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Ask Dr Rosemary Leonard: 'Why Won't My GP Give Me Prostate Cancer Blood Tests?'
A reader asks: I am a 77-year-old man and was diagnosed with prostatitis at 49. I had a year with no symptoms, but they have returned again and don't seem to be going away. On the advice of my previous doctor I've had a PSA test every year (my reading last May was 0.6) but my new GP doesn't seem very concerned and told me that if I had prostate cancer I would probably die with it not of it and that I didn't need another PSA test. I have been prescribed tamsulosin which seems to be working but is this just masking the problem?
DR ROSEMARY SAYS: Prostatitis is the medical term for inflammation of the prostate gland. There are two main types – acute, where the symptoms come on and go away quickly, and chronic, where symptoms are more persistent, which is what you have.
The main symptom is pain, which may be around the base of the penis or anus, in the lower abdomen or in the lower back. Though this can sometimes be severe - and worse during sex - it tends to vary from day to day.
Other symptoms can include a need to pass urine more frequently, with a poor stream, tiredness and general aches and pains. Not surprisingly many men feel anxious or depressed.
The cause of chronic prostatitis is unclear and it is now often referred to as chronic pelvic pain syndrome, or CPPS, as some men with symptoms of prostatitis do not have an inflamed prostate. Treatment is aimed at relieving pain, either with standard painkiller such as paracetamol, or drugs that block pain messages to the brain, such as pregabalin. Medications that relax the muscles of the bladder, making it easier to pass urine (such as the tamsulosin you are taking) are also prescribed. There have been some studies that have suggested that men with inflammation of their prostate might be more likely to get prostate cancer, but more research is needed to be sure if the two are linked.
PSA is a protein produced by the prostate gland. Levels rise slowly with age and abnormally high levels can occur when the gland is enlarged or inflamed, and in some (but not all) cases of prostate cancer. Your level last May was very low, which suggests that your gland is not inflamed, which is good news and makes it very unlikely that you have prostate cancer. Even if you did, as your GP has suggested, it would be so slow growing that it would be a serious threat to your health.
So in answer to your question, the tamsulosin is not masking a problem and if it is helping your symptoms you should continue to take it.
● If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.Co.Uk. She regrets she cannot enter into personal correspondence or reply to everyone
New Research On Prostate Cancer May Lead To Better Diagnostics, Treatments
Researchers are reporting that a program aided by artificial intelligence (AI) has helped them identify two distinct subtypes of prostate cancer — a finding they say could improve diagnosis and treatment of the disease, including preventing unnecessary surgery.
Their study was published today in the journal Cell Genomics.
In it, researchers from the University of Oxford and the University of Manchester in England identified the prostate "evotypes" using AI to analysis DNA data.
Researchers studied changes in prostate cancer samples from 159 people using genomic sequencing to identify the pair of evotypes.
The researchers say the findings could help develop a genetic test that, when combined with conventional staging and grading, could provide patients with a precise prognosis and treatment.
Rupal Mistry, PhD, a senior science engagement manager at Cancer Research UK, which helped fund the study, told Medical News Today that the research "laid the foundations for personalized treatments for people with prostate cancer, allowing more people to beat their disease."
"Our research demonstrates that prostate tumors evolve along multiple pathways, leading to two distinct disease types," said Dr. Dan Woodcock, a lead study researcher and a group leader in translational data science at the Nuffield Department of Surgical Sciences at the University of Oxford, in a press statement. "This understanding is pivotal as it allows us to classify tumors based on how the cancer evolves rather than solely on individual gene mutations or expression patterns."
Dr. Michael Morris, the prostate cancer section head at the Memorial Sloane Kettering Cancer Center in New York who was not involved in the study, told Medical News Today that that the evotypes identified in the study could tell doctors and patients "which path they are on and how far down the path they have come" in their disease progression.
Doctors currently have a number of diagnostic tools for prostate cancer at their disposal, said Morris.
The prostate cancer Gleason score, for example, is based on factors such as prostate-specific antigen (PSA) results and the bulk of an existing tumor. There also are other commercially available assays that can provide genomic classification of prostate disease.
However, Morris said, these tests only provide a snapshot of where the disease is at the time of assessment, whereas the evotyping envisioned in the latest study "is a more dynamic mode."
Morris noted that AI is also being used in other ways, such as evaluating pathology slides and imaging.
"This technology on multiple fronts is changing how we assess prostate cancer," he said.
Still, under-diagnosis and over-diagnosis of the disease is far from uncommon, experts said.
"We simply don't know enough about what a prostate cancer diagnosis means at present. There are many men who have disease which is or may become aggressive and being able to treat aggressive disease more effectively is critical," said Naomi Elster, PhD, the director of research at the Prostate Cancer Research Institute who was not involved in the study.
"But on the other side of the coin are the too many men who live with side effects of cancer treatment they may never have needed," Elster told Medical News Today. "These results could be the beginning of us being able to take the same 'divide and conquer' approach to prostate cancer that has worked in other diseases, such as breast cancer."
