Prostate Cancer Risk Can Be Predicted With a Single PSA Test

The highly acclaimed Institute of Medicine and now the U.S. Preventive Task Force have recommended against routine screening of asymptomatic men for prostate cancer. Now, a study presented by Christopher Weight, MD from the Mayo Clinic Department of Urology adds more information and confusion to the fire. Dr. Weight presented his data at a recent meeting of the American Urologic Association.

The Mayo Clinic followed men younger than 50 years old for 16.8 years.  They concluded that men at age 40 with a PSA value of less than 1ng/ml had a less than 1% chance of having prostate cancer at age 55. They had less than a 3% chance of having prostate cancer at age 60.  They concluded that men with a baseline PSA < 1% in their 40s appear to be able to safely avoid annual screening until age 55.  “Men with a baseline PSA greater than or equal to 1 have a substantial risk of subsequent biopsy and cancer diagnosis and should be followed annually.”

This is one of the first research studies to quantify the actual relationship of screening young asymptomatic individuals and the subsequent risk of developing the disease.  It is the type of research needed to help guide us to make safe and sane recommendations about the type of screening for prostate cancer and frequency of screening using blood tests, ultrasound and of course digital rectal examination to palpate the prostate. All the patients in the Mayo study received a PSA assessment, digital rectal exam and transurethral ultrasound of the prostate at study entry and biennially thereafter.

This study affirms the recommendation for performing a screening digital rectal exam on all men at age forty and subsequently. It begins to answer the question of who needs follow-up PSA testing and when.  However, more research is clearly needed.

The Veteran and the Oncologist

The 80 year old veteran was seated in the clinical exam room with his two sons who had brought him across the country for a visit with the Chief of the Leukemia and Lymphoma Section at a major Center of Excellence.  The veteran and the doctor had hit it off famously as soon as the patient walked into his office for the first time and noticed a picture of a military officer in an Australian army uniform hanging on the wall.

The veteran had come at the insistence of his sons to receive suggestions for treating a rapidly progressing lymphoma. He had been given a bleak prognosis by his local oncologist and his children felt a second opinion was worth the three hour plane flight and expense.

When the veteran walked into the office of the doctor and saw the picture of the Australian soldier hanging on the wall he said “I served with that outfit in the Philippines during WWII in the jungles. Who is that gentleman?”  “That’s my father,” the doctor answered.  For the next few minutes they swapped war stories.  These were not gruesome battle tales but stories of young men from different parts of the world relaxing and playing together to relieve the stress of battling a common and evil foe in an inhospitable climate far from home. The doctor and patient bonded with the doctor hearing many of the same limited number of war year stories these veterans shared with their families. He was now hearing it from a “Yanks” point of view. They swapped stories about the US and Australian unit working together and ambushing a British beer convoy on its way to bring the English troops their daily beer ration. The Aussies and Yanks buried month’s worth of beer in the jungle and then traded it back to the Brits in exchange for favors.   They shared stories about drinking scotch in the jungle and how the doctor’s favorite scotch was the same brand of scotch the veteran’s father had loved as well.

After two days of evaluation, the veteran was told he should be placed on an aggressive regimen of chemotherapy usually reserved for younger patients. Before his first administration of the drugs the doctor walked into the infusion center and leveled with the veteran. “We have not used this cocktail of four drugs on many individuals your age. I think you will do fine but I have to be honest with you that we don’t have much experience with these medications in older men and women.  Are you frightened by this?“ he asked.

The veteran calmly looked at his children and the doctor and said, “I haven’t really been afraid of anything since August 8th, 1945. “   So began the tale never shared before. On August 8th, 1945 , the soldier just six weeks shy of his 21st birthday , along with 99 of his fellow soldiers in the 11th Airborne Division, were training for a low altitude  jump mission for volunteers only . They were training in the remote jungles of the Philippines, jumping from slightly over 150 feet in preparation for a secret mission.  On that August morning they were assembled and were ordered to pack their parachutes and be ready for a mission briefing. Their commanding officer told them that they were leaving that evening to jump into Japan to map the beach landing sites for the Allied invasion of Japan to soon follow. They were to maintain complete radio silence until they had completed their reconnaissance and transmitted the information. If they survived that portion of the mission, they were to reassemble and began a secondary series of missions aimed at sabotage and local destruction of communications assets.  As they lined up to board their planes, the commander of Pacific operations thanked them for their service to their country and that he did not expect any of them to survive the mission.

