Aren’t we a patriarchy?

The NHS normally only provides PSA blood tests – which can show an increased risk of prostate cancer – from the age of 50, if requested, or from the age of 45 when there is a family history of disease.

There is no NHS screening programme for prostate cancer.

The incidence of prostate cancer is higher or lower than that of breast?

The screening program for breast cancer is how large?

27 comments on “Aren’t we a patriarchy?

  1. Questions from Tim we can answer: lower but not by much.

    Screening has major problems, mainly the high false positive rate when you look at patients with no signs of disease. On mammography, over 90% of first screening “suspicions” turn out to be nothing. If you get a false positive mammogram you go back for a repeat and possibly ultrasound, after a few nervous days to weeks. The jury is out on the cost/benefit of screening, even though it definitely saves some lives.

    Psa is even less reliable and the subsequent investigations more horrid than for mammography. Other things too, the cancer can be so slow growing and start so late in life as to be irrelevant, breast cancer is almost always highly aggressive and affects younger women.

    But maybe that’s just mansplaining…

  2. Anecdote alert

    My uncle died of prostate cancer and its metastisis to bone (if I remember rightly) and my father died with it (not from it) from ceasing to make blood and living off transfusions. I don’t know whether the cancer had anything to do with it.

    He underwent hormone therapy which put an end to his active sex life (with his second partner) after having the illness ignored for two years after detection. NHS saving money. He was 80 but living like a 70 year old. Too old to justify an op. I still remember his anger at the phrase the doc casually threw out. ‘What do you expect Mr. BB’ dad, you are past your sell-by date’ A sort of ‘why don’t you f**k off and die and save us all some money?’.

    As a non-medic it seems that early on-set prostate tends to be much more aggressive and likely to get you while late on-set can be controlled and/or operated away.

    I do find my more feminist friends poo-pooing the idea that prostate cancer is a not problem a shade excessive. Apparently a woman without a breast suffers horribly (and I know my mother did, breast cancer in the early 60s, then bowel, then lung, then spine, paralysis and death) but can still get down and dirty, whereas a man usually loses that part of his life.

    Question for BiG who seems pretty up on this sort of thing:
    I once read that in older men a lack of ejaculation is bad for the system. What I mean is, as an older man should I ask my wife for greater frequency as a health issue, or do I have to put up with what I get? 🙂

  3. There’s some evidence that more frequent ejaculation reduces risk of any prostate issue, but try teasing out cause and effect from that one (or even just correcting the obvious correlation of age with frequency of sexual activity). Sex is about the psychology of 2 people more than anything else.

  4. One of the tests is sticking a camera tube up your dick. Who the Hell in their right mind is going to trust the NHS with that little chore?

  5. Ecks,

    Some people get off on it!

    For reasons I’ve never quite got to the bottom of, a disproportionate amount of my professional contact with medics involves urologists. The discussions over drinks, including the things people have stuffed up their John Thomas for the pleasure of it, are truly fascinating.

  6. PSA screening of the general population seems to be a Thing for which there is less support these days, because correlation between high PSA levels and prostate cancer is decidedly iffy. Mine’s been abnormally high for decades, and my previous urologist (a lovely lady) got worried enough that I had several prostate biopsies.

    Luckily these days science has evolved far enough that one can put off the biopsy until a prostate MRI – completely non-invasive – has shown likelihood of cancer. And so about a year ago the new urologist (the nice lady retired) said go have an MRI. So I did.

    And the radiologist said – yep, looks like cancer. So went back to the urologist for the biopsy – which these days can be done with a giant-screen TV showing the position and direction of aim of the biopsy probe overlaid on the 3-D image recorded during the MRI. And, yes, you get to watch in glorious Technicolor (but no 3-D goggles – I felt cheated there)

    Long story short, no cancer. Just chronically inflamed prostate, which manifests very similarly on an MRI. And those biopsies were a contributing factor.

    So my guess would be that it’s good to have a PSA track record taken over some time to build history, including variations over time (my PSA has always been significantly higher in wintertime, for example), and then sampled more rarely. If the PSA spikes up, have an MRI and then see what’s there.

