Older Men Are Still Being Overtested for Prostate Cancer

A 79-year-old man came to see Dr. Jesse Sammon at the urology clinic at Henry Ford Hospital in Detroit the other day. The patient was referred by his primary care doctor because of a slightly abnormal reading on a screening test for prostate cancer.

“It happens weekly,” Dr. Sammon said, with frustration.

Eight years have passed since the United States Preventive Services Task Force recommended against routine use of PSA screening — a blood test that measures prostate-specific antigen — in men older than 75. In 2012, the task force recommended against all routine PSA testing, regardless of age.

Because most prostate cancer develops slowly, it doesn’t typically threaten survival or cause troubling symptoms for eight to 10 years. Even medical associations that disagree with some of the 2012 conclusions, like the American Urological Association, therefore discourage PSA testing for men with limited life expectancy.

Dr. Sammon’s patient probably won’t survive another decade, according to the standard tables used to predict life expectancy. Heart disease and diabetes — he was taking 10 prescription drugs — reduce his life expectancy further.

Moreover, many conditions besides cancer can produce an elevated PSA reading, including an enlarged prostate — for which this patient was already taking medication.

“The chances of our detecting prostate cancer in this gentleman are so small, and if we did find it, we wouldn’t treat it,” Dr. Sammon said. For low-risk prostate cancer, he pointed out, “the treatment of choice is observation.” Meaning: Watch and wait.

As the medical axiom goes, the man was likely to die with, not of, prostate cancer — if he had it at all. “We counseled him not to have PSA screenings anymore,” Dr. Sammon said.

Yet he wouldn’t be surprised to see the patient again next year, with results from yet another PSA test. “There’s a reasonable chance his physician will order it again, just out of habit,” Dr. Sammon said.

That happens a lot to older men.

After the task force report in 2008, researchers reported virtually no change in screening rates among older men. The guidelines in 2012 had greater impact. “That was really a bombshell,” said Dr. Scott Eggener, a urologic oncologist at the University of Chicago.

Still, his research and other studies published in the past year have found only modest declines, or no significant declines, in the group with perhaps the least to gain and a lot to lose from PSA screening: men older than 75.

■ Dr. Eggener and his colleagues analyzed data from the National Health Interview Survey and found that from 2010 to 2013, the screening rate in that age group fell to 37 percent from about 44 percent, a statistically significant decrease but smaller than the drop for younger men.

Even among men with a high risk of mortality within nine years, almost 38 percent of those older than 75 were screened. The great majority of men being tested in their 80s were also likely to die within nine years.

“That’s just insanity,” said Dr. Eggener, who went on to call such widespread screening “bad medicine, poor use of health care resources and poor decision-making.”

■ In a JAMA article, Dr. Sammon and his fellow researchers, using a somewhat broader sample from the same national database, reported statistically significant declines in PSA screening only in men younger than 75. In the older group, the rate fell to 36 percent from 39 percent from 2010 to 2013, not a significant decrease.

■ Similarly, in 2011, the Department of Veterans Affairs, the largest health care provider for American men, screened 39 percent of men with limited life expectancy — in this case defined as five years or less, based on age and an index of serious diseases.

The 2012 recommendation against all routine PSA screening remains hotly controversial. Critics point out that screening has contributed to a sharp decline in the death rate from prostate cancer in the United States. Indeed, the task force will update its recommendations in a report expected in 2018.

There’s little medical dispute, however, about stopping PSA screening for men unlikely to live more than nine or 10 years because of their age and health. That so many in this category continue to be screened nonetheless — two million men older than 75 in 2013, the Chicago researchers estimated — is cause for considerable dismay.

For starters, the PSA test loses accuracy at older ages. In fact, abnormal results quite often return to normal in subsequent testing.

Yet abnormal results often lead to more invasive testing and then to treatment — surgery or radiation — that can cause life-altering side effects, including incontinence and sexual dysfunction.

“A PSA screen is not just a blood test,” said Dr. Victoria Tang, a research fellow at the University of California, San Francisco, and the lead author of the V.A. study. “It’s signing up for a prostate biopsy if the screening is positive. And that biopsy can cause pain, bleeding, infection.”

The biopsy, taken with a rectal probe, finds cancer in only 30 percent to 40 percent of men with abnormal PSAs, Dr. Eggener said. If it’s a low-risk cancer in a man unlikely to live another 10 years, guidelines advise “watchful waiting” or “active surveillance.”

