Doc: How do you find prostate cancer without screening for it?
Dear Dr. Roach: Every year, I used to get a physical, which included a prostate exam as well as blood tests with PSA. When my doctor retired, I had a hard time finding a new one I liked. It has been three or four years since my prostate was checked, but my new doctor doesn’t do the prostate exams (I am 63). He says that recent studies do not recommend them, and I have seen news reports about the unreliability of the PSA test. How do you find out if you have prostate cancer if you don’t look for it? My brother-in-law found out he had it at 52, and it was successfully treated. I don’t really want to wait until I am showing symptoms, and there is no history in my direct family. What do you think about this?
Dear T.D.: Prostate cancer isn’t really one disease. It can be very aggressive — both with local invasion and spreading to bones quickly — but it also can be very indolent, hardly growing at all over years. Yearly prostate cancer screening with PSA is more likely to find the slower-growing cancers, since they are around for a long time. The goal of screening is to find aggressive cancers, the fast-growing ones that can go from undetectable to too-late-to-do-anything-about in a very short time.
But a downside is that screening may lead to unnecessary treatment of the more-indolent cancers, most of which can be carefully monitored and will not need surgery or radiation, at least not for years.
If a man elects to undergo prostate cancer screening, he should understand the benefits (finding prostate cancer early enough it can be cured) and the risks (treatment for prostate cancer causes complications frequently; these can include incontinence and loss of sexual function). Not treating low-risk prostate cancer reduces the risks.
Low-risk prostate cancer is defined by a PSA below 10, a very small or non-detectable tumor by palpation or imaging and a low Gleason score, which is based on how the tissue looks to the pathologist. Six or less is low risk. Most men in this situation do not need immediate treatment. Some men have difficulty NOT treating cancer, but treatment does not appear to improve the already good prognosis. Choosing not to treat is hard for some men.
Dear Dr. Roach: My partner and I are in our 60s, exercise regularly (three to five times per week), eat a well-balanced diet and are of average weight. Recently, we went bowling for two games and found ourselves sore in the area right below our buttocks. We were very sore for several days, making walking difficult, especially up and down stairs. What would have caused this area to get so sore? We named it “bowling butt” for lack of a medical term.
Dear M.B.: Starting a new activity will often cause people to overuse some muscles that aren’t used to the strain. Bowling involves forceful extension of the thigh, which is the gluteus maximus muscle, as well as other muscles in the hip to maintain stability. Two games were enough to exhaust that muscle, and the untrained muscle will often suffer small tears, which take days to heal properly. The fact that you were sore with activities involving thigh extension helps confirm the diagnosis. Some people think it’s lactic acid in the muscle, but that is gone after a few hours.
Naming a disease is serious business, and I did a look for similar names in the literature. I did find “Wii butt,” a pain sensation after playing games, including bowling, on the Wii video game system, but none for actual bowling. I’m not sure “bowling butt” will catch on, however.
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