Although the government does not run a national screening programme, men can request testing. But should they?

Experts’ views are mixed.

Prostate cancer, the second most common cause of death in UK men, is treatable, but the disease can be advanced before the man gets any symptoms.

The prostate specific antigen (PSA) test can help doctors decide whether prostate cancer is likely, but it is not foolproof.

Some men with prostate cancer do not have a raised PSA and some men with a raised PSA do not have prostate cancer.

For every 100 men with a raised PSA, only about a third will have any cancer cells in their prostate.

It is not yet clear if lives are saved by the test Dr Chris Hiley, the Prostate Cancer Charity Prostate test ‘of little value’

If PSA is raised, the man will need a biopsy of their prostate - a needle which extracts cells from the gland - to diagnose the problem. Biopsy can be painful and cancers can still be missed.

Even if cancer is present, a man may die with it rather than from it.

By the age of 80, about 50% of men will have prostate cancer but only 4% will ultimately die of the disease as a result.

Also, the treatments available have side-effects, including impotence, incontinence and psychological stress.

And there is no consensus as to the best treatment. A project is running for the next 10-15 years in the UK to work out whether it is best to treat men with prostate cancer with surgery or radiotherapy or simply to monitor them.

also disagree about whether interventions actually save lives.

Pros and Cons

The NHS’s screening committee advises against PSA testing for men with no symptoms who are unlikely to live for longer than 10 years.

Men can get a PSA test from their GP if they wish to after all of the pros and cons have been discussed with them.

Despite this, private health companies like BUPA routinely offer PSA testing to men over the age of 50 as part of “wellman” checks (BUPA Wellness Classic, Premier or Later Life Health Assessment).

Reasons for an increased PSA Prostate cancer A benign prostate growth (BPH) Urine infection Ejaculating in the past 48 hours Vigorous exercise such as riding a bike in the past 48 hours Prostate biopsy in the past six months A digital rectal examination in the past week

Dr Peter Mace, clinical director of BUPA Wellness, said:
“Before offering men routine screening for prostate cancer (PSA), we ensure that they are informed of the pros and cons of testing. Ninety per cent of them have the test.

“Where we find an illness, people are very grateful that it has been caught early. Where nothing is found, people are relieved.

“The majority of our health assessment clients have private medical insurance which covers the cost of follow-up tests or treatment.

“We believe that regular health screening is a valuable contributor to people’s knowledge of their own health.”

A survey by the Prostate Cancer Charity found two-thirds of 150 male GPs would not bother to have a PSA test.

Dr Chris Hiley, head of policy and research at the Prostate Cancer Charity, said: “We believe all men need to know that PSA testing is available from their GP, but that it is not yet clear if lives are saved by the test.

“Men need to be fully informed of the risks and benefits of this type of testing.”

Knowledge better than ignorance

Mr Neil O’Donoghue, consultant urologist at University College London, said it was more debatable what to do when the test is positive rather than whether to do the PSA test itself.

“Ignorance is not always bliss in relation to PSA.

“If a man asked me whether he should have a PSA test, I would say he should have it. It’s always better to have information. You don’t have to do anything about it.

“You still have to take decisions if someone has an elevated PSA. The first is ‘Are they going to go for a biopsy?’ and the second is ‘If the biopsy is positive, what sort of treatment should we offer them?’

He said the best treatment depended on many factors, such as the patient’s age and the aggressiveness of the cancer.

He thinks men with a life expectancy of less than 10 years should be offered and could benefit from screening and treatment.

If there’s one check that every man should have routinely its blood pressure Peter Baker Men’s Health Forum

Peter Baker from the Men’s Health Forum said: “We are not in a position where we can say men should have a PSA test when they have no symptoms.

“We do not have the evidence yet to say that lives would be saved. We do not know which the best treatment is and if it saves lives.

“I certainly would not advise someone to rush off and have a PSA test. Talk to your doctor.”

He said men who are at greater risk of prostate cancer - those with a family history of prostate cancer, whose father or brother had it, and men of Afro-Caribbean descent - should think about it more actively than other men.

Private health checks could be very expensive and that men should be encouraged to get simple health checks for free through the NHS, he added.

“If there’s one check that every man should have routinely its blood pressure because blood pressure produces no symptoms but it’s a killer,” he said.

