My 50-year-old stepson twice requested a PSA test from his doctor to check for prostate cancer, but was denied. Both his father and his paternal grandfather had the disease. He has no symptoms, but neither did his father when he had his first PSA test at age 50, which showed elevated levels, and even when he eventually needed treatment, he had no symptoms. What do you think my stepson should do?
Elevated levels of prostate-specific antigen, or PSA, in the blood are a sign that something is wrong with the prostate. It can be caused by cancer, but it can also increase due to a range of benign conditions, such as infections or even after sex. In fact, most men with an elevated PSA level will not develop cancer.
For this reason, PSA testing is not used as a routine screening tool, unlike mammograms or Pap smears that are commonly offered to large numbers of healthy, asymptomatic women to detect early-stage breast and cervical cancer. If it were, many men would end up having to undergo unnecessary and invasive procedures to rule out cancer.
Today’s reader asked Dr ELLIE CANNON if her GP was wrong when she refused to test her middle-aged son for prostate cancer despite a family history of the disease
Men over 50 can request a PSA test from their doctor for any reason, as long as they understand the possible outcomes, including the risks of false positives and other drawbacks. Before having the test, patients should talk to their doctor to weigh the pros and cons. They can then choose to take the test if they want to continue.
This approach is especially relevant for individuals with a significant family history of prostate problems. It’s surprising that GPs don’t know about this – the recommendations are set out in the government’s Prostate Cancer Risk Management Program, published in 2016.
Prostate Cancer UK (prostatecanceruk.org) and the NHS (nhs.uk) both provide valuable resources to facilitate these discussions and provide men with comprehensive information.
Why is it so difficult to get a diagnosis of vitamin B12 deficiency? I have all the signs and symptoms, but my doctor says my blood tests are normal. I just don’t believe it and I’m worried. I’m considering purchasing B12 injections online so I can treat myself. What do you think?
A vitamin B12 deficiency causes a range of symptoms, including fatigue, a sore tongue, brain fog, heart palpitations and headaches. There may also be nerve problems, including tingling and numbness.
We see low levels in people who follow a vegan diet – because B12 is mainly found in eggs, milk, meat and fish – and also in people with intestinal disease who do not absorb the nutrients well. It is also the side effect of some medications, including medications for diabetes, heartburn, and gout.
But blood tests offered by the NHS to check for low levels are very accurate. If they return to normal, there is no indication of a deficiency and no need to treat it.
Low levels of B12 can be seen in people who follow a vegan diet
So I would see what else could be causing these symptoms.
Other tests can detect problems such as iron deficiency anemia, folic acid deficiency, and thyroid problems, as they cause similar problems. Perimenopause and menopause can also be a factor in middle-aged women.
Anyone who doubts the diagnosis made by a GP should go back and ask for a better explanation or seek a second opinion, either within the practice or elsewhere.
I do not recommend buying medications online and then treating them yourself – this can be dangerous. It is much better to follow medical advice.
At the end of last year I had surgery to remove the cancer from my right lung. I’ve been out of breath ever since. I also suffer from high blood pressure and have been told I have too much water in my blood. The doctor says there is nothing I can do but take my medicine. I can’t even walk through my garden. Is there anything that can make me feel better again?
You would expect that surgery on the lungs could cause shortness of breath, but there may be other causes. My first thought would be heart problems, especially in someone with high blood pressure.
This condition, also known as hypertension, puts a strain on the heart, causing it to work harder. In some people this can lead to heart failure, where the heart does not pump as well as it should. This leads to fluid accumulation in the lungs, causing shortness of breath.
Treatment to relieve pressure on the heart involves reducing the amount of fluid in the body with diuretics such as bumetanide or furosemide. In addition, other medications would be prescribed to lower blood pressure, such as a beta blocker.
Anyone who is still breathless from these medications, even during the mildest exertion, may be referred to a cardiologist for specialist advice as more medications may be available. There have been some promising results treating some forms of heart failure with a drug called dapagliflozin.
Regular, gentle exercise is important for someone with heart failure and your GP may suggest a supervised group program for this. People with heart failure are also given advice on how to weigh themselves regularly, as weight jumps can indicate fluid retention.
Don’t let a glucose gadget give you diabetes anxiety
I am not the only GP who has been approached in recent months by healthy patients who are convinced that they have diabetes. The reason? They have joined in on the health craze by wearing a continuous blood glucose monitor, pictured above.
These are brilliant devices that help patients with type 1 diabetes manage their condition. They need to know when their blood sugar levels are high so they can administer medications.
However, the trendy Zoe diet app – created by celebrity doctor Professor Tim Spector and led by Davina McCall – recommends using the monitors to provide ‘insight’ into how your body reacts to different foods.
This causes unnecessary worry, with patients thinking that a normal rise in blood sugar levels after eating is a sign of a serious illness.
My advice is: if you don’t have a diabetes diagnosis and you’re considering sticking one of these gadgets to your skin… don’t. If you – or someone you know – does not have diabetes but is alarmed by a reading from one of these monitors, please write to me at the email address below.
When the boss came to visit me
A few weeks ago I bumped into Amanda Pritchard, the CEO of NHS England, at an event. I boldly suggested that if she wanted to see a GP practice working well, she should come and spend an afternoon at my practice in North London.
And she did just that on Monday. As in all areas of the NHS, there are things that are difficult – we struggle with mountains of paperwork and the flood of online e-consultation forms, completed by patients for the most spurious of reasons, but which have yet to be assessed.
We’ll get by, but as a patient I know from experience that not all operations go so well, with ridiculous waiting times for appointments.
I’m glad Amanda has seen this first hand, as she may be able to do something to ease this pressure and give GPs more time to see patients in person.