Results of PSA screenings lead to two different approaches
Dr. Keith Roach
DEAR DR. ROACH: I am 79. Two recent tests confirmed that my PSA level was 4.6 ng/mL. Previously, my results were never higher than 1.4 ng/mL. Flomax has been a necessity for me for the past 20 years, and my original diagnosis of benign prostatic hypertrophy (BPH) was 30 years ago, at age 49.
Out of my three longtime friends, all have BPH. Two of them also had cancer, and they both had prostatectomies. One had a good result, while the other has had incontinence ever since. Does every male over 70 suffer from BPH?
My former urologist told me to get an MRI-guided biopsy as soon as possible, so I am on a waiting list for that. My current urologist says that due to my age and the just-out-of-range result, I should not be overly concerned. That urologist suggested I see whether the readings go higher and perhaps get the biopsy if the result is 8 ng/mL or higher. I’d like to live to be 100. How would you advise me? — B.W.
ANSWER: To answer your first question, over 80% of men over 70 have BPH. Although BPH isn’t cancer, and men with BPH aren’t at a higher risk for cancer, prostate cancer is also very common in older men. Probably over 50% of men over 70 have prostate cancer, although many of these cases are so small and slow-growing that they might never be noticed without screening.
Both of your urologists are suggesting reasonable approaches. Your PSA level is not very high, but has increased by more than 200%. Many 79-year-old men would be happy with the wait-and-see approach, but an aggressive approach is also entirely reasonable. If your goal really is to live to 100, then an MRI-guided biopsy (if appropriate based on the result of the scan) is likely to help you achieve that.
Not all cancers that are found need to be treated. Many prostate cancers found by a PSA screening test can be followed by a blood test and imaging studies if the biopsy shows the more common, less-aggressive cancer.
DEAR DR. ROACH: I would like your opinion on the safest medication for osteoarthritis. I have tried Tylenol, but it doesn’t seem to help. NSAIDs have different side effects, so are there any other solutions? — J.D.
ANSWER: The safest treatment for osteoarthritis, the most common form of arthritis in adults, isn’t medication at all — it’s exercise. Regular movement of the affected joints reduces pain and improves function.
Large joints, like the hip and knee, respond very well to walking, with the person gradually building up the distance they can reach. Smaller joints, like the hands, respond to movement against resistance, like a hand grip device or even a tennis ball.
Most people who need medication do well with anti-inflammatory medicines, such as ibuprofen. Although these do have many side effects, most people who take low to moderate doses with food do well with these medications. However, some people may need to try several different ones before finding one that works well and doesn’t cause any problems.
Supplements like glucosamine and chondroitin, curcumin, and others provide benefit for some people and are generally well-tolerated. It’s still not clear whether they are better than a placebo, but I have had patients who have significant symptom improvement while taking them.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.