Last year I was diagnosed with prostate cancer after a routine PSA test. It had not spread, and the doctor decided to adopt a six-monthly blood and prostate examination. Had I not had the PSA test I feel I would have soldiered on in blissful ignorance. But receiving no treatment sends my mind into overdrive.
Mr W McBryde, Dumfries
Your worry is understandable. Most people diagnosed with cancer are keen to have treatment as soon as possible to get rid of all signs of it. But with prostate cancer, all is not what it might seem. One of the most important things to point out is that this type varies greatly in how aggressive it is: prostate cancer is mostly something you die with, not of. Since the arrival of PSA testing — which measures a protein called prostate-specific antigen — there have been more prostate cancer ‘diagnoses’. But PSA levels can be raised for other reasons, too (such as an enlarged prostate or even recent sexual activity), and a biopsy is needed for confirmation.
Prostate cancer is one of the most common cancers in the UK, yet receives only a portion of the NHS funding reserved for women’s cancers. Besides the fact that the prostate biopsy carries risks (it is painful and can trigger a potentially life-threatening infection in a tiny number of cases), it may lead to a diagnosis of cancer in men who would otherwise have remained unaware of the illness, and lived on for years, only to eventually die of something else. Many men have cancers that will not progress significantly if left alone. For these, treatment — which may involve prostate removal surgery, and radiotherapy or chemotherapy — may be unnecessary and not worth the complications, such as incontinence and impotence.
The difficulty is in deciding which confirmed prostate cancers are the less aggressive, semi-dormant ones that will not shorten life. The key is a measurement called the Gleason score, given by the pathologist who examines biopsy tissue samples. The lower the Gleason score (two or three is considered low, six to eight is high), the more favourable the outlook. In such circumstances the specialist would typically advise watchful waiting, the recommendation you have. The research is complex, but I will quote you one 20-year study involving 1,300 men with Gleason scores below six. They were deemed to be at low risk of dying from their prostate cancer.
Risky: Many prostate cancer treatments can leave patients with bladder or sexual dysfunction
They were followed in the same way as you, with PSA tests, digital rectal examination and prostate biopsies when a change was noted. In that time, 49 died, 47 of them from causes other than the cancer. More than 90 per cent of the group were alive ten years later. Therefore, provided your initial tests confirmed a low risk, the wait-and-see policy advised by the specialist was a good decision, despite the anxiety caused by the necessary review process. It’s what I want if ever my time comes.
There has been much publicity about the anti-inflammatory effect of turmeric. I would love to take it as a supplement for lumbar problems, but read it should not be taken by people with gallstones, which I have. Can you advise?
Doreen Clarke, by email
Turmeric is the tuberous root of curcuma longa, a plant native to southern Asia. The powder ground from it has long been used as a condiment, dye and in food colouring, and recently there has been interest in it as complementary medicine. Its medicinal value is said to lie in the chemical curcumin, responsible for its bright yellow colour. But finding reliable evidence is not easy. What studies do show is that curcumin is beneficial as an anti-inflammatory and antioxidant, mopping up harmful free radicals. This is similar to aspirin, an anti-inflammatory and antioxidant which started as a natural product.
Studies also show curcumin may reduce osteoarthritis pain. This is where you may find it helps your lumbar (lower back) pain.
You ask about gallstones — small stones, usually made of cholesterol, that can form in the gallbladder, which stores bile after it has been secreted by the liver. The gallbladder then contracts to mix bile with food. Gallstones are seen in 6 per cent of men and 9 per cent of women, though many won’t be aware they have them.
It is thought that curcumin may stimulate the flow of bile from the liver. If so, it may also cause the gallbladder or bile ducts (which carry bile to the gut) to contract.
If the gallbladder has stones, when stimulated by curcumin, the gallbladder’s contractions may, in theory, push the stones into the bile ducts, causing pain known as biliary colic. Fatty meals have the same effect. And while those with gallstones may be advised to minimise fatty foods, some fat or oil is essential in a balanced diet.
There is so little firm evidence of curcumin being contraindicated in those with gallstones that I cannot confidently counsel you — but I think it’s a risk worth taking.
BTW: GPs CAN’T TAKE ON ANY MORE PATIENTS…
Every doctor I’ve ever met is determined to do the best for all their patients: that’s how we are, and any who lack that commitment invariably fall by the wayside. Yet there is now a real risk that, following a vote, GPs in England will close their lists and decline to take on new patients. Such industrial action would mean some people will be unable to register with a doctor, the cornerstone of NHS care — general practice accounts for 90 per cent of all medical interventions. I have no doubt that unregistered patients with emergencies will still be treated by doctors as ‘temporary residents’, but those with long-term conditions needing ongoing care will find it hard to get continuity of care, which is vital for good outcomes.
We don’t have to look far to see why doctors are so angry that they feel the need to do this: GPs are struggling to find enough time to treat the patients already on their lists — thanks to population increases, greater life expectancy, and an ever larger proportion of elderly patients, many of whom need increasingly complex care for multiple health problems. To try to offset this, the Government has promised 5,000 more GPs, though we all wonder where they will come from, and whether the increased funding also promised will ever materialise: there is little forthcoming so far, hence the threat from the GPs and the ballot for industrial action.
But what about the Hippocratic Oath, the moral duty for doctors to provide care for the sick? Its core theme is ‘I will utterly reject harm and mischief’. To force doctors to do more, with such limited resources, means patient care will suffer and we will inevitably end up breaking this oath. And that is something we cannot tolerate as it destroys everything that we stand for. I fear industrial action is wrong, but I can see why it might be inevitable.
By Martin Scurr for the Daily Mail