In this two-part series, we’ll describe the PSA test — how it’s used, and how doctors perform next steps in the event of an abnormal reading. Our first post addresses PSA screening for prostate cancer. In the second part of our series, we’ll describe how doctors use the PSA test to check the status of a cancer that’s being watched or treated.
All prostate cells make PSA, a protein that helps to dissolve semen so that sperm cells can more easily reach and fertilize an egg. Normal and cancerous cells in the prostate each make PSA in similar amounts. But since cancer cells are leakier, they release more of the protein into the bloodstream.
PSA screening for prostate cancer came into widespread use during the early 1990s. But the test is controversial: prostate cancer grows slowly, and the concern is that PSA screening flags too many low-grade tumors that might not be harmful during a man’s life. Still, studies do suggest that PSA testing, because it can detect cancers at early and more treatable stages, can be lifesaving in some cases.
The US Preventive Services Task Force (USPSTF), an influential volunteer panel of experts in prevention and evidence-based medicine, takes a cautious stance on the matter. The USPSTF advises doctors to discuss the pros and cons of PSA screening in men ages 55 to 69, but also cautions against screening men over the age of 70, and gives no recommendation at all for men under 55.
Some expert groups recommend earlier screening for men in higher-risk groups. Black men, for instance, are about twice as likely to be diagnosed with and die from prostate cancer than white men. The American Cancer Society (ACS) advises PSA screening for Black men at age 45, or even earlier screening for men with first-degree relatives who developed prostate cancer at young ages, as well as for men who test positive for mutations in certain cancer risk genes, such as BRCA1 and BRCA2.
Importantly, activities that put pressure on the prostate gland (such as biking and sex) can cause PSA levels in blood to spike, so you should refrain from these activities for two to three days prior to testing. Health conditions affecting the prostate, such as infections, inflammation (prostatitis), or enlargement of the gland that occurs normally in older men (benign prostatic hyperplasia), can also cause PSA levels to spike in ways that are unrelated to cancer.
In general, PSA levels over 4 nanograms per milliliter (ng/mL) in blood are considered abnormal. But doctors may also vary PSA cutoffs by age. For instance, a PSA of 3.5 ng/mL for a man in his 40s “is definitely abnormal,” says Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases. However, a PSA of 5.5 ng/mL among men in their 60s, Dr. Garnick adds, may not be. It’s best to think of PSA values as being on a continuum, with higher levels associated with having prostate cancer.
PSA testing can sometimes miss a cancer diagnosis altogether. One study found that up to 15% of men with PSA levels under 4 ng/mL actually did have prostate cancer, and a sizeable fraction of these tumors were clinically significant. It’s also possible for high-grade cancer to be present without causing a large increase in PSA. That’s because high-grade cancer cells can lose their ability to actually make the protein.
It used to be that elevated PSA readings were followed routinely by a prostate biopsy, and then treatment if cancer was detected.
Today the paradigm is shifting. An abnormal result is now likely to be followed by a magnetic resonance imaging (MRI) scan, which can identify areas of the prostate gland that look suspicious for cancer. In Europe and some hospitals in the US, men with abnormal PSA readings might avoid an initial biopsy altogether if the MRI results are negative. However, many physicians will still opt for an initial biopsy in such cases, followed by periodic PSA tests and MRI scans to determine if further biopsies are needed.
If the initial biopsy and MRI results are positive, then doctors will perform a targeted biopsy focused on areas where the MRI showed evidence of cancer. If a cancer diagnosis is confirmed, then next steps will be initiated. Today, many low-grade cancers are watched with active surveillance, and treated only if follow-up biopsies and MRI scans show worsening of the disease. Higher-grade cancers will be treated immediately.
"The goal of this risk-adapted approach to screening," Dr. Garnick says, is to “identify clinically significant cancers that actually do need treatment while decreasing diagnoses of clinically insignificant cancers that do not.”
Rather than subject everyone with an elevated PSA reading to a biopsy, some doctors perform additional tests that involve more detailed interpretations of PSA levels.
In the next part of our series, we’ll address how PSA is used as a test for monitoring and managing patients with prostate cancer.
[enclosures] => Array ( ) [categories] => Array ( ) [uid] => 3152603e53d01235b55eeb704a8ce63d1057cbd9 ) [1] => Array ( [uri] => https://www.health.harvard.edu/blog/gratitude-enhances-health-brings-happiness-and-may-even-lengthen-lives-202409113071 [title] => Gratitude enhances health, brings happiness — and may even lengthen lives [timestamp] => 1726005600 [author] => [content] =>Several evenings a week, as Tyler VanderWeele gathers around the dinner table with his wife and two young kids, the family deliberately pauses during the meal to do something simple but profound. Each member shares several things for which they're grateful — an act that VanderWeele, co-director of the Initiative on Health, Spirituality, and Religion at the Harvard T.H. Chan School of Public Health, feels changes his family dynamic for the better.
