For the sake of marital harmony, people ?occasionally do things they would rather avoid. That’s why retired ?business consultant Simon D’Arcy went to his doctor for a PSA test. He is glad he did, as is his wife, Gina, because that simple blood test saved his life.
It detected signs of a cancer which is so common that three men in Simon’s family have been struck by it (they are not related by blood).
Prostate cancer kills one man every hour in the UK, yet seven out of 10 who are at risk know nothing about the test.
In the clear: Gina and husband Simon D’Arcy, who had no symptoms. a PSA test revealed he had prostate cancer
The prostate is a tiny gland, around the size of a walnut, located around the urethra, which makes the fluid that carries semen.
The PSA test measures levels of a protein produced by the cells of the prostate gland — prostate specific antigen (PSA) — in the blood. Raised levels can be a sign of a ?problem, which may be cancer.
‘I had no idea what a PSA test was,’ admits Simon, 59, from Headley, Hants. ‘my wife is a practice nurse and two years ago, when I was going to my GP for a blood pressure test, she told me to ask for the PSA test too. I now know the chances of developing prostate cancer increase with age, but I had no symptoms.
‘I was a fit, active, non-smoker. I couldn’t see the point. my brother-in-law Charles had died from it 14 years earlier at 46 but I thought that was an unlucky one-off. I thought if I had cancer, I’d know about it. I was wrong on both points.’
To Simon’s surprise, his PSA reading was high. Two subsequent tests were higher still, and his GP referred him to Haslemere Hospital in Surrey. Gina, 55, advised him not to worry.
‘she explained that there was no reason to expect it to mean cancer,’ says Simon. this is the problem with the test: the results are never clear-cut. Raised levels of PSA can be a sign of prostatitis (often caused by an infection) or benign prostatic hyperplasia, a relatively harmless and fairly common condition in which age and hormones cause the prostate to enlarge.
Complicating matters further, prostate cancer can range from an aggressive form which kills, to a much more common cancer which is so slow-growing most men will die of other causes. The PSA test can’t differentiate between the two, which means men may end up having unnecessary treatment.
This includes radiotherapy, which can lead to bowel and ?urinary problems; hormone therapy, which may cause loss of libido and fatigue, and surgery, which can lead to erectile ?dysfunction and incontinence.
For these reasons the test has been the subject of debate for years among medical professionals. some doctors are ?reluctant to offer it: a survey last year by the Prostate Cancer Charity showed that one in five men who requested the test had been turned down by their GP.
Earlier this month health authorities decided against a national screening programme using the test because the risks posed are greater than potential benefits, the UK National Screening Committee said.
This announcement was described as ‘extremely disappointing’ by John Neate, the chief executive of the Prostate Cancer Charity.
However, experts believe all men should be informed about the test and make their own decision about whether to have it.
‘While there are benefits, there are risks of over-diagnosis and over-treatment,’ explains John Anderson, consultant urological surgeon at Sheffield Teaching Hospitals.
Unnecessary? Most men who have the test do not have cancer but go through the fear (posed by model)
‘a European screening study of 200,000 men, published last year inthe new England Journal of Medicine, showed a reduction in the numberwho died from prostate cancer among those who had the test, but therewas also an enormous incidence of over-diagnosis. Forty-eight men weretreated to save one from death.’
Dr Richard Ablin, researchprofessor at the University of Arizona, is the man who identified the?antigen. ‘I believe testing for PSA in healthy men has been a hugewaste of money and led to many men being left unnecessarily frightened,frustrated, impotent and incontinent,’ he wrote in the Daily Mail lastyear.
‘The majority of these patients could have lived painlessly with their tumours until the natural end of their lives.’
Simon takes a different view. His high test results led his consultant to recommend a biopsy.
‘The whole thing brought back vivid memories of Charles’ death. I felt very vulnerable and thought: am I going to go through the same thing?’ Simon recalls. ‘He was incredibly fit, had three teenage children with my sister Sarah and had settled in
Wiltshire where he was a ?senior partner at a GP surgery.
‘one somehow felt that as a GP he’d have spotted the symptoms and known — but like me, he didn’t have any. Charles died three years after the diagnosis.’
Simon and Gina discussed his condition with their three children, then aged 26, 24 and 22, and he had the biopsy at the Royal Surrey Hospital in Guildford.
When he returned with Gina to get his results on Valentine’s Day last year his consultant confirmed that he had moderately aggressive prostate cancer.‘On the way home in the car I was angry,’ he remembers.
‘why didn’t men know more about this cancer? my stepfather had died two years before in his 90s, and died with the disease rather than of it, but it brought it home to me how common this is.’
In a four-hour keyhole procedure, Simon’s prostate was removed in August last year. ‘I woke up feeling tremendously relieved. They’d managed to avoid most of my nerves, so side-effects should be minimal.
‘Three days later I was out of hospital. I did experience a little incontinence, but things were soon back to normal.’
Two weeks later the surgeon confirmed that there was no ?evidence the cancer had spread, though it was only just ?contained within the prostate.
Simon will have regular PSA tests for three years to check the cancer has not returned, and in response to the experience he has retired to spend more time with his family and doing the things he loves. this summer he sailed solo around the UK in a 24ft Cornish Crabber to raise awareness of the test and highlight that it is available to men over 50 in request from their GP.
‘I understand the test is controversial and not right for everyone, but I believe men ought to know about it,’ says Simon. ‘It’s an absolute tragedy that it won’t be used for national screening.
‘The utterly shocking thing is that I was not in an at-risk group and I had been living a normal, symptomless life with this ?cancer for four or five years.
‘Had I ignored my wife’s ?suggestion to have the test, the cancer would have spread outside the prostate in the not-too-distant future. that is a terrifying thought.’ n To find out more, go to ?prostate-cancer.org.uk or call 0800 074 8383.in the clear: Gina and Simon D’Arcy, who had no symptoms