Yesterday’s announcement that men should not get routine PSA tests to check for hidden prostate cancer is sure to spark controversy for months to come. But the U.S. Preventive Services Task Force (USPSTF) made the right decision. On the surface, rejecting the use of a simple blood test that can detect cancer in its early and still-treatable stage sounds foolish. Cynics have been saying it is the handiwork of a group concerned more about health-care rationing and cutting costs than about health. The decision is wise, not foolish, and will improve men’s health, not harm it. The word “cancer” usually brings to mind images of a fast-growing cluster of cells that, without aggressive treatment, will invade other parts of the body, damage health, and potentially kill. That certainly describes many cancers. But not most prostate cancers. Most of the time, prostate cancer is sloth-like. It tends to grow slowly and remain confined to the prostate gland, with many men never knowing during their entire lives that a cancer was present. These slow-growing prostate cancers cause no symptoms and never threaten health or longevity. That means many men with prostate “cancer” never need treatment.
A simple blood test to check seemingly healthy men for hidden prostate cancer does more harm than good and shouldn’t be part of routine medical care. That’s the long-awaited final recommendation from the United States Preventive Services Task Force (USPSTF), published today in Annals of Internal Medicine. About half of men over age 40 get this test as part of a regular checkup. It measures the amount of a protein called prostate-specific antigen, or PSA, in the bloodstream. An above-normal PSA level can signal hidden prostate cancer. But it can also be a sign of prostate infection, an enlarged prostate, and other problems. Hunting for hidden disease in the absence of any outward signs or symptoms is called screening. The task force says that for every 1,000 men who have routine PSA tests, 0 to 1 deaths from prostate cancer will be prevented. But that is offset by 3 serious cardiovascular deaths due to treatment, along with 47 men who will live with treatment-related erectile dysfunction or incontinence.
A large study from Europe does little to resolve the controversy over whether men should have a simple blood test to look for hidden prostate cancer. In the study, the number of deaths over the course of the 11-year study were the same in men tested for prostate-specific antigen (PSA) and in men who didn’t have the test. Because prostate cancer usually grows very slowly, detecting it in an older man generally isn’t helpful. Some men live with the side effects of treatment—notably impotence and incontinence—for a cancer that would have had no effect on the length or quality of their lives. This study and others suggest that we rethink the widespread use of PSA testing, especially the yearly screening that is common in the United States.
Many prostate cancers grow very slowly and never escape the prostate. They cause no symptoms, and never threaten health or life. Yet almost 90% of men told they have prostate cancer opt for immediate treatment with surgery or radiation therapy—which often cause trouble getting or keeping an erection and an assortment of urinary problems. Yesterday, a panel of experts convened by the National Institutes of Health recommended that many men with localized, low-risk prostate cancer be closely monitored, and that treatment be delayed until there was evidence that the disease was progressing.
At least for men, being more fit may have a bigger health payoff than losing weight, according to a new study of more than 14,000 well-off middle-aged men who are participating in the Aerobics Center Longitudinal Study. Researchers followed their health, weight, and exercise habits for 11 years. Compared with men whose fitness declined over the course of the study, those who maintained their fitness levels reduced their odds of dying from cardiovascular disease or any other cause by about 30%, even if they didn’t lose any excess weight. Those who improved their fitness levels saw a 40% reduction. For optimal health, being fit and maintaining a healthy weight are best. But if you are overweight and inactive, this study and others suggest that getting more activity is the best place to start to improve your health.
As many as 32 million American women and men have some degree of incontinence—the unintended loss of urine or feces that is significant enough to make it difficult to do ordinary activities without frequent trips to the restroom. The most common causes of incontinence are childbirth and aging in women; prostate disorders and their treatment in men. Treatments include exercises to strengthen the pelvic floor, fluid management, medications, and surgery. For people with urinary incontinence, fluid management is an easy place to start, explains Better Bladder and Bowel Control, a new Special Health Report from Harvard Medical School. This involves drinking only when you are thirsty, limiting your fluid intake from all sources to six to eight 8-ounce cups of fluid per day from all sources, and minimizing caffeinated and carbonated drinks, as well as alcohol.
For many men, trouble getting or keeping an erection, formally known as erectile dysfunction, is often an early warning sign of heart disease or other circulatory problems. Atherosclerosis, the same disease process that clogs coronary arteries with cholesterol-filled plaque, does the same thing to the arteries that supply blood to the penis. Since an erection depends on extra blood flow to the penis, any obstructions can prevent an erection from occurring. According to Erectile Dysfunction, a Special Health Report from Harvard Medical School, blood vessel problems are the leading cause of erectile dysfunction and serve as an early warning sign of trouble in the heart or elsewhere in the circulatory system. Simple lifestyle changes like losing weight, exercising more, or stopping smoking can improve erections, as can Viagra and other erectile dysfunction drugs, devices, and sex therapy.
Alzheimer’s disease is a “disease of behaviors” that can wear down family and loved ones. In a talk called “Dementia and Cognitive Decline (Aging Gracefully)” Barbara Moscowitz, coordinator of geriatric social work for the Geriatric Medicine Unit at Harvard-affiliated Massachusetts General Hospital, offered helpful insights and tips into caring for people with Alzheimer’s disease. Moscowitz drew not only her 30 years of professional experience, but also on the personal experience of helping take care of her mother, who suffered from dementia the last several years of her life.
It isn’t easy to get rid of a harmful habit like drinking too much, or to make healthy changes like losing weight and exercising more. Media stories often sugar-coat changes like these, making them seem easier than they really are. In a moving essay in the American Journal of Health Promotion, Michael P. O’Donnell (the journal’s editor) describes his dad’s efforts to become healthier for his sake and the sake of his family. There was no monumental struggle, no epiphany—just a regular guy doing his best each day to become healthier for his sake and for his family. It’s a truly inspiring story.
Potato chips and potatoes (baked, boiled, and fried) were the foods most responsible for weight gained gradually over four-year periods among 120,000 healthy women and men in long-term studies. Other key contributors included sugar-sweetened beverages and red and processed meats. On the flip side, yogurt, nuts, whole grains, and fruits and vegetables were linked to weight loss or maintenance. Potatoes may be a “perfect food” for lean people who exercise a lot or who do regular manual labor. But for the rest of us, it might be safer for the waistline to view potatoes as a starch—and a fattening one at that—not as a vegetable.