Dear doctor

Prostate fears

Q I'm a worried man of 43. Recently, I had a urine infection which cleared up with a course of antibiotics. My GP took a blood test which included a PSA test to check my prostate. I have just been told it is four. The GP wants to refer me to a specialist to check for prostate cancer. I have no symptoms but am anxious and upset. Can you reassure me?

A Don't panic. It's a shame you had the PSA tested while you had a urine infection. PSA (prostate specific antigen) is a chemical produced by the prostate that rises whenever the gland is upset. As it sits just under the bladder, urine infections can have a knock-on effect and cause the PSA to rise. Infections, inflammation and cancer can cause a high PSA. Even enthusiastic sex and jiggling around on a bicycle seat are said to affect your PSA. Levels rise as you age because the prostate tends to grow. In your 40s, PSAs should certainly be less than 2.5, and consistently higher values do need to be checked out.

In the unlikely event that you do have cancer, you will be pleased to have had it detected promptly. Evidence is growing that 90% of prostate cancer treated at an early stage, results in cure.

Horse whispers

Q My 10-year-old spends her weekends at a stables. I have read that Glanders is a dangerous disease that can be caught from horses. Is it a risk to her?

A Glanders has featured in the lists of potential bioterrorism weapons. Anyone who enjoys being frightened may peruse the excellent Public Health Laboratory Service website for details of these potentially fatal, contagious, untreatable infectious agents. The last case of Glanders in the UK was in 1928 so your daughter isn't at risk in the stables. There are still cases in SE Asia and the Middle East. Humans can catch Glanders from an infected animal if they have large cuts which the bacteria can get into. It' s fatal to humans in 90% of cases.

www.phls.co.uk

Cheeky GP

Q I am a 51-year-old woman whose periods are now three to six monthly. My doctor says this is normal. However, when I asked if we could stop contraception, he just grinned and asked if I thought I would conceive at my age. I find this answer unsatisfactory.

A The usual advice is that women who want to avoid pregnancy should use contraception for a year after the last period if you are over 50. Under 50, you should use contraception for two more years to be safe. Your chance of getting pregnant may be slight but it's not impossible. Women can carry on ovulating up to their very last period. Over 90% of women aged 40-55 who have regular periods actually ovulate every month. You can take the oral contraceptive pill if you don't smoke and have no tendency to thrombosis. This means you'll get some extra oestrogen which can help against early menopausal symptoms like hot flushes. Or consider the progestogen-only pill if you don't fancy the oestrogen. A coil with or without added progestogen is an excellent option and some women prefer condoms, caps or spermicidal gels

Jowl trouble

Q Can you suggest facial exercises for getting rid of double chins? I am thin but seem to be developing jowls. I am planning to start a general exercise programme to get fit but was wondering if you could suggest anything specific?

A A sagging jaw is the product of gravity and genes. Facial exercises to tone the muscles of the neck may make your jawline look better and there are some lovely ones on the website below. Cosmetic surgery is a more drastic measure - few of us would go that far.

www.womenfitness.net/beauty/skin/facial.htm

· These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.

Thanks to guardian.co.uk who have provided this article. View the original here.