Dr Ellie The GP is refusing to test my son for prostate cancer – is this right?

MY 50-year-old son has twice requested a PSA test from his GP to check for prostate cancer, but has been turned down. Both his father and paternal grandfather had the disease. He has no symptoms, but neither did his dad when he had his first PSA test at 50, which showed raised levels, and even when he eventually required treatment he didn’t suffer any symptoms. What do you think my stepson should do?

RAISED levels of prostate specific antigen, or PSA, in the blood is a sign there is something wrong with the prostate. It can be caused by cancer, but it can also rise due to a range of benign conditions, such as infections or even after sex. In fact, most men with a raised PSA level will not have cancer.

For this reason, PSA testing is not employed as a routine screening tool, as opposed to mammograms or cervical smear tests that are usually offered to large numbers of healthy, asymptomatic women in order to pick up early stage breast and cervical cancer.

If it was, many men would end up having unnecessary and invasive procedures to rule out cancer.

Men can request a PSA test from their GP for any reason, however, as long as they understand the potential outcomes, including the risks of false positives and other drawbacks. Before undergoing the test, patients should talk with their GP to weigh-up the pros and cons, then they can opt for the test if they wish to proceed.

This approach is particularly relevant for individuals with a significant family history of prostate issues.

WHY is it so difficult to get a Vitamin B12 deficiency diagnosis? I have all the signs and symptoms but my GP says my blood tests are normal. I just don’t believe it and I’m getting worried. I’m considering buying B12 injections online so I can treat myself. What do you think?

VITAMIN B12 deficiency causes a range of symptoms, including tiredness, a sore tongue, brain fog, palpitations and headaches. There may also be nerve problems, including pins and needles and numbness.

We see low levels in people on vegan diets — as B12 is mainly found in eggs, milk, meat and fish — and also those with bowel disease who do not absorb nutrients properly. It is also the side effect of some medications, including those which treat diabetes, stomach acid and gout.

But blood tests to check for low levels are very accurate. If they’re coming back normal, then there is no indication of deficiency and no reason to treat it.

So I would look to see what else could be causing these symptoms.

Other tests can look for issues such as iron deficiency anaemia, folic acid deficiency and thyroid problems, as these cause similar problems. The perimenopause and menopause can also be a factor in middle-aged women.

I don’t recommend buying medication online and then self-treating — this can be dangerous. It’s much better to follow medical advice.

AT THE end of last year I had surgery to have cancer removed from my right lung. Since then, I have been getting breathless. I also suffer from high blood pressure and have been told I have too much water in my blood. I can’t even walk down

my garden. Is there anything that could get me feeling better?

MY first thought would be heart problems, particularly in someone with high blood pressure. Also known as hypertension, the condition puts a strain on the heart, making it work harder. In some people this can lead to heart failure. This leads to fluid building in the lungs, causing shortness of breath. The treatment to take the strain off the heart involves reducing the amount of fluid in the body with diuretic medicines such as bumetanide or furosemide. Other drugs would be prescribed to lower blood pressure, such as a beta blocker.