really important, even at a low level.
Preeya Alexander: Paul's saying the idea of having a baseline, perhaps. But I have to say, are you potentially detecting cancers which were never going to cause any problems? Because that's the whole debate with prostate cancer, isn't it; you might detect cancers that someone might live with and die with the cancer, as opposed to die of it. And so this attaining a baseline and routine testing, gosh, it's filled with conundrums, and you need to have a big chat to the patient beforehand.
Norman Swan: And some people can have prostate cancer with a normal PSA. But what Jeremy would say, if I was channelling Jeremy Grummet here, is that that's what MRI is for, is to sort this out for you. And if there's nothing much there, then you can relax.
Preeya Alexander: But it's not always easy to access, either the MRI or the urologist. As we've just said, it's a little bit of a conundrum I think still.
Norman Swan: It is.
Preeya Alexander: Yep, but we love hearing from you. So if you want to write in with any topic suggestions or comments or questions, it's healthreport@abc.net.au.
Norman Swan: And you don't have to be a GP to write in.
Preeya Alexander: No, you don't, please, ideally everybody, all community dwellers.
Norman Swan: And don't forget our companion podcast, What's That Rash? , and this week we're going to be talking about concurrent workout regimes. Should you combine cardio with strength exercises? Interesting question, I'm sure it's dominated your life for a long time. Tune in to What's That Rash? to find out. We'll see you next week.
Preeya Alexander: We will.
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