One figure, Yasser al-Sirri who runs the Islamic Observation Centre in London, says he received news over the weekend regarding Mr Bigley.

Mr al-Sirri told the BBC that he sent an email appeal though an intermediary in Iraq last Thursday and then received a number of messages back over the weekend including one indicating that Mr Bigley was alive and that Mr al-Sirri’s appeal would be taken into account when determining the British hostage’s fate.

Let his release be a message to the British people to prove that Islam is a religion of forgiveness Yasser al-Sirri

On Sunday, Mr al-Sirri made on the al-Arabiyah and al-Jazeera TV stations to make further appeals.

“We asked the group in our appeals to release the hostage as a gesture of generosity, after Blair and his government let him down,” he said.

The potential significance of this lies in the content of Mr al-Sirri’s message as well as his background.

‘Political context’

His lengthy original appeal was based on detailed arguments surrounding Islamic law, quoting from the Koran.

But his message also had a political context: “let his release be a clear message from you to the British people, and a call for them to realize the impotence and criminal nature of their government,” Mr al-Sirri said.

He argues that Tony Blair has let Ken Bigley down by not securing his release and therefore by showing mercy to Mr Bigley, Mr al-Zarqawi could embarrass Mr Blair.

He also argues that Mr Bigley is merely an ordinary worker and that it would have more of powerful impact to release him.

“Show mercy to the weak. … Let his release be a message to the British people to prove that Islam is a religion of forgiveness,” read the appeal.

A similar appeal has also been made by another Islamist in London, Saudi dissident Dr Muhammad al-Masari who runs the Party for Islamic Renewal.

He told the BBC that though contact has been difficult and “haphazard”, he has been able to talk over the phone to militants in Iraq.

‘Radical links’

Of course, it is impossible to know whether the messages Mr al-Sirri received back are valid since the contact is indirect.

But he is known as a figure with extensive links and credibility amongst more radical Islamists.

His Islamic Observation Centre monitors arrests and of Islamists around the world.

Mr al-Sirri himself was sentenced to death in absentia in an Egyptian court in 1994 for his role in an assassination attempt on the Egyptian prime minister and he successfully fought off an attempt by the US to extradite him for links to terrorists.

A British judge also cleared him of conspiracy in the 2001 murder of Afghan General Ahmad Shah Masood in Afghanistan.

His background makes it more plausible that he could be able to get in contact with Zarqawi’s group and, if he did, that his appeals would have more impact, although ultimately it is hard to be sure how significant the impact of these less mainstream Islamist voices will end up being in Ken Bigley’s fate.

Dr Nic Wilson from the University of London tested samples using a new technique that accurately spots the of tablets.

She told the British Pharmaceutical Conference in Manchester how many authentic-looking tablets were fakes.

Drug giant Pfizer, which manufactures Viagra, is conducting its own investigations into the fake copies.

Dr Wilson used a technique called near infrared (NIR) microscopy which provided a detailed picture of what was in each tablet.

This technology is similar to the older method called NIR spectroscopy but gives much more information.

There is a high probability that the tablets have no clinical effect Researcher Dr Nic Wilson

Dr Wilson explained: “A counterfeit tablet may contain lactose as an ingredient in the bulk tablet, whereas the authentic tablet does not.

“NIR spectroscopy could only show that the tablet is different, while NIR microscopy could actually identify the likely presence of lactose.”

Many of the samples tested contained less of the active ingredient sildenafil than authentic Viagra.

They also contained different components from the bona fide Viagra.

Dr Wilson said: “We don’t know that ‘wrong’ components will be harmful, but the user runs the risk of poor quality and possible toxicity, not to mention the fact that there is a high probability that the tablets have no clinical effect.”

She said NIR microscopy should help regulatory monitor the movement of counterfeit tablets.

Crackdown

It is the job of the Medicines Healthcare products Regulatory Authority to investigate any reports it receives of websites under its jurisdiction which appear to be in breach of regarding advertising, or sale and supply of medicines.

In 2003, counterfeit Viagra with an estimated value in excess of 2.35m was seized.

Pfizer said it welcomed the research and was also analysing the samples.

A spokesman said: “We do not recommend that anyone obtains any prescription-only medicine online without seeing a doctor.

“Without knowing what ingredient is in a counterfeit medicine a patient could be putting their health at risk.

“It is important for men to see their doctor if they have erectile dysfunction as it may be an indicator of a more serious condition.

