Do I have to give up tea for my prostate?

Fifteen years ago I underwent an operation for an enlarged prostate; since then it has grown again and my doctor has put me on medication — tamsulosin.

I’m 82 and my father died of prostate cancer. My doctor says not to worry, but do you think I should have regular check-ups?

I was also told not to have tea, coffee or chocolate. Could you tell me why? I have always been a big tea drinker and find it hard not to have the odd cup.

D. Redmond, Telford, Shropshire.

Drink but don't go mad: Tea and coffee can act as a diuretic

This is an unfortunate position in which you find yourself: unable to enjoy a cup of tea, worried that you may develop prostate cancer like your father, and no clear route forwards to settle your mind.
The condition from which you have suffered, and for which you underwent surgery, is benign prostatic hypertrophy.
This is a common complaint as men age; the prostate gland gradually enlarges throughout life, in much the same way as you lose the hair on your head, and for similar reasons — something to do with responses to male hormones.
The gland sits beneath the bladder and is wrapped around the urethra, the tube that is the exit pipe from the bladder. As the gland increases in size, it inevitably narrows this pipe as well as distorting the shape of the base of the bladder, all of which has at least some effect on urinary function.
The severity of symptoms varies from man to man, with many experiencing very few. However, if they do arise they are usually increased frequency of urination, getting up to go several times a night, poor stream, or the symptom of urgency — if you’ve got to go, you’ve got to go.
No doubt the operation you had was a transurethral resection, in which excess prostate tissue is removed by a keyhole technique to open up a good channel for flow. However, as you have experienced, the prostate can re-grow.
The most important point I can make is that benign prostatic hypertrophy is not a risk factor for prostate cancer.
Your condition occurs mainly in the central zone of the prostate gland, whereas cancers tend to arise in the outer part.
Your doctor has chosen tamsulosin as treatment, one of a group of medicines that work by relaxing smooth muscle in the prostate, which eases some of the symptoms.
The important side-effect of tamsulosin is a lowering of blood pressure — the walls of arteries are made of similar ‘smooth’ muscle — and this can cause faintness when you stand up suddenly.
See your doctor once a year and request the examination of your prostate.
There is an emerging view that senior gentlemen such as yourself are being screened too frequently and, as yet, that there is little or no evidence of benefit from having check-ups more than once a year — though I accept it is hard to take that caution on board with your father’s history.
And so to the issue of your beloved cuppa. The reason you have been advised to stop having tea and coffee goes hand in hand with advice to avoid drinking anything near to bedtime.
The drinks act as mild diuretics and can make the symptoms slightly worse.
However, I urge you to conduct an experiment. For a week or two have a couple of cups of tea each day, and compare this with a couple of weeks where you had none at all. You may find that it makes little or no difference, in which case, enjoy your tea!

After consuming some margarita cocktails on holiday a few years ago my mouth swelled up on the left hand side, making it hard to talk.

Once I got home, every time I ate or drank anything with lemon, lime or orange ingredients the same thing would happen. Since then this has gathered legs — I react to wine vinegar, balsamic vinegar, pineapples and kiwis — and the list is growing.

Can you help or recommend anything for this condition?

Susan Weaver, by email
This sounds to me like oral allergy syndrome. In this condition fruits containing pips — such as oranges, lemons, apples and many others — will rapidly cause itching, burning and swelling around the lips, mouth and throat.
Those who have the allergy are also allergic to some pollens — especially birch — and also to some nuts.
All of these contain protein molecules that trigger the misplaced immune response we call an allergic reaction. If the fruit that causes your symptoms is cooked, the protein is inactivated and can no longer trigger the process — you may already have noticed this.

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Always consult your own GP with any health worries.

Although we don’t know why adults suddenly develop allergies, there do seem to be certain times in our life when they are most likely to strike, with one being the menopause.
Oral allergy syndrome is not a medically worrying problem unless the swelling of the tongue or throat is to such an extent that it affects breathing.
Fortunately, this is rare, but if there is a suspicion of this allergy,  detailed investigation by an allergy specialist is essential.
The problem is that, in the NHS, these people are thin on the ground — and you must be cautious about those who work in the alternative health sector, as it is difficult to judge qualifications and expertise. Indeed, there is more anecdote-based nonsense and pseudo-science talked about allergy than almost any other subject in medicine.
Avoidance of foods you have found to be troublesome is a must. If you do eat something that causes a reaction, then wash your mouth out with water and, if available, take an antihistamine like Piriton (chlorpheniramine) to ease the symptoms.
Unfortunately, there is no cure, as therapies that desensitise the mouth to allergic reactions  — as used for allergies such as hay-fever, where tiny amounts of allergens are injected into the body — are not yet available. This means the current strategy is to learn which foods are likely to cause the problem and avoid them.
And so I’m afraid margaritas may truly be a thing of the past in your case; perhaps try switching to champagne cocktails (in moderation, of course).

By the way... Keep taking aspirin, it's a life-saver

Don't give up on it: Aspirin can help heart disease sufferers

Aspirin is never out of the news — just weeks ago I was reflecting on the subject of aspirin having been shown to prevent several common types of cancer when taken in small daily doses over long periods of time.
Now, a new study gives us different but equally important information: heart disease patients who stop taking the aspirin they have been prescribed are at a 60  per  cent risk of a further heart attack.
Patients who are known to have coronary heart disease, and have fatty cholesterol deposits clogging the arteries that supply their heart with oxygen and fuel, are always prescribed aspirin long term. This mini marvel makes the blood less sticky, meaning it is far less likely to clot in the arteries and kill.
The reasons that people stop taking the aspirin are multiple, but it is widely thought they neither realise how important it is, nor the penalties for stopping it. Aspirin seems to be doing nothing — it is so cheap, available and low-tech that it just doesn’t seem important.
So why do patients not follow medical advice correctly? Medics call this particular conundrum ‘patient compliance’.
What research shows is that a positive relationship between the doctor and the patient is the most important factor in improving compliance. When time is taken over discussions during consultations, patients are more likely to learn what is important and stick to advice.
And what is missing these days? Continuity and time: the consequences of ever greater pressure, the need for doctors to do more, see more patients, be ever more ‘efficient’.
Of course, some people stop the aspirin because of side-effects, such as heartburn or even bleeding in the intestine. But then there are strategies to help that — and aspirin is so important it is best not to throw out the baby with the bath water.
The bottom line is that doctors need to be good teachers, friends even, spending time taking care of patients. Then aspirin does not get abandoned, and lives are saved.