Dear doctor. cockroach: I recently had a health fear about my prostate, but fortunately I was able to treat it successfully. Because of my close call (I was diagnosed with moderately aggressive prostate cancer and appears to have been cured with surgery), I encourage my male friends to seek medical advice on prostate problems. But a friend seemed cynical and reluctant to seek medical advice. How can I convince him that it is in his best interest to go to the doctor without being too urgent? – A.m
Answer: Most women know they need regular breast and cervical cancer screenings, and I usually have a hard time convincing men and women to get colon cancer screenings. However, prostate cancer screening has been a controversial topic, and many men don’t want to think about it, let alone act on it. Even a rectal exam has been a reason for many men to avoid prostate cancer screening. (Good news, guys: You don’t need a rectal exam anymore.)
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The PSA blood test is now the primary screening method, and is recommended for men approximately 50 to 75 years old (family history and other risk factors and other medical problems the man considered when starting and stopping screening). Most men will have a low PSA level and it is recommended to retest every one to two years. Men who have an abnormal level, or a level that has increased significantly, even if it is not very high, will recommend a follow-up test with a urologist. Many of these findings will show a benign cause.
However, some men with a high PSA will be diagnosed with prostate cancer, but many prostate cancers detected by screening are of the low-risk type: they are usually noticed over time as part of the active surveillance process. This approach reduces the amount of surgery, radiotherapy, and chemotherapy needed. Few men will get what you had: prostate cancer that is set to spread, but was caught in time to prevent it. We recommend a PSA scan specifically for your situation.
You are in a position to share this with your reluctant friend, if you are comfortable doing so. The personal story is a powerful motivator. Of course, that’s his decision, but telling him the test is easy and could potentially lead to life-prolonging might motivate him to seek care. Hopefully his doctor can figure out why he’s hesitant and cynical, and deal with his concerns.
Dear doctor. cockroach: I understand that flu vaccines lose effectiveness over time, so I’m wondering if I should wait until I’m near the height of flu season before I get vaccinated? – FM
Answer: I recommend getting it now, if you haven’t already. It is true that flu vaccines provide diminished protection, but they provide very good immunity for about six months. Flu season usually starts in December where I train and lasts until about April or May (humidity correlates a lot with flu season, as does the fact that people tend to be indoors more during the winter). Getting a flu shot now should provide protection all the way through to the end of flu season. I don’t usually recommend getting a flu shot as soon as it comes out in August, just for the reason you’re concerned.
Dr. Roach regrets being unable to respond to individual messages, but will include them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu Or send a mail to 628 Virginia Dr., Orlando, FL 32803.
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