Your health questions answered.
QI am in my 50s, and a regular topic of conversation at work seems to be prostate cancer and the PSA test. What is the PSA (prostate specific antigen blood test for the prostate)?
AThe PSA test, along with a digital rectal exam (DRE), are used to detect prostate cancer in men of 50 and over.
Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test is a simple blood test which can be done in most laboratories.
It is normal for men to have low levels of PSA in their blood; however, an elevated level of PSA in the bloodstream does not necessarily indicate cancer of the prostate. An elevated PSA is simply a warning signal that further tests need to be done as benign (non-cancerous) conditions can also increase PSA levels.
During a DRE, a doctor inserts a gloved finger into the rectum and feels the prostate gland through the rectal wall to detect bumps or abnormalities.
Doctors often use the PSA test and DRE as prostate cancer screening tests - together, these tests can help doctors detect prostate cancer in men with no symptoms.
The PSA test is also used to monitor patients with a history of prostate cancer to see if the cancer has returned. If PSA level rise, it may be the first sign of recurrence.
However, a single elevated PSA in a patient with a history of prostate cancer does not always mean the cancer has come back. A man who has been treated for prostate cancer should discuss an elevated PSA level with his GP.
The doctor may recommend repeating the test or performing other tests to check for evidence of recurrence. The doctor may look for a trend of rising PSAs over time rather than a single elevated PSA.
QI am 64 years old and my GP has sent me for a scan as he thinks I may have an abnormal swelling of the main blood vessel in my abdomen. Can you tell me what this could be - and should I worry?
AYour general practitioner is worried that you may have an abdominal aortic aneurysm, which means that the main artery running through your abdomen (aorta) may be abnormally enlarged. This abnormality is more common in patients who are over 60.
Most people don't know they have one, as they generally don't cause symptoms and are most commonly detected when you are having investigations for another complaint.
Your GP is absolutely correct to arrange for a scan. This may or may not confirm the presence of an aneurysm and, more importantly, if present, will indicate its size.
In general, an aneurysm that has grown to a size greater than about 5cm will require treatment.
All surgery is potentially a major undertaking. Conventional surgery to repair an abdominal aortic aneurysm requires an incision down the centre of your abdomen and the aneurysmal (diseased) part of the aorta is replaced with an artificial tube. This surgery may take up to four hours, after which you will return to the intensive care unit.
You may be left on a ventilator (machine to aid your breathing) overnight, after which you will be able to breathe normally.
Unfortunately complications (heart, lungs, kidneys and bowel) do occur but the team looking after you in hospital will do their best to ensure that you come through with minimal problems.
A new keyhole technique of repairing aneurysms is now available and is carried out in specialist vascular surgical units in Ireland. Two small cuts are made in the groin and a stent graft is passed over a wire and then released to seal the aneurysm.
This is an increasingly popular way of treating aneurysms, and rapidly becoming the treatment of choice. The risk to you is much less - in the order of 2 per cent. While the stress to you as a patient is much less with this technique, the drawback is that you will require more regular review afterwards. There is also a small risk of the aneurysm rupturing - even after a successful repair.
In some cases your surgeon may decide that the risk with open surgery is too high and may suggest that nothing is done.
This column is edited by Thomas Lynch, consultant urological Surgeon, St James's Hospital, Dublin with a contribution from Prakash Madhavan, consultant vascular surgeon, St James's Hospital, Dublin
If you have a health query e-mail it to healthsupplement@irish-times.ie