“Viagra may not be suitable for all men and there are also some men for whom sexual activity is not considered safe or for whom an oral treatment may not be appropriate.”

As domestic alarm rises over the potential threat posed by neighbours China and North Korea, and Washington seeks allies to help shoulder the burden of its foreign policy, Japan is coming under increasing pressure to play a more assertive role on the international stage.

Its leaders have responded by instigating a wide-sweeping review of Japan’s UN role, its constitution, and its general security policy.

But any changes are in a country which is still haunted by the atrocities it wreaked during its wartime occupation of the region.

Japan’s post-war constitution forever renounces war, and its soldiers have not fired a shot in conflict since 1945.

Japan’s WWII memories have hampered its international role

The government already went too far, in the eyes of people like Mr Kodama, when it pushed through legislation last year to allow it to send troops to Iraq.

The 550-strong contingent is only there to help rebuild the nation, not to fight. But many fear it could get drawn into conflict in what is, in reality, still a combat zone.

Yet Washington would like Japan to do more, for example by extending the military’s powers so that they can fire to defend their allies, and not just themselves.

Some lawmakers in Japan would also like a freer hand, frustrated not only by the country’s impotence on the international stage, but by its inability to adequately defend itself.

“They think Japan should stand up for itself much more…. should be an equal partner with the United States,” said Christopher Hughes at the University of Warwick.

There’s a big distinction between in UN peacekeeping resolutions and invading China again Taro Kono, ruling party lawmaker

The most obvious threat to Japan is North Korea, which demonstrated in 1998 that it had missiles which can reach Japan. It is also believed to have nuclear weapons.

But analysts say the real, unspoken, worry is China - Japan’s long-term rival for regional trade and resources.

As a result, Japan is currently undertaking a comprehensive review of its security policy. This week, a government panel recommended a series of changes, including
the relaxation of its arms sales ban, a debate on offensive missile capability, and a fuller international policing role for its armed forces.

Separately, the ruling Liberal Democratic Party is reviewing the constitution, including the pacifist Article 9, and wants to hold a referendum on possible changes in about five years’ time.

How far to go?

Japan cannot wholly reinvent itself. Severing its post-war US alliance and declaring itself completely neutral, for example, is unrealistic for a country so reliant on Washington for security and trade.

PACIFISM UNDER THREAT? Japan’s constitution renounces the use of force This has been stretched to allow troops 1992 law allowed troops to join UN and relief work overseas 2003 law said troops could go to non-combat zones in Iraq PM Koizumi wants to give Japan even greater powers

It is lobbying for a permanent seat on the UN Security Council, which would give it more say in international diplomacy. But analysts think it unlikely the current permanent members will welcome a new face, and thus the dilution of their powers.

But Japan can shape its security policy, and in doing so decide how it negotiates an identity for itself in the 21st century.

Taro Kono, an LDP lawmaker who sits on Japan’s parliamentary select committee for constitutional reform, denied that the security review under way marked the start of a creeping militarism.

Chinese football fans showed their distrust of Japan earlier this year

“There’s a big distinction between participating in UN peacekeeping resolutions and invading China again,” he said.

Ben Self, US-Japan security analyst at the Stimson Center in Washington, was equally sanguine, arguing that Tokyo was only taking tiny steps.

“I think it’s political manoeuvring to show Washington that movement is there without actually going there yet,” he said.

But Warwick University’s Christopher Hughes argued that Japan’s military role had been expanding at an accelerating rate over the last few years, suggesting Japan’s “overall trajectory” was towards building a full combat force.

It is difficult to judge how the public feel. Opinion polls by major newspapers to mark Constitution Day last month all agreed that for the first time in half a century a majority of Japanese were in favour of revising the constitution.

Akira Kawasaki from the Japanese NGO Peace Boat complained that the public was not helped by debate predicated on broad questions of national pride such as “If you don’t have any kind of military force, how can you protect your own country?”

He said the country needed to make the debate more specific and honest - for example, by Japan’s ties to the US - in order to give the public something to get its teeth into.

It is not clear how much change Japanese people can stomach. But the issue may at least force more public discussion about Japan’s wartime past, and its future role.

“Usually Japanese people don’t like discussion or expressing opinions openly, and now is a good time to have a discussion about this basic problem,” said Mr Kodama.