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PSA and Prostate Cancer

Dear Dr. B: Recent reports on PSA and prostate cancer have really confused me. Can you please tell me about the tests required for early detection of prostate cancer and where does PSA fit in?

Dear Reader: You are not the only one who is confused. PSA-based screening for prostate cancer has always been confusing and controversial. Even doctors are confused!

I am into my seventh year of writing these columns. And looking back I have written at least five columns on PSA and prostate cancer. And we haven’t heard the last word on it.

Let us look at the recent media attention given to PSA and prostate cancer. An article published in the New England Journal of Medicine (NEJM) asks: What is the prevalence of prostate cancer among men with low prostate-specific antigen (PSA) levels?

Currently, the cut off point for PSA level is 4 ug/L. If the PSA level is 4 ug/L or more then the patient is referred for a biopsy of the prostate gland to check for cancer.

Some experts have argued that this cut off point is high and we may be missing lot of cancers in patient whose levels are lower than 4 ug/L.

The NEJM article reports on the results of PSA levels and prostate biopsy done on 2950 men who completed the seven-year-trial. The study found that the risk of cancer increased with increasing PSA level, from 6.6 per cent for levels of 0.5 ug/L or less to 26.9 per cent for level of 3.1 to 4.0 ug/L.

It has been estimated that by using the current cutoff point at 4 ug/L we will miss up to 82 per cent of cancers in younger men and 65 per cent of those in older men. This finding is the most recent reminder that that PSA measurement is not a good screening test for early detection of prostate cancer.

Is there anything better? Unfortunately, no! It is suggested that monitoring the rate of rise of PSA levels over time may help. For example, if your baseline PSA is 1.0 ug/L and over a period of time it gradually increases then there may be an indication for prostate biopsy. This hypothesis has not yet been validated.

Prostate cancer is the most frequent cancer and the second leading cause of death from cancer in men, exceeded only by lung cancer. In our region, 80 to 90 new cases of prostate cancers are diagnosed each year. And each year 10 to 15 patients die of the disease.

Every man, who lives long enough, will develop prostate cancer. The risk of getting prostate cancer increases rapidly after the age of 50. In fact, by age 75, the risk of getting prostate cancer is 30 times higher than age 50.

So, for early detection tests, what we have is better than nothing. The current tests are digital rectal examination and PSA blood test and they are still available. How often one should undergo these tests also remains controversial. But the best thing is to discuss your risk factors with your doctor and he or she can advise you accordingly.

Thought for the week:

“Success is that old A B C – ability, breaks, and courage.”

-Charles Luckman

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Interesting Medical Stories

Medical science has many interesting stories. To day, let me share with you three stories which were published recently.

Which twin is the father?

Answer to this question is expected to come from Mr. Justice Paul Jolin of the Quebec superior court. It involves a Montreal man claiming paternity of his former girlfriend’s five-year-old child.

The woman has acknowledged that she had an affair with the man. But she was also having sex with his twin brother at the time of conception – a tripartite relationship!

So, who is the father? Can DNA answer the question?

Identical twins have similar DNA. That means it may be impossible to determine who the father is. The judge has ordered the man seeking paternity to undergo DNA test to see if his claim has some relevance. If there is some relevance then the brothers may have to undergo DNA testing to see if they are identical twins.

The court does not cover the cost of DNA testing. And it looks like there is no legal precedent for this unusual court case. A Montreal lab charges $645 for legal paternity testing. It also charges $195 to establish if siblings are identical or fraternal twins, says a report in the Globe and Mail.

Well, King Solomon, where are you?

India finds creative uses of condoms.

A report in the Medical Post says that condoms earmarked for an AIDS prevention program in India are being snapped up by businesses to build roads, waterproof roofs and to polish gold-embroidered garments.

India’s auditor general says that only one-quarter of the condoms in India are being used for birth control and protection against sexual diseases. India manufactures 1.5 billion condoms annually.

The report says that contractors add condoms to concrete and tar to make roads. The latex in the condoms helps make the roads smooth and resistant to cracks.

Roofers spread an underlayer of condoms that melt and form a seal. India’s military has covered gun and tank barrels with condoms as protection against dust.

Weavers use lubricated condoms to maintain their looms and to polish the gold in sari material. People in rural areas also use them as portable water containers while in the field.

History of condoms is interesting. An internet site says that early condoms were made of linen or pig or sheep’s gut, tied at the end with ribbon. After sex, they were rinsed out and reused!

In England, condoms are known as ‘French Letters’. In Italy, they used to be called ‘English Overcoats’

Well, now you know, there is more to condoms than sex!

Thought for the week:

Raquel Welch, the sexy 62-year-old actress says her secret of youthful beauty is -exercise, diet and attitude. She says, “If you are feeling great, you look better.” Well then let us all keep smiling!

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Trans-fats

Dear Dr. B: What are trans-fats? Why all the fuss about them?

Before we discuss trans-fats we need to understand something about fat and fatty acids.

Fat is an important component of our diet. It is made up of two main groups of fatty acids – saturated and unsaturated fatty acids. Unsaturated fatty acids are further subdivided into mono and poly-unsaturated fatty acids.

