So, this week I took a helpline call from a 93-year old man,
and he had his PSA taken, I think, back in November and it was four. He knew he had BPH,
and so the doctors I think put him on finasteride, and then a couple — about six months later,
he took his PSA again, and it was 5.9. He went in for a digital rectal exam, clear. Has not had
any sort of biopsy, and the doctor looked at him and said you have prostate cancer—just based off
the elevated PSA. So he calls me freaking out, and then the doctor says, "You're 93 years old,
we're not going to do anything about it." Doesn't give him any sort of education, and he calls me
and goes, "Wait a minute, like do I actually have prostate cancer? There's no pathology. There's no
Gleason. There's no bump on my prostate. Like, what is he thinking?" So, can you tell me maybe
what the doctor's thinking in this situation because to me it was a little surprising even?
Unfortunately, this individual is dealing with a semi-incompetent doctor.
The incidence of people having prostate cancer in their 90s is very high, but we know that
even serious prostate cancers take more than 10 years to make you sick and or kill you. So,
as long as he's satisfied with living to 103, then he doesn't really have anything to worry about.
The behavior of the doctor is sad and inappropriate, and obviously, he's frightened
this man unnecessarily. The word cancer is like a club and when people throw it around without any
expertise they can really cause a lot of harm, and you can see the repercussions in the situation.
So, it's it's unfortunate that not all health care providers are sophisticated and knowledgeable in
what they're doing, and this gentleman just needs reassurance that he can continue checking his
PSA — doesn't need to be concerned about ever getting sick or dying from prostate cancer.
I mean, I know that the percentage likelihood of you possibly having prostate cancer is basically
your age, so is the doctor telling him that because he's 93 and he has a 93%
chance that he has prostate cancer?
Well, we don't know, of course, what's in the doctor's mind or head or his thought process. The
issue really comes down to trying to educate the public about how different prostate cancer is from
other types of cancers, and it's very logical that people would just sort of throw this together
in one basket because we've all been touched by people who have had unfortunate pancreas cancers,
lung cancers, you know, bone cancers that can cause people to expire in
a year it's natural to assume that prostate cancer has that same potential, but it doesn't,
and this is part of the PCRI's calling and mission is to help people understand that
not only are most prostate cancers not life-threatening, that even the ones
that are life-threatening take more than 10 years to cause any health-related problems.
Is zinc good for prostate health? Is there any evidence,
any studies, showing that it actually benefits prostate health overall?
I am not aware of any studies that show that men with prostate cancer should take zinc. The
studies that I've seen suggest that men with prostate cancer should avoid zinc. However,
there are pretty good studies according to expert eye doctors indicating that as people age they may
be able to prevent macular degeneration and things like this with the addition of zinc
and I always say that the eye trumps the prostate. Our vision is so, so valuable, and the evidence
that zinc is deleterious for prostate cancer, really, comes from very old studies in men with
very very advanced prostate cancer, so I see a lot of our patients being advised to take
zinc for ocular reasons and I think that that is fine, but I don't know of any reason that zinc
should be used to help men with prostate cancer or BPH or any other prostate-related issues.
So, our next question is, "Does chemotherapy in any way reduce bone pain
for metastatic prostate cancer patients?"
It certainly does, and patients who come with metastatic progressive prostate cancer
and are experiencing discomfort in their bones typically,
when we initiate chemotherapy, we're not a hundred percent sure it's going to work on everybody.
So, the things we look for are reduction in PSA and a reduction in bone pain,
and the reduction in bone pain in men who are going to respond is usually the first thing
that appears. So, we would look for relief of pain within a week or two as a sign that the
chemotherapy is engaging and is likely to be an effective therapy in that particular individual.
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