Prostate Cancer Archive

Articles

Ask the doctor: Concern about a now "normal" PSA

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.

Some prostate cancer treatments increase heart attack risk

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.

Vasectomy and prostate cancer


Image: iStock

Ask the Doctor

Q. I had a vasectomy many years ago, at age 45. I recently read that this increases my risk of prostate cancer. Should I be concerned?

A. Despite the reports you've heard about the connection between vasectomy and prostate cancer, the evidence is weak for a cause-and-effect relationship. Right now, this hypothetical risk should not cause you undue concern.

Ask the doctor: Saw palmetto and prostate health

Q. Some of my friends take saw palmetto supplements to reduce urinary problems caused by an overgrown prostate, which I was recently diagnosed with. My friends swear by it, but is there any good evidence this stuff helps? Is saw palmetto safe?

A. The short answer is that we don't have great scientific evidence that taking saw palmetto truly reduces male urinary problems. On the other hand, it doesn't appear to cause major side effects either.

Prostate cancer: Treat or wait?

Choosing active surveillance for prostate cancer depends on carefully weighing medical as well as personal factors.

Image: Thinkstock

An approach called active surveillance allows some men with low-risk cancer to delay the decision to treat.

Biomarkers for better prostate cancer screening

Biomarkers are "chemicals" that can indicate both normal and abnormal processes in the body. One of the most famous is prostate-specific antigen (PSA). The PSA test, which detects abnormally high blood levels of PSA, has been used for decades to screen for prostate cancer and potentially catch it early.

There are two problems with the PSA test. First, PSA levels can tell you that something is going on with the prostate — but that "something" isn't necessarily cancer. High levels may mean other benign prostate conditions. Second, when high PSA levels do turn out to be the result of prostate cancer, the PSA level alone won't tell you which cancers are aggressive and need treatment, and which are slow-growing and can be managed more conservatively.

Ask the doctor: Prostate surgery and ED

Q. I am scheduled to have my prostate removed and am concerned about the risk of erectile dysfunction (ED) after the surgery. I've heard that taking an ED drug daily during my recovery could help. Do you recommend this?

 

 

A. About half of men lose some erectile function after radical prostatectomy, which removes the entire prostate gland. ED drugs help men to have erections after surgery, but so far research has not shown that taking it daily produces better results than taking the medication as-needed—when you anticipate sexual activity.

How to make your prostate biopsy go better-before, during, and after

 

 

 

 

 

 

Before a prostate biopsy, discuss all the
steps you or your doctor can take to make
the experience as comfortable, safe, and
informative as possible.

Image: Wavebreakmedia Ltd/Getty Images

Here is what men need to know to minimize discomfort of a prostate biopsy and get the best results.

Prostate cancer: What's your risk?

Images: Thinkstock

Prostate cancer risk statistics can be misleading. Although 15% of American men will be diagnosed in their lifetimes with prostate cancer, 3% of all men will actually die because of the disease.

Age, family history, and race are the main influences.

Ask the doctor: Prostate cancer and multivitamins

Q. In the May 2014 issue, you reported on findings from the Selenium and Vitamin E Cancer Prevention Trial (SELECT), which said that taking vitamin E and selenium raises the risk of prostate cancer. My multivitamin contains both of these nutrients. Should I worry?

A. Based on what we know right now, there is no reason to think that a multivitamin would raise your risk of prostate cancer. Standard multivitamins contain less vitamin E and selenium than men took in SELECT. Also, multivitamins have not been linked to an increased risk of prostate cancer. For example, in a study of over 14,000 male physicians, taking a multivitamin (compared to placebo) did not affect the risk of individual cancers, although it reported a very modest reduction in total combined cancers over 11 years. This effect has not been reproduced in other studies.

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