Experts say that our diet should contain less than 30 percent of fat. But who on earth would be able to calculate what percentage of fat he or she eats in a day? I have never been able to figure out how much fat is in my diet.

What I try to remember is that anything I eat that is oily, greasy or fatty immediately gets converted into fat and goes to my storage areas in my waist and butts. Eating fat hardens my arteries and raises my cholesterol level. And eating fat makes me fat. So, no surprises there!

Some fatty acids are good for us. But we should know which ones to eat so we can make the right choice. We should avoid foods containing saturated fatty acids and trans fatty acids. They are not good for our arteries and heart. We should eat food containing unsaturated fatty acids (both mono and poly) and Omega-3 fatty acids.

Red meat, poultry, most dairy products (butter, cream, cheese, and full-fat milk), coconut oil, palm and palm kernel oil contains saturated fatty acids. But some of the stuff listed here tastes so good that it is hard to not to eat this! But we have to be careful. We should minimize saturated fat in our diet.

The dreaded trans-fats are artificially produced. They have the properties of saturated fats. They are also known as hydrogenated fats. Hydrogenation is a process where by liquid oils are made more solid i.e. unsaturated fat is processed to become more saturated which helps to increase the shelf life of processed foods.

Trans-fats are found in bakery products (crackers, cookies, and cakes), fried foods (chips, french fries), other commercial snack foods, and margarine made with partially hydrogenated vegetable oil or shortening.

Now, who can resist the temptation of freshly baked cookies and cakes? I guess we have to if we want to stay healthy. Trans-fat is very popular with food manufacturers. They increase the shelf life of their products, and often improves the texture of the food as well. That improves sales and profit margin!

When it comes to trans-fats and saturated fatty acids, the best thing is to eat leaner meats and low-fat dairy products. And avoid commercial foods that contain partially hydrogenated vegetable oil or shortening. Read the labels when you buy cookies, crackers, microwaved popcorn, vegetable shortening and some margarine.

Unsaturated fatty acids help reduce blood cholesterol and Omega-3 reduces the risk of heart disease. Olive, canola and peanut oils, sesame, soy, corn, sunflower oils, non-hydrogenated margarines and nuts and seeds are good. And eat lots of fish – two to three times a week for Omega-3 fatty acids.

Well, I am getting hungry. I wonder if my favorite peanut butter chocolate chip cookie from Tim Horton’s has trans-fats. Well, do I really want to know?

Thought for the week:

“There is one way to be born, but a million and one ways to die.”

-Newsweek.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Walking and My Grandma

Walking is a wonderful exercise. My grandmother started walking five miles a day when she was 60. Now she is 97 years old and we don’t know where the hell she is!

Okay, don’t worry, that is not true. We know where she is. She is somewhere in heaven. Probably looking down and smiling at me and at my silly little joke. And the joke is from one of many e-mails I receive where some jokes are really funny and some are really stupid – I guess stupidity is meant to be funny.

Come to think of it, my grandma did like walking. Quite often there was no choice. We lived in small towns of Musoma and Mwanza on the shores of Lake Victoria in Tanzania. And the best mode of transportation was our legs or bikes. We did not own a car. We walked or biked everywhere.

As a young boy, I remember holding my grandma’s hand helping her walk through the dark alleys and the roads of those small towns. There was no electricity. We used flash light or kerosene lanterns.

Every evening, my grandma would go to a prayer hall to pray and meditate. In fact, we would all go as a family – every single day! And one of us was put in charge of her safety. Those were the days of big extended families where we all looked after each other. There was nothing like nursing homes, group homes or assisted living. We took care of our own.

My grandma was in her 90s when she died. She had a severe case of asthma but she died of old age.

Medicine Hat reminds me of Musoma and Mwanza except it is bigger. But it is small enough to have everything within walking distance. But how many of us walk to work or go shopping?

Of course there are exceptions. Everybody is not lazy like me. There are lots of people who walk or bike to work and go grocery shopping. And there are many people for whom using a vehicle is important – for health and safety reasons.

Walking is not always easy. Changing weather and flu season is a hindrance to establish consistent walking habit. We are so seasonal in everything we do in a year that our brains are frozen in that mentality. And icy roads and side walks are dangerous.

But we do have many good days in Medicine Hat. The majority of the people (including me!) should be able to walk to most of the places. But the problem is we are always in a hurry to get to our destination and then rush back home. We never seem to stop and ask – why am I rushing? Why cannot I take my time and enjoy the walk?

You can walk leisurely 30 minutes a day for general health benefits. You can walk briskly to improve cardiovascular fitness by walking 30 minutes a day five days a week. If you are trying to lose weight then you need to walk briskly for 45 to 60 minutes a day five days a week. And make your dinner slimmer!

So, be like my grandma……… walk, walk, walk and be healthy and happy – you may even go to heaven!

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Thought for the week:

“The longer the explanation, the shorter the attention span.”

– From Images and Reflections by Dennis van Westerborg, a local artist and writer.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!