Men's Health Archive

Ask the doctor

Q: I am 68 years old, and recently my PSA level (which was normal before) increased to 5.2 nanograms per milliliter (ng/ml). My doctor repeated the test one month later, and it was normal again at 3.3 ng/ml. Should I still be concerned?

A: One of the reasons that routine PSA testing is so controversial is the inability of the test to distinguish men with prostate cancer from those without it. A common cutoff is 4 ng/ml, but this is hardly a black-and-white answer. In fact, 30% of men with a PSA result between 4 and 10 have cancer. (The remaining 70% have benign causes, like an enlarged prostate.) In men with a "normal" PSA in the 2-to-4 range, 20% have cancer. So the risk is still present.

Fostering strong social connections does not come easy for many men, but it is one of the best means to a longer and healthier life.

Social connections are as important to your health as proper diet and exercise. Research has linked social bonding to longer lives, lower incidence of depression and anxiety, and reduced risk of disease.

"Our brains and bodies function best when we are part of a community and maintain close, personal connections," says Dr. William S. Pollack, assistant clinical professor in the Department of Psychiatry at Harvard Medical School.

The annual check-up is important for older men. Here is how to make the most out of your visit.

Men have a long reputation for avoiding check-ups, and that resistance tends not to soften when they are older.

"Many older men put off exams because they fear finding out something is wrong," says Dr. Suzanne Salamon, a geriatrician with Harvard-affiliated Beth Israel Deaconess Medical Center. "Also, many of today's baby boomers don't think they will have medical problems associated with age, so it can difficult for the 'younger older men,' like those in their 60s and early 70s, to see their doctor."

Declining muscle mass is part of aging, but that does not mean you are helpless to stop it.

The saying goes there are two certainties in life: death and taxes. But men should also add loss of muscle mass to the list.

Age-related muscle loss, called sarcopenia, is a natural part of aging. After age 30, you begin to lose as much as 3% to 5% per decade. Most men will lose about 30% of their muscle mass during their lifetimes.

In the journals

If you have suffered a heart attack and plan to undergo prostate cancer treatment, you may want to weigh the risks and benefits of androgen deprivation therapy (ADT). ADT decreases the amount of androgens in the body, which prostate cancer needs to grow and survive. It is also often used along with radiation therapy, and the combination has been shown to prolong survival in men with unfavorable-risk prostate cancer—defined as cancer with two or more high-risk factors, like a PSA level between 10 and 40 ng/mL, a Gleason score of 7 or higher, or biopsies with 50% or higher cancerous cells.

But a study in The Journal of the American Medical Association suggests that men who had a prior heart attack can increase their risk of a fatal one if they undergo both radiation therapy and ADT. Researchers compared overall survival and death from prostate cancer, fatal heart attack, and other causes in a group of 206 men with unfavorable-risk prostate cancer. The men received either radiation alone, or radiation and six months of ADT. The researchers also categorized the men into subgroups based on other health conditions, including heart disease.

In the Journals

Alpha blockers, a type of medication that many men take for urinary difficulties caused by an overgrown prostate, are associated with a dangerous but very small risk of falling, according to a recent study in BMJ. This should reassure men who have heard that the drugs could cause dizziness from a sudden drop in blood pressure.

The Canadian study identified more than 147,000 men in Ontario prescribed one of three drugs: alfuzosin (Uroxatral), silodosin (Rapaflo), and tamsulosin (Flomax). Most of the men (84%) took Flomax, although all three drugs work the same way.