M
ay
21, 1997 • T he
P ortland O bserver
P agi H?
H e a lth ©Science
Targeting Prostate Cancer Screening
Every year, most middle-aged
American men get a test that can
help detect prostate cancer, the pros­
tate specific antigen (FSA) test.
However, about 70% o f men can
safely be tested every two years in­
stead of annually — saving roughly
$225 million in health care costs
every year, according to Dr. H.
Ballentine Carter, an associate pro­
fessor o f urology at the Johns
Hopkms University School of Medi­
cine in Baltimore, Maryland.
“There is really no rationale to
suggest that yearly testing is more
effective than any other interval,”
he said at an American Medical
Association-sponsored media brief­
ing in New York on Tuesday. “For
the majority o f men between the age
fast growing tumors that can be
deadly.
Currently, it can be difficult to
determine the aggressiveness o f can­
cer, and some prostate cancer treat­
ments carry a risk of serious side
effects, including incontinence and
impotence.
In the new study, Carter and col­
leagues looked at blood samples
from 40 men who eventually devel­
oped prostate cancer and 272 men
who did not develop the cancer.
They found that if the PSA test was
less than 4 ng/ml, and a cancer was
present, the majority of tumors were
very small — about the size of a
pencil eraser — a size “that most
experts believe are potentially un­
important,” said Carter. However, if
of 50 and 70, annual testing is not
necessary, and a testing interval of
two years, rather than annually, will
maintain detection of curable can­
cers.”
To help catch and treat prostate
cancer early, the American Cancer
Society currently recommends that
all men over 40 have a digital rectal
exam annually and a PSA test every
year after age 50.
When blood levels o f PSA in­
crease above 2 nanograms o f pro­
tein per milliliter ofblood (ng/ml), it
can be a sign o f either a benign
enlarged prostate, or prostate can­
cer. And the test has been controver­
sial because it can pick up extremely
small, slow growing cancers that
may never need treatment, as well as
New Hone for Ovarian Cancer
the PSA test was 4 to 5 ng/ml, the
tumors that were detected were cur­
able, but fewer of them were o f the
smaller type that probably don’t need
treatment.
Only one out of three men who
have a PSA over 4 ng/ml — but no
other symptoms or risk factors —
actually have cancer when their pros­
tate is biopsied.
The finding suggests “that a PSA
level o f 4 to 5 (ng/ml) is an accept­
able range for maintaining the de­
tection of curable tumors, at the same
time minimizing the detection of
very small tumors,” he said.
A tumor was considered incur­
able if the men did not have a drop in
PSA after treatment.
The researchers also found that if
at Harvard University in Boston,
according to Reed.
The therapy is so expensive be­
cause patients need to take other
drugs to prevent side effects, such as
problems w ith kidney or bone mar­
row function.
However, only three patients
dropped out of the study because of
such side effects, Reed noted. And
Reed said that there is one impor­
tant thing that women newly diag­
nosed with ovarian cancer can do to
help increase their chances of dis-
ease-free survival: have their sur­
gery performed by either a gyneco­
logic oncologist or a surgical
oncologist.
“When the surgery is done by a
specialist, the ovarian cancer pa­
tient is more likely to have all of the
visible tumor removed during the
course o f the surgery. There are very
specific things that need to be done
during the course of surgery," ex­
plained Reed. "These specialists are
trained to know what to look for and
what to do.”
the Medical Ovarian Cancer Sec­
tion at the National Cancer Institute
in Bethesda, Maryland.
In a new study o f 60 patients with
advanced ovarian cancer— patients
with disease that could not be mostly
removed by surgery — 70% of pa­
tients were disease-free almost two
years after the new treatment.
In general, only 50% o f patients
are disease free 18 to 19 months
after treatment — and that's with a
good initial prognosis.
The women were given a series of
three ovarian cancer drugs — cy­
clophospham ide, paclitaxel and
cisplatin — followed by an injec­
tion o f granulocyte-colony stimu­
lating factor (GCSF), a protein that
helps to protect bone marrow. The
treatment was given once daily for
nine days.
Currently, the experimental treat­
ment is more expensive than stan­
dard therapy, about 50% to 100%
higher than the normal cost of che­
motherapy. And it’s only available
at the National Cancer Institute or
Pain management: the basics
Pain is not only the most common
ymptom that we as humans experi-
:nce, but the one that is most alarm-
ng to patients. Controlling pain has
»ecome a true science, and literally
:very year we improve the way we
:an control pain.
Rheumatologic diseases afford us
i variety o f opportunities to under-
land when we should use which
lrugs to treat joint, bone, tendon,
ind muscle pain as well as non-
ipeciftc pain.
Pain medications (analgesics) can
>e placed into a number of broad
;ategories depending upon how and
■vhere they work. The most com­
monly used analgesic agents are the
anti-inflammatory types. These are
11 ) Non-Steroidal Anti-Inflamma­
tory Drugs (NSAIDs) — commonly
represented by aspirin, ibuprofen and
naprosyn, and (2) Steroidal Anti-
Inflammatory Drugs — the most
common are cortisone, prednisone,
medral, and other cortisone deriva­
tives.
