San Antonio Express-News (Sunday)
Man, 91, with high PSA still has options
Q: I’m a 91-year-old male who has had excellent health all of my life. I’m very active for my age, as I play golf twice a week, workout at the local gym once or twice a week and walk about ½ mile once to twice a week, including a rather steep grade.
At my recent annual physical exam, my blood test showed everything was normal except my PSA (prostate specific antigen), which had jumped to 15.8. I was told I could probably live another five to 15 years. Of course, 15 years is a stretch. My question is, What’s realistic? What am I to expect at my age considering I have no other problems? Also, I understand there is a rather slow cancer and a more aggressive cancer. How do I find out which one I have?
A: The prostate specific antigen test is a blood test that identifies an enzyme made by the prostate, which is secreted into semen but also normally found in small amounts in the blood. High amounts of PSA are found in the blood of most men with prostate cancer, but high PSA levels may be found as a consequence of benign conditions as well. I don’t know if you have prostate cancer or not now.
A PSA level that has suddenly increased could be due to a rapidly growing prostate cancer; however, it may also be due to inflammation or infection of the prostate. These are usually, but not always, symptomatic.
It is not normally recommended to test a PSA level in a man who is 91 years old, but you aren’t a normal 91-year-old. Still, you have the result, and you have to decide what to do. One approach is to ignore the result. This isn’t satisfying, as you will still be left wondering what is going on.
If you decide to move forward in making a diagnosis, the first step is always a careful exam and history, followed by a picture of the prostate. MRI is the preferred way of taking pictures when available, as the MRI can give important information about potential cancer.
If the MRI is suspicious for cancer, a biopsy would then be recommended. Once you have a biopsy and MRI, and probably with another PSA test to determine how fast it is rising, you will know whether this is cancer. And if so, you will have a very good idea if it is a more aggressive or more slow-growing type.
Armed with this information, you can decide whether treatment or active surveillance is more appropriate for you.
Q: If a person has a very severe reaction to a COVID booster, will they benefit from it? My cousin got very ill after her third shot. She has severe allergies. Will she be immune to COVID?
A:
Severe reactions to any dose of the COVID vaccine are unusual and unfortunate, but normally the vaccine is still effective at providing protection to the COVID virus. As we have seen, vaccinated people can still get infected, but they are much less likely to get so sick that they need to be in the hospital (or worse).
Q: I am wondering if the claims of the health benefits from the manufacturers of saltwater hot tubs are factual.
My blood pressure reading was high, and it was suggested by my doctor to watch my salt intake. After reading the labels on food products, the sodium was very significant in most items. Since then, I have been able to drop it, but
it is still slightly high.
I use a saltwater hot tub, and I am wondering if salt is absorbed through the skin and how much that would increase blood pressure.
A:
Many times, what seem to be health claims — whether it’s a supplement, vitamin or device — are followed by the words: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.” (Sometimes, the writing is very small, but if you look for it, you’ll find it.)
When you see that statement, you can be sure there is not strong evidence that there is benefit from what they are trying to sell you. However, there might still be health benefits that have not yet been proven.
In the case of hot tubs and saunas, some of the proposed
subjective benefits include stress relief, muscle relaxation and pain relief. Most people who enjoy hot tubs probably get these benefits. There is weak evidence that regular hot tub use might improve diabetes control, and preliminary evidence that it might help cardiovascular health. While large studies have shown that people who use saunas or hot tubs enjoy a longer lifespan, it is not at all clear that the heat treatments are causing the observed benefits.
I can tell you that salt is not absorbed through the skin to any appreciable amount, so you need not worry about that. You’ll get far more benefit from cutting out some of the highsodium items from your diet.
Q: I am suffering with vertigo. I went to an ENT doctor and was diagnosed with Meniere’s
disease. However, I have neck pain occasionally and have a hump on my neck. A friend suggested I go to a chiropractor for adjustments. Could what the chiropractor treats possibly be the cause of my vertigo issues?
A:
Meniere’s disease is a cause of vertigo (a sensation such as spinning when a person isn’t moving), along with hearing loss and tinnitus (a perceived sound such as ringing when there really isn’t any sound). Meniere’s disease is caused by buildup of fluid in the inner ear.
Spinal manipulation, such as chiropractic manipulation, has been shown to provide immediate pain relief that was superior to medications, but not as effective as home exercises. I could find no convincing evidence that any kind of spinal manipulation would be effective for Meniere’s disease, and no reason to think that it would be.
I’m not sure what you mean by a hump on your neck. We all have a prominence in the seventh cervical bone, but it’s possible you have kyphosis, which should be evaluated by your regular doctor.
Standard treatment for Meniere’s disease includes a lowsodium diet, caution with caffeine and alcohol, and vestibular rehabilitation (a series of exercises supervised by a physical or occupational therapist with special training). These have been shown to reduce the symptoms of imbalance. Some people will benefit from medication to reduce fluid buildup in the inner ear, such as diuretics.
Q: I have stiff legs when I get up in the morning. I can alleviate the pain with stretching exercises, but it has been getting harder to totally get rid of my leg stiffness. I am 82 years old and getting stiffer each year. Is there a medicine (or secret exercise) for stiff leg muscles?
A:
I’m not 100 percent sure it’s your muscles that are sore. Most people at age 82 have some degree of joint stiffness, although it can be hard sometimes to tell exactly what structure is causing the stiffness or discomfort. In my experience, joint stiffness from osteoarthritis is a much more common cause of leg stiffness in the morning (or after prolonged sitting) than muscle pain. Regular moderate exercise is an effective treatment and preventive for both types of pain.
Muscle pain and tenderness to touch in the muscle itself should prompt a visit to your doctor. I would be especially concerned if you had tenderness in the leg muscles on an exam and were taking a medication that could cause muscle damage, such as a statin.
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.