Dear Dr. Spence,
I have been having problems with urination and I am concerned about prostate cancer. How do I know if I have it?
Signed, Concerned in Marianna
Dear Concerned,
First, prostatic symptoms correlate poorly with disease state. At least fifty percent of men over the age of fifty will have some symptoms of prostatic enlargement, also referred to as BPH (benign prostatic hyperplasia), but few will actually have cancer. Symptoms of BPH include frequent urination (especially at night), dribbling, hesitancy and urgency, and a generally weakened stream. Of course, medications are available to treat this condition.
Prostate cancer screening consists of checking the blood prostate specific antigen (PSA) and performing a digital rectal exam. Neither is particularly sensitive nor specific at detecting cancer. PSA velocity, the rate at which the PSA rises over time, may also be an important clinical indicator in deciding when a biopsy should be considered. At present, there is insufficient evidence to determine whether screening for prostate cancer reduces mortality or impacts quality of life. Only forty percent of patients with an elevated PSA will have cancer but most will have undergone expensive and painful prostatic biopsies. Prostate cancers are also notoriously slow growing. Autopsy data suggests that perhaps greater than 50% of patients older than 85 years of age have prostate cancer. Rarely is this the cause of death, however, What do we do with this information? Prostate cancer still claims an estimated 27,050 lives annually and 1 in 34 men will die from the disease. I generally recommend starting screening around age 50 unless family history warrants earlier testing. Though not a perfect science, it is the best screening tool currently available.
Dear Dr. Spence,
My doctor has sent me to an orthopedic surgeon for carpal tunnel syndrome. Are there any other options besides going under the knife?
Signed, Wrist pain in Sneads
Dear Wrist pain,
Two randomized trials have demonstrated that oral steroids like prednisone can be effective in treating the symptoms of carpal tunnel syndrome (CTS). Perhaps even more efficacious are localized injections at the carpal tunnel itself. I have personally had great success with the latter and have helped many patients prolong or even prevent surgery. The medical literature is divided on the efficacy of night splints, but given the relative lack of overall risk, they remain a reasonable and inexpensive first option if not tried previously.
Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.
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