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Dear Dr. Roach, Every year, I had a physical exam, which included a prostate exam as well as blood tests with PSA. When my doctor retired, I had trouble finding a new one that I like. It's been three or four years since my prostate was checked, but my new doctor does not do the prostate exams (I'm 63). He says that recent studies do not recommend them and that I have seen a lot of information about the unreliability of the PSA test. How do you know if you have prostate cancer if you do not look for it? My brother-in-law found out that he was 52 years old and that he was treated successfully. I do not really want to wait until I show symptoms and there is no history in my direct family. What do you think about this?
T. D.
Prostate cancer is not really a disease. It can be very aggressive – both with a local invasion and spread quickly to the bones – but it can also be very indolent, hardly getting magnified over the years. Annual prostate cancer screening with PSA is more likely to detect slower-growing cancers because they have been around for a long time. The purpose of screening is to detect aggressive cancers, those that develop rapidly and can go from undetectable to too late.
But one drawback is that screening can lead to unnecessary treatment of more indolent cancers, most of which can be closely monitored and will not require surgery or radiotherapy, at least not for years.
If a man chooses to be screened for prostate cancer, he must understand the benefits (detect prostate cancer early enough to heal) and the risks (treatment of prostate cancer often causes complications, including incontinence and loss of badual function). Not treating low-risk prostate cancer reduces the risks.
The low-risk prostate cancer is defined by a PSA of less than 10, a very small tumor or tumor not palpable or imaging and a low Gleason score, based on the appearance of the tissue for the pathologist.
Six or less is low risk. Most men in this situation do not need immediate treatment. Some men have trouble not treating cancer, but the treatment does not seem to improve the already favorable prognosis. Choosing not to treat is difficult for some men.
Dear Dr. Roach, My partner and I are in our 60s, exercise regularly (three to five times a week), eat well and have average weight. Recently, we played bowling for two games and found ourselves sore in the area just below our bad. We had a lot of pain for several days, which made walking difficult, especially on the stairs. What could have made this region so painful? We named it "bowling tip", lack of medical term.
M. B.
Starting a new activity often leads people to abuse certain muscles that are not used to tension. Bowling involves an extension in strength of the thigh, which is the gluteus maximus muscle, as well as other hip muscles to maintain stability. Two games have been enough to deplete this muscle, and the untrained muscle will often suffer small tears, which take days to heal properly.
The fact that you have trouble with activities involving an extension of the thigh helps to confirm the diagnosis. Some people think that it is lactic acid in the muscle, but it left after a few hours.
Naming an illness is a serious matter, and I looked for similar names in the literature. I found "Wii Butt", a feeling of pain after playing games, including a bowling, on the Wii video game system, but none for the actual bowling. I'm not sure that the "bowling butt" hangs well, though.
Dr. Roach regretted that he could not reply to individual letters, but would incorporate them in the column whenever possible. Readers can e-mail their questions to [email protected]
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