Sixty percent of all men with low-risk cancer still opt for surgery or radiation, however. “When they hear they have cancer, they want to treat it aggressively,” Dr. Sammon said.

While men, especially older ones, increasingly choose to wait and watch, even those who do must face anxiety and repeated testing.

Why do so many older men start down this road?

In a 2014 study in the journal Cancer, the great majority of patients older than 75 who’d had a PSA test told researchers that their doctors had recommended it.

More than half remembered their doctors explaining the test’s advantages, but only about a quarter recalled discussing its disadvantages.

The kind of doctor influences testing, too. In the V.A. study, veterans with limited life expectancy were more likely to be screened if they had older rather than younger doctors, and attending physicians rather than residents.

Women doctors ordered PSAs less often than men. Only 22 percent of veterans with limited life expectancy were screened if they saw geriatricians. Urologists, by contrast, screened 82 percent.

Perhaps older men trying to avoid overtesting should start shopping for younger female geriatricians. But the more direct approach, of course, would be to ask questions.

What tests will your physician order on those tubes of blood you’ve just provided? Is a PSA screening among them?

For 75-year-olds still running marathons, the test might make sense. For most others, it probably doesn’t.

This Is Exactly What Someone With Bipolar Disorder Needs From A Relationship

“You’re like, bipolar,” my ex-boyfriend once told me. I should have seen it coming. My moods were extreme, and at the good old age of 20, he wasn’t much help in the situation due to his lack of understanding. I would tell him to shut up and say he was rude for saying that. Little did I know that, about six months later, I would also tell him he was right.

Turns out, I have bipolar II disorder. About a year and a half ago, I was diagnosed. And although a lot of things began to make sense, it killed a part of my self-esteem. Like many others with a psychological or mood disorder, I tend to feel shame and embarrassment in the fact. But it is who I am.

Bipolar II is described as “high episodes of euphoria and low episodes of depression, together known as hypomania.” But this is so much more than having a good or bad day here and there, and we are not “crazy.” With the help of my best friends and loved ones, I found the help I needed.

In a relationship, it takes two. I can look back now and realize that. In the grand scheme of things, my ex and I both took part in the failure of our relationship. I couldn’t get over our past, and he never got to know or understand my illness.

When you’re dating someone like me — someone with bipolar disorder  — you have to be ready for a bumpy ride. We are extreme. You’ll never be loved harder or shown more affection in your entire life. We’ll shower you with gifts, love letters and all of your favorite things.

We’ll stay up all night kissing and loving you because you are our ultimate high. You have just shown a person who believes they aren’t lovable that they can, in fact, be loved. You are our saving grace. You are our world, our backbone, our everything. You are what we dreamed of when we were 18 and breaking down on the bathroom floor because another boy just stole another part of us.

You’ll realize our laugh is contagious, and we always want you to feel the extremes with us. We want to take that feeling all the way to the top of a mountain, and we want to feel your heart race with ours. We want you to hold our hand so tightly during take off so we know just how little we are in that big sky.

Our love is extreme; our love is unmatchable. But sometimes, for you, our love is unhealthy. And we know it, too.

Sometimes we sit there in our lonesome, and we become a person a you won’t recognize. Suddenly, we stop taking care of ourselves, and you will notice. We feel so empty, you’ll look at us and wonder what you did wrong. We’ll sit there and tell you that this time it’s not you, and we’ll mean it.

We want you to understand these “bad” moods, aren’t fair to us, either. But it’s a part of who we are, and it’s a part of accepting the person you love. We need you to know that when we have these days, weeks or even months during which our moods are uncontrollably solemn, we just need you nearby. You need to be the voice of reason. We need you to say, “I love you.” We need to hear you tell us our feelings don’t define us, and that you’ll be there to get us through.

The problem here is sometimes we don’t always know what we need. Most of the time, you won’t feel like you’re enough to help solve the issue. You’re not doing anything wrong. The reality of our illness is just that nothing is ever enough. Nothing ever helps. To put it bluntly, that’s why we’re on medication. We have mood stabilizers for the behavioral aspect, and Xanax for the anxiety that comes with being in your own head all the time.

We are so sorry, and we feel so much guilt in the confusion that we cause you. But the problem with this doesn’t always have to do with you, it has to do with the fact that we sometimes don’t address our issues ourselves.

We don’t always say what we need from you. We don’t always explain to you our condition, and because of that, you unfortunately get pushed to the side when we need you the most.

