As my grandfather had prostate cancer I feel that I should have a PSA test every year to check for it. Is this necessary, and if so do I have to go private? I am 63.
Whether a man should be screened regularly for prostate cancer is not straightforward, as there are risks and benefits that need to be weighed up.
A PSA blood test looks for levels of a protein – called prostate specific antigen – that rise when a man has prostate cancer. The problem is that they also rise with other conditions, including benign prostate problems, or even after sex and vigorous exercise.
This is why the UK doesn’t have a PSA screening programme – because the risks of incorrectly diagnosing prostate problems are tremendous. Men can end up having unnecessary treatments that are very invasive and can result in lifelong problems.
Whether a man should be screened regularly for prostate cancer is not straightforward, as there are risks and benefits that need to be weighed up (stock photo)
So in most cases an annual test does not make sense.
GPs do offer PSA testing on request, but this would be on the basis of individual circumstances such as family history and symptoms. Having a grandfather with prostate cancer would not be unusual, as it is common over the age of 80, but a family history in a father or brothers would be more relevant.
I am asthmatic and for about two years I have been suffering from a severe shortness of breath. I have had pleurisy so thought that might be the cause, but lung scans, blood tests and other results have all been normal. The doctors don’t seem to be able to pinpoint the cause of my breathlessness. What could it be?
Shortness of breath can be a result of a host of underlying conditions involving the lungs, the heart, the blood, side effects from medication and even psychological disorders.
While a symptom of pleurisy is shortness of breath – caused by inflammation of the lungs usually from a viral infection such as flu – it is normally a short-term condition that can be cleared up with antibiotics without doing any long-term damage.
There are plenty of checks a GP can undertake, including blood tests, chest X-ray and spirometry, which measures the capacity of the lungs. But if these are not providing a clear answer, it is likely that a doctor will refer to a specialist as more invasive testing might be needed.
I am asthmatic and for about two years I have been suffering from a severe shortness of breath, a reader asks Dr Ellie (stock photo)
More from Dr Ellie Cannon for The Mail on Sunday…
This can include a bronchoscopy, where a camera is inserted into the lungs, or a CT scan of the chest – both give a clearer indication of any lurking disease than an X-ray can.
In fact, a fifth of lung cancers would be missed on a chest X-ray, and blood tests might not show it up either.
Pulmonary fibrosis is a little-known lung condition that causes shortness of breath. There are also other conditions that would be detected with specialist tests.
It isn’t unusual for doctors to check the heart when looking for the cause of breathlessness as it can be a symptom of a number of conditions, particularly valve problems or even heart failure. Both of these could be detected with an echocardiogram scan.
It can also be a symptom of blood problems such as anaemia. And many people don’t consider mental health problems as a potential cause of breathlessness, but anxiety and panic disorders are surprisingly common culprits.
A few weeks ago I noticed a lump on the back of my hand – below my thumb, near the wrist. It is on the bone area and is very painful. I am 76 – could it be rheumatoid arthritis?
It isn’t common for rheumatoid arthritis to develop in one joint over the age of 75. The condition is usually symmetrical, affecting both hands at the same time, and mostly appears for the first time at a younger age.
When the arthritis affects one joint, on one side, it is normally osteoarthritis or a different type of arthritis such as gout. This is especially likely for adults over the age of 75.
Our thumb joints are unique and very sophisticated. They allow our thumb and littlest finger to touch.
This might not seem like an important movement but it is a phenomena known as opposition – and is what makes us different from other animals. It allows us to write and use fine instruments, but is why the thumb joint suffers a lot of wear and tear, making it particularly susceptible to osteoarthritis.
Do you have a question for Dr Ellie?
Email [email protected] or write to Health, The Mail on Sunday, 2 Derry Street, London, W8 5TT.
Dr Ellie can only answer in a general context and cannot respond to individual cases, or give personal replies. If you have a health concern, always consult your own GP.
Most people will develop some osteoarthritis of the thumb at some point in later life. If this is the case, using an anti-inflammatory cream such as Voltarol, as well as ice, will help.
Hand exercises recommended by a physiotherapist are available from the charity Versus Arthritis.
A very common lump to find in this area, though, would be something called a ganglion cyst.
These are soft and feel like a firm gel, and aren’t always painful. They are not made of bone, but fluid which normally sits around the tendons in the area and which can leak out and swell beneath this skin.
Ganglion cysts are more common in people with arthritis. They can easily be diagnosed during a face-to-face consultation with a GP.
If a ganglion causes persistent pain or difficulties with movement, a small operation could be offered to remove the fluid. But for most people, no treatment is necessary.
Strep A deaths are awful but it is not time to panic
I have been inundated with messages from parents worried about strep A.
I’m not surprised. At the time of writing, 15 children have tragically died from the bacterial infection, and some scientists are suggesting we restart social distancing in schools.
At the time of writing, 15 children have tragically died from the bacterial infection [strep A], and some scientists are suggesting we restart social distancing in schools (stock photo of mother taking her daughter’s temperature)
But I want to emphasise that severe cases of strep A remain incredibly rare. In fact, the number of cases haven’t yet surpassed what we’d expect in a normal year – they’re just happening before the peak of winter, when we usually see them.
Experts believe that most of the children who have become seriously ill have had a viral infection at the same time, so they’re being hit very hard. Be reassured, the overwhelming majority of coughs, colds and fevers will not be serious.
A telltale danger sign, however, is a downward trajectory in an unwell child – they’re getting sicker and sicker, and nothing seems to help. Then it’s time to see a GP.
Thumbs-up from Professor Whitty
Dr Ellie Cannon said Chief Medical Officer Chris Whitty (pictured) told her ‘that he reads my column and thoroughly enjoys it. I was delighted to hear that he is a fan of our Health section’
I was officially star-struck last week when I came face-to-face with England’s Chief Medical Officer, Chris Whitty.
Professor Whitty, who is an infectious diseases doctor, was speaking at an event about gambling addiction that I also attended – and it took me by complete surprise when I saw him smiling at me, as if he knew who I was.
Later he stopped for a chat. He told me that he reads my column and thoroughly enjoys it. I was delighted to hear that he is a fan of our Health section.
That’s no surprise, with such top-quality reporting – and our commitment to arming our readers with the very best, most accurate health information.
So there you have it – the medical pages in The Mail on Sunday are approved by the top doctor in the land!
This post first appeared on Daily mail