MEN'S HEALTH MATTERS:There can be various different reasons for an elevated PSA level, writes Thomas Lynch.
Q:I WILL BE 50 in September and am going to have a general check-up including the prostate blood test - PSA. What if the screening test results show an elevated PSA level?
A:You should discuss elevated PSA (prostate specific antigen blood test for the prostate) results with your doctor.
There can be various different reasons for an elevated PSA level - including prostate cancer, benign prostate enlargement, inflammation, infection, and race.
If your PSA level is high on a single test, or has been increasing over a period of time - or if a suspicious lump is detected during the DRE (digital rectal examination of the prostate), your doctor may recommend other tests, to determine if there is cancer or another problem in the prostate.
A urine test may be used to see if you have a urinary tract infection or blood in your urine.
If no other symptoms suggest the presence of cancer, your doctor may recommend repeating the DRE and PSA tests regularly, in order to watch for any changes.
If cancer is suspected, a biopsy of the prostate will be required, and this is performed with a local anaesthetic using an ultrasound probe to help guide the biopsy needles into the prostate gland.
Your doctor will be able to explain all of these details to you, but you must remember that the majority of men will have a normal PSA level and even if the PSA is raised, a majority of this group will not have cancer when checked out.
Q:I noticed a small swelling in my neck about three months ago and went to my general practitioner. She says that I have a lump on my thyroid gland and has referred me to an ear, nose and throat surgeon.
Should I be worried?
A:The thyroid gland is located low down in the centre of the neck and wraps around the front and sides of the windpipe. It produces thyroid hormone, which plays an important role in regulating the body's metabolism.
If you do not have enough thyroid hormone, you may feel mentally and physically sluggish. Your hair may be brittle and your skin thick and dry. Other symptoms include slow heart rate, constipation and cold intolerance.
Too much thyroid hormone causes anxiety, heat intolerance, sweating, palpitations, muscle weakness and weight loss in spite of increased appetite. Swellings of the thyroid gland are very common and do not usually alter the amount of thyroid hormone in your blood stream.
Typically, they cause no symptoms other than a visible or palpable lump in the neck. Gross enlargements can compress the airway with reduced exercise tolerance.
A thyroid swelling may be a uniform enlargement of the whole gland or it may consist of single or multiple nodules; most are entirely harmless.
Your specialist will probably arrange for you to have an ultrasound in order to get more information on the nature of your problem. If this confirms that you have a single nodule, he will then arrange a needle biopsy as an outpatient.
Most of these biopsies indicate a benign non-cancerous process. In this situation, the surgeon will reassure and recommend a single repeat needle biopsy three to six months later.
If the needle biopsy finds suspicious or frankly cancerous cells, your surgeon will recommend partial or total thyroidectomy (surgical removal of the thyroid gland).
Thyroidectomy is done under general anaesthetic through an incision in the lower neck. Hospital stay will vary from one to several days and recovery usually takes about two to four weeks.
Most thyroid swellings turn out to be benign. Even in the event that your thyroid swelling turns out to be malignant, it is likely to be an eminently curable papillary or follicular cancer, with a high cure rate - in the region of 95 per cent.
So the message is not to be too worried - but do go and get checked out by your specialist.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Mr John Kinsella, consultant ear nose and throat and head and neck surgeon, St James's Hospital, Dublin
• If you have a health question you would like addressed, e-mail healthsupplement.irish-times.ie