The men flew in radio silence throughout the night of August 8th, 1945 and in the predawn hours of August 9th jumped into Japan.  The veteran said that as he left the plane his body was shaking in fear and for the first time in combat he voided into his pants on the way down. “I thought that I would be shot and killed by enemy fire before I hit the ground. I never expected to be alive to celebrate my 21st birthday. “The troops met no resistance and went about their primary mission quietly and expertly still maintaining complete radio silence. When they assembled at their rendezvous point, and broke radio silence to transmit the information they had been trained to obtain, they learned that the second atomic bomb had been dropped on Nagasaki that morning. A truce had been declared.  For these brave soldiers the war was over. Three weeks later they were in San Francisco awaiting discharge and a return home.

The chemotherapy went flawlessly. The soldier tolerated the first round well and returned home to complete the therapy locally under the direction of the Center of Excellence. Eight years later he remains disease free. He has never shared another war story with me, his proud son.

I Lost 52 Pounds And Feel Fantastic!

Patients have noticed my recent 52 pound weight loss but, for the most part, have been reluctant to approach me to discuss it. I’m sure many have wondered if this was a planned weight loss or the result of a serious illness.

Let me bring clarity to any concerns. My weight loss was planned as part of a lifestyle improvement program and, as a result of my commitment, I now feel great!

Like many Americans, I had accumulated extra pounds due to poor food choices, large portions and poor health habits. Finally, I decided to get healthy BEFORE I became ill and my doctor insisted on it.  I established certain criteria in choosing a weight loss program. It had to be safe, effective and rapid. I did not want medications or injections to be involved. Any program I was to consider had to have a proven safety record with no patients becoming ill.  There needed to be a sane transition program and maintenance program to teach me how to prevent regaining the weight rapidly and how to move on and live a healthy future life.

After much research I found the Take Shape for Life Program (www.tsfl.com).  Clinical studies by Johns Hopkins, the National Institutes of Health (NIH) and other organizations have proven the effectiveness of this program.  It has been recommended by over 20,000 doctors.

Take Shape For Life provides a network of ongoing behavioral support, education and other tools while using the nutritionally-sound Medifast meal replacements.

TSFL participants eat six small meals per day – all of which are low in fat and sugar but rich in protein and nutrients.  The five daily small Medifast meal replacements are supplied by TSFL and are eaten every two to three hours along with one lean and green meal that you prepare yourself.  These small frequent meals keep you from becoming hungry and getting cravings. As part of the program you have access to a free health coach / guide / cheerleader who assists with recipes, lifestyle tips and helps order product. The low average monthly cost to participate in the TSFL program is about $315.

I started the program in mid January and reached my goal weight in just four months. I am now working on transitioning to the maintenance program. My lovely wife is also participating in the TSFL program and has over 40 pounds to date.

I suggest those of you who are struggling to lose weight discuss it with me.  The program is perfect for diabetics, hypertensives, individuals with heart disease and individuals with gluten sensitive enteropathy.

Please contact me with any questions you may have, to request information or, to begin your journey to achieving optimal health by enrolling in Take Shape For Life.

Modest Jogging Extends Lives

As part of EuroPrevent 2012, researchers presented data from the 19,780 participant Copenhagen Heart Study that evidenced individuals who jogged for at least one hour per week, at even a very modest pace, extended their healthy life.  For men who jogged, the increase in life expectancy was at least 6.2 years, while for women it was 5.6 years.  The study noted that joggers experienced a 44% reduction in death risk over 35 years.  In addition, the study recognized a mere 122 deaths among joggers in the 35 years under review, while the non-jogging group suffered 10,158 deaths.  The lead researcher talked about the joggers living a healthier, happier and higher-quality life.

The authors felt that the benefit was even more profound in seniors who began jogging at, or over, age 70. It is important to note that before anyone begins a jogging or exercise program, they need to see their medical doctor to discuss the risks and benefits of these activities.

