Dear doctors: I read your column on prostate cancer. I was surprised that you did not discuss the PSA test. My doctor has used this method many times when testing my blood. I have heard that for some, it is not very accurate. I am 75. Should I stop these tests?
W.S.
PSA testing is one of the biggest controversies in medicine now. The data show PSA testing leads to small (or even no) gains in life expectancy, and often leads to worse quality of life, due to the treatment for the prostate cancer.
Unfortunately, prostate cancer found by PSA testing is usually not the kind of cancer that spreads from the prostate to bone throughout the body. Those aggressive kinds of prostate cancer are hard to find using PSA testing, because they spread quickly.
Even if you get PSA tests yearly, it may be too late to cure the cancer through surgery. As medical treatments get better, it becomes less important to find the cancer early.
That's why the U.S. Preventive Services Task Force has stated that the expected benefits of screening are outweighed by the risks. As men get older, benefits tend to decrease and risks increase, so at 75, I would strongly recommend against screening.
It's important to note that "screening" refers to looking for a condition in someone who has no symptoms. PSA testing remains valuable in trying to find out why a man has urinary symptoms, even though, if a cancer is discovered, one option may be to just wait and see, since many prostate cancers mind their own business for years without causing problems.
Anyone with a diagnosis of prostate cancer should see a urologist and perhaps a medical oncologist to discuss options. All treatments for prostate cancer can lead to harm, including erectile dysfunction and incontinence. It's important to think through the options before deciding to act.
Dear doctors: Several months ago, my internist prescribed Detrol for some urinary problems I was having. The first time I took it, I had a hallucination of something hovering over me in bed. It frightened me terribly. I immediately stopped the Detrol and described my experience to the internist. The reply came back: "Stop having cocktails." I had another experience, only this time I thought I saw a young woman. This hallucinating is frightening me. Any suggestions? R.Y.
Hallucinations are reported in about one per cent of people who take Detrol, so the first episode could be related to the medication. Stopping the Detrol was the right thing to do. I am more concerned about the second episode, since it would be rare to have another episode so long after stopping the medication. There are other causes of visual hallucinations. It seems wise to speak again to the internist or a neurologist.
