DEAR DR. ROACH: I read your recent column on PSA screening for prostate cancer. As an oncologist who specializes in prostate cancer, I wanted to add that it is important for patients to understand that 1) screening is very different from diagnosis and treatment, and 2) that the PSA test is a very good and accurate test that does exactly what it is supposed to do: measure the level of PSA in people with prostate cancer. I’ve heard so many patients, even with metastatic prostate cancer, saying, “I read in the news that PSA is a bad test and doesn’t really matter for my prostate cancer.” This is entirely untrue. One of the messages that has trickled out to patients in the controversy over PSA screening is that PSA never matters -- again, not true. For patients who have been treated for prostate cancer or are undergoing treatment for metastatic prostate cancer, the PSA is a very valuable tool. A rising PSA in that setting has very different implications than when a PSA is used for screening. Health-care professionals made a huge mistake when someone decided to biopsy every man with a PSA above 4 for no good reason whatsoever. But for patients with concerning signs and symptoms (which is not “screening”) who have an elevated PSA, it can be meaningful and should not be brushed off -- which is happening quite a bit in the community. Just for full disclosure, I do believe in getting a PSA in some high-risk men (those with a strong family history, symptoms or are African-American, for example) those in a particular age group (50-70, or those with a life expectancy of at least 10-15 years) after careful counseling to engage the patients re: risks and benefits. -- Dr. Won Kim
ANSWER: I thank Dr. Kim for his thoughtful reminder that the PSA test remains a very useful means of following the course of disease in men with diagnosed prostate cancer. I agree completely that some men still may benefit from a PSA test, including men at higher risk due to family history or being African-American. I also want to specifically agree that when men have symptoms that could be related to prostate cancer, then the PSA test is part of the appropriate workup to discover the cause of the symptoms, and is not screening at all.
The booklet on the prostate gland discusses enlargement and cancer. Readers can obtain a copy by writing: Dr. Roach Book No. 1001, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address.
Please allow four weeks for delivery.
DEAR DR. ROACH: You recently wrote about spinal stenosis. My pain doctor tried everything, including a spinal stimulator and steroid shots. Finally, he said I should get a rolling walker, lean forward on it, and see if that will “unpinch” the nerve. It seemed a strange prescription, but I did it, and I have had no pain since 2007. -- M.E.
ANSWER: Spinal stenosis is caused by a mixture of abnormal growth and the position of bony and soft structures in the back pressing directly on the spinal cord or on the nerve roots as they exit the spinal column. This causes pain and sometimes numbness or even weakness. Relief of symptoms upon leaning forward is an important diagnostic point. Your pain doctor made a great suggestion for you, and it may help others, but I think you are more fortunate than most to have found such long-lasting pain relief. Spinal stenosis is often a progressive condition. I appreciate your writing to share your experience.