Dear Dr. Roach: I had a biopsy done, and several samples showed prostate cancer. A PET scan showed no other cancer. My doctor is uneasy about removal or treatment because of my age (80 years old). Otherwise, I am in excellent health. What treatment, if any, should I have?
R.B.
Prostate cancer really isn’t one disease. There’s a large spectrum of aggressiveness. Highly aggressive cancers can spread locally or to distant sites very early on in the course of disease, while much more slow-growing cancers are unlikely to ever grow enough to become a problem in a person’s lifetime. As a general rule, younger people are more likely to have aggressive cancers, but this isn’t always the case.
The goal of prostate cancer screening is to find cancers that are “just right.” They are aggressive enough to grow and spread, but there’s still enough of a chance to find the cancer before it’s too late. This generally includes men who are between the ages of 50-75. (Some men at a high risk should begin at age 45.)
In men over 75, most of the cancers are so slow-growing that screening for prostate cancer doesn’t make a lot of sense. Prostate cancer surgery causes harm, with erectile dysfunction and incontinence being common (and even a small risk of death). Screening begins to have a net benefit after about 10 or 15 years.
I recommend surgery only if this were a higher-risk cancer based on the pathology of the tumour, the level of your PSA, the size of the tumour through a scan, and possibly the genetic characteristics of the tumour. Most men at your age do not benefit from treatment of a more indolent cancer, and it is usually far better to keep an eye on the cancer by repeat blood testing and scans.
When you speak to the urologist again, you want to have a clear idea of whether this is a more aggressive cancer or one of the more common, slow-growing kind that will likely never cause you any symptoms.
Dear Dr. Roach: About six years ago, it was thought that I might have had a mild transient ischemic attack (TIA). No damage to my brain tissue was discovered, and I’ve been taking 12.5 mg of metoprolol (a half-dose because of its side- effects) and 20 mg of atorvastatin ever since.
Should I be monitoring this part of my health with an occasional visit to a specialist (a neurologist or cardiologist?) or through special tests? Nothing further was suggested, but strokes and heart attacks run on my mother’s side of the family. I am 77.
H.S.
A TIA has symptoms similar to a stroke, but the symptoms are temporary. No death of brain cells occurs. However, a person with a TIA is at a higher risk for a stroke, so careful control of any stroke risk factors is important to reduce the likelihood of a stroke.
Among the most important risk factors are blood pressure and cholesterol. Metoprolol is not the common first-line treatment for blood pressure, so I wonder why it was chosen. But if your blood pressure isn’t under ideal control (less than 120 mm Hg systolic and less than 80 mm Hg diastolic), then that’s the critical issue. Blood pressure should be checked frequently. Atorvastatin is a powerful medicine, so cholesterol usually doesn’t need to be rechecked as often.
Your regular doctor can check on these and any other risk factors you may have (such as smoking and diabetes). You should consult with a neurologist as well.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