Heart Attack Risk Assessment – Everyone Needs One

MedPage, an online medical news service is reporting that the European Association for Cardiovascular Prevention and Rehabilitation (EuroPrevent), currently meeting in Dublin, Ireland, has called for a once in a lifetime cardiac assessment for all men over age 40 and all women over age 50.

Ian Graham, MD, professor of cardiovascular medicine at Trinity College suggests that we use “age risk terminology,” as it is far easier to understand.  For example, it has been concluded that most 30 year olds are low risk, by virtue of their age, for the presence of cardiovascular disease. “If that 35 year old is a smoker, you can tell him that his risk of having a heart attack is the same as a 65 year old man. That is meaningful.”

The recommendations have been synthesized into a short 63 page document which establishes whether the evidence for each suggestion is strong, moderate or weak.  While many of the guidelines have remained the same, the new documents make it easier for health professionals to access and use the guidelines.  Your primary care physician can easily perform the cardiac assessment.

“Buyer Beware”- Supplements Are Not What They Are Advertised to Be

According to an article authored by Maria Elena Martinez’s (Ph.D., University of California, San Diego) in the Journal of the National Cancer Institute, “Consumers need more information and guidance about the risks as well as the benefits, of using dietary supplements for cancer prevention.” Dr. Martinez states that dietary supplements have little supporting evidence for health benefits in disease prevention – particularly cancer.

“Despite this evidence, marketing claims by the supplement industry continue to imply anti-cancer benefits“ Martinez wrote.  “Insufficient government regulation of the marketing of dietary supplement products may continue to result in unsound advice to consumers. Both the scientific community and government regulators need to provide clear guidance to the public about the use of dietary supplements to lower cancer risk.”

Half of US adults use one or more daily dietary supplements. “Use of supplements has been fueled primarily by marketing oriented claims of wide ranging benefits,” Martinez and her co-authors wrote. “As a result, sales of dietary supplements have grown into a $30 billion a year industry.”

To assess the current status of evidence supporting use of supplements, Martinez and her associates reviewed literature for supplements that have been tested in adequately powered clinical trials or in large, well-designed observational studies.  The review looked at data for the use of antioxidants, folic acid, Vitamin D and calcium to prevent cancer.

Preclinical studies suggested that dietary antioxidants including beta carotene, alpha tocopherol, and Vitamin C encouraged growth of normal cells and tissue and inhibit growth of abnormal tissue. Clinical studies failed to support those ideas:

>  Beta carotene did not prevent recurrence of non melanoma skin cancer

>  Beta carotene, alpha tocopherol and Vitamin C failed to prevent recurrence of colonic adenomas

>  Beta carotene, Vitamin A and alpha tocopherol did not prevent lung cancer

>  Vitamins C and E did not protect against cancer

>  Alpha tocopherol, Vitamin C and beta carotene had no effect on cancer incidence or mortality

>  Vitamins A, C and E with beta carotene alone or in combination did not prevent gastrointestinal cancers

>  Alpha tocopherol and selenium failed to prevent prostate cancer in average risk men

In some instances studies actually showed an increased risk of cancer in those taking supplements.

Two different randomized trials showed an increased risk of cancer (prostate) and pre cancerous lesions (colonic adenomas) in individuals taking long term folic acid supplementation.

The paper was equally negative about Vitamin D use. They cited three short term studies that failed to demonstrate an effect of Vitamin D on cancer incidence or mortality. The authors went on to support the Institute of Medicine position that “there is not enough evidence to state that there is a causal association between low Vitamin D intake and increased cancer risk.”

The material was published in the Journal of the National Cancer Institute and summarized recently in the on line news service MedPage.

In my practice I will continue to emphasize that a balanced diet prepared in a manner to preserve the nutrients is the best way to meet your nutritional needs. I will screen for those malabsorptive states and surgical situations that require supplementation with vitamins and supplements. These are sufficiently rare. In some cases, administration of medications such as anti-cancer agents causes depletion or malabsorption of vitamins and trace elements. In those cases I will supplement.  Women requiring calcium to prevent osteopenia and osteoporosis should be supplemented. In most other instances, I will suggest a balanced diet and correct preparation of food which should provide all the vitamins, minerals and antioxidants needed to stay healthy