Very Short
Health
By Abby Tallmer
Happy June, Happy Summer, and Happy Father’s Day! Last month this column printed mostly women’s health-related content in honor of Mother’s Day. Now it’s the other half’s turn. June’s “Very Short,” as promised, has a decidedly male-oriented focus as a nod toward fathers and men in general. We are nothing if not true to our word. What follows is a roster of items primarily, if not exclusively, oriented toward our health-conscious male readers.
Making Sense Out of Prostate Test Results
Of all of the health questions middle-aged and older men have to grapple with, one of the most complex is prostate health. What is a prostate test? Who should get one, and at what age? And how on earth can people without medical degrees be expected to understand the results? The New York Times recently tackled all this in a highly informative article, “Deciphering the Results of a Prostate Test,” by Jane Brophy
The now-standard test for prostate health is known as the “PSA Test.” PSA stands for prostate-specific antigen, a substance generated only by the prostate gland and found in sperm. The PSA test, advised for all men 50 and older, measures the nanograms per milliliter of PSA in a man’s blood. The larger a man’s prostate, Brophy notes, the more PSA is produced. Current guidelines recommend that biopsies be conducted in cases where a man’s PSA level reaches beyond 4 and/or if a “significant rise” occurs between any two PSA tests. These biopsies can oftimes presage some form or forms of prostate surgery to further test tissue for malignancy and/or remove any detected non-benign tissue.
However, it’s not quite as simple as all that. The reading of the PSA test is both increasingly controversial and exasperatingly imprecise, according to most professionals in the field of urology. First, there are various factors (inflammation or infection of the prostate, variations in lab assays, the decline in testosterone levels, and the drug finasteride (prescribed for hair loss) that can have impact on PSA measurements. Biological variability alone can result in up to a 15 per cent difference between readings.
What happens after the PSA numbers are in? Right now, standard practice tends to lean to what can be called the better-safe-than-sorry approach, with doctors more often than not opting for biopsy and/or surgery in cases where a man’s PSA level is viewed as abnormal. But according to The Times, “this [better-safe-than-sorry] approach has resulted in many biopsies in men who did not have cancer – about 70 percent of those with elevated PSAs are cancer free – and debilitating prostate surgery in men with cancers that would have never become a threat in their remaining years of life.”
The fact is that, although the PSA test has seemingly helped to significantly lower the rate of mortalities from prostate cancer in the U.S. over the past 15 years, prostate cancer itself is highly variable and the presence of a prostate malignancy is unlikely to prove fatal. Only 1.4 percent of the 15 percent of 50-year-old men who will be diagnosed with prostate cancer within the next 30 years will die within that time. Of American men age 85 and over, fully three-quarters give evidence of prostate cancer; with many of them having lived with the disease for more than ten years. In addition, recent research has found that in nearly 50 percent of men with an abnormal PSA, test results normalize within one to four years without any further treatment.
All this has led the American Urological Association to draft soon-to-be-released revised guidelines regarding prostate health which will, it is hoped, prove more precise and lessen the amount of unnecessary biopsies and surgeries. The new guidelines call for measuring the “PSA velocity,” or rate of variation of PSA levels in an individual over time. The AUA will advise that all men have a test for their baseline PSA velocity level at age 40, and that the test be repeated at age 45 and 50, after which the recommendation is that men have their PSA velocity levels tested annually until age 70. Further, “the new guidelines will lower the PSA level at which a biopsy should be considered,” based in part on results of a recent and important trial which found that 15 percent of men with a PSA level below 4 tested positive for prostate cancer, and that 15 percent of that 15 percent “had high-grade, potentially life-threatening cancers.”
Ms. Brophy’s entire detailed article is worth reading and is obtainable at www.nytimes.com.
Lots of News on Heart Disease
Heart disease, long regarded as a “man’s disease” although it is the leading cause of death for both men and women in the U.S., made headlines quite a number of times this past month. The influx of studies and stories include:
The Pros and Cons of Aspirin
Aspirin, widely prescribed by doctors as a preventive measure, said to lower (but not eliminate or reverse) the risk of heart disease, was the subject of two studies which presented in stark form the medication’s pros and cons. On the one hand, while older research has suggested that one low dose of aspirin per day may not only promote heart health but also help to ward off the onset of Alzheimer’s by as much as 13 percent, recent randomized studies call this claimed Alzheimer’s benefit into question, especially one research which tracked more than 6,000 older women over a 10-year period and found that those who took 100 milligrams of aspirin daily did no better on cognitive tests than those who had been given a placebo on the same schedule.
Also this month, many computer users found themselves greeted by this startling opening to a Yahoo health-news item: “If you think fighting red-hot blazes in collapsing buildings is risky, think again. Swallowing one aspirin each day for a year poses the same risk of death, new research suggests.” The story went on to stress that the gastrointestinal bleeding often caused by regular aspirin usage, and of which many aspirin users are ignorant, is a serious danger that can be life-threatening. It cited a recent study that found the fatality rate among those taking a daily aspirin for 12 months as equal to or greater than the annual mortality rates for firefighters and law-enforcement workers (about 11 per 100,000 persons). “It’s intriguing to think that a person taking aspirin therapy has a reasonable likelihood to prevent a life-ending heart attack, but then may then drive off on a motorcycle without a helmet,” remarked one doctor quoted in the Yahoo item.
Concerned heart patients and others who use aspirin regularly should indeed consult with their doctors about aspirin’s risks versus its benefits. To read more on this matter, go to http://news.yahoo.com.
