5 March 2020: I have learned a lot about prostate cancer screening tests. I was lucky enough to be diagnosed in time, before it had spread.

Which is why I found myself knocking on Dr Lorraine Becker‘s door with a big Thank You, a week after my radical prostatectomy surgery. She’s the GP (with a specialisation in sexual medicine) who somehow insisted on checking my prostate when I went to her for an apparently unrelated issue in November 2019. If it wasn’t for her hunch and prompt follow-through, I might be blissfully unaware till today. By which time the cancer would have spread through my body. She literally saved my life.

My timeline

At the time of diagnosis I had absolutely none of the classic enlarged prostate symptoms (such as frequent urination, difficulty urinating etc). I was also very confident I didn’t have prostate cancer. My PSA level of 3.3 was still well below the danger line of 4, rising at 20% a year. (PSA stands for Prostate Specific Antigen, often used for prostate cancer screening blood tests but not very reliable as a diagnostic tool.)

[Editor’s note January 2022: Here’s a brand new review article summarising the shortcomings of PSA as a screening method and outlining the better options in the global healthcare pipeline.]

Back in 2012, my GP Dr Brian Biddulph had explained the need to have a physical examination known as “digital rectal examination” or DRE (short for the finger-up-the-bum test) in addition to the PSA blood test. I told myself that I was also getting these checks done annually. The actual data shown below prove I was not as disciplined as I thought.

Chart showing PSA rising slowly below danger mark of 4

It turned out (see my medical backstory) that even though my PSA appeared safe, I actually had serious prostate cancer. The post-op pathology report showed it was just beginning to erupt beyond the capsule of the prostate by the time it was removed in February 2020.

Lessons for men over 40

You should have your prostate checked both ways every year after you turn 40 if you are African, after 50 if you are of non-African descent:

  • Both the simple blood test called PSA, and
  • Simple physical examination known as digital rectal examination (DRE) can be done by your GP

Not more than half an hour per year to cover both, and it could save your life. You can also check out Prostate Cancer SA on Facebook.

Editor’s note, Nov 2021: Here is a useful diagram from the 2021 Prostate Cancer Foundation Patient Guide that updates the PSA danger level from my previous notes:

prostate cancer screening

Source: US PCF Patient Guide 2021 www.pcf.org

Other men’s stories

Since my diagnosis I’ve spoken to lots of men who have been diagnosed with prostate cancer. Their stories provide backing for the recommendations above:

  • About a third got a clear danger signal from both PSA test and physical examination
  • About a third got the all clear from the PSA test but (like me) the physical examination got them on the path to diagnosis
  • Some got the all clear from physical examination but PSA test warned them of the lurking danger.

Do both – every year!