I’m 75 and recently had a scan and biopsy of my prostate, which came back clear — but my PSA levels are still 8. How concerned should I be? P. Davenport, Stoke-on-Trent, Staffs.
I understand this must be concerning but let me reassure you that it’s not something for you to lose sleep over.
One in eight men will develop prostate cancer, but for most it is a cancer they die with, rather than of. For those unfamiliar with the term, PSA is a blood test to measure levels of prostate-specific antigen (PSA) — a protein that’s often, but not always, raised in men with prostate cancer.
Indeed, PSA is also produced by healthy cells in the prostate and its level can be raised for a number of reasons, including benign prostatic hyperplasia (where the prostate ‘grows’ with age), infection, inflammation and even vigorous exercise.
The NHS has decided to abandon accuracy in pursuit of ‘woke’ philosophy, writes Dr Martin Scurr (pictured)
This is particularly the case with cycling — sitting on the bike saddle puts quite a lot of pressure on the prostate.
The normal PSA range for a man of your age (70 to 79) is 0 to 6.5 nanograms per millilitre, although this figure varies according to the size of the individual’s prostate gland. Following your test, you say in your letter that you were referred for a scan and a biopsy.
As all these came back clear, I would conclude that the cause of your slightly raised PSA is an enlarged prostate (and possibly some degree of inflammation).
This is the most likely reason for a raised PSA and is increasingly common in men over the age of 50. In your age group, 80 per cent of men will have some degree of prostate enlargement.
I’m sure your doctor will have advised you to undergo a repeat PSA test after a year. In the meantime, please don’t worry.
All my life I’ve suffered with bronchial chest problems. I have bronchiectasis and every cold I get settles on my chest. When I lie down it feels like mucus is sticking to my vocal cords and this keeps me awake. I wake up feeling fatigued.
Terry Phillips, by email.
My suspicion is that the bronchiectasis is the key to all your symptoms.
This condition is caused by damage to the airways in the lungs. As a result, the walls of the airways become inflamed and thickened, and the airways widen, triggering excess production of mucus and a persistent cough.
These symptoms will emerge gradually over years and may become worse if you have any kind of lung infection.
In fact, the condition often starts with an infection. Having whooping cough as a child, for example, is a risk factor for developing bronchiectasis in adult life.
Allergies and smoking may also contribute to the risk, but in half of cases there’s no obvious cause.
The symptoms can be exacerbated by even a simple cold, and I believe this might lie behind the other problems you describe in your letter, such as the disturbing sound in your chest that you hear when you lie down.
My suspicion is that the bronchiectasis is the key to all your symptoms. In fact, the condition often starts with an infection. Having whooping cough as a child, for example, is a risk factor for developing bronchiectasis in adult life (File image)
When you do get a flare-up, it’s important that the correct antibiotic is prescribed, and that means a sample of your sputum must be analysed at the laboratory. So when you visit your GP to request a referral to a physiotherapist, ask if you could have some sterile containers so that you can gather a sample (File image)
A cold will cause further inflammation in your airways, an increase in mucus production and, at times, fatigue and even fever and chills.
The sound you hear when you lie down is due to the accumulation of that sticky mucus, and the mainstay of treatment for this is postural drainage. This can be taught to you by a physiotherapist, and involves using gravity and physiotherapy techniques to help clear the secretions.
Once you have mastered this, you will have to spend a few minutes twice a day doing it.
When you do get a flare-up, it’s important that the correct antibiotic is prescribed, and that means a sample of your sputum must be analysed at the laboratory.
So when you visit your GP to request a referral to a physiotherapist, ask if you could have some sterile containers so that you can gather a sample.
I’m hopeful that your condition will improve with the help of these measures.
WRITE to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email email@example.com — include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.
In my view… NHS advice must not ‘erase’ women
Accuracy is everything in medicine. Medical students undergo particularly strict training in the use of language and the need to describe symptoms precisely.
It’s only by taking care with words that medical errors can be averted.
Now we learn the NHS has decided to abandon accuracy in pursuit of ‘woke’ philosophy.
References to women have been dropped from its website guidance on ovarian and womb cancer. These conditions only affect women with female chromosomes who have female anatomy.
Using de-sexed language is an inexcusable inaccuracy which may present hazards to the 99.3 per cent of the population who are not transgender.
Those who are transgender need specific advice about their own particular health threats.
In the 1970s I was the medical adviser to the Self-Help Association for Transsexuals, and my great concern was that transgender women with male physiology were at risk of life-threatening blood clots due to the large doses of oestrogens they took. The NHS ‘de-sexing’ of language is a step in the wrong direction.