We need you to help us when you see we’re down. Tell us you notice our beautiful soul on our darkest day. Tell us we shine when we’re curled up in our bed unable to talk, touch, kiss, feel you.

But please don’t give up on us if you know our heart is in the right place.

Remote ultrasound robot that give operator sense of touch pioneered by scientists

A remote ultrasound robot that enables the operator to sense touch has been developed by Victoria scientists.

The pioneering technology could dramatically improving access to diagnostics tools for those living in regional and remote parts of the country.

The machine allows medical professionals to remotely conduct abdominal ultrasound procedures on a patient up to 1,000 kilometres away and diagnose a range of conditions including abdominal pain, abnormal liver function and enlarged organs.

While robots are not new to medical practice, what sets this device apart is an advanced haptics - or force feedback system, which gives the operator the sense of touch.

The head of surgery at Barwon Health, Professor David Watters, said it was an important development in the use of robots in healthcare.

"It actually adds to what's currently available with robots, where you can operate remote from the patient, but you don't get any sensory feedback of how hard you are pressing or what the tissues feel like," he said.

"The opportunity to get this sensory feedback means that we will actually be able to do more operations and do them probably better."

Robot could address 'looming health worker shortage'

Professor Watters said the device could help address a looming worldwide shortage of health workers.

"By 2030, we estimate we're going to need another 40 million health workers and we may be 15 to 18 million health workers short," he said.

"The fact that we can get skilled procedures remotely to a patient will be of tremendous advantage to rural and remote communities and also low-income countries and low-middle-income countries that are struggling to train enough health workers to service their populations."

Even in the short term, smaller countries in the Asia-Pacific region which could benefit from the technology.

"They have a lot of islands that are independent nations but only have a small population and therefore they are never going to be able to train all the medical specialists that they need," Prof Watters said.

Built-in protection for patients

The director of Deakin University's Institute for Intelligent Systems Research and Innovation, Professor Saeid Nahavandi, said the world-first trial of the technology had been successfully tested using 4G wireless data links between Melbourne and several regional and rural cities within Australia.

Further tests will be conducted over larger distances before the device is approved for hospitals.

Several different technologies are built in to ensure the patient is never harmed by the robot.

"Our technology measures the amount of discomfort by the patient and at any one time, if the patient is uncomfortable, both information is relayed back to the sonographer or radiographer remotely and they can ease off," Professor Nahavandi said.

"Built-in sensing technology never ever allows the robot to exert more than a certain amount of force onto the patient, so there are several levels of safety built into that system."

New method may preserve fertility during cancer treatment

Researchers have developed a novel method that may help preserve fertility in female cancer patients receiving treatments like radiation and chemotherapy.

“The good news is that more young women are surviving cancer. But many cancer treatments increase the risk of premature ovarian insufficiency (POI) and infertility,” said Ewelina Bolcun-Filas from The Jackson Laboratory in the US.

While assisted reproductive technologies can address infertility, she said, they fail to preserve ovaries’ natural function — which has an important role in women’s health that goes beyond reproduction.

Bolcun-Filas and co-researcher Terri L Woodward from the University of Texas described their novel method in an opinion article published in the journal Cell Press Trends in Cancer.

Many cancer treatments cause DNA damage, not only in cancer cells, but also in normal tissue such as in ovaries. The natural response to this damage is thought to be the elimination of damaged oocytes through apoptosis — or programmed cell death.

Their new method — developed through studies in mice — highlights that targeting proteins involved in apoptosis protects oocytes and prevents infertility in females exposed to radiation. The researchers reviewed findings demonstrating how cancer therapies induce apoptotic death in oocytes and how this knowledge could be applied to design better treatments.

“A better appreciation of oocyte response to radiation and anti-cancer drugs will uncover new targets for the development of specialised therapies to prevent ovarian failure,” the researchers said.

The best foods for weight loss

Besides low-calorie foods we must also choose foods that provide us with weight loss. We opt for those that are high in fiber and water.

Obesity increases the risk of developing coronary problems and strokes; why many people want to lose weight, because they have excess kilos, and while cutting calories is essential for this purpose, it is important to choose the right foods for the diet is effective. There are certain foods that help accelerate weight loss, know them then.

