Dr. Keith Roach: There are pros and cons to prostate screening
Dear Dr. Roach: Your recent discussion on prostate cancer screening appears to bear out my belief that neither statistical evidence nor anecdotal evidence can be ignored in proving or disproving a case for screening.
I am a 93-year-old who is 17 years post-op, having had a radical prostatectomy in 1998. My PSA had been 2.4 for at least a dozen years before it doubled in a year. A biopsy revealed cancer cells and a Gleason score of 5. I decided that I did not want anything malignant in my body, statistics or not.
During the surgery, it was discovered that the seminal vesicles were involved, and the pathology exam upped the Gleason to 9.
Postoperative radiation was prescribed, and I underwent 36 sessions. I did lose sexual function but experienced very little incontinence or other problems, and have been able to enjoy an active and happy life — a very good bargain, I would say.
I have annual examinations, including PSA tests.
Dear A.M.: You are quite right that it is impossible at the individual level to prove the benefit of screening. At the population level, most authorities who have looked at the data dispassionately have concluded that there is no large net benefit nor harm. For this reason, there are conflicting guidelines. The U.S. Preventive Services Task Force has stated that the harms likely outweigh the benefits, and it recommends against screening, but screening remains the choice of the individual, best made with a provider who has reviewed that person’s individual risks and fears. At age 76, you normally would not have been recommended for screening, and since you have thankfully exceeded your life expectancy at that time, it shows another limitation to guidelines on screening.
I have found your experience after receiving the diagnosis of prostate cancer the norm — nobody likes the idea of a cancer inside slowly growing, and even if there might be increased risks of removing it compared with leaving it there, most men want to remove it.
In your case, given the findings in surgery, it does appear that you may have been one of the “lucky” ones who had significant prolongation of life from treatment, and the final vote on whether you made the right decision is yours.
Dear Dr. Roach: I read that microwaving food can cause the food to lose nutritional value or even to become carcinogenic.
Is this true?
Dear S.G.: Not really. Heating food does cause some nutrients, such as vitamin C, to break down. But microwaves don’t do that more than any other cooking method does. In general, the longer a food is kept very hot, the more nutrients are lost. So quick heating keeps in the most nutrients. Quickly steaming is another way. That’s essentially what a microwave does, since it heats water molecules very efficiently, steaming the water contained in food or that you use to rinse it. In fact, microwaving may be better than boiling, since many nutrients can be lost in the water if you just throw it out.
As far as carcinogens (cancer-causing chemicals) go, these are products of very high heat, especially grilling meat. Because microwaves can heat unevenly, some areas of the food can get very hot while others stay cold, which is why it’s best, when microwaving, to cook for a short while and allow the heat to distribute itself before heating further or serving.
Email questions to ToYourGoodHealth@med.cornell.edu.