DR MICHAEL MOSLEY:Men should learn from my dad's cancer diagnosis

08/28/2021 Health News

DR MICHAEL MOSLEY: Lessons every man should learn from my dad’s prostate cancer diagnosis

Over the course of a week I read a lot of scientific articles (so you don’t have to) and one of the things I always keep a keen eye out for is anything on prostate cancer.

It is the most common cancer in British men and over the last decade, while deaths from other common cancers such as bowel and breast have fallen, deaths from prostate cancer have risen.

I have a particular interest in prostate cancer because my dad was diagnosed with it when he was in his 60s (roughly the same age that I am now).

I am acutely aware of the fact that because dad had prostate cancer, my chances of getting it are around two-and-a-half times higher than if he hadn’t.

So you might think that I am very pro screening for prostate cancer but if my dad’s experience taught me anything, it’s that this particular issue is far more complex than you might think.

It is the most common cancer in British men and over the last decade, while deaths from other common cancers such as bowel and breast have fallen, deaths from prostate cancer have risen

The prostate is a gland, about the size of a walnut, which surrounds the urethra — the tube which you pee through. Unfortunately it grows from our 50s onwards and men often experience symptoms caused by the prostate compressing the urethra such as waking up frequently during the night and finding it hard to start urinating.

Although these can also be symptoms of prostate cancer, they are normally the result of an enlarged prostate.

One of the scary things about prostate cancer is there are rarely any symptoms until the tumour has got quite large or has spread.

And once that happens you might experience back pain, problems getting or keeping an erection, blood in the urine or unexplained weight loss.

Your chances of developing prostate cancer increase beyond the age of 50 and it is more common in men of African-Caribbean or African descent. As I mentioned, your risk is two-and-a-half times greater if your brother or father had it, and there is research which suggests that being significantly overweight also increases your risk.

Which brings us back to screening.

Lots of famous people have had prostate cancer, including Noel Edmonds and Robert De Niro. Most of these famous names only discovered they had the cancer by taking a PSA test — a blood test which measures prostate specific antigen, a protein, levels of which increase if cancer is present.

A couple of years ago the author and presenter Stephen Fry described, on Twitter, being diagnosed with prostate cancer after a routine health check found he had a high PSA level. It turned out that they caught it just in time because it was, in Stephen’s words, ‘an aggressive little bugger’.

Examples like his would seem to make the case for routine PSA tests, but it is not that straightforward.

PSA levels can rise not just due to cancer but also due to an infection or everyday inflammation.

When I was at medical school I was told that PSA stands for ‘promoting stress and anxiety’, and that routine PSA tests may do more harm than good. That message was reinforced a few years ago, when I put myself through a battery of health tests for a film for BBC’s Horizon, to see which were worth doing.

These included having my blood pressure measured, a PSA test and bowel scope screening (which may involve a tube up your bum).

I concluded having my blood pressure and my bowels checked were a good idea, but the benefits of the PSA were less clear.

Not only does it throw up lots of ‘false positives’ but it also warns you about the presence of cancers that may never impact your life; 70 per cent of men over the age of 80 have prostate cancer, but most will die of something else. My father is a good example.

He had a PSA test, as part of a private health check, and further investigations revealed he had prostate cancer. He had invasive surgery to get rid of it, but the impact of the surgery blighted the last years of his life.

It’s possible the treatment slowed the disease, but it is also possible that it was a slow-growing tumour and he would have died never knowing he had it. In fact, he died of unrelated heart failure several years after the operation.

The good news is that tests that can discriminate rapidly growing cancers from more benign forms are becoming widely available. These include a ‘multi-parametric magnetic resonance imaging’ (mpMRI) scan, which creates more detailed pictures of the prostate than a standard MRI scan.

These are available on the NHS, and recent trials have shown that they are significantly better at identifying dangerous prostate cancers than biopsies (where they have to stick needles into your prostate to see if it contains any cancerous cells).

Since biopsies and over-treatment — treating cancer which may never prove troublesome — often lead to impotence and urinary incontinence, I will book myself an mpMRI should the need arise.

The other good news is that treatments have improved since my dad’s surgery 30 years ago.

There are now lots of other options, including cryotherapy (freezing the cancer cells) and high-intensity focused ultrasound — using ultrasound to heat the tumour to try to kill it.

If you do have symptoms, or are simply concerned, talk to your GP.

Why it pays to go to work on an egg

I used to dash out the door every morning after a quick breakfast of toast or cereal. These days, I have a more filling, protein-rich breakfast, such as scrambled eggs or kippers.

That’s because I know it will keep me fuller for longer, so I won’t have cravings at 11am. Another good reason is that a protein-rich breakfast may help build muscle.

In a study researchers in Japan gave 60 middle-aged women a food questionnaire, then tested their grip strength.

The women who ate more protein for breakfast did better on the grip strength tests.

Studies with animals have shown that even when they don’t consume more protein overall, protein consumed earlier in the day leads to bigger muscles.

A good excuse for a hearty breakfast.

As we get older most of us struggle with our memory, particularly when it comes to putting names to faces. But there are some remarkable individuals called ‘superagers’ whose brains seem to be impervious to the passage of time.

Scientists from Harvard Medical School have recently identified the secret of their success. To do this they asked 40 superagers, with an average age of 67, to take part in a memory test while they were lying in a functional magnetic resonance imaging (fMRI) scanner, which measures brain activity, and got 25-year-olds to do the same.

The researchers were interested in studying the visual cortex, the part of our brain that processes what we see. It has distinct clumps of brain cells whose job is to just identify faces, animals or objects. As we get older the ability to identify particular things, called neural differentiation, diminishes. We struggle to make connections, to put names to faces.

But in this experiment superagers were as good as the 25-year-olds in the memory tests, at least in part because their brains maintained the same high level of neural differentiation as the youngsters. What is not known is if this is an innate ability or the result of some form of brain training.

I struggle to remember names and so i create mental images, which I tag people with. If I meet someone called ‘Ben’ I might imagine a huge clock (Big Ben), on his forehead to help me remember his name.

The team from Harvard have started a trial to see if a course of electromagnetic stimulation (which delivers a small electrical shock to areas of the brain) can improve memory in older adults. I like to think I won’t need it, but you never know.

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