SMOKINCHOICES (and other musings)

December 3, 2012

PSA – Hallucinagenic side-effects

TO YOUR GOOD HEALTH

PSA screening has limited benefits

PAUL G. DONOHUE AND KEITH ROACH

Q: I read your column on prostate cancer. I was surprised that you didn’t discuss the PSA test. My doctor has used this method many times when testing my blood. I’ve heard that, for some people, this isn’t a very accurate test. I am 75. Should I stop having the tests?

A: PSA testing is one of the biggest controversies in medicine.

The data show that prostate-specific antigen testing leads to small (or even no) gains in life expectancy and often to a worsening quality of life because of the treatment for prostate cancer.

Prostate cancer found by PSA testing is usually not the type of cancer that spreads to bones throughout the body. Aggressive prostate cancers are hard to find using PSA testing because they spread quickly. Even yearly PSA tests might be too late to cure the cancer through surgery.

The U.S. Preventive Services Task Force has stated that the expected benefits of screening are outweighed by the risks. Because you are 75, we would strongly recommend against screening.

PSA testing remains valuable in trying to find out why a man is having urinary symptoms — even though, if cancer is discovered, one of the options might be to just “wait and see” because many prostate cancers cause no problems for years.

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, such as erectile dysfunction and incontinence.

Q #1)  The doctors have ably handled this one per the most conclusive, recent findings.  Yet many physicians still cling to standard, accepted procedures, outmoded or not.  To continue this process seems to fly in the face of newer and more perceptive judgement.   The PSA is all but useless for doing what is hoped, for it cannot, nor can the most propitious of judgements be relied on to read the results.  PSA much like the mammograms, are  outmoded.  

Medical costs being what they are, it is about time that decision makers or whoever are clamping down on unnecessary expenses leaving more resources (in limited supply) for truly beneficial procedures.  Jan

Q: Several months ago, my internist prescribed Detrol for some urinary problems. The first time I took it, I had a hallucination of something hovering over me in bed. This frightened me terribly. I immediately stopped the Detrol and notified my internist, who said, “Stop having cocktails.” I had another experience; this time, I thought I saw a young woman.

A: Hallucinations are reported in about 1 percent of people who take Detrol, so the first episode certainly could be related to the prescription. Many medications list hallucinations as a rare side effect, so the internist should not have been flippant. Stopping the Detrol was the right thing to do.

We’re more concerned, however, about the second episode; having one so long after stopping the medication would be quite rare.

There are other causes of visual hallucinations, so you would be wise to speak about them again to the internist or a neurologist.

Drs. Donohue and Roach answer letters only in their North America Syndicate column but provide an order form of available health newsletters. Write them at P.O. Box 536475, Orlando, FL 32853-6475.

Q#2   Well, here we have seemingly a lot of concern about the prescription med “DETROL” and what might be the best thing to do with regard to that.  Personally, I am much more concerned about the man’s urinary tract problem which is not named.  From a no-information perspective, it is difficult to imagine “fixing” something about which nothing is known.    So of course, I would want to know what the problem is in order to deal with it at all.  The usual tests would seem in order – urine, blood.  These reveal what the body has going on.   

Knowing nothing about this person, one can only be somewhat generic, but a dietary cleanup might be the best thing for him – especially if his kidneys are over-burdened, it would be time for a cleanse and/or a trip to a naturopath who tries to deal with ones problem in a more holistic way with (non-injurious) herbs and foods.  You’de be surprised what some Milk-thistle (Silymarin) mixed with Dandelion Root and Burdock root can do to relieve over-burdened kidneys. Lets face it, our kidneys are closely tied in with our Blood Pressure and anything to do with the cardiovascular system.  (not to mention swollen ankles from edema)  So yeah, ya need the blood tests – comprehensive ones which ‘can’ tell the story.   (How can we  know if this is a renal condition of some sort or some kind of STD with out the revealing tests?)

Then you won’t need any meds at all or have nightmares or hallucinations.  . . . .just sayin’. .  .  Jan

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