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Ask Dr. Gott 2/8

Consider all options for prostate cancer

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DEAR DR. GOTT: In early 1997, my enlarged prostate was removed. My PSA was barely detectable in 2001, but in late 2003 it was 0.5, and in early 2005 it was 1.4. Our local radiation oncologist recommended immediate radiation treatments, saying his cure rate indicated 35 percent to 50 percent odds of a cure in my case with less than 5 percent permanent side effects. I consulted an oncology-urology team at Hershey Medical Center and was informed the cure rate was 20 percent with possible side effects of colon damage, incontinence, etc. Whom do I believe? Hormone therapy that won't cure it but might slow the cancer growth was suggested.
    I will be 79 next month. I am in good health and with a history of 90-plus years for ancestry. I raise nearly all of my fruits and vegetables without pesticides and catch all of my fish. I have drastically reduced my animal-fat intake and eat little red meat. I do a lot of rather strenuous physical labor. I am 5 feet 10 inches tall and weigh around 180 pounds.
    I would appreciate your comments on the course of treatment you would recommend and the PSA level at which to begin treatment.
    DEAR READER: The role of PSA in diagnosing prostate cancer is undergoing a revolution. Many specialists believe that the test, if elevated, leads to unnecessary surgery and other therapy. They recommend close follow-up, perhaps with biopsy. Your PSA, although normal, should not be rising year by year following your surgery, so this is a concern.
    You shouldn't consider radiation treatment or hormone therapy without first being tested for prostate cancer. The risk/benefit ratio is unacceptable at this point. You need a thorough urological exam that should include a biopsy of any lumps discovered during the examination.
    If the exam and testing are relatively normal, you may choose to wait and be examined by your doctor every six to 12 months. However, if the testing reveals cancer, you will have to consider aggressive therapy. Your urologist can advise you.

    DEAR DR. GOTT: My doctor said I have a duodenal (peptic) ulcer because the pain radiates from the breastbone to mid-back. I have been taking a proton-pump inhibitor for six weeks and watching everything I eat. Things seem to be getting better, but slowly. I am 59 and wonder how long ulcers last at my age. What causes the bloating, and why does bending over seem to cause pain in that area? The bloating bothers me the most.
    DEAR READER: If you do indeed have a peptic ulcer, your medicine should have relieved your symptoms within days. Because you continue to be bothered by pain and bloating, I believe you need a gastrointestinal X-ray study. If, however, you have had this test, I suggest a consultation with a gastroenterologist. Your symptoms may have another cause, such as gallbladder disease, hiatal hernia, a lung problem or a heart abnormality.
    Let me know how my suggestions work out.

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