ASK DR 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 [email protected]. She regrets she cannot enter into personal correspondence or reply to everyone


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