“Leaves of three, let them be!”

Take precautions to avoid contact with poison ivy plants, but do not worry about “catching” it from someone else.  The oil from the poison ivy plant (urishiol) is indeed contagious, so if it’s still on your clothes or skin, someone who touches it can get the rash, too.  But once the oil is washed off, it is no longer contagious.  No matter how bad your
rash looks, spreads, oozes, or itches, it is not itself contagious.

VITAMINS AND SUPPLEMENTS

Americans spend millions of dollars on vitamins
& supplements each year. However, taking vitamins and supplements is NOT a
substitute for eating a healthy diet. A recent study suggested that patients
who take vitamins (multivitamins, B vitamins, iron and minerals) have a higher
mortality rate than patients who don’t take vitamins. This increased risk
may be related to high doses of vitamins. People who have been diagnosed
vitamin deficiencies, such as vitamin D, vitamin B12 and iron deficiency,
should take supplements as recommended by their doctor. The rest of us should
strive to eat a diet rich in fruits and vegetables and skip the vitamins.

To screen or not to screen?  The United States Preventative Services Task Force (USPSTF) says, “No.”

We all know somebody who has been touched by prostate cancer:  A relative, a friend, perhaps even yourself.  The statistics are a little frightening.  One in six males will develop this disease.  80% of men aged 80 or older have prostate cancer.  It is the second most common cancer and the second leading cause of cancer death in American men.  With such a prevalent disease, in this era of science and technology, isn’t there some way we can predict and prevent the consequences of prostate cancer?

Apparently not.  The USPSTF, an expert panel that reviews the evidence pertaining to preventative tests and treatments, has recommended against screening for prostate cancer in healthy adult males of all ages.  There is good reason for this recommendation but it should be interpreted with a few caveats.

The PSA (a test that reflects the amount of a prostate protein in the bloodstream), usually in combination with a rectal exam of the prostate, is the traditional screening protocol for prostate cancer.  It’s a lousy test.  The vast majority of men with an elevated PSA do not have cancer.  Up to a quarter of men with prostate cancer do not have an elevated PSA.  And in terms of diagnostic accuracy, the rectal exam is even worse.   To make matters more complicated, even if prostate cancer is present, the chances of dying from prostate cancer (as opposed to some other unrelated cause) are very low.  Take a low death rate from a disease and add to that an imperfect screening test and you have to screen 1400
men and diagnose 50 cases of prostate cancer to prevent one prostate cancer death over a 10 year period.

Then there are the physical and psychological ramifications of making the diagnosis of prostate cancer.  If treatment is pursued  -whether it’s surgery, radiation or hormones-  they all have complication rates approaching 30% for symptoms that affect urination, erectile function or bowel function.  If treatment is deferred (the “watchful waiting” approach) then patients are often beset with anxiety associated with harboring an untreated cancer in their bodies.

The problem is that there are men who die from prostate cancer and these deaths are potentially preventable if screening is undertaken.  So how do we reconcile these theoretically preventable deaths with data that show essentially no benefit from
screening?  First, it’s important to understand that the USPSTF’s recommendations are made on imperfect data.  No medical study is flawless and it is possible that the researchers simply didn’t follow the participants for a long enough period of time or were unable to control for patients who were not supposed to be screened but were screened anyway or vice versa.  Second, we need to realize these are guidelines, not mandates.  There are certain individuals who are at higher risk for prostate cancer for whom screening may be appropriate or whose mental mindset is such that not screening
is likely to cause more problems than screening would.  Third, we have to be patient.  Better screening tools and less risky treatment options are continuously under development and evaluation.  It’s only a matter of time before we are able to identify, through accurate and noninvasive testing, those individuals whose lives can be improved through early detection of prostate cancer.

Prostate cancer detection and treatment is clearly a work in progress.  Regardless of guidelines meant to apply to the population at large, we recognize that every patient is different and has different needs.  Our best recommendation is to discuss your options with your physicians at Signature Healthcare.  We’ll help you come to a decision that is right for you.