Heart Attack Death Rates on the Decline
The results of a just-released six-year international study of nearly 45,000 patients in 14 countries who had major heart attacks or perilous partial artery blockages show the fatality rate of heart patients as being cut nearly in half between 1999 and 2005. Study authors at the University of Edinburgh attribute this dramatic fall in death rates to many advances in treatment of heart disease, including the growing use of cholesterol-reducing drugs and blood thinners and angioplasty, a procedure which allows doctors to open previously clogged arteries. Additionally, the study found that heart-attack patients treated within the past few years are far less likely to have another attack within six months of being hospitalized, as compared to heart patients who were treated six years earlier – an indication of the efficacy of the more aggressive heart-treatment methods employed by doctors in recent years. “It’s much more dramatic than we expected, in the course of six years,” says Dr. Keith Fox, cardiology professor and lead author of the study.
“These results are really dramatic, because, in fact, they’re the first time anybody has demonstrated a reduction in the development of new heart failure,” Dr. Fox told the Associated Press. For more information on this groundbreaking project, see the full AP story at:
(The original study first appeared in the Journal of the American Medical Association and can be found at the Website: http://jama.ama-assn.org)
Scientists Find Chromosome Link to Heart Disease
And here are more developments to be filed in the “What do we do about this?” category.
Researchers have established a chromosomal link to heart disease. According to both National Public Radio and the BBC, scientists have identified a genetic flaw that increases the likelihood of heart disease and heart attack among white people.
Researchers in Canada and in the U.S. scanned the genomes of 23,000 human beings, including patients who had suffered a heart attack or those with coronary heart disease. Both teams found a difference in the DNA between those with a propensity toward heart disease and heart attacks and those without such a propensity; specifically, they found a section of DNA — termed “an allele” — on a particular chromosome that is seemingly directly associated with heart disease. This genetic variant, or allele, was found in nearly one of every four white people, and it apparently accounts for as many as one in five heart attacks among the white heart patients in the study. (The stories did not address the question of why only Caucasians were selected as study participants.) Researchers additionally found that participants who carry one copy of this allele have a moderately increased risk of heart disease, but those carrying two copies – 20 to 25 percent of the white people studied – have a 30 to 40 percent higher risk of heart disease than those who carry no copies of the allele.
Researchers hastened to add that the findings, while significant, do not mean that presence or lack of presence of this allele precisely correlates with who gets heart disease and who will be spared. So-called “lifestyle factors,” such as quitting smoking, getting enough exercise, and eating a diet low in fat and high in fiber, still play the largest role in terms of lessening an individual’s likelihood of developing heart disease. Nonetheless, “screening healthy people for this genetic marker could provide information on future risk of heart disease and help identify those individuals who would benefit most from early applications of strategies to reduce heart disease risk” – thus a researcher quoted by the BBC.
For more on the study and its findings, see the BBC story at http://news.bbc.co.uk.
Having Trouble Concentrating? Try Meditation
Since men are constantly being accused by women of being inattentive, some of our more beleaguered and/or eager-to-please male readers may want to consider the following tip: A recent article entitled “Mental Training Affects Distribution of Limited Brain Resources,” appearing in the online edition of PloS Biology, a peer-reviewed, open-access journal published by the Public Library of Science, tells us that three months of rigorous training in and practice of meditation can lead to a major change in the way the human brain allocates attention. It’s the first such study to specifically look at the way in which meditation affects attention quality and span.
The New York Times summarized the complex work this way: “In the study, 17 volunteers with no meditation experience spent three months at the Insight Meditation Society in Barre, Mass., meditating 10 to 12 hours a day. A novice control group meditated for 20 minutes a day over the same period.”
Both groups were then given attentional blink tests with two numbers embedded in a series of letters. As members of both groups looked for the numbers, their brain activity was recorded with electrodes on the scalp.
Everyone could detect the first number, [study lead author Richard Davidson, a professor of psychology and psychiatry at the University of Wisconsin in Madison] said. But the brain recordings showed that the less experienced meditators tended to grasp the first number and hang onto it, so they missed the second number. Those with more experience invested less attention to the first number, as if letting it go. This led to an increased ability to grasp the second number.
The attentional blink was thought to be a fixed property of the nervous system, Dr. Davidson said. “But this study shows that it can change with practice. Attention is a flexible, trainable skill.”
One participant, Daniel Levison, a staff researcher in the psychology department at the University of Wisconsin who meditated for three months as part of the study, described to The Times his own meditative experiences. “I’m a much better listener,” he said. “I don’t get lost in my own personal reaction to what people are saying.”
Who knows? What doesn’t kill you may make you stronger — it may be worth a try. See Plos Biology at http://biology.plosjournals.org for the full report, and www.nytimes.com for the Times’s simplified interpretation of the study.
And on a final Father’s Day note, there’s this:
Dad’s Parenting Style Helps Determine Children’s Obesity
What is Father’s Day for if not to invoke guilt in parents and children alike? On that note, we dutifully report the results of an Australian study of nearly 5,000 children and their parents, which found that the parenting style of fathers – but not mothers – had directly influenced their children’s weights.
“The researchers found that fathers with permissive (no limits on their children) or disengaged parenting styles were more likely to have overweight or obese children, while fathers with a consistent style (clear limits, following through with instructions, etc.) were less likely to have children with a higher-body-mass index. There was no association between the mothers’ parenting styles and children’s weight, said the study authors from the Centre for Community Child Health at the Royal Children’s Hospital, Melbourne, and the Murdoch Children’s Research Institute” (quoted from a Yahoo Health news item on the study, found at http://news.yahoo.com.
Sorry — we couldn’t resist. See you next month, when we will resume our usual practice of exploring items of relevance and interest to both genders (or an equal balance thereof, anyway). Meanwhile have fun, and don’t forget the sunblock!
