MEN'S HEALTH MATTERS:If you are over 75 years of age, there is no need to get your PSA level checked
Q I am 76 years old and recently had my PSA check-ed at my own request. It was within the normal range for my age. I had a chat with my GP about this and he said that I did not need to have it checked for another few years. I am a bit worried that I should leave it for a few years.
AYour general practitioner has given you very good advice which is based on evidence in the literature. The United States Preventive Services Task Force (USPSTF) recently concluded (consistent with previous recommendations from 2002) that there is insufficient evidence to assess the benefits or harm of having a PSA test done in the over-75 year age group.
The task force recommends against checking the PSA in men over 75 years or older, since the harm of screening outweighs the benefit. If, however, a man has his PSA checked then the task force recommends having it repeated no more than every four years.
The group’s recommendations are based on findings from a systemic review of the evidence of benefits and harms, balancing them to identify the net benefit of a preventive procedure. They found that the benefits of checking to see if a man has prostate cancer are uncertain.
There are two large international high-quality studies being conducted at present to determine if population-based screening with subsequent treatment is beneficial. Some people might consider it to be ageist by recommending that men older than 75 years should not have their PSA checked, and this is definitely not the case.
It is very important to be sure that men would benefit from treatment and this has not been proven in this age group. Similarly, we do not have screening for breast cancer in this age group.
There are, however, men with prostate cancer in their 70s and 80s who do benefit from treatment, but what is being discussed here is the “screening” of all men in this age group.
Q Can acupuncture reduce symptoms in men with chronic prostatitis/pelvic pain syndrome?
AChronic prostatitis/chronic pelvic pain syndrome is characterised by pain, usually urinary symptoms and, unfortunately, no effective treatment. The details of this condition have been discussed previously in this column.
A number of different treatments may be used which are often ineffective, so doctors are on the lookout for new therapies all the time.
A recent study reported in the American Journal of Medicine evaluated the role of acupuncture in 89 men. This study compared acupuncture twice weekly for 30 minutes with a sham group treatment (patients had needles placed but no acupuncture) over a 10-week period.
The study demonstrated that approximately 30 per cent of patients treated with acupuncture noticed a decrease in symptoms but, interestingly, 13 per cent of patients receiving sham treatment also noticed a difference. Some patients with this syndrome may respond to acupuncture, but the results are not very impressive.
Q When I try to lift a cup of tea at breakfast I have terrible pain in the outer part of my elbow. A friend of mine mentioned tennis elbow. What is the cause of this and what can be done?
AAs you say the most likely cause of your pain is tennis elbow, which is a misnomer. The correct term is a lateral epicondyle enthesopathy, which means inflammation at the junction between the muscle and the bone fibres on the lateral side (outside) of the elbow. This condition often occurs in people who have never played tennis.
If pain occurs on the inside (medial side) this is called golfer’s elbow and to confuse the issue further golfer’s elbow sometimes occurs in tennis players and tennis elbow occurs in golfers!
The pain can sometimes be referred from the shoulder or the neck, which can simulate an elbow problem. The nerve roots involved in the front of the elbow are cervical spine 5/6 and at the back of the elbow is cervical spine 7.
There are more than 100 different types of arthritis and most of them can affect the elbow, although the diagnosis would be obvious by looking at the other joints, particularly the hands.
You should go to your doctor who will listen to your history, making special note of repetitive strain injury or overuse. Your joints will then be examined and laboratory tests may be recommended. However, investigations including blood tests and X-rays are not usually helpful. Movements of the elbow are assessed.
Tenderness over the bony part of the lower lateral bony part of the elbow is suggestive of tennis elbow. Resisted wrist extension with the elbow in full extension is the movement that is most hurtful. The range of movement of the elbow is not affected but, in severe cases, may in fact be restricted, particularly passive extension of the joint.
Ergonomic advice about the care of the elbow is important. Physiotherapy exercises including stretching can be very helpful.
Persistence of pain, which interferes with normal daily activity, may require a local injection of steroids, but it is important to point out that the “rule of three”, which means no more than three steroid injections, should be used.
The good news is that the prognosis is excellent for complete disappearance of the symptoms, and it is important to highlight that there is rarely any serious problems with the elbow joint.
- This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin, with a contribution from Dr Eoin Casey, consultant rheumatologist.
- Please send your questions to healthsupplement@irishtimes.com