Cucumber

Cucumber has vitamin A, C and K, and minerals such as magnesium, calcium, manganese, phosphorus, copper, iron and zinc. It is ideal for adding to a weight loss plan; it is rich in fiber and low in fat, and especially helps reduce your waist. Add to your salads or eat it with salt and olive oil.

Cucumber juice is ideal for weight loss, because of its high water content; also it provides the necessary electrolytes, restores hydration of body cells and keeps you feeling full longer. Cucumber juice is often used in cleansing the body, being able to drink alone or mixed with other vegetables.

Celery

Celery helps lower cholesterol, and is used as an appetite suppressant because it is very low in calories and rich in fiber. Celery juice is a great anti-inflammatory, and is excellent to help detoxify the body; It has a diuretic effect as it helps eliminate fluids and toxins, and increases intestinal transit.

Detoxifying broth

Prepare a pot with four liters of water, and add a bunch of celery, two apples and two large onions, and simmer everything until ingredients are tender. Strain the liquid and store in the fridge, and have a cup of broth half an hour before each main meal by adding the juice of half a lemon every time. Take three times a day; You can consume this wine, time you want. It is desinflamante and helps you lose accumulated liquids; you will begin to see results after a week.

Oats

Oatmeal is an excellent source of vitamin B1 Tryptophan, selenium, manganese, iron and phosphorus, and; also it contains low-fat protein. Soluble fiber helps you lose weight, because it brings a feeling of fullness for longer. Try to include in your breakfast oatmeal mixed with vegetable or milk with yogurt or kefir.

Lemon

Lemon juice is a rich source of vitamin C, which increases liver function and fat metabolism and increases levels of glutathione, a powerful antioxidant, which makes it slim and detoxify the body more efficiently. Notably, the lemon is a great diuretic, so it is very effective drink lemon juice with warm water fasting, help cleanse your gut, while diuresis and promote weight loss.

Learn more about Weight Loss at TheBlueHealth.com

Bad News, This Doctor Says It’s Totally Possible To Get Pregnant From Anal Sex

Oh sh*t is right. As everyone who’s ever taken a high school sex ed class knows, it’s impossible to get pregnant from having anal sex. Sure, you may die instantly from an STD (if your ex-marine gym teacher is to be believed), but at least you won’t have to worry about having a baby. Right?

WRONG. As Dr. Brian Steixner explained to Men’s Health, it is technically possible for a woman to conceive through anal sex.

Dr. Steixner, now the Director of the Institute of Men’s Health at Jersey Urology Group in Atlantic City, was a mere medical student when he studied a female patient who had a “cloaca.” While a common part of reptile and bird anatomy, in humans a cloaca is a very rare condition in which a woman’s underdeveloped bladder, vagina and rectum open through one chamber.

When this woman came back to the ER clearly pregnant, Dr. Steixner says,

    We knew about her condition, and we had followed her for a decade. After doing a whole bunch of X-rays, we determined that she got pregnant from having anal sex. Was she going to have to poop the baby out? I thought that would be hilarious, but ultimately, the OBGYNs couldn’t figure out a way to effectively deliver the baby through the rectum safely. So she had a C-section.

So, yes, there’s a very, very slim chance a woman could become pregnant through the backdoor. In that case, though, you likely have bigger problems on your hands — like telling your vagina from your rectum. Let’s just be thankful the worst thing we’ll be delivering through our butts is Chipotle.

'Half a million people die due to cancer every year in India'

Half a million people die of cancer annually in the country due to lack of proper mechanism to identify the disease and necessary medical facilities to treat the terminal illness, VK Subburaj, Secretary Department of Pharmaceuticals, said on Tuesday.

Delivering a lecture at CSIR-Indian Institute of Chemical Technology here, Subburaj said there are only 20,000 beds available for treatment of "psychiatric problems" against the requirement of 10 million. "Every year one million cancer cases are identified. Half of them die even before the disease is identified or diagnosed. We should focus (on) developing science and technology that would help reduce cost for the patients," he said.

"Cancer cases and cardiovascular cases are killing our economy (in terms of treatment cost)," he said in his lecture titled "Drugs and Diseases: An Indian Overview".

Subburaj said as many as 25 lakh patients suffering from cardiovascular problems need surgical interventions every year whereas the current infrastructure provides facility for only 2.5 lakh patients. He asked the scientist community to focus more on developing technologies for non-communicable diseases such as diabetes.

According to him, 80 per cent of the district headquarters in the country do not have psychiatrists and there is shortage of two million MBBS doctors as on today.