DEAR DR. ROACH: I had a biopsy performed, and a number of other samples confirmed prostate most cancers. A PET scan confirmed no different most cancers. My physician is uneasy about removing or therapy due to my age (80 years previous). In any other case, I’m in glorious well being. What therapy, if any, ought to I’ve? — R.B.
ANSWER: Prostate most cancers actually isn’t one illness. There’s a big spectrum of aggressiveness. Extremely aggressive cancers can unfold domestically or to distant websites very early on in the midst of illness, whereas way more slow-growing cancers are unlikely to ever develop sufficient to change into an issue in an individual’s lifetime. As a normal rule, youthful individuals are extra prone to have aggressive cancers, however this isn’t all the time the case.
The objective of prostate most cancers screening is to seek out cancers which are “good.” They’re aggressive sufficient to develop and unfold, however there’s nonetheless sufficient of an opportunity to seek out the most cancers earlier than it’s too late. This usually consists of males who’re between the ages of 50-75. (Some males at a excessive threat ought to start at age 45.)
In males over 75, many of the cancers are so slow-growing that screening for prostate most cancers doesn’t make a number of sense. Prostate most cancers surgical procedure causes hurt, with erectile dysfunction and incontinence being frequent (and even a small threat of loss of life). Screening begins to have a internet profit after about 10 or 15 years.
I like to recommend surgical procedure provided that this have been a higher-risk most cancers based mostly on the pathology of the tumor, the extent of your PSA, the dimensions of the tumor by means of a scan, and probably the genetic traits of the tumor. Most males at your age don’t profit from therapy of a extra indolent most cancers, and it’s often much better to regulate the most cancers by repeat blood testing and scans.
Once you converse to the urologist once more, you need to have a transparent concept of whether or not this can be a extra aggressive most cancers or one of many extra frequent, slow-growing form that may seemingly by no means trigger you any signs.
Extra recommendation
DEAR DR. ROACH: About six years in the past, it was thought that I might need had a light transient ischemic assault (TIA). No injury to my mind tissue was found, and I’ve been taking 12.5 mg of metoprolol (a half-dose due to its uncomfortable side effects) and 20 mg of atorvastatin ever since.
Ought to I be monitoring this a part of my well being with an occasional go to to a specialist (a neurologist or heart specialist?) or by means of particular checks? Nothing additional was advised, however strokes and coronary heart assaults run on my mom’s facet of the household. I’m 77. — H.S.
ANSWER: A TIA has signs just like a stroke, however the signs are non permanent. No loss of life of mind cells happens. Nevertheless, an individual with a TIA is at the next threat for a stroke, so cautious management of any stroke threat elements is necessary to scale back the probability of a stroke.
Among the many most necessary threat elements are blood strain and ldl cholesterol. Metoprolol is just not the frequent first-line therapy for blood strain, so I ponder why it was chosen. But when your blood strain isn’t underneath splendid management (lower than 120 mm Hg systolic and fewer than 80 mm Hg diastolic), then that’s the vital problem. Blood strain needs to be checked often. Atorvastatin is a strong drugs, so ldl cholesterol often doesn’t have to be rechecked as usually.
Your common physician can test on these and some other threat elements you will have (similar to smoking and diabetes). You must seek the advice of with a neurologist as effectively.
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Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column each time doable. Readers might e mail inquiries to ToYourGoodHealth@med.cornell.edu or ship mail to 628 Virginia Dr., Orlando, FL 32803.
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