Prostate cancer survivor Guy Williams talks about the PSA test, being diagnosed with cancer and why he decided to have surgery to remove his prostate.
Guy was 51 when he first considered having a prostate cancer test. Both his father and uncle had the disease. His age and a family history of prostate cancer put him in a higher risk group.
But his first attempt to have the PSA test, a blood test which looks for the early signs of cancer, showed just how divided the medical community is on the usefulness of the test.
PSA (prostate-specific antigen) is a protein made by the prostate gland. Some of it will leak into your blood, depending on your age and the health of your prostate. A raised PSA level in your blood may mean you have prostate cancer.
On the one hand, the PSA test could save your life if it detects the early signs of cancer.
On the other hand, a wrong diagnosis – which does happen occasionally – could lead to unnecessary anxiety and potentially life-changing treatment.
"My GP leant strongly towards me not having a test," says Guy, a secondary school drama teacher and a father of three. "He suggested the PSA test was not entirely reliable and talked me through its pros and cons.
"He was entirely professional and gave me material to read to help me make a decision." After mulling over his doctor's advice and reading more about the condition, Guy decided not to have the test.
Getting a second opinion
"When I told my father, he hit the roof," he says. "He insisted that I go back to the surgery and have the test. A short while later I went back to see a different doctor at the surgery."
Because of Guy's family history, the second doctor felt he should have the PSA test. "I got the results back the next day," Guy says.
"The test showed that my PSA level was raised. The doctor said there could be several reasons for this so, to be on the safe side, he did another test."
When this came back again with a PSA reading higher than is probably normal in someone of his age, Guy was referred to a specialist for a physical examination. He was then referred for a biopsy, which involves analysing tissue samples taken from the prostate.
The biopsy confirmed that Guy had cancer. A surgeon advised him that the best treatment option would be to have his prostate gland completely removed, a procedure called a prostatectomy.
"I was trying to ask the right questions but I was overwhelmed by the whole situation," he says. "Although the diagnosis wasn't completely out of the blue, it still really knocked me."
Treatment for prostate cancer generally depends on how fast the cancer is growing, whether it has spread outside the prostate gland, and the person's age and general health.
But all treatments, whether it's a prostatectomy, radiotherapy or hormone therapy, carry the risk of significant side effects. These include loss of sexual desire, erectile dysfunction and urinary incontinence.
There's not always a clear medical reason for choosing one type of treatment over another. The decision may be based on a person's values, needs and preferences.
Prostate surgery
Guy read up on all his options, received help from Macmillan Cancer Support and Prostate Cancer UK.
"All my research was really helpful but by the end I felt I had too much information," says Guy. "The more I knew, the more difficult it was to make a decision. I wanted someone to tell me what to do."
Guy was advised by his surgeon that the best course of action would be to surgically remove his prostate gland. Concerned about the possible side effects of a prostatectomy, he asked for a second opinion.
"I put all of my questions, worries and concerns to the next consultant I saw," he says. "After considering my circumstances, he too recommended surgery. At the end of the day, you must put a certain amount of trust in the professionals. Ultimately, they're the experts.
"I was worried about the side effects of having a prostatectomy, but at least you live. On balance, that's what I wanted. In the end, it wasn't really a choice."
In May 2011, five months after having the PSA test, Guy went in for surgery at Brighton's Royal Sussex County Hospital.
"The surgery went well," says Guy. "The pain and the bladder control, the side effects of the operation, are now much better. Exhaustion is my main problem. After a day's teaching I'm totally knocked out."
Guy's prostate gland was analysed after it was removed and tests showed the cancer was more aggressive than previously thought.
"For me, surgery was the right thing to do," says Guy. "If it had not been for my dad encouraging me to get a second opinion on having the PSA test, I probably would never have known I had prostate cancer."
Find out more about whether you should have a PSA test.
Your health, your choices