February 21, 2007

Prostate Cancer

I am 78 years old, and at a recent check was found to have an elevated prostate-specific antigen (PSA). My doctor could not feel an abnormality in my prostate but a couple of biopsies he had taken showed prostate cancer cells. He discussed what he called "watchful waiting." What do you think?

Prostate cancer is very common in older men. It has been said if we lived long enough, all men would get it. It is not uniform in its behavior. Prostate cancer is often given what is called a “Gleason” score for its aggressive features. This score, if high, is associated with more rapidly progressive disease.

Most prostate cancer is also staged using a scale that measures the tumor locally, and takes into account lymph node and metastatic involvement.
Of course, the sooner any cancer is diagnosed, the better—both for the stage and, consequently, the prognosis. Prostate cancer may be very idle in some males. In the group of men with early-stage cancer, low Gleason scores, low PSA (prostate-specific antigen) levels, cancer shows up in only a couple of biopsy specimens. Even then, it involves less than 50 percent of the specimens that seem to bear “watching.”
2007 1506 page14Of course, age is a very important factor as well. Men 65 or younger—as a group—are treated more aggressively to match the usual state of their cancer, which tends to be more aggressive.

“Watchful waiting” is more importantly “watchful.” Strict monitoring is required. A rapid rise in PSA, or a change in Gleason score on follow-up biopsies, or palpable growth would all indicate a need for intervention.

Some may ask, “Why wait?” Life expectancy may, for some, be much shorter than the prostate cancer’s course. All treatments carry significant risk of complications. These include impotence, urinary incontinence, and possibly rectal irritation following irradiation of any kind.
The patient’s comfort in waiting must also enter into the equation. Some feel much more content hitting the cancer hard while others would prefer a more cautious approach.
If your urologist is keeping a close eye on you, at your age, with a less aggressive tumor, it is quite possible that you could live many years and die of an unrelated condition.
A recent study out of Johns Hopkins reported on a group of 38 men who fit the criteria for watchful waiting. This group did just as well as a group of 150 men who underwent immediate surgery. Much study is ongoing in this area. New advances made every year mean that hope for cure improves each year as well.
For readers wondering what can be done to prevent prostate cancer, current understanding finds no correlation between sexual activity and prostate cancer. Dark-skinned males have increased prostate cancer, especially in more northern climates. This suggests vitamin D—the “sunshine” vitamin—may be important in protecting against prostate cancer.
Lycopene, found in tomatoes and released from them more by cooking, also may be protective, as may be a moderate intake of soy products. Selenium, found in Brazil nuts, may also be protective.
One of the factors we can do little about is our genetic predisposition, which prostate cancer involves. When there is a strong familial tendency, greater vigilance is called for.

Since my wife died, I have been rather lonely. I have always been a shy person. My daughter says I need to socialize more, and it's unhealthy to be alone so much. Is this really true?

How dangerous to your health your “loneliness” is is impossible for us to answer. We do know, for example, that following a heart attack, persons who could answer affirmatively to “Does your spouse show you his/her love?” did better than those responding negatively.
A lot of evidence shows that better health is found in the groups who regularly attend church and participate in social activities.
Loneliness, however, is rather subjective. Some feel lonely even in a lively house, while others may feel fine living by themselves.
Transportation availability, such as owning and driving a car, may reduce loneliness. Of course, disability makes it difficult to get out.
Depression often shadows our lives without us being aware of it. Feelings of worthlessness or despair will magnify loneliness.
A report from the Chicago Health Aging and Social Relations Study found high blood pressure was related to loneliness. The magnitude of the blood pressure elevation was comparable to that found in those who lack exercise or were obese.
If you feel lonely, do something about it. Volunteer at the hospital, library, or seniors’ home. If you have the energy, volunteer at the Boys and Girls Club. You can even make cookies. Volunteer for something at church. You will be appreciated and find friends. Accept invitations to go out. Many lonely people are their own worst enemies because they isolate themselves.
Remember, God loves you as much as anyone in the entire world. Try to let yourself be more relaxed; many lonely people tie themselves up in rules and regulations. Let your hair down and be yourself.
Allan R. Handysides, M.B., Ch.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.
Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland, 20904. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.