  7. I’ve heard it said that most men die with prostate cancer but very few die of it. How true that is I don’t know but it sounds nice.

    As to whether frequent ejaculation might prevent the problem, I do notice that if I fail to roll one off the wrist regularly my urine stream slows to an even weaker trickle and I spend even more time on the loo.

    So, best not to take any chances, eh?

    Which is why I’m even more thoroughly pissed off with Treason May and her so-called tory government for forcing me to pay for a porn pass next week. At my age, a little visual stimulation helps but our betters have decided that all that money, time and effort we spent on developing the internet in order to watch porn should be thrown away in a fit of prudery.

  8. Kevin B,

    Rather pay for a VPN service, NordVPN costs peanuts. I use it to watch BBC videos in Australia, Australian Foxtel when outside Australia and the odd bit of porn, strictly for the health of my prostrate you understand.

    Since you mentioned the treacherous May, I’ve sent an email to Viktor Orban, urging him, in the name of democracy and the majority of UK citizens, to reject any extension to Brexit. Others may wish to do the same and encourage others to do likewise.

  9. In Gigerenzer’s excellent book on risk he discusses the (probable) uselessness – even harmfulness – of mass screening for breast cancer.

    He also remarks that in a survey of German specialists they were asked whether they used screening for themselves or recommended it for their wives. The overwhelming answer was “no”.

    I think (but my memory is vaguer on this) that he wasn’t much impressed by the case for mass screening for prostate cancer either.

    https://www.amazon.co.uk/Reckoning-Risk-Learning-Live-Uncertainty/dp/0140297863

  10. Kevin B and DocBud:

    The Opera browser has a free built-in VPN. Not sure how it will deal, or not, with the porn block.

    I did see some mention – and I don’t know if it’s true – that the ban will only be effective against pay sites.
    If so, that will make it even more ridiculous and pointless than it seemed already.

  11. Men die with prostate cancer not because of it, so no big deal really.

    Have a go at living with prostate cancer, frequent, often painful micturition, urine retention, bladder infections, incontinence, wearing a dribbler bag, continuous urethral catherisation (a particular joy) or urethral stents, loss of sexual function, TURPS to relieve symptoms.

    Elsewhere: NHS runs Well Woman Clinics, but ever heard of a Well Man Clinic?

  12. 2019 https://www.cancer.gov/types/common-cancers

    Cancer Type Estimated New Cases Estimated Deaths
    Lung (Including Bronchus) 228,150.00 142,670.00
    Colon and Rectal (Combined) 145,600.00 51,020.00
    Pancreatic 56,770.00 45,750.00
    Breast – Female 268,600.00 41,760.00
    Liver and Intrahepatic Bile Duct 42,030.00 31,780.00
    Prostate 174,650.00 31,620.00
    Leukemia (All Types) 61,780.00 22,840.00
    Non-Hodgkin Lymphoma 74,200.00 19,970.00
    Bladder 80,470.00 17,670.00
    Kidney (Renal Cell and Renal Pelvis) Cancer 73,820.00 14,770.00
    Endometrial 61,880.00 12,160.00
    Melanoma 96,480.00 7,230.00
    Thyroid 52,070.00 2,170.00
    Breast – Male 2,670.00 500.00

    Can’t make it format better.

    Based on deaths, breast cancer should get 132% of the funding of prostate cancer. Does it? Doubt it.

  13. The curative therapy for not-yet metastasized breast cancer, as with prostate is resection, often after neoadjuvant and/or radiotherapy.

    Resection of breast cancer leaves a rather lesser functional defect than prostate resection. Breast is generally more aggressive, killing more quickly and more likely to, and also easier to detect. Even in the absence of screening, of the big four it is the easiest to notice before met (when you have the best chance of a curative therapy), for the simple reason that the lesion is close to the surface and women are good at being aware of breast changes. None of this occurs to the other big 3.

