DEAR DR. ROACH: I recently had a health scare about my prostate, but fortunately, I was able to get it treated successfully. Because of my close call (I was diagnosed with a moderately aggressive prostate cancer and was apparently cured by surgery), I encourage my male friends to seek medical advice for prostate issues. But one friend seems cynical and reluctant to seek medical advice. Without being too pushy, how do I convince him it’s in his own best interest to see a doctor?
ANSWER: Most women know they need regular screenings for breast and cervical cancer, and I usually have little trouble convincing both men and women to receive 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 the rectal exam has been a cause for many men to avoid prostate cancer screening. (Good news, guys: You don’t need the rectal exam anymore.)
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The PSA blood test is the primary screening modality now, and it is recommended for men from about age 50 to age 75 (family history, other risk factors and other medical issues a man has are taken into account for starting and stopping screening). Most men will have a low PSA level and will be recommended repeat testing every one to two years. Men with an abnormal level, or one that has greatly increased, even if it isn’t yet very high, will be recommended follow-up testing with a urologist. Many of these results will show a benign cause.
However, some men with a high PSA will be diagnosed with prostate cancer, but many cases of prostate cancer found by screening are of the low-risk variety: These are usually observed over time as part of an active surveillance process. This approach minimizes the amount of surgery, radiation and chemotherapy treatment needed to be given. A few men will have what you had: a prostate cancer that is destined to spread, but was caught in time to prevent that. It’s precisely for your situation that we recommend PSA screening.
You are in a position to share that with your reluctant friend, if you are comfortable doing so. A personal story is a powerful motivator. Of course, it’s his decision, but letting him know the test is easy and can lead to a potentially life-extending outcome may motivate him to get care. Hopefully, his doctor can find out why he is reluctant and cynical, and address his concerns.
DEAR DR. ROACH: I understand that flu shots lose their potency over time, so I am wondering if I should wait until I am closer to the peak of flu season before I get my shot?
ANSWER: I’d recommend getting it now, if you haven’t already. It is true that flu shots provide protection that wanes, but they provide pretty good immunity for about six months. The flu season normally starts in December where I practice and lasts until around April or May (humidity has a lot to do with flu seasonality, as does the fact that people tend to be indoors more during the winter). Getting a flu shot now should still provide protection all the way until the end of flu season. I don’t normally recommend getting the flu shot as soon as they come out in August, for just the reason you are concerned about.
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