The pros and cons of the PSA prostate cancer test


DEAR DR. DONOHUE: I am 82. At this late stage, I am now being told that a PSA test (that I’ve always had and always passed well within limits) is no longer recommended.

What is a guy to do? Early detection has always been encouraged, so how am I to know if I will need treatment? — F.O.

ANSWER: The value of the PSA (prostate specific antigen) for the detection of prostate cancer has aroused a great deal of discussion and debate. Your premise about the early detection of cancer is true for most cancers. It isn’t always true for all the forms of prostate cancer.

PSA isn’t a perfect test. It can yield normal results when a man has prostate cancer. It can yield abnormal results when a man’s cancer requires no treatment or when no cancer is present. A high proportion of older men — perhaps as many as 90 percent of men in their 80s — have areas of prostate cancer in their gland. Quite frequently, that cancer is the kind that grows slowly and doesn’t lead to death. However, a high PSA almost always is followed by a prostate biopsy and often a form of treatment — surgery or radiation. The complications of treatment can be worse than having a low-grade prostate cancer. Loss of bladder control, erectile dysfunction and radiation burns are some of those complications.

Your doctor has advised against continued testing for the above reasons. Screening benefits younger men and men at great risk of developing prostate cancer. Black men are more likely to have it than are white men.

Some authorities feel that only men with a life expectancy of 10 or more years ought to have regular PSA tests. All medical professionals encourage men to discuss the pros and cons of PSA testing with their doctor. If you feel anxious about not having the test, you can request that one be done.

The booklet on the prostate gland discusses prostate cancer and prostate enlargement in depth. To obtain a copy, write: Dr. Donohue — No. 1001, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Allow four weeks for delivery.

DEAR DR. DONOHUE: Can a person get glasses if he has AIDS? How does it affect the eyes? — T.Y.

ANSWER: People with AIDS can get glasses.

In the days before effective AIDS treatment, a small number of patients experienced damage to the smallest blood vessels that feed the eye’s retina. In those days, eye infections from germs difficult to treat were common. These complications are seldom seen these days.

DEAR DR. DONOHUE: Will you please remind everyone of the importance of covering one’s mouth and nose during a sneeze and a cough? Most people do not bother to do so, and they spread their germs.

An uncovered sneeze or cough disseminates droplets containing germs in the air. I remind co-workers to cover their coughs and sneezes. Most of them roll their eyes or have a smart comeback.

Hand-washing is also important after blowing the nose, coughing or sneezing. We all would be much healthier if everyone practiced good hygiene. — P.H.

ANSWER: I’m with you, P.H.

If people don’t have a tissue or handkerchief to cover their sneezes and coughs, they should cough or sneeze into their elbows. Better the germs stay on their clothes than in the air. President Barack Obama gave a great demonstration of this during the past flu season.

Frequent hand-washing is important for coughers, sneezers and those who aren’t doing either.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from