Physical prostate exam not always part of annual physical

 DEAR DR. ROACH: I am a 66-year-old male and was a patient of the same doctor for over 30 years. He recently retired. Part of my annual physical for as long as I can remember included a prostate exam. I now have a young, new doctor and at my recent physical, he did not give me a prostate exam. While the exam isn’t something I looked forward to, I’ve always thought that a prostate exam was very important for someone my age. Should I be concerned? — T.A.    

  ANSWER: The prostate exam remains controversial. Even though the prostate exam is no longer recommended by many authorities, I still think you may be right to be concerned.
       Prostate cancer is a common condition affecting men in their 60s (it’s very uncommon below age 50), and becomes even more common in the 70s and older. Prostate cancer is a whole spectrum of illness, ranging from very aggressive cancers that spread rapidly, both locally and to the bones, to very indolent cancers that will never cause problems. In general, younger men are more likely to have the rare, aggressive cancers, and older men are more likely to have more indolent cancers. Unfortunately, that doesn’t always hold.
       Age 66 is a time when prostate cancer is not uncommon, so it is worthwhile discussing screening for cancer, with a PSA blood test (the prostate physical exam probably adds little to the blood test).
       I would have hoped your new doctor would have discussed the benefits and risks of screening, including a discussion on why the manual exam isn’t recommended anymore. You should have heard that the PSA test may find cancer, but much of the time, the cancer has a low risk for progressing, and is watched carefully rather than treated immediately. This is because treatment of low-risk cancer causes more harm than good. It’s natural to want to remove any cancer, but it is neither necessary nor helpful. The goal of prostate cancer screening is to find the unusual case of a high-risk prostate cancer, which is treated aggressively. Although the evidence is mixed, I believe that lives can be saved with screening, and if men receive proper counseling about NOT treating low-risk cancer, unnecessary procedures can be minimized.   

   DEAR DR. ROACH: I have glaucoma and am treated with latanoprost. My progress is checked every three months. My eye pressure varies from 14 to 22. My eyesight is still good. I read quite a bit. I will be 98 tomorrow. Is latanoprost the only help for my situation? — J.K.

       ANSWER: Happy 98th birthday.
       Glaucoma is a disease of the retina. Increased pressure inside the eye is the leading risk factor for developing this condition. If untreated, it can lead to loss of eyesight, especially in the periphery (what we see at the edges of our vision). Most glaucoma is called “open angle” and the cause is unknown. I’m going to assume that’s what you have, since closed angle glaucoma is normally treated with a laser surgery.
       Lowering intraocular pressure (eye pressure) is the goal of treatment, since that has been shown to slow or stop retinal damage. Your range of 14 to 22 is in a range that is the goal for most people.
       I’m not sure why you are interested in changing treatment. Latanoprost is generally well-tolerated with few side effects, and now it is available as a generic for low cost. However, there are several other classes of drops used to treat glaucoma (such as beta blocker drops), and laser surgery is another option.
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       Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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