These agents work just as their
name implies — by blocking in­
flammation. Whenever you injure a
body part, whether it be by banging
or twisting it, or h?.ve an infection,
an antibody-antigen reaction, or have
a build-up of muscular tension, there
is an acute inflammatory response.
The inflammation causes redness,
heat, swelling, tenderness, and pain.
The result on the body is acute injury
yet, frequently, there is chronic re­
sidual damage.
The pain that accompanies an
acute injury is due to the processes
associated with the inflammation.
Therefore blocking the inflamma­
tion also blocks the pain. This is a
double bonus since immediate pain
relief is important to the patient and
in the long run, there is less perma­
nent damage This is especially im­
portant for people with arthritic con­
ditions such as rheumatoid arthritis
or gout.
In some arthritic conditions such
as degenerative joint disease (DJD),
I
•
the anti-inflammatory response is
less important since there is only
low grade inflammation; typically,
non-specific analgesics provide ad­
equate relief. Fortunately, many of
the NSAIDs also have non-specific
analgesic effects in addition to their
anti-inflammatory effects (see PAIN
MANAGEMENT magnets)
The side effects of NSAIDs in­
clude:
1. Gastrointestinal (GI) effects
— gastritis and ulcer
2. Anticoagulant effects — thin­
ning of the blood and prevention of
blood clot formation (these can be
beneficial). The major difference
. between aspirin
• • and
I other KIC
NSAIDs
is that aspirin blocks clotting in an
irreversible way whereas the effect
of NSAIDs lasts only as long as the
drug is present in the bloodstream.
3. Hepatic (liver) effects — in­
flammation and/or necrosis can oc­
cur in approximately 15% of pa­
tients. This usually reverses when
the drug is withdrawn.
4. Renal (kidney) effects — salt
and w ater retention leading to edema,
elevated blood pressure, interference
with some blood pressure medica­
tions, and to kidney damage.
million every two years,” said
Carter.
However, he noted that not all
men would get tested, and there are
costs in addition to the test itself—
such as the visit to the doctor to get
the test.
"I would use that estimate as a
very, very rough one at best,” he
said.
The study findings do not apply
to men over 70 or African Ameri­
cans, who were not included in the
study.
Black men are at greater risk of
prostate cancer than whites, and they
may need to begin testing for the
cancer at a younger age — though
studies have not shown that this is
helpful, said Carter.
Coping with stress using Progressive Relaxation
....
... relaxation ¡c is wnnHpr-
rrogressive
a wonder­
ful way to reduce stress and achieve
deep-seated rest. The beauty of this
technique is that it does not cost you a
cent.
Let's begin.
Sit in a comfortable chair. Or. if you
prefer, lie down and follow this proce­
q
Although ovarian cancer ac­
counts for only 4% of all cancer
cases in women, it is one of the most
feared diagnoses. Because the symp­
toms are vague, including stomach
discomfort, gas or a distended abdo­
men, more than 75% o f these can­
cers have spread to other parts of the
body by the time they are detected
— and less than half of women
diagnosed with ovarian cancer sur­
vive for five years or more.
However, an experimental treat­
ment may offer hope to women with
ovarian cancer. The new treatment,
called "dose intensive three-drug
therapy,” combines high doses of
three drugs currently used to treat
ovarian cancer.
The therapy increased survival
in women with a poor prognosis,
reported Dr. Eddie Reed, at an
American Medical Association-
sponsored media briefing in New
York on Tuesday.
"We think this new therapy is
very hopeful and we are particularly
excited about it,” said Reed, chief of
a man’s PSA test was 2 ng/ml or
less, only 1% of those with cancer
reached 4 to 5 ng/ml when tested
two years later.
“For men who have an initial PSA
level o f 2 or less, annual testing
would appear to be unnecessary,”
Carter said.
About 70% of men between the
ages o f 50 and 70 would have a PSA
test that is less than 2 ng/ml, he
noted.
“If you made the assumption that
every man between the age 50 and
70 has a PSA test on an annual basis,
and you make the assumption that
the test costs $25 to $30, if you only
use the cost o f PSA test and no other
cost, eliminating annual testing for
70% o f those men would save $450
.b.rj
dure:
Tighten the muscles in your legs
by stretching them out as far as you can
by lifting them up into the air or by
pressing them into the floor very hard.
Stiffen them. Your objective is to tense
and tighten every muscle in your legs
from the bottom of your feet to your
waist Hold
Hold this
this tightness
tightness for
for five
five s sec­
waist
onds. Then, suddenly and quickly re­
lease the tightness in your legs. Make
them as limp as you can. Drop them
heavily as if they weigh aton. You will
feel a deep surge of relaxation flow
through your legs as stress drains out of
them
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