Tag Archive for: prostate cancer

PSA: Sharing the Decision

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PSA screening is controversial because it may or may not indicate prostate cancer without additional testing and it may or may not indicate mortality from prostate cancer. As I said, many elderly men will die with prostate cancer but not of it. How do you know what to do? A recent study may provide some guidance.

Regular PSA Testing and Mortality

The Veterans Administration can be a challenging bureaucracy, but it’s one entity that can provide medical information on millions of subjects. Researchers wanted the answer to a simple question: Do higher rates of PSA testing yield a reduction in metastatic cases of prostate cancer?

The survey population included male patients getting a PSA test at 128 U.S. Veterans Health Administration facilities across the system from 2005 to 2019. The reason those years were chosen is that the U.S. Preventive Services Task Force (USPTF) had modified guidelines for PSA screening to recommend less frequent use of the test for men over 70. Over those years, there was a decrease in annual testing by 10% to 15% in non-VA healthcare facilities, and that was matched in the VA system. The USPTF recommended against screening all men, and PSA testing again fell in all age groups.

The data showed that as PSA testing decreased, the rates of metastatic prostate cancer increased. Drilling down into the data, those VHA facilities with higher rates of PSA screening had lower rates of metastatic prostate cancer.

Shared Decision-Making

The researchers were diplomatic in their conclusions. They simply presented the findings and suggested that the physician and patient should jointly decide on the course of action. Should we test? When do we proceed with a biopsy? What do we do if it’s benign? If it’s malignant? And a whole bunch more.

The Bottom Line

The researchers easily could have recommended that everyone gets tested and everyone gets a biopsy if the PSA is too high, but PSA testing is not precise enough. Some men have prostate cancer with PSA less than 4.0 and some do not have it with PSA over 10. The best course is having a discussion with your urologist and coming to a joint decision that satisfies you both. It’s also not a bad idea to get a second opinion, of whether you agree with the plan or not.

One thing for sure: always do the screening test again, regardless of whether it’s PSA, cholesterol, or HbA1c. For the most part, tests are accurate and reliable, but there’s always the possibility of a mistake; one test does not a diagnosis make. Retest, discuss, and plan a course of action with your healthcare professional.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Oncol. doi:10.1001/jamaoncol.2022.4319

Controversy: PSA Testing

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Medical testing is a blessing at times, a curse at others, and a source of controversy in the medical profession itself. I recently wrote about colonoscopies and why they provide information other colon health tests do not. The PSA (protein specific antigen) screening for prostate cancer has also been controversial. Here’s why.

If the PSA exceeds a specific number (another point of controversy), especially if a digital rectal exam reveals an enlarged prostate, more tests follow. The prostate biopsy takes samples of the prostate to see if cancer is present. If not present, the PSA was a false positive that resulted in a much more expensive test that probably increased the anxiety of the individual.

But wait—there’s more. Even if cancer is diagnosed, it may or may not indicate treatment. That’s because many prostate cancers are very slow growing, especially in elderly men, and will not impact how long they live. They may die with prostate cancer but not of prostate cancer.

How do you decide whether testing PSA is necessary? A new study may provide some direction, and I’ll cover that Saturday.

The Insider conference call is tomorrow night, and the topic is important: a recent study and the medical press that followed have indicated your ability to purchase dietary supplements may be under attack. If you’re an Insider, you don’t want to miss this call. If you’re not, purchase your Insider membership by 8 p.m. ET Wednesday night to get the latest information as well as all the other benefits of membership.

What are you prepared to do today?

        Dr. Chet

The Dog Will See You Now

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The Memo title is from Malcolm Gladwell’s podcast about canine screening of disease, and I would urge you to listen to it. While the focus is on prostate cancer, the logical question comes up: could dogs be used to screen people for COVID-19? The answer is yes. No one knows for certain whether they can they smell the virus, but they can smell the proteins that are being made when the virus replicates in the body. Maybe it’s the spike protein, maybe a different one, but the tests indicate dogs can smell a person’s mask and identify COVID infections immediately with an accuracy of 83% and higher; some dogs approached 99% accuracy.

Will we see dogs checking folks at the door any time soon? I doubt it, whether for COVID testing or any other type of disease. Why not? Let’s take a look.

