Testing times?

A couple of weeks ago I had the pleasure of Brian’s company. He’d been at the golf club the night before at one of their legendary social functions. These functions used to be a simple excuse for a night of bacchanalian excess, but in these times of scrutiny and accountability even the hallowed portals of the Ambridge and District are not sacred and every function must serve an higher purpose. To that end the committee had invited in someone to do a bit of “health promotion” and offer “screening” before they sat down to their fifteen course banquet with attendant wine list, port and cigars to follow and brandies after the Loyal Toast.  

If you are detecting a hint of irony here I fear it was utterly lost on Brian.

In any event the screening on offer posed us a bit of a problem. It seems that Brian was informed his test (a P.S.A. allegedly) was “high”.

And that was all.

No advice about symptoms, no suggestion of what to do next, indeed no quantifiable information on what “high” might mean in “pounds shillings and ounces” *. Apparently the same was true for a few other stalwarts of the A&D, but fortunately they will be off bemusing their own medical attendants as none of them saving Brian are registered with us.

So what to do now? Well P.S.A. is a notoriously fuzzy test at the best of times. It’s undoubtedly captured the zeitgeist of those men, like Brian, of a certain age, and many attend seeking the “reassurance” of a quick test, on the assumption that a “low” result will ward off the spectre of prostate cancer. And here we run into a few difficulties.

The test measures a chemical put into the blood by an “unhappy” prostate. The problem is the source of prostatic disquiet could be anything on a spectrum from infection through inflammation to cancer. There had been hopes a few years back that it might prove useful as a test for the latter, but the test is just too imprecise to be useful and indeed the prevailing wisdom is that the potential harm of the number of unnecessary biopsies and other procedures that would arise from using it as a screen far outweigh any benefits it might provide in identifying new cases of prostate malignancy.

Needless to say, just because the medical establishment, hampered as it is by a need to evidence practice, doesn’t view the test as a good thing, doesn’t mean, now the Djinn is out of the bottle and the movers and shakers of groups like the A&D up and down the country won’t engage the services of the 21^st century equivalent of the Snake Oil salesmen of old. So it is that they end up buying in unproven services from unscrupulous predators, keen to turn a fast buck at the expense of the anxious and ill informed, all from the best of motives. But this leaves Brian with a bit of a problem. Now he’s had a “screen” and it is “high”, but he has no symptoms of prostate disease.

I’ve offered him an examination (not described here for the sake of the squeamish—fans of Billy Connoly will know what I’m talking about though) but for now he has declined. Do we repeat the test, and if so when, and what do we do if it comes back raised again.

He’s agreed to go away and think about it for a while, and knows to come back at any point if he starts developing symptoms that suggest his prostate is unhappy, but I’m not sure he won’t be back asking for a lab test at some point in any event.

*EVCHN for attribution as usual.