Intended for healthcare professionals


Michael Wilks: campaigner who helped found the Sick Doctors Trust after his own experience with alcoholism

BMJ 2019; 364 doi: (Published 21 March 2019) Cite this as: BMJ 2019;364:l1329

Re: Michael Wilks: Mr Christopher Booth’s rapid response

I hope Mr Booth, a retired urological surgeon, will forgive me and will help with answers to my puzzlement.

In my youth the textbook of pathology (I think it was William Boyd’s) stated bluntly that prostates of old men will mostly show malignant cells even when they have died of other causes.

I lived with my wife’s death from breast cancer. I do not want comparisons of which cancers are better. Indeed all painful, incapacitating illnesses are horrible. No comparisons.

Now to PSA and screening.

Mr Booth wants the PSA to be used properly. Could he kindly explain HOW it should be used? How reliable is it?
Mr Booth wants universal screening.
It would be a good idea - if only you knew what to do with the results of the screening tests.
Would you inform the “patient “about the significance of the results? About the reliability of the tests?
At what level of PSA would you consider a biopsy of the prostate?
Would you, the urologist, take care of the “patient”? Would you hand him over to an oncologist?
Would you transfer him to a nurse’s care? To the GP’s care?

Hoping that Mr Booth will enlighten us. Please do not screen unless you have the means of taking care of the patient. A previously healthy person becomes a patient the moment you apply a diagnostic label.

Competing interests: Aged. Not surprising that I am coexisting with malignancy

12 July 2019
JK Anand
Retired doctor
Free spirit