DEAR DR. ROACH: My sister-in-law believes that the COVID-19 vaccine will cause side effects that aren’t known yet. She won’t get the vaccine, and she has persuaded my brother not to as well. Although he doesn’t agree with her beliefs, he won’t go against her wishes. My wife and I are fully vaccinated, but I am uncomfortable allowing them to visit because my young children aren’t vaccinated. Medically speaking, am I right to keep my children away from them? — Anon.

ANSWER: With more than 250 million doses of the vaccine being given, and almost a year of follow-up, the likelihood that an unknown, serious side effect will manifest in the future is highly unlikely. Vaccine side effects normally become apparent within hours or days, seldom weeks and rarely months. Scientists are looking very critically at possible new effects, such as blood clots and inflammation of the heart. So far, these have been at so low a level that it isn’t clear that the vaccine is increasing the risk.

On the day I write this, there are still over 4,000 deaths weekly in the United States from COVID-19. The vaccine has low risk and very high benefit. In the same last week, over 280,000 new cases were reported. Since the vast majority of these are in unvaccinated people (over 99% in recent studies), the risk for your brother and sister-in-law of getting a new COVID-19 infection is still significant. I don’t know how careful they are about wearing masks and avoiding crowds; some, but not all, people who refuse vaccines also refuse masks. Consequently, staying away from potentially infectious people, such as your unvaccinated family, remains important. While most young children are at lower risk for severe complications should they get COVID-19, there are risks to younger children, including death. I would recommend minimizing close contact between your children and the unvaccinated until your children can be vaccinated (studies are ongoing on vaccinating younger children) or until the prevalence of COVID-19 in your community is low. Unfortunately, between new, more contagious variants and slowing uptake of vaccines, it may be a very long time before community prevalence is low.

DEAR DR. ROACH: My PSA (prostate-specific antigen) levels have been rising with every doctor’s visit. I chose to wait and see. On my most recent visit, the urologist recommended I have a biopsy. My concern is that if it is cancer, it could spread faster by having a biopsy. The urologist doesn’t think so. What are the facts? — E.J.K.

ANSWER: Many people have worried that getting a prostate biopsy could spread cancer. Although it is possible, it is extremely rare, with barely a handful of case reports, despite approximately 1 million prostate biopsies done yearly. With no other reliable way to make the diagnosis of prostate cancer, a biopsy is essential to get the information necessary to decide whether you need treatment or not. The tiny risk of cancer spreading should not keep you from getting essential information to determine whether you need potentially life-saving treatment.

There are some types of cancers where a biopsy has a higher risk of causing spread. In those cases, surgeons usually recommend going straight to definitive surgical removal. Prostate cancer is not one where spread is likely from biopsy.

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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.

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