DEAR DR. DONOHUE: My PSA count went from 4.1 to 9.4. I have an appointment with a urologist. What kind of tests will be done? In your opinion, do I have prostate cancer? What would the treatment be? – Worried

ANSWER: Prostate cancer is not the sole cause for a rise in PSA. Noncancerous prostate enlargement increases it, as does an infection of the gland. The infection can be so mild that it produces no symptoms. However, cancer is the issue that has to be resolved. PSA readings between 4.1 and 10 carry a 25 percent probability of being cancer.

Don’t let that panic you. Fifty percent of men 80 and older harbor cancer in their prostate glands, and many of them will never have a symptom from it, nor will it shorten their lives.

The next test will be a biopsy of the gland. The urologist will use an instrument that takes many biopsy samples simultaneously, with only minor discomfort.

If the biopsy shows cancer, then you have lots of choices. The choices are based on a man’s age, his general health, whether the cancer has spread out of the gland and its aggressiveness. The pathologist who reviews the biopsy puts a number on the cancer, called the Gleason score, which tells how aggressive – how fast the cancer grows and how likely it is to spread – the cancer is.

If the cancer is confined to the gland, if the PSA is less than 10 and if the Gleason score is 6 or less, choices include removal of the gland, insertion of radioactive pellets into it, external radiation from a machine or watchful waiting. Watchful waiting – not doing anything – is a reasonable choice for an older man with a less threatening cancer and whose life expectancy is less than 10 years. No one likes to think about how many more years he has, but such a consideration is mandatory when choosing prostate cancer treatment.

The prostate pamphlet spells out details of this gland’s problems, both cancerous and noncancerous. 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 $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am a female over 90. A recent DEXA showed I have osteoporosis. Who doesn’t at this age? My doctor prescribed Fosamax, which I refused. Now I have information on Actonel. How does this compare with other HRTs (hormone replacement therapies)? – C.B.

ANSWER: A DEXA (dual energy X-ray absorptiometry) test is one of the best tests for detecting osteoporosis. Regardless of the person’s age at discovery, osteoporosis carries with it a grave danger for broken bones, so pulling out all the stops to check or reverse it is worth the effort.

Actonel is a member of a medicine family called bisphosphonates. So is Fosamax. Neither is a female hormone. They strengthen bones by inhibiting daily bone dissolution. Bones undergo constant remodeling. The bones we have today are not the same bones we had yesterday. They are being dissolved and restored 24/7. With age, bone breakdown outstrips bone restoration, with osteoporosis being one of the results.

Actonel puts the breaks on the bone resorption process. It makes bones denser and lessens the chances of having to deal with a broken bone.

Actonel is available in two doses: a low dose that is taken daily, and a high dose that is taken once a week.

If a doctor told me that I had osteoporosis and I was 110, I would jump at the chance of taking a medicine that could modify that process.

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.

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