Has anybody had a finger in their bum recently?

[OneArmedBandit]

I cannot make head nor tail of this paragraph.

But - guessing what you are trying to say - you may be over estimating GPs skills. I saw two different GPs (in Australia, but still) who palpated my broken clavicle and assured me that it was healing well. I on the other hand thought the same broken end of bone was still sticking up and it hadn't knitted at all. Return to blighty for my x-ray, and I was right. If you can't tell the difference between the snapped end of a collarbone, and the bolus that forms if it's is healing correctly, I really doubt they will be able to differentiate between an normal and enlarged prostate (especially one that hasn't got large enough to cause any symptoms) unless they have a lot of practice.

Remember they won't normally be examining it unless someone has a raised Gleason score. Also they issue foam boards to "try" to people know what they are feeling for.

Of course GPs are far from perfect, but they should have a good idea. With considerable pressure on our services we would not normally accept a referral based on symptoms alone because it would simply involve cancelling someone else because as soon as it is possible cancer they go on two week wait. However each case is judged on clinical merit.

 

[PK99]

Yes, and no one is advising people to ignore symptoms. The same applies to abnormal bowel symptoms, which people ignore because of the silly attitude to examinations that some people have demonstrated in this thread. It's a great idea for everyone to educate themselves about what the symptoms of these conditions are. What is not a good idea, if one has no symptoms at all, is to keep pestering the GP to waste time doing unnecessary examinations.

A friend was completely symptom-free, a friend of his developed prostate cancer. My friend went to his GP and asked for the DRE. A few weeks later he had prostate surgery.

By the way, would you tell a symptom-free woman she did not need to go for routine mammograms? Most of the people I know with breast cancer were symptom-free and it was picked up on a routine scan.

 

[Salar]

I was diagnosed with prostate cancer a few years ago.

No symptoms really, but my doctor carries out PSA tests on all men over 50 off his own back during routine annual checkups, he doesn't have to, but he does.

Fortunately he picked my cancer up and I received treatment. I'm eternally grateful to him, who knows what state I would be in now?

Anyway my first examination was carried out by a 6 foot plus Maori who wouldn't have been out of place in the All Blacks with fingers like sausages.
I had a few more after that, they weren't so bad as the consultant had little hands.

The biopsy was probably the worst, but a few sessions of discomfort compared to the possible alternative is a no brainer.

As said above screening can provide wayward results and anxiety, but I'm glad I was checked out.

Progress is being made regarding less intrusive examination methods, so the finger test may be obsolete in a few years.

 

[PK99]

Think you may have missed TMN's post earlier. It appears that routine prostate screening does more harm than good as false positives result in needless worry, and surgery - and any surgery has the potential to go wrong. Also for some cases of actual prostate cancer surgery is not helpful as the thing is so slow progressing and would only kill the patient by the time they are 130, so better left alone.
It also has false negatives which result in complacency in those who would benefit from intervention. Thus screening "just in case" is actually harmfull. Targetted screening of men who are deemed higher risk is a different question

Breast cancer screening on the other had has been shown to have benefit ao it is encouraged. As is the camera up the arse thing for 55+ men and women looking for bowel cancer.

Each disease's management needs to be considered carefully on its own science and statistics

I'm confused. You seem to be referencing my post upthread about PSA testing.

 

[PK99]

Yes that too. Have updated the literature review in my post

This, by the guy who developed the PSA test, sayng in terms that PSA testing should NOT be used as a screening tool.


http://www.healthbeatblog.com/2010/...-public-health-disaster-why-this-is-good-new/

As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t. “

Moreover, the benefits of treatment are uncertain. Last year, The New England Journal of Medicine published results from the two largest studies of the screening procedure, one in Europe and one in the United States. The results from the American study that over a period of 7 to 10 years, screening did not reduce the death rate in men 55 and over. The European study showed a small decline in death rates, but also found that 48 men would need to be treated to save one life. “That’s 47 men who, in all likelihood, can no longer function sexually or stay out of the bathroom for long,” Albin adds, referring to the fact that treatments can lead to long-term incontinence and/or impotence.

