Prostate can­cer screen­ing poses risks

The News-Times - - ADVICE/GAMES - Keith Roach, M.D.

Dear Dr. Roach: Every year, I used to get a phys­i­cal, which in­cluded a prostate exam as well as blood tests with PSA. When my doc­tor re­tired, I had a hard time find­ing a new one I liked. It has been three or four years since my prostate was checked, but my new doc­tor doesn’t do the prostate ex­ams (I am 63). He says that re­cent stud­ies do not rec­om­mend them, and I have seen news re­ports about the un­re­li­a­bil­ity of the PSA test. How do you find out if you have prostate can­cer if you don’t look for it? My brother-in-law found out he had it at 52, and it was suc­cess­fully treated. I don’t re­ally want to wait un­til I am show­ing symp­toms, and there is no his­tory in my di­rect fam­ily. What do you think about this?

T.D.

An­swer: Prostate can­cer isn’t re­ally one dis­ease. It can be very ag­gres­sive — both with lo­cal in­va­sion and spread­ing to bones quickly — but it also can be very in­do­lent, hardly grow­ing at all over years. Yearly prostate can­cer screen­ing with PSA is more likely to find the slow­er­grow­ing can­cers, since they are around for a long time. The goal of screen­ing is to find ag­gres­sive can­cers, the fast-grow­ing ones that can go from un­de­tectable to too-late-to-do-any­thing-about in a very short time.

But a down­side is that screen­ing may lead to un­nec­es­sary treat­ment of the more-in­do­lent can­cers, most of which can be care­fully mon­i­tored and will not need surgery or ra­di­a­tion, at least not for years.

If a man elects to un­dergo prostate can­cer screen­ing, he should un­der­stand the ben­e­fits (find­ing prostate can­cer early enough it can be cured) and the risks (treat­ment for prostate can­cer causes com­pli­ca­tions fre­quently; these can in­clude in­con­ti­nence and loss of sex­ual func­tion). Not treat­ing low-risk prostate can­cer re­duces the risks.

Low-risk prostate can­cer is de­fined by a PSA below 10, a very small or non-de­tectable tu­mor by pal­pa­tion or imag­ing and a low Glea­son score, which is based on how the tis­sue looks to the pathol­o­gist. Six or less is low risk. Most men in this sit­u­a­tion do not need im­me­di­ate treat­ment. Some men have dif­fi­culty NOT treat­ing can­cer, but treat­ment does not ap­pear to im­prove the al­ready good prog­no­sis. Choos­ing not to treat is hard for some men.

Dear Dr. Roach: My part­ner and I are in our 60s, exercise reg­u­larly (three to five times per week), eat a well-bal­anced diet and are of av­er­age weight. Re­cently, we went bowl­ing for two games and found our­selves sore in the area right below our but­tocks. We were very sore for sev­eral days, mak­ing walking dif­fi­cult, es­pe­cially up and down stairs. What would have caused this area to get so sore? We named it “bowl­ing butt” for lack of a med­i­cal term.

M.B.

An­swer: Start­ing a new ac­tiv­ity will of­ten cause peo­ple to overuse some mus­cles that aren’t used to the strain.

Bowl­ing in­volves force­ful ex­ten­sion of the thigh, which is the glu­teus max­imus mus­cle, as well as other mus­cles in the hip to main­tain sta­bil­ity. Two games were enough to ex­haust that mus­cle, which take days to heal prop­erly.

Nam­ing a dis­ease is se­ri­ous business, and I did a look for sim­i­lar names in the lit­er­a­ture. I did find “Wii butt,” a pain sen­sa­tion af­ter play­ing games on the Wii video game sys­tem, but none for ac­tual bowl­ing. I’m not sure “bowl­ing butt” will catch on, how­ever.

Read­ers may email ques­tions to: ToYourGood­[email protected] .cor­nell.edu or mail ques­tions to 628 Vir­ginia Dr., Or­lando, FL 32803.

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