Prostate cancer treat or not treat?
DEAR DR. DONOHUE: On one hand, I have been told that many men die with prostate cancer but few die of prostate cancer. On the other, statistics are announced stating that prostate cancer is in the top five causes of death in men! Hello? My doctor has not ordered a PSA test for me in a number of years. I don’t push the issue because I don’t want to appear to be a hypochondriac, but I don’t feel sufficiently informed. I would appreciate your comments. I am 82. — F.O.
ANSWER: Cancers — all the varieties — are the second leading cause of death in men and women. Prostate cancer comes in second place for cancer-caused male deaths. Around 28,000 men die from it every year in the U.S.
PSA, prostate specific antigen, is a blood test used for detection of prostate cancer. The problem with PSA is that it is sometimes high for reasons other than cancer, and it doesn’t indicate the cancer’s aggressiveness. Most prostate cancer isn’t lethal. Why, then, do so many men die from it? For one, many men have it. Almost all men in their 80s have patches of prostate cancer in their gland, and many men in their 70s have it. A large percentage of these men will live out their full life span without ever having a single prostate cancer symptom. If a man could be assured that his prostate cancer would not be lethal, that man most likely would choose not to treat it. Treatment can come at a price. It can lead to erectile dysfunction, urine leakage and the complications of radiation, such as damage to the rectum. For these and other reasons, the United States Preventive Task Force — an expert panel that gives guidance on which tests to have and which illnesses to treat — recommends that men 75 years and older or men with a life expectancy of less than 10 years not be tested with PSA.
Not everyone agrees with these guidelines. Testing for prostate cancer at older ages is something best left to a well-informed patient and his doctor.
The booklet on the prostate gland explains this common cancer and its treatment. Readers can order a copy by writing: 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: I am a 60-year-old man in good health. I work out five days a week, one hour each session, with a mix of weight training and cardio. A recent blood test showed my creatine kinase to be high. My doctor asked if I have any muscle pain. I do not. He had me stop my statin drug for two weeks and repeat the test. The results were about the same. Should I be concerned? Could it be caused by my exercise? — L.K.
ANSWER: Creatine kinase, CK, is an enzyme found in muscle. Elevated blood levels can indicate muscle damage. Muscle illnesses called myopathies, a sluggish thyroid gland and underactive parathyroid glands can cause a rise in CK. Large, muscular people have higher-than-normal levels. Exercise definitely can elevate the reading.
Stop exercising for a week or two, and have the CK rechecked. If it doesn’t drop, then exercise is not the cause. I’m sure your doctor has considered other causes and found none. Pursuing a slightly elevated CK — and your elevation is only slight — in a person with no symptoms is usually a waste of time and money. Keeping an eye on such a person is about all that is necessary in most instances.
DEAR DR. DONOHUE: I am 74 and had a five-way bypass with replacement of the aortic valve in 2003. Lately, after eight or nine hours of sleep, I wake feeling I haven’t had any sleep. I mentioned this to my doctors, and they just shrug their shoulders. That’s hardly an answer, is it? — W.M.
ANSWER: Fatigue is one of the leading complaints that bring people to doctors. For someone like you, the most important organ to examine is your heart, to see if all is well there. Fatigue can be a sign of poor heart pumping. If the heart is OK, then things like the thyroid gland, anemia, hidden infections, adrenal gland malfunction and depression have to be considered. A shoulder shrug isn’t an answer. Don’t let your doctors off the hook. Demand an answer.
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 www.rbmamall.com.

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