 

[Salar]

He may well be the expert, but all I can say is I'm glad I had PSA tests and a biopsy as may not be typing this today.

 

[Profpointy]

I'm confused. You seem to be referencing my post upthread about PSA testing.

Ah, re-read. Looks like I'm suggesting you've not read your own post - whilst forgetting to read it

(edit) deleted my earlier post now as it really didn't make sense in the context of being a reply

 

[PK99]

He may well be the expert, but all I can say is I'm glad I had PSA tests and a biopsy as may not be typing this today.

From the same article.

Inevitably, the posts drew some irate responses from readers who were sure that they, their husband, or their uncle’s life had been saved by PSA testing. The truth is that once a patient is treated for early-stage prostate cancer there is usually no way of knowing whether he would have been one of the very few who might have died of the disease if he had not been treated– or one of the many who would have died of something else, long before the diseases caused problems. If they hadn’t been tested, those men would never have known that they had prostate cancer. But once treated, few want to admit that the treatment might have been unnecessary, particularly if they wind up coping with life-changing side-effects. Human beings will do anything to avoid regret.

 

[jefmcg]

Yes. To assess screening tests, we need to do proper population studies, with a randomised group who are screened and one that is not, then the outcomes (incontinence, ED, death from all causes, surgeries etc) compared for both groups.

This stuff isn't simple: a treatment that reduces deaths by one cause can increase it equally by another.

So, more money to find out the best screening regimes, which will actually improve outcomes across the population.

<google>The leading cancers are lung, bowel, prostate, breast. The fact that the last two have swapped is significant as indicating the value of research and awareness.

Breast cancer research has a high profile and high success. Prostate and testicular are catching up (think Movember), though there is much more to be done. The main cause of lung cancer are well understood (though 20% or so never smoked, and must be really angry). The hard one to make sexy, but where we could do the most good, is bowel cancer.

But how do we get people to buy brown ribbons?

 

[Profpointy]

At the risk of being serious for a moment, I recently had the camera up the arse screening for bowel cancer. Apparently, it's now recommended as a matter of course for my age group ans I understood this to be nationwide rather than a trial. Presumably the stats do support it being of value compared with the risk. Anyhow, it was merely uncomfortable for a few minutes rather than painfull, so not really worse than, say, a tooth filling. The staff took a fair bit of trouble to make an undignified rigmarole as comfortable and unembarassing as possible so it was really no bother. Even the self administered enema thing just results in a single impressive bog visit then leave it an hour before going in. Lots of hanging around and getting ready, but the procedure itself no big deal so there's no embarrasment or fear reason for not getting it done if you get the letter. I'm assuming they've done the risk reward assessment correctly, else the NHS would presumably not be spending the money.

 

[PK99]

. I'm assuming they've done the risk reward assessment correctly, else the NHS would presumably not be spending the money.

I would not be overly confident on that as a general rule for the NHS. Bowel cancer screening. Yes. Grommets in kids ears to keep surgeons busy when tonsillectomies went out of vogue - I'm not so sure. And as for homeopathy...

 

[Julia9054]

that people will go away happy when they feel they have had some sort of ... <ahem> ... intervention.

As someone with hypochondriac tendences, i understand that. Despite being someone with a love of statistics, evidence and a good understanding of calculating risk!

 

[PK99]

. It's a fascinating aspect of the doctor/patient relationship - that people will go away happy when they feel they have had some sort of ... <ahem> ... intervention.

And that is one of the reasons the NHS spend as much as it does on antibiotics for routine viral chest infections.

 

[Tim Hall]

What this thread needs is someone with a knowledge of NHS commissioning procedures.

 

[Salty seadog]

What this thread needs is someone with a knowledge of NHS commissioning procedures.

Just a few days earlier and all that could have been.