Prostate cancer is among the most common forms of cancer among men.
However, it's also a unique form of cancer in that physicians may recommend no treatment at all in some circumstances, such as when the cancer appears to be slow growing or the person is elderly (and thus likely to die of natural or other causes before their prostate cancer becomes a health threat).
"Prostate cancer is a common disease process where many of the cancers diagnosed are not aggressive and treatment may cause complications and thus many of these less aggressive cancers are carefully monitored with active surveillance," said Dr. Anurag Das, the chair of the urology department at Staten Island University Hospital in New York who was not involved in the study. "However, some of these less aggressive cancers over time may become more aggressive and there are also many intermediate risk cancers which could be followed or treated."
"By combining this [diagnostic] method with more traditional methods using histochemical grading, it may be possible to better stratify the disease process and treat cancers that need to be treated while sparing treatment for patients whose disease is unlikely to progress," Das told Medical News Today.
Dr. Christian Thomas, the director of clinical research at the New England Cancer Specialists in Maine who wasn't involved in the study, told Medical News Today that while the findings are interesting, the study has several limitations, including a small sample size and people whose prostate cancer risk was characterized as low to intermediate.
"We really cannot draw any conclusions from this in terms of clinical management yet," he said. "This is the kind of finding — there have been many research papers in the past doing very similar things — that would need to be confirmed in a larger clinical study, preferably a prospective trial that is randomized with meaningful clinical parameters as outcome measures."
Vegetarian Diet Could Help Men With Prostate Cancer
Getting more plants into your diet can bring a huge number of health benefits. (Getty Images)
Men with prostate cancer stand to benefit from switching to a vegetarian diet to ease some of their symptoms, a new study has suggested.
Eating a diet rich in fruits, vegetables, grains and nuts, but low in meat and dairy, was linked to fewer issues with erectile dysfunction, urinary incontinence and other symptoms.
Researchers from New York University Grossman School of Medicine and Harvard TH Chan School of Public Health analysed more than 3,500 men with prostate cancer to determine whether a more plant-based diet could improve problems that arise after treatment for the disease.
Prostate cancer is the most common cancer in men, with more than 52,000 UK men diagnosed with it every year on average. According to Prostate Cancer UK, this is equivalent to 144 men every day.
The NHS says the condition does not usually cause symptoms until the cancer has grown large enough to put pressure on the urethra, which can then lead to needing to pee more frequently and difficulty peeing.
But treatments for prostate cancer, like radiotherapy and hormone therapy, can lead to side effects like bladder inflammation that causes problems with peeing, tiredness and weakness, and difficulty getting and maintaining an erection.
Prostate cancer is the most common cancer in men. (Getty Images)
The latest study, published in the journal Cancer, examined the link between diet and quality of life as a result of these side effects, and found that the group of men who consumed the most plants had better scores in measures of sexual function compared with the group that consumed the least.
Men who ate the most plants scored 8% to 11% higher compared to those who ate the least in this area. Similar results were found for urinary health, with the group eating the most plants scoring up to 14% higher than those who ate the least.
The former group experienced fewer instances of incontinence, obstruction and irritation in relation to their urinary health.
Additionally, men who ate the most plants scored up to 13% better in hormonal health, which included symptoms like low energy, depression, and hot flashes.
Urologist Stacy Loeb, MD, lead author of the study, said: "Our findings offer hope for those looking for ways to improve their quality of life after undergoing surgery, radiation, and other common therapies for prostate cancer, which can cause significant side effects.
"Adding more fruits and vegetables to their diet, while reducing meat and dairy, is a simple step that patients can take."
Previous studies have suggested that a plant-based or vegetarian diet could lower the risk for certain cancers. A 2022 review of 32 studies found that it has the potential to improve prostate cancer outcomes.
Following prostate cancer treatment, eating a diet rich in fruit, vegetables, grains and nuts could help ease side effects, the study suggests. (Getty Images)
Of the studies, a third were observational, which means they relied on information in databases and health registries, while the rest were interventional and involved prostate cancer patients who were observed over time.
Most of the observational studies showed that people who ate plant-based diets developed prostate cancer at lower rates compared to those who ate meat. In more than half of the interventional studies, researchers found that the levels of a prostate-specific antigen (PSA) rose more slowly in plant-eaters.
The rise in PSA levels suggests the cancer is getting worse or recurring. The reviewers pointed towards the slower rise in PSA among plant-eaters, as well as better overall health and a delay in the need for further treatment, as support for the conclusion that vegetarian diets can be beneficial.
However, Dr Stephen Freedland, urologist and director of the Centre for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Medical Centre, cautioned that large-scale clinical trials need to be carried out to confirm the link.
Dr Loeb said the results from her study "add to the long list of health and environmental benefits of eating more plants and fewer animal products".
"They also clearly challenge the historical misconception that eating meat boosts sexual function in men, when in fact the opposite seems to be true."
She cautioned, however, that most of the men assessed were white healthcare professionals, and said the team plans to expand the research to a more diverse group of patients.
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