    There is no cancer for which there is a single test that detects all cases with 100% accuracy, and rules out all non-cases with 100% accuracy. The accuracy of testing is also affected by the population you look at. If you take a mostly healthy population (screening scenario) you will get a lot of false positives – in fact for mammography the ratio is over 9 to 1. IF you take people with clinical suspicion of breast cancer, the ratio is the other way around.

    Screening means you will also inevitably miss cases (false negative), so the liability issue, and negative press about incompetent docs mitigates against doing widespread screening.

  14. “One of the tests is sticking a camera tube up your dick. Who the Hell in their right mind is going to trust the NHS with that little chore?”

    Nonsense.

    The tests for prostate cancer are PSA (unreliable unless there’s a trend), PCA3 (not available on the NHS. Costs c.£500. Not very reliable.), MRI scan (which won’t show a tumour under 0.5cm diameter) and biopsy (can be unreliable – only a template biopsy caught my small tumour).

    I have prostate cancer, but no symptoms – apart from a PSA of 22.8. The cancer is not particularly aggressive, but it might become so. Brachytherapy generally only works on men with PSAs of 15 and below and a prostate of 60ml volume or less. Surgery is generally not available for those aged 70+. Which leaves external beam radiotherapy, or in those over 80 hormone treatment. Radiotherapy carries an increased risk of bone and rectal cancer, anal bleeding, erectile dysfunction and drier/dry ejaculations. Surgery often leads to ED and to urinary incontinence. Hormone therapy often leads to ED and brittle bones….

    With any luck, I’ll die of something else.

  15. @ Fred Z
    Tha is US data, not UK.
    Prostate Cancer UK (a charity) reckons that 11,000 men in the UK die from (not just with) Prostate Cancer each year.
    According to Cancer Research UK, there were (in 2016, its most recent year’s, data) MORE deaths from Prostate Cancer than Breast Cancer.
    Funding for Prostate Cancer is not 101% of funding for Breast Cancer.
    After Lung Cancer and Bowel Cancer (male and female numbers combined) Prostate Cancer is the third biggest cancer cause of death.
    I looked some of this up ‘cos the elderly Chairman of a former employer “ran” the London Marathon last year in aid of Prostate Cancer UK (wrong side of six hours but he finished!)

  16. @Theophrastus

    HIFU seems to be giving encouraging results, but limited NHS availability at present.

  17. ‘the subsequent investigations more horrid than for mammography.’

    Urology has a problem with, “First, do no harm.”

    I’ve had a few drawn out arguments with my physician over this. The PSA test is done on blood, which, when you are getting a physical, is taken anyway. I.e., the test is ABSOLUTELY innocuous. You have no way to know if they are even doing it.

    My physician thinks that urologists are such fvck ups that you shouldn’t even have a PSA test. My words, not his.

    BlokeInTejasInNormandy’s post makes it sound like the urologists have finally improved their methods.

    Now, for gastroenterologists. To check me for colon cancer, you want to do WHAT ?!?!

  18. Torrent Maget
    magnet:?xt=urn:btih:364603ad3a10089e5beb6efce5a0cee621d3659d&dn=PirateBrowser_1.0b.exe&tr=udp%3a%2f%2fopen.demonii.com%3a1337&tr=udp%3a%2f%2ftracker.coppersurfer.tk%3a6969&tr=udp%3a%2f%2ftracker.leechers-paradise.org%3a6969

  19. “HIFU seems to be giving encouraging results, but limited NHS availability at present.”

    But the side-effects are quite grim – catheterization and pain immediately after treatment, often followed by ED.

    HIFU may turn out to be more like a management treatment (like cryotherapy) than a cure.

  20. Game Cock,

    A lot of those after-workshop drinks involve discussions about trannying (cos its a urology thang). While I don’t care for the politics or psychology of trannying, the surgical details are too fascinating to me, given my day job, to not inquire. I am regularly assured that M2F is now cosmetically indistinguishable, on external inspection, from the real thing.

    In most countries, especially transpondian countries, it would not surprise me if the most expensive investigations to follow up an elevated PSA are mandated in most cases.

    So, like you said, issues with “first do no harm”.

Leave a Reply

Name and email are required. Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.