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BMJ 2009; 339 doi: (Published 19 August 2009) Cite this as: BMJ 2009;339:b3356
  1. Adrian Manning, retired consultant physician, Shipley, West Yorkshire
  1. amanning{at}

    In December 2007 my 56 year old younger brother, living and working in a major city in the United States, underwent his routine yearly company medical examination. He phoned me afterwards to ask what the “PSA” was, because his was high. I, an NHS gastroenterologist, gave him our party line: the prostate specific antigen (PSA) test can indicate prostate cancer but has too many flaws to be useful for screening. He had a transrectal biopsy, which he described to me vividly, and it showed cancer. His urologist proposed robot assisted laparoscopic radical prostatectomy. The urologist said that this was the only operation considered these days; he did no other. It was, he said, best for reducing blood loss, for speed of recovery, and for nerve sparing and hence potency; any right thinking second opinion giver would say the same.

    I did what many patients, relatives, and doctors do: I consulted the internet. Among many helpful (and unhelpful) things I learnt was that a major risk factor for prostate cancer is a positive family history. We had no …

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