MEN'S HEALTH MATTERS:A new three-minute prostate test uses light energy to measure fluid, writes DR THOMAS LYNCH
Q There was a lot of news recently about a new rapid test for prostate cancer. Why is it not available in this country? Can you explain what this test is and how it helps to diagnose prostate cancer?
AA new three-minute prostate cancer test that uses light energy to measure fluid from the prostate is in the very early stages of research and so is not used in clinical practice in this or any other country.
The researchers have looked at only 20 samples to date, but their results are sufficiently encouraging to expand their investigations and look at another 200 volunteers; so even if it proves useful it will be years before it could be used in routine clinical practice.
Researchers developed the test by using light energy to measure the level of citrate in fluid samples from the prostate gland. The technique could provide the basis of a rapid means of detecting prostate cancer and for monitoring people with the disease.
They have developed a technique that measures the wavelength of light as it is shone through diluted samples of body fluids. The researchers from Durham University and the University of Maryland believe the technique which can measure, with speed and accuracy, how citrate levels fall in the prostate gland as cancer develops, could also find use for the diagnosis of other medical conditions associated with poor kidney function.
Citrate and lactate are vital for our bodies’ metabolism. Citrate provides energy for cells and the amount found in the prostate varies considerably due to an enzyme called m-aconitase which transforms it. This enzyme is very sensitive to zinc and, in prostate cancer sufferers, zinc levels are depressed and the enzyme switches on again.
The new test requires only a microlitre of fluid and the researchers have developed a portable instrument that can give results in three minutes.
Ultimately, this could provide an accurate method of diagnosing prostate cancer in men in about three minutes once a biopsy of the prostate (needle samples from the prostate) has been obtained from the patient.
A possible way forward is to examine the citrate levels in seminal fluid samples, which are made up of 50 per cent prostate fluid.
It must be remembered however that this is still a research tool and may be found to be of no clinical use.
Q I am 27 years old and have a lot of difficulty retracting my foreskin. It is very uncomfortable and my GP has advised that I may need a circumcision but a friend of mine mentioned that there are alternative surgical procedures. I thought that only children had a circumcision.
AA circumcision is the most definitive treatment for a tight foreskin and is the procedure of choice where there is evidence of scarring or infection of the foreskin.
This operation, which is commonly performed in adults, involves removal of the foreskin or loose sleeve of skin covering the end of the penis so as to permanently expose the glans (head). It can be performed with either a general or local anaesthetic.
Alternatives to a formal circumcision are possible in selected cases if you want to preserve your foreskin.
A Frenuloplasty involves the division of the frenulum (under surface of the foreskin) without any removal of foreskin.
To recommend this, the foreskin must be fully retractile without any evidence of inflammation.
A partial circumcision involves the removal of the constricting skin. Many men who opt for this are dissatisfied with the amount of redundant foreskin remaining and often opt for a full circumcision at a later date.
A dorsal slit (ie cutting a slit along the top of the foreskin) is sometimes suggested. If the slit is kept short then similar problems to partial circumcision may be encountered.
A preputioplasty may be effective in some cases of phimosis when there are no other problems with the foreskin evident such as inflammation. This consists of dividing any glandular adhesions (areas where the foreskin is adherent to the glans penis) and making a short slit longitudinally on the tight foreskin and then re-stitching the edges transversely.
A small T-shaped scar remains on the tip of the foreskin and, like all scars, is less elastic than the surrounding skin but the opening in the end of the foreskin is enlarged slightly.
If you are keen to preserve your foreskin it is very important to discuss these issues with your surgeon before you make any decision.
- This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin, and Mr Richard Power, consultant urological surgeon, Beaumont Hospital, Dublin