DEAR DR. DONOHUE: Of interest to all men are PSA numbers. I am 90, and my number went from 4.6 to 5.1 in three months. My doctor insists I see a urologist. I have no symptoms of prostate trouble, and this really has me upset. I am at a breaking point. — H.L.

ANSWER: PSA, prostate specific antigen, is a blood test for the detection of prostate cancer. Experts argue about what value to choose to indicate a positive test result — that is, at what level the test truly indicates cancer. Many set four as that number. However, lower numbers are more meaningful at younger ages and higher numbers at older ages. In fact, many would stop testing for PSA in a man who’s 90 years old.

Let me give you some more numbers and information that will only add to your grief.

If the PSA test increases by 0.75 in one year, that’s a significant increase that would trigger some doctors to ask for more testing. If the original PSA was 4, then an increase of 0.35 in one year would do the same.

All of this testing is contested at the present moment. You are 90. Many feel that this age is too old to demand that a man submit to more testing, like a biopsy. Others feel that if a man of 90 is in good health, that man should be offered further investigation.

If I were in your shoes, I wouldn’t hesitate to hear what a urologist had to say. I might, however, decline to seek more testing and the prospects of an operation. In truth, since I am not that age, I’m not positive how I would react.

The booklet on prostate cancer and prostate enlargement gives further information on these conditions. Readers can obtain 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. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have a lot of problems with sinus infections. I had sinus surgery about 10 years ago. At that time, my ENT doctor said I had pockets of infection in the sinus cavities. He performed surgery to clean the pockets. For a few years I had fewer infections, but they are a problem again. The only antibiotic that clears the infection is Avelox. The most recent infection does not seem to be responding to Avelox. Can you offer any advice? — Anon.

ANSWER: It’s time to again consult an ENT — ear, nose and throat doctor. Such a doctor has a scope that allows inspection of the sinuses for detection of chronic infection. It also allows the doctor to sample tissue for culture so the infecting germ can be identified and tested for antibiotic susceptibility. That way, the doctor will know what to prescribe. And if the lab is alerted, it can test for the germ’s susceptibility to Avelox.

That’s the best advice I can come up with.

DEAR DR. DONOHUE: Some medicines, like the calcium-channel blocker nifedipine, bear a warning to avoid eating grapefruit while taking them. However, they never give an explanation why. Will you? — E.N.

ANSWER: Grapefruit interferes with some medicine by blocking body enzymes that degrade those medicines. That, in turn, leads to higher blood levels of those medicines. It also could lead to toxic effects of those drugs when their blood levels rise too high.

The effect lasts for 24 hours, so you cannot overcome it by eating grapefruit in the morning and taking the medicine at night. This applies to grapefruit juice as well as grapefruit.

I have to believe that warnings of such interactions are included in the information that comes with all prescription drugs.

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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