DEAR DR. DONOHUE: I am an 80-year-old male whose annual physical exam was good. My wife and I have a good sex life. We’ve been married 61 years.
However, my PSA rose to 5.7. My family doctor sent me to a urologist, who suggested a biopsy. The urologist said my prostate gland is normal for my age and had no hard spots or lumps. My dad died at 87 due, in part, to prostate cancer. A brother also had difficulties. I read that at my age, I should enjoy life without such procedures. Your opinion, please. — B.M.
ANSWER: What to do when the prostate specific antigen (PSA) blood test is higher than normal is a controversial subject. Every year, about 192,000 men are diagnosed with prostate cancer. Close to 70 percent of those cancers are low-grade, meaning they don’t pose a serious threat to life. Such cancers, depending on the man’s age and his health, may not require any treatment other than scheduled monitoring.
One of the ingredients that goes into the mix for making a decision for “active surveillance” is what’s seen on the biopsy. The pathologist examining the prostate tissue discovers if any cancer is present and assesses the cancer’s stage and its potential to be an aggressive cancer. If the cancer is in its early stages and if its appearance is one that’s not threatening, then the decision for treatment is something that can be discussed with the doctor. Quality of life is as important as extension of life. However, I believe you should have the biopsy. It has some rare complications, but it provides information not obtainable in any other way.
You are a very young 80-year-old. You have no other health problems that might shorten your life. You have a family history of prostate cancer. If the biopsy shows a low-grade cancer, then talk to the doctor about your wishes. One of those wishes could be active surveillance.
The booklet on the prostate gland discusses gland enlargement and cancer. Readers can order a copy by writing: Dr. Donohue — No. 1001W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I am a 52-year-old male in good health. I am not a drinker or a smoker. My problem is premature ejaculation. I am on no medicines. Are there any vitamins or supplements that would help me? — Anon.
ANSWER: This discussion should start with your family doctor. The doctor can, after talking with you, decide if the problem is physical or psychological. Both are possible causes. Anxiety, depression and prostate gland inflammation are examples of things that can lead to your problem.
Sometimes simply starting and stopping and then restarting relations will solve the problem. A numbing agent like the combination of lidocaine and prilocaine cream might be helpful. A condom should be worn so that your partner isn’t affected by the cream. Fluoxetine, paroxetine and sertraline are medicines that have been successful for some men. Vitamins or supplements are not likely to help.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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