Prostate cancer test has both good and bad points
DEAR DR. DONOHUE: I am a gentleman going on 80. I have been biopsied three times in the past 10 years for an elevated PSA. Four months ago it shot up to 10.5, and I had biopsies and ultrasounds, all of which were normal. With all we hear of the importance of PSA, it seems not to matter in my case. Should I go back for another test, as I was advised to? -- D.C.
ANSWER: PSA -- prostate-specific antigen -- is a blood test used to detect prostate cancer. It is a test of mixed blessings.
Most labs accept a value between 4 and 10 as being a gray zone. To take the grayness out of the zone, doctors recommend a biopsy of the gland. Only about 20 percent of those whose PSA values lie between 4 and 10 turn out to have cancer.
PSA is not a perfect test. It is, however, about the best that medicine can offer right now.
A modification of the test can make it more accurate. That test measures free and bound PSA. Bound PSA is glued to blood proteins. Free PSA floats in the blood all by itself. If the percentage of free PSA is greater than 25 percent of the total PSA, the chances of a cancer diminish.
The free PSA test has been approved by the Food and Drug Administration, and it is being used with greater frequency. It might help you out of your dilemma.
Definitely have your PSA level checked again. If an error is to be made when it comes to cancer, it should be made on the conservative side.
DEAR DR. DONOHUE: Many of our friends have shingles. I know that if you have had chickenpox, the virus lies dormant and causes shingles later in life.
Now I hear that shingles is extremely contagious and that it can cause death in the elderly. Others say it is not at all contagious unless you have not had chickenpox. What are the facts? How can one prevent having shingles? -- C.W.
ANSWER: Chickenpox is a highly contagious disease. Few adults have passed through childhood without having an encounter with the chickenpox virus. Some, however, might not have blossomed with the typical chickenpox rash and symptoms, so they believe they and the chickenpox virus are strangers.
You are correct. The virus remains in the body for life once it enters -- rash or no rash. It invades nerve cells and stays there till it is reawakened. In some people, it will remain dormant. When it wakes from its sleep, it travels down nerve cells to produce the shingles rash and pain. Rarely, if ever, does it cause death.
If an adult has never had any encounter with the chickenpox virus, that adult can catch chickenpox (not shingles) if exposed to the fluid in the shingles rash. That is not at all common.
Children who have never had chickenpox and who are picked up by adults having shingles are more likely than adults to come down with chickenpox -- not shingles.
Prevention of shingles hinges on prevention of chickenpox. When today's vaccinated children reach adulthood, the hope is that they will never have shingles. Time will tell.
Work is going on to test the chickenpox vaccine in adults to see if it will prevent them from developing shingles. The vaccine induces a production of antibodies against the chickenpox/shingles virus, so it might keep a dormant virus in an adult in the dormant state. If the virus does waken and leave its sanctuary, the boost in antibodies could inactivate it. Again, only time will tell.
The new shingles pamphlet presents all the details on that common scourge of older people. To obtain a copy, write to: Dr. Donohue -- No. 1201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 along with the recipient's printed name and address. Please allow 4-6 weeks for delivery.
DEAR DR. DONOHUE: I have genital herpes. I am having LASIK eye surgery. I assume I am OK to go ahead with the surgery. -- G.N.
ANSWER: If you don't touch the infected site and then touch your eyes, you will have no trouble.
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Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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