The Problem with Dogs

Science has shown that dogs can detect odors down to 1.5 molecules per trillion. They don’t even have to be purebred dogs; mixed breeds can be taught to do it. Therein lies the problem: training. It takes time to train the dogs to be able to distinguish that one unique scent among the hundreds of thousands they may encounter in an airport, a school, or a place of business.

They also get tired, not physically but mentally. They’re still dogs that want to run, jump, and play. They love to work, but they’re not like an inanimate testing device that accepts samples and tests them all day long without needing to be fed and given bathroom breaks. Dogs get fatigued, and that means they could make mistakes.

Those are just details that can be worked out. Dogs can screen up to 250 people in an hour at an estimated cost (including their handlers) of about $2 per person. Compare that with a PCR test for COVID-19 that can cost $200 per person. The real problem lies with humans.

The Healthcare Complex

It would be easy to criticize the medical community for not wanting to endorse this unconventional approach to medicine. The papers I read thought it was impractical to train dogs to do such screenings.

What they would rather do is develop an artificial neural nose that could do the job instead. One big problem with that: they have no clue what the dogs actually detect when they perform the screening. They admit that “clinical diagnostic techniques, artificial intelligence, and molecular analysis remain difficult due to the significant divide between these disciplines.” It could take years to come up with such an artificial nose, and then you’d need humans to manufacture, operate, and maintain those devices; I don’t even want to think what the costs would be. Dogs are already being trained that can be ready in a couple of months.

I’ll let you draw your own conclusions as to why the healthcare complex is resistant to pursuing the canine screening solutions. But I suspect health insurance companies and other organizations such as school districts that actually pay the bills will pay a lot of attention to the difference in price as well as the timeline.

The Bottom Line

If I could train a dog to identify a vitamin or mineral deficiency by sniffing the breath, the urine, or feces of humans, I wouldn’t waste time—I’d do it right now. It’s not a threat to what I do; it would be a powerful tool to use to help people address their nutritional deficiencies perhaps before they manifest in disease.

Do we want to get kids back in school? I’d love to know a dog was testing Riley and all his classmates, teachers, and staff every day before they walk in the building. Getting the subjects to not play with the testing equipment would probably be the biggest hurdle, but we’ve been teaching Riley to recognize dogs that are working and not to bother them. Yes, we’d need a lot of dogs, but we can get that done if we’re really committed.

Let’s hope the healthcare complex realizes they already have the noses they need to get the job done, and all the bearers of those noses want is to play with a ball as a reward for their hard work. I’ll say it again: it’s time to let the dogs out.

What are you prepared to do today?

        Dr. Chet

References:
1. J Travel Med. 2020 Dec 23;27(8):taaa131. doi: 10.1093/jtm/taaa131.
2. PLoS One. 2021.16(2):e0245530. doi: 10.1371/journal.pone.02455

Diagnosing Disease: The Canine Frontier

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Malcolm Gladwell, one of my favorite authors, recently did a show on his podcast “Revisionist History” concerning the use of dogs in screening for prostate cancer. You probably recognize his name from his many books including “The Tipping Point”; if you haven’t tried his podcast, I recommend it.

If there’s one thing that keeps men from getting their prostate examined, it would be the invasive nature of the prostate exam known as the digital rectal exam. This refers to the old meaning of digital: performed with a finger. If any problems are suspected, the typical follow-up procedures include the protein specific antigen test (PSA) and prostate biopsy. I know first-hand how uncomfortable these exams can be, and I understand why men would put it off whenever possible, even to the detriment of their health. But what if there were another way? Time to let the dogs out.

No, this new method did not involve dogs doing what they always seem to do, which is to sniff behinds; these dogs were trained to identify prostate cancer in urine samples. Exactly what they’re trained to identify is still a mystery, but most likely it’s a protein. How accurate were they? Over 95%. Anyone that tests positive by canine would then be followed up by a human physician.

Will we be making appointments to see our canine diagnosticians anytime soon? Probably not—even though just about every type of cancer you can think of has been canine-tested and found to be accurate. Are there other conditions that canines can identify? Yes, and I’ll cover that on Saturday.

The Insider Conference call is tomorrow night. I’m going to talk about the COVID vaccine as well as answer Insider questions. Become an Insider before 8 p.m. Eastern Time, and you can join in on the call.

What are you prepared to do today?

        Dr. Chet

Reference: Urologiia. 2019 Dec;(5):22-26.

Coordinating BPH Herbals and PSA

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Happy Father’s Day to all the fathers, father figures, and so on. Now let’s work on making you all healthier.

