Författare: Dipa Kamdar Senior Lecturer in Pharmacy Practice Kingston Un

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A recent BBC investigation questioned the accuracy of prostate-specific antigen (PSA) self-tests – rapid at-home tests for men worried about prostate cancer. The BBC analysed five of these tests using one blood sample and found varying results: one positive, three negative, and one unreadable.

PSA blood tests measures levels of PSA, a protein produced by the prostate gland. All men have some PSA in their blood but a raised level can suggest a problem with the prostate, including cancer.

In the UK, prostate cancer is the most common cancer in men. One in eight men will be diagnosed with prostate cancer during their lifetime.

Unlike many other cancers, there is no national screening programme for prostate cancer and the NHS doesn’t offer routine PSA testing. But anyone who has a prostate and is over 50 years old – or over 45 and from a high-risk group – can request PSA testing on the NHS. A doctor may also request testing if they think a patient has prostate cancer symptoms or want to monitor a diagnosed prostate condition.

A faster and potentially more convenient alternative is self-testing. Currently, anyone over the age of 18 can buy a PSA self-testing kit for home use. With no proactive NHS screening programme, home testing is on the rise to catch prostate cancer early – even before there are any symptoms. By catching fast-growing cancers early, treatment can prevent them from spreading and causing serious problems.

As with COVID self-testing, the PSA home kits use test cassettes. You use a lancet (small needle) to prick your finger to get a few drops of blood, put the blood into a pipette and then drip this on to the test cassette along with a buffer solution. Depending on the test kit, a positive or negative result is displayed in five-to-ten minutes.

This might sound convenient, but some users find the detailed instructions for home PSA tests difficult to follow, which can lead to errors. A review found the information provided with self-tests is generally inadequate.

But as the BBC report showed, even when used correctly, PSA home tests can give varying results.

Not a cancer test

Positive tests or high PSA levels may cause men to worry unnecessarily. PSA tests are not blood tests for prostate cancer, and a PSA test can neither diagnose nor rule out prostate cancer. Rather, higher levels of PSA indicate a potential problem with the prostate.

In many men, this could be caused by a benign prostatic hyperplasia – an enlarged prostate. This is a non-cancerous condition affecting 8% of men in their fifties, where the prostate gland grows larger. It can cause urinary problems, such as difficulty in starting pee, a weak urine stream and frequent or urgent urination. The likelihood of developing an enlarged prostate increases with age.

An inflamed prostate (prostatitis) can also cause raised PSA, as can urine infections – and even vigorous exercise and sexual activity.

In some cases, rapid home tests can give a false negative result, offering false reassurance for users who should go on to have further tests for cancer.

Another drawback of home-testing kits is that there is no medical professional to refer a test user for further checks or to help interpret results. For example, a normal PSA level doesn’t mean the person testing is cancer-free: PSA levels can be normal even in someone with prostate cancer.

Tests are not a GP substitute

While rapid at-home PSA tests can be unreliable, other types of PSA self-testing kit allow you to collect the blood sample in a small tube, then send it to a laboratory for testing. Getting these results can take a few days but can offer a more detailed PSA value, compared with rapid at-home tests. But again, these lab tests can neither diagnose nor rule out prostate cancer.

Whatever the method of testing, high PSA levels should be followed up with a doctor who can order more tests and scans to check for cancer.

Many men might find the Prostate Cancer UK online risk checker useful. It asks three main questions about age, ethnicity and family history.

The older a man is, the higher their risk of prostate cancer. Men of black ethnic heritage have double the chance of developing prostate cancer, while those with a close relative – father or brother – who has had prostate cancer are also at increased risk.

The online risk checker also provides useful resources, information to take to the doctor, and contact details for specialist nurses.

If a man is experiencing any symptoms of prostate problems, falls into a higher risk group, has genetic risk factors, has a positive PSA home-test, or just has concerns about prostate cancer, it’s always best to check with the doctor – they can provide more support, information and further testing. Läs mer…

What do King Charles and Gwyneth Paltrow have in common? Give up? They’ve both at one point or another caused coffee colonic-related controversies.

