Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: My husband is 89 and taking amiodarone. He had a heart attack and is taking iron infusions for anemia. He was diagnosed with prostate cancer. His PSA level is over 300 ng/mL, but his bone enzyme level was normal.
What do you think about him getting the Lupron shot? His kidneys were failing, but they are now functioning at 50%. — Anon.
ANSWER: A PSA level over 300 ng/mL suggests advanced prostate cancer, but I expect him to be recommended for a CT scan to see how extensive the disease is, as well as a biopsy to confirm the diagnosis. Just because his bone enzymes aren’t high doesn’t guarantee he doesn’t have prostate cancer that has spread to the bones.
Most of the time, in a man with a PSA level that high and biopsy-proven prostate cancer, X-rays and bone scans are done to determine the severity of the involvement of the bones, which can be common with advanced prostate cancer.
I am also worried about the possibility that he has locally advanced disease, meaning that there might be a large amount of the tumor in his pelvis. If the prostate cancer is large, it can block drainage of urine, leading to kidney failure. I’m very concerned that it might be the cause for his kidney failure, whose function can be completely or partially restored by a procedure such as a drainage tube. This allows urine to flow without pressure.
If he indeed has advanced prostate cancer, treatment with a medication like leuprolide (Lupron), which blocks production of testosterone, is a very standard treatment that can improve both his length and quality of life. Most people with medical conditions such as heart disease tolerate this therapy well. However, there is a lot more that you and your husband need to be sure of before being able to make an informed decision.
DEAR DR. ROACH: It seems as if the number of recommended vaccines increases every year, especially for us in the “over 65” crowd. It’s hard to imagine how the immune system can keep up!
Is it possible to receive too many vaccines, or at least too many within a given time-frame? Thanks. — M.T.
ANSWER: Don’t underestimate the work that your immune system does for you every day. You are always exposed to millions of antigens, which are specific parts of foreign material such as bacteria, virus, food, dust and pollen. We get exposed to tens of thousands of new antigens daily. Our immune systems work to fight off potential invaders and almost flawlessly ignores what it recognizes to be parts of ourselves.
Because vaccines only use a tiny part of the relevant bacteria or virus, the antigens that your body learns to respond to are just a tiny fraction of what it normally “sees” in a day. A typical modern vaccine contains 1-69 antigens, compared to vaccines from the 1940s that contained thousands of antigens.
I have had patients get as many as 30 vaccines in a single day (when they were in the military) without any problems.
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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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