Why can’t anything be done for my prostate?
NINE years ago, I had my prostate removed after it was shown to be cancerous. I was clear for five years, then a test showed that I have markers in my blood stream that indicate the cancer has returned. However, my doctors have told me they can’t do anything until these so-called PSA markers reach a certain level. Is there T really nothing I can do? Ron Jay, Aylesbury, Bucks. HIS is an awful turn in your life and you have my utmost sympathy. It must have given you great concern when you heard that your PSA — prostate specific antigen — could once again be detected.
This marker is produced by both normal prostate cells and prostate cancer cells, but a raised level in the blood stream suggests the presence of the latter.
after a radical operation to remove the prostate gland — which sits underneath the bladder and surrounds the tube that carries urine from the body, the level of PSA is usually undetectable.
When after five years this level rises once again, the implication is that some of the prostate cancer cells did remain, somewhere in the body, despite the procedure.
This is known as biochemical recurrence, and can sometimes occur when cancerous cells remain in the prostate bed — the area where the gland sits.
If symptoms include urinary difficulties, or a bone scan has revealed signs of spread, or if the PSA doubles in less than three months, then it is usual for hormone treatment to be proposed.
Prostate cancer cells are highly dependent on male hormones such as testosterone for survival, and taking steps to reduce levels can suppress the progress of the cancer, freezing it for months or years. This can be achieved either by a preparation given as a daily tablet, or as a monthly or three monthly injection.
However, this treatment comes with side-effects that can significantly affect quality of life, such as weight gain, breast bud development and sexual dysfunction.
you tell me that your PSA has reached a level of 5.8. The reason you have been told that nothing can be done until it has reached a level of ten is not so much that there are no medical options, but more the fact that there is no advantage for you to have any treatment at this stage.
due to the significant side-effects of treatment, specialists hold off until a PSA level of eight or ten has been reached, although I admit the choice of this level is rather arbitrary.
ALTHOUGH there is relatively little value in a single anecdote, I am always heartened by the experience of one of my patients who presented, at the age of 80, with a painful shoulder after a game of tennis. an X-ray showed what appeared to be metastases — cancerous cells — at the top of his arm, where it joins the shoulder.
These cells were shown to have spread from prostate cancer, and the PSA was over 900. With no further treatment apart from hormone suppression tablets, he lived for more than nine years, to his 90th birthday. We never measured his PSA again, and he never had any more tests — he just got on with life.
So although your latest results were troublesome, I urge you to stop seeking anything specific to do at this stage; eat a healthy diet, take regular exercise, and try to stop fretting. MY son-in-law, aged 40, has suffered from recurring mouth ulcers for 20 years. He gets them on the inside and roof of his mouth and even on his tongue. Any advice you can give would be very welcome.
Mr W. Darlow, Kempston, Beds. THESE acutely painful occurrences blight countless numbers of us, yet remain largely a mystery.
Technically known as aphthae, these round or oval ulcers have a white or greyish base and occur singly or in crops. They often strike from childhood right through adult life in susceptible people, and tend to run in families.
What seems to happen is the lining of the mouth, called the mucous membrane, becomes inflamed and breaks down to leave an incredibly sore area. We are still unsure as to a specific cause, but factors that seem to increase the risk are stress, infections, hypersensitivity to certain foods (which vary from person to person), and, oddly, giving up smoking.
a common constituent of toothpaste, sodium lauryl sulphate, has also been implicated as a precipitant of attacks — though in common with so many triggers, it is hard to be sure.
Ulcers are commonly seen in patients with coeliac disease — which is caused by an allergy to gluten — and also in inflammatory bowel disease such as Crohn’s disease. other causes are chemotherapy, and vitamin and mineral deficiencies.
Typically, the ulcers heal in ten to 14 days without scarring. In any attack, it seems that the entire oral lining is more vulnerable, and even if a toothbrush slips the minimal injury soon turns into an ulcer. For this reason I have heard it said that avoiding hot drinks during any given bout will result in fewer ulcers and a shorter attack.
Some people have two or three ulcer attacks per year — yet I also recall one young medical colleague who had ulcers continuously from early childhood until it suddenly resolved when he was over 40.
The common treatments include topical steroids which can be prescribed by a doctor or dentist as a paste or as locally applied lozenges, but apart from that there is little else of confirmed value. It is even uncertain if the steroids really work.
I wish your son-in-law some relief, and hope that he can find some treatment or strategy that works for him. Unfortunately for sufferers, at the moment it is a case of watch this space — and waiting for medical scientists to throw some light on this common yet underinvestigated complaint.
WRITE TO DR SCURR
TO CONTACT Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.