If you take one of the BPH medications, you have to work with your physician to determine how you’ll work out your PSA testing. What might not have been clear was that the medications don’t cause prostate cancer, but they can mask a rising PSA level by keeping it artificially low and that could delay detecting prostate cancer. I left you with the question: what about herbals that are used for BPH such as saw palmetto? Do they impact the PSA levels?

Based on a couple of studies, the answer is no. The mechanism by which the herbs help with prostate issues is different from BPH medications. So if you’re one of the many men who use saw palmetto, I wouldn’t be concerned based on current research to date.

However, I would be prudent. There are only a couple of studies that have looked at specific combinations of herbals and the impact on PSA levels. While they showed no impact on PSA levels, that’s not a completely free pass. What I would do is to stop using saw palmetto or any other type of herb or plant sterol a couple of weeks before your next PSA test. There’s no research to know how long it may take to clear the system, but two weeks seems reasonable. Once the blood is drawn, go back to using the product as before. That seems to be the best way to approach herbal treatments for BPH.

BPH can really mess with a man’s life and especially with sleep. If that’s you and you’re taking a medication or an herbal, there’s no reason to stop. Just be smart. Talk with your physician; understand how to deal with the potential issues and live your life. That’s a bottom line we can live with.

What are you prepared to do today?

        Dr. Chet

References:
1. Int J Cancer. 2005 Mar 20;114(2):190-4.
2. Prostate. 1996 Oct;29(4):231-40.

BPH Treatment and PSA

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One of the reasons I love what I do is that I learn something new just about every day. In this case, it may help some men sooner rather than later if they have benign prostatic hyperplasia (BPH).

The urethra runs right through the prostate gland. As a man ages, the prostate gland has a tendency to enlarge, and when it does, it can interfere with urine flow. The result is the inability to empty the bladder completely, which can cause frequent urination; a man may have to get up multiple times through the night to urinate.

The typical treatment is to use a medication called a 5-alpha reductase inhibitor that includes finasteride and dutasteride. By reducing the production of a specific form of active testosterone, the prostate can stop enlarging and urination improves. The problem with using the medication is that it can reduce the protein specific antigen level, a marker that can indicate a man has prostate cancer. Could it impact the diagnosis, treatment, and even death from prostate cancer? We’ll look at a recently published study that examined those very questions on Thursday.

The monthly Insider conference call is tomorrow night. You can take part by becoming an Insider today at drchet.com; if you’re a Member, you can upgrade to Insider and the charge will be prorated.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2019;179(6):812-819. doi:10.1001/jamainternmed.2019.0280.

Update on Prostate Cancer Treatment

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The treatment of prostate cancer has been changing over the past few years. For most men with prostate cancer, wait and see has become the norm. It all depends on age, the location, and the aggressiveness of the cancer. The more aggressive types of cancer, located close to the outer capsule of the prostate, typically required radiation treatment. The question has been the best time to begin that treatment. A recent study provided some insight.

Researchers selected 1,566 consecutive men who had a prostatectomy in various medical centers. Based on a scoring system that ranked the severity, location, and other factors, they either received immediate radiation therapy or they were monitored until the cancer returned and then given salvation radiation therapy. The immediate-radiation patients experienced reduced biochemical recurrence (as assessed by PSA), they had lower rates of the cancer spreading, and the death rate was lower when compared with salvation therapy. In this case, the more aggressive treatment for men with aggressive prostate cancer produced better outcomes.

The Prostate Health webinar will be available for a few more weeks. If you’re concerned about the health of your prostate or what to do for benign prostatic hypertrophy or prostate cancer, you absolutely have to watch this webinar. If you want to know what questions to ask your physician, this webinar is a must see. Order it today.

What are you prepared to do today?

Dr. Chet

 

References: JAMA Oncol. 2018;4(5):e175230. doi:10.1001/jamaoncol.2017.5230.

 

Who Decides?

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After the past two messages, I hope you’ve taken the time to think about screening tests. There are many ways to respond, from outrage to “Who cares what some obscure researchers say?” To me, it’s complicated but it always comes back to statistics.

In Tuesday’s message, the opinion voiced the concern that going against the evidence presented by the USTFPS by a political body was opening the door to more intervention based on emotion rather than fact. The facts were that more women would be faced with the stress to their minds and their bodies if they . . .

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