PSA test

Could a prostate test leave YOU fighting for life? Prostate biopsies are very low-risk, but what if you're unlucky?

By JOHN MANNERS FOR THE DAILY MAIL

PUBLISHED: 01:41, 11 August 2015 | UPDATED: 02:17, 11 August 2015

Doctors and nurses crowded around me, inserting tubes and wires into my body as I lay shaking uncontrollably and drenched in sweat on a hospital trolley.

My organs were shutting down and I was struggling to stay conscious - the A&E team kept shouting questions at me to try to keep me alert: 'John, do you know where you are? Who is the Prime Minister?'

I had no idea, and my answers were apparently a nonsense jumble of words. I could feel my heart racing and knew I was fighting for my life - in fact, although I didn't realise it, I'd just had a heart attack.

Raised PSA (prostate specific antigen), a protein produced by the prostate, can be a sign of cancer, among other things. For a man of my age, 68, a normal reading would be less than 4 [file photo]

Only 48 hours earlier, I'd been perfectly fit and healthy. And then I underwent a test for prostate cancer.

It had all begun just over a month ago when I had decided to get an NHS 'well man' check at my local GP surgery. I had not long retired and while I had no symptoms of ill health, a check-up seemed a good idea for the future.

As the results of the various blood, urine and body checks trickled in, all seemed well.

The prostate result took longer - two weeks after the test my GP sat looking at it on his computer screen when, without a flicker of emotion, he said: 'It could be cancer I suppose.'

His words hit me like a thunderbolt. It seemed I had a raised PSA, prostate specific antigen, a protein produced by the prostate. Raised levels can be a sign of cancer, among other things, and my reading was 6.9 - for a man of my age, 68, a normal reading would be less than 4.

The GP continued to stare into the screen and went on: 'Best to have the prostate checked for cancer in hospital with a biopsy.'

As John's was 6.9 the GP advised it best to have the prostate checked in hospital with a biopsy [file photo]

 

My feeble mutterings of past private medicals showing that I had a slightly enlarged prostate - which can raise your PSA yet be entirely benign - were as much use as a cracked thermometer. But there was no chemistry between us. We hadn't had time to build a relationship, as he was the fourth GP I'd seen in four visits to the practice since moving to the area ten months earlier.

The GP rattled on about raised PSA, new 14-day rules on urgent hospital appointments and biopsy processes.

Then my alloted time was up and I found myself standing in front of the practice manager who announced that she could book me into the hospital for an urgent biopsy within two weeks.

And so a short while later I found myself sitting in front of the head of urology at my local hospital for a biopsy briefing. A kindly man, he put me at ease. As I was a former Fleet Street journalist, we joked about the Press. It was like talking to a wise old uncle, and I felt like inviting him home for dinner.

Then he outlined the biopsy procedure and the risk involved: a 3 per cent chance of infection, always a risk when inserting foreign bodies inside you.

Not bad, I thought. An infection - a rash, stinging or something like that, blood in the urine, constipation, water retention, dizziness maybe, I thought.

The biopsies had not shown any malignancy. For that, I am eternally grateful. But I almost had to die to find out

At the time I was more worried about the undignified procedure than the possible aftermath.

My mind was working overtime as I listened intently to his words: a needle inserted into the rectum for a local anaesthetic; insertion of an ultrasound probe; another needle pushed along the ultrasound probe into the prostate gland; a firing mechanism that cuts tissue. Ughh!

Even after all that, the test is not always 100 per cent accurate.

Putting on my bravest face, I opted to go forward and two weeks later found myself swallowing a precautionary antibiotic given to me by a nurse as I sat in the waiting room outside the theatre.

Thirty minutes later, I was led into a small room with a hospital screen on wheels; a surgical operating table; a couple of machines with wires; a doctor in a loosely fitting shirt; a nurse and a collection of people in civvies!

'Would you mind if these students observed the procedure?' asked the doctor. I looked at the four or five smiling young men and women in horror. If it had been my arm or foot, no problem.

'Sorry guys,' I said, trying not to show any embarrassment. 'But this is a little undignified.'

Clearly disappointed, they filed out, saying they understood.