In a 2004 speech to the Royal College of Obstetricians and Gynaecologists on complementary therapies and cancer care, the then Prince of Wales’s comments on Gerson therapy – a health programme, marketed as an alternative treatment for cancer, that includes regular coffee enemas as a way to clear toxins from the body – seemed to endorse the unproven regimen. The prince’s opinion drew criticism from medical experts.

Wellness influencer Gwyneth Paltrow, on the other hand, promoted a DIY coffee enema kit on Goop, her lifestyle website – again drawing criticism from specialists who urged Goop fans to “keep the coffee out of your rectum and in your cup”.

Read more:
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Despite the expert critique, coffee enemas continue to be a social media wellness trend offered in many alternative health clinics as a method to cleanse the colon and detoxify the body. More worryingly, coffee enemas are still recommended by some influencers as an alternative treatment for cancer and other serious illnesses.

So, why does the popularity of this controversial trend persist despite the bad press? Do the benefits of a coffee enema outweigh the risks?

An enema clears the bowel of faecal matter. Usually, the procedure involves inserting a nozzle attached to a pouch containing fluid into the rectum so the liquid can be squeezed in. In conventional medicine, enemas are used to clear the bowel before surgery, for severe cases of constipation or sometimes as part of a bowel management scheme – in people with inflammatory bowel diseases, for example.

It’s claimed by some coffee enema advocates that, before the advent of modern painkillers, Florence Nightingale used coffee enemas as a form of pain management in soldiers during the Crimean War, and doctors used them in the second world war.

Gerson therapy

But despite the advances in medicine and technology since Nightingale was nursing injured soldiers, coffee enemas continue to be promoted as a health practice.

Gerson therapy continues to be highly publicised as an alternative option to chemotherapy. Patients follow a strict organic vegetarian diet, which can include up to 13 glasses of fruit juice and up to five coffee enemas daily.

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The Gerson Institute claims the enemas can increase gut movement which helps to empty bowels. Coffee enemas are believed to help the body expel toxins from the liver and gut, which is thought to relieve pain.

Coffee contains compounds kahweol and cafestol, thought to boost an enzyme which helps remove harmful substances from the body. These substances are turned into bile salts and expelled from the body. The caffeine in coffee is thought to stimulate the liver and widen the bile ducts to increase the flow of bile and help remove toxins.

Several studies show there is no evidence to prove this regime works to cure cancer and it is not supported by any reputable cancer organisations. But it’s possible the placebo effect might help some patients feel better. A review showed there were more reports about the side effects of coffee enemas than their efficacy. Some people, for instance, experienced proctocolitis – inflamed rectum and colon – and rectal burns.

Self-cleaning

Because of the amount of waste that is expelled from the gut, coffee enemas can remove potassium from the body. This can lead to electrolyte imbalance, dehydration, muscle weakness and nausea. In severe cases, it can cause irregular heartbeats and lung problems. Using any enemas regularly for a long time can cause the bowel muscle to weaken, which is linked to constipation and inflammation of the bowel. In some cases, enemas may damage the balance of good bacteria in the gut, which can cause cramping, diarrhoea and bloating and increase the risk of infection.

There no need for DIY enemas of any kind: the gut is self-cleaning. Regular digestion and bowel movements means the body gets rid of waste naturally. A high-fibre diet, rich in fruits, vegetables, wholegrains and seeds should be enough for good digestive health and could even reduce the risk of cancer. Current advice suggests we consume at least 30g of fibre daily. Most adults, however, have an average of only 19g of fibre daily. Drinking plenty of water is also crucial to gut health. Research suggests that eating fermented foods, such as kimchi, kefir and kombucha, can help the good bacteria in the gut and aid with digestion.

Drinking coffee is more likely to be beneficial for health than coffee enemas. Studies show that moderate coffee intake is linked to lower risk of heart disease, for example.

Social media can be a useful way to learn about health but it’s important to check who is giving this information – do they have credentials to back up their claims? It’s always best to check with your doctor or specialist before embarking on any alternative or complementary therapies. Läs mer…