Dear Dr. Roach: I am 90 years old and have a history of prostate cancer, which I battled two decades ago with 43 weeks of radiation therapy. Recently, I noticed a slight increase in my PSA level, rising from 0.03 ng/mL to 0.09 ng/mL. My internist has suggested that I undergo a PET scan. Do you think this is necessary?
— H.L.
Dear H.L.: When your PSA level rises after undergoing radiation treatment for prostate cancer, it may indicate that some cancer cells have survived and are beginning to proliferate. The general threshold of concern for PSA levels is 0.2 ng/mL. If your levels continue to rise, you might reach this threshold within one to three years. However, it's also possible that your levels may stabilize or even decrease.
This phenomenon is often referred to as a biochemical recurrence. If your PSA levels are rising quickly, or if your original tumor was particularly aggressive (as determined by the Gleason score), this situation could be more concerning. On the flip side, given that your PSA level remains quite low after 20 years, the likelihood of the prostate cancer becoming significant enough to impact your health dramatically is minimal.
I strongly recommend that you consult with your urologist, who is likely more experienced with these scenarios than an internist. Some urologists may opt for a PET scan once the PSA exceeds 0.2 ng/mL, but I believe it may not be necessary for you at this stage. Much will depend on the PSA level when it's re-evaluated in the next 6 to 12 months.
Dear Dr. Roach: My otherwise healthy wife, aged 65, consumes a significant number of vitamins and dietary supplements daily. Although her doctor has approved this regimen, it seems she is taking far more than a dozen. Do these large amounts of vitamins and supplements actually provide any health benefits? I understand that vitamins are essential, but could such high doses be harmful?
— S.W.
Dear S.W.: Numerous studies have sought to determine whether vitamin and mineral supplementation leads to health benefits in healthy individuals. The consensus from these studies is that, as a group, these supplements have consistently failed to demonstrate any significant improvements in quality or length of life. For this reason, I do not recommend vitamin or mineral supplementation for individuals who are healthy.
While some people may choose to address specific symptoms with dietary supplements, there are only a handful that have been shown to be effective. It appears your wife is taking these supplements with the intention of enhancing her overall health, but I do not believe they are achieving that goal. Generally, serious side effects from vitamins and minerals are uncommon unless the doses are excessively high. However, it is likely that she is wasting money on these products.
Many of my patients find it challenging to discontinue their long-term supplement routines, as they may have been taking them for years or believe strongly in their efficacy. Changing deeply held beliefs about health can be difficult, even in light of new information.
Dear Dr. Roach: I have received two doses of the shingles vaccine. Is this sufficient? Additionally, do I need to get the chickenpox vaccine as well? I cannot recall if I had chickenpox as a child.
— S.R.E.