Five minutes later, I had slipped into a white gown loosely tied at the back, signed a procedure consent form and was lying on my side on the operating table with my knees pulled up.

Trying to make light of the situation, I chattered on about my fear of needles but promised I wouldn't be a baby - even though I was now in the foetal position - and declined a general anaesthetic.

The procedure began with me gripping the iron rails of the table. 'My goodness, your knuckles have gone white,' the doctor joked.

I heard the sound of my false laughter as we got into full swing - the injection, the probe and tubes going in hurt, but I was taking it like a man. And then...

'You'll hear a series of bangs, like a gun going off,' the doctor said.

He had my full attention.

'How many bangs?' I squeaked.

'Twelve: I will be cutting 12 pieces of tissue from your prostate. Six each side. Here we go, ready?' he went on, not waiting for an answer.

Bang!

It was the most awful two minutes of my life and seemed to go on for ever. At each bang I felt the cut and lost count after six.

'That's it,' the doctor said triumphantly. 'Not too bad, was it?'

'No, no, fine, really.' I lied, my neck, arms and hands aching from the tension.

But, in fact, I was quite pleased with myself. And less than an hour later I was home, unprepared for what was to come.

I had been told to take paracetamol if needed. But while I was tired and sore, everything seemed in working order and I busied myself watching a bit of TV and reading the papers.

But as the evening drew on I began to feel unnaturally tired, and so I went to bed early. The next day I felt 'out of sorts', and by late afternoon, weak and fluey.

The doctor agreed to pop round after surgery, and noting my high temperature, racing heart and drop in blood pressure, suggested I'd had a reaction to the test. He prescribed paracetamol and antibiotics and told my wife to keep me cool. But four hours later it was as if someone had flicked a switch in my body. I woke up shivering with cold, although I was burning up. The shaking became convulsions, and I was unable to control my arms and legs, let alone get up from the bed.

My wife dialled 111 and I am told a hospital paramedic arrived within ten minutes, but I don't remember him, only a sea of faces peering down at me later when the ambulance crew he'd called arrived.

As the ambulance rushed me to the hospital, the paramedic and my wife struggled to keep me conscious, talking to me all the time, asking me easy questions. But I couldn't remember where I lived, my date of birth or what day it was.

My wife was told I had developed septicemia from the biopsy and my organs were shutting down. I tested positive for E.coli. I'd also suffered a heart attack

All I remember were ceiling lights as I was speedily wheeled into A&E and rolled onto a medical table. My teeth were chattering and the convulsions were increasing.

Doctors and nurses were everywhere and I could feel wires and needles going into my body. Machines on trolleys were beeping all around me. Was this it? I'd always wondered how it would end.

There were constant questions from the medics working on my chest, arms and stomach as my wife looked on. I heard them say my feet and hands were going cold, but the perspiration was pouring off me.

My wife was told I had developed septicemia from the biopsy and my organs were shutting down. I tested positive for E.coli. I'd also suffered a heart attack at home or on the way to A&E, which had led to atrial fibrillation, an erratic heartbeat.

My wife was advised to send for my daughters as the worst could happen, and they travelled through the night to be by my side in East Anglia.

More than 15 hours after I was wheeled into A&E, that wonderful medical team brought me back to Planet Earth and I woke to find myself on the cardiac ward, wired to a heart monitor, being drip-fed antibiotics and with a catheter in my groin.

The cardiac surgeon in charge of my sorry state informed me that my heart had been knocked out of rhythm by the trauma of the infection and that at some point soon they would have to 'stop and start' my heart - ie, shock it into its normal rhythm.

They would try this four times - if that didn't succeed I faced a future on anti-coagulants to prevent my blood clotting.

After a week I was discharged. However, the story didn't end there. The catheter had been taken out, but the next day I was in agony, unable to pass water properly.

After my GP's surgery said that this wasn't uncommon and to give it a few days, my wife rang the hospital ward sister, who said to go straight to A&E.

An hour later, I was in A&E having tests and scans. For the first time in my life, I was getting my NHS money's worth. Then, finally, my agonisingly full bladder was drained; I now have another catheter.

