Psa May Detect Cancer

GOOD HEALTH Dr. Paul Donohue

October 24, 1998|Dr. Paul Donohue

Dear Dr. Donohue: In 1995, my PSA test was 2.2. In early 1997, it was 3.4. My doctor dismissed this as "fine." However, the increase bothered me. I saw a urologist. My PSA test with him was 4.7. The urologist agreed to do a biopsy. The biopsy showed cancer. I was treated and now, four months later, my PSA is 0.45. My experience may be of interest to your readers. -- M.K.

Dear M.K.: Prostate-specific antigen -- PSA -- is the blood test for prostate-cancer detection. It often presents perplexing dilemmas.

If a PSA level is 4 or less, cancer is unlikely. If the level is 10 or more, the chance of cancer increases. Levels between 4 and 10 are in a no-man's zone, leaving patient and doctor up in the air.

Medicine is seeking to refine the PSA test to aid men in that gray area. One method is the PSA velocity, the rapidity at which a PSA count rises. That's the route you intuitively took. Another refinement of the PSA test is adoption of different norms for men of different ages. Higher values in older men are less suggestive of cancer.

PSA floats in the blood attached to a protein life preserver, called "bound PSA," or swimming all by itself, "free PSA." If 25 percent or more of total PSA is of the "free" variety, the cancer threat greatly diminishes. Many doctors close the book there and do not seek an immediate biopsy.

Dear Dr. Donohue: In '93, I had a pacemaker inserted due to a heart block. Two months later, I had a spot on my forehead checked and was diagnosed as having sarcoidosis. This past year I was diagnosed as having cardiomyopathy. Have you heard of any connection between sarcoidosis and cardiomyopathy? -- E.M.

Dear E.M.: Sarcoidosis is an illness where heaps of cells are deposited in many tissues and organs. Those cell mounds -- granulomas -- are the remains of warrior body cells sent to battle an intruder whose nature remains undiscovered.

Most often sarcoidosis affects lungs, skin, lymph nodes and eyes. Only five times in 100 does it involve the heart. When it does, it can cause heart-muscle malfunction and can block normal heartbeats. Cardiomyopathy embraces a wide spectrum of heart diseases where the primary trouble lies in the heart muscle and not in heart arteries or valves. Sarcoidosis can cause cardiomyopathy and can create a need for a pacemaker


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