Three weeks later, I wait for the heart and urology treatment to get me back on my feet. The new catheter can't come out until after the 'stop and start' treatment, just in case it causes another infection. I'll then need monitoring to make sure there's now no blockage.

On the second day that I was on the cardiac ward, the doctor who'd performed the biopsy poppped in and apologised for what had happened, saying that I had been very unlucky.

If I had known that the PSA test I had read and heard so much about would lead to me fighting for my life in A&E, I would have stayed at home and watched another John Wayne movie. But you just don't imagine you will be among the 3 per cent who develop an infection.

A few days after getting home, I received a welcome letter from the head of urology, informing me that the biopsies had not shown any malignancy. For that, I am eternally grateful. But I almost had to die to find out.

Onwards and sideways, as they used to say in Fleet Street.

John Manners is a pseudonym.

Why I'm wary of health screening 

By Dr Michael Mosley

By far the most difficult conversation I ever had with my father was telling him not to have surgery to remove a slow-growing tumour on his prostate as the chances were his heart disease would see him off long before the cancer could do its worst.

But Dad couldn't bear to live with the knowledge he had cancer, so he had the operation. The tumour was taken away, but as side-effects he was left incontinent and impotent.

He died two years later of heart disease aged 72, the end of his life blighted by indignities caused by surgery I'm convinced he didn't need. Twelve years on, I still rue the day my father had the screening test that told him he had cancer in the first place.

'Getting ahead of symptoms means you can often end up frightening people who could have remained in blissful ignorance of conditions that weren't ever going to trouble them'

Dad's is a case in point of when medical screening ends up being bad for your health. An example of how the modern preoccupation with wanting to predict our medical futures can lead to over-diagnosis, unnecessary investigations and treatment.

This is what forms the basis of my latest Horizon documentary, which screens tomorrow night and sees me undergo a battery of screening procedures in an attempt to establish how useful is the knowledge they give us.

They range from a simple blood cholesterol test to a high-tech scan of my heart and a cancer-seeking scope inserted into my bowel.

I'm now in my late 50s, and at an age when you really start to worry about your health. None of the men in my immediate family made it beyond 72, the age my father died.

I want to live a fair bit longer and in good health. So, any test that can pick up on what's lying in wait seems a good idea. But then look at the test my father had, which led to his diagnosis. As part of a routine assessment, he was offered a blood test that measures levels of prostate specific antigen (PSA), a protein produced by the prostate.

Raised levels can indicate cancer and will prompt an oncologist to order further tests and advise surgery if it's found. But prostate cancer is typically extremely slow growing.

The reality for older men is that most of us will die with prostate cancer, but we won't actually die from the prostate cancer. The PSA test is based on research carried out in the Seventies by U.S. urologist Professor Richard Ablin; it was intended as a way of tracking existing cancer, but in the Nineties doctors started using it for screening.

Millions of men had it, and there is no dispute this resulted in lives being saved. But some doctors began to suspect it was detecting thousands of cases that were growing so slowly they would never have caused any harm.

But a Pandora's Box had been opened. Because if, like my father, the test flags up the disease, it's very difficult to put that knowledge to one side and hope that you'll die before the cancer can take hold.

Professor Ablin appears horrified his work had been hijacked and used in this way.

'The science was pushed too far,' he told us. 'People were too fast to biopsy, too fast to treat. In the U.S. alone, some $60 billion has been wasted on over-diagnosis and over treatment.'

He described it as 'a public health disaster'.

Looking for diseases that may lurk inside us has become big business. In the UK, we spend about 135 million a year on private health tests and around 754 million on NHS screening.

Of course, if you find a lump or have other symptoms of disease, you should always visit your doctor. But if you're healthy on the outside, is it really worth probing your insides, too?

Getting ahead of symptoms - which, after all, is what screening is all about - means you can often end up frightening people who could have remained in blissful ignorance of conditions that weren't ever going to trouble them. And having made this programme, I'm not convinced there is anything healthy about that.

Horizon: Are Health Tests Really a Good Idea, BBC2, Wednesday 8pm.



Read more: http://www.dailymail.co.uk/health/article-3192968/Could-prostate-test-leave-fighting-life-Prostate-biopsies-low-risk-unlucky.html#ixzz3icW2i5af 
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