"I do think it makes a difference and can be a very powerful practice," he says. "Even on those bad days where life seems difficult, that effort is worthwhile."
How can the power of gratitude affect our lives? Recent research has pointed to gratitude's myriad positive health effects, including greater emotional and social well-being, better sleep quality, lower depression risks, and favorable markers of cardiovascular health. Now, new data from the long-term Nurses' Health Study shows that it may extend lives.
"Gratitude has been one of the most widely studied activities contributing to well-being, but we couldn't find a single prior study that looked at its effects on mortality and longevity, much to our surprise," says VanderWeele, co-author of the new research.
Published July 2024 in JAMA Psychiatry, the new study drew on data from 49,275 women enrolled in the Nurses' Health Study. Their average age was 79. In 2016, participants completed a six-item gratitude questionnaire in which they ranked their agreement with statements such as, "I have so much in life to be thankful for," and "If I had to list everything I felt grateful for, it would be a very long list."
Four years later, researchers combed through participants' medical records to determine who had died. There were 4,608 deaths from all causes, as well as from specific causes such as cardiovascular disease, cancer, respiratory diseases, neurodegenerative disease, infection, and injury. Deaths from cardiovascular disease — a top killer of women and men in the United States — were the most common cause.
Participants with gratitude scores in the highest third at the study's start had a 9% lower risk of dying over the following four years than participants who scored in the bottom third. This did not change after controlling for physical health, economic circumstances, and other aspects of mental health and well-being. Gratitude seemed to help protect participants from every cause of death studied — including cardiovascular disease.
But what does this actually mean?
"A 9% reduction in mortality risk is meaningful, but not huge," VanderWeele says. "But what's remarkable about gratitude is that just about anyone can practice it. Anyone can recognize what's around them and express thanks to others for what's good in their life."
While the study couldn't pinpoint why gratitude is associated with longer life, VanderWeele believes several factors may contribute.
"We know that gratitude makes people feel happier. That in itself has a small effect on mortality risk," he says. "Practicing gratitude may also make someone a bit more motivated to take care of their health. Maybe they're more likely to show up for medical appointments or exercise. It may also help with relationships and social support, which we know contribute to health."
The study was observational. This means it can't prove that gratitude helps people live longer — only that an association exists. And the particular sample of people analyzed is both the biggest strength and limitation of the research, VanderWeele says. All were older female nurses with high socioeconomic status. The vast majority were white.
"Does the longevity effect extend to men, to those who are younger, and to those with lower socioeconomic resources?" VanderWeele asks. "Those are all open questions."
On the plus side, he says, the study sample's large size is one of its biggest strengths. So is the extensive data gathered on potential confounding factors such as participants' physical health, social characteristics, and other aspects of psychological well-being.
"Between the quality of the data and the size of the sample, we were able to provide reasonable evidence for this modest longevity effect," he says.
Not feeling especially grateful today? You have the power to change that. Asking yourself certain questions can evoke gratitude, such as
Similarly, a few simple actions can infuse gratitude into your days. Try VanderWeele's family routine of regularly expressing gratitude around the dinner table. Another well-known practice — that's perhaps becoming forgotten in this digital age — is penning thank-you notes.
"I do think writing a thank-you note or gratitude letter gets your mind to dwell on something positive for a longer period, to think more deeply about it, because you have to put it not just in words, but in writing," VanderWeele says. "It also deepens the relationship and builds that bond."
One less-recognized but valuable gratitude practice is called a "savoring exercise," which builds on aspects of mindfulness. All that's required is "pausing, looking around you, and taking in and enjoying everything that's good in your current setting," VanderWeele says. "It's not a big leap to go from recognizing the good to expressing gratitude for what you have."
[enclosures] => Array ( ) [categories] => Array ( ) [uid] => 30e263b98b7020fa1b158855ea1fa39beeae457f ) [2] => Array ( [uri] => https://www.health.harvard.edu/blog/respiratory-health-harms-often-follow-flooding-taking-these-steps-can-help-202211092848 [title] => Respiratory health harms often follow flooding: Taking these steps can help [timestamp] => 1667948400 [author] => [content] =>Heavy rains and sea level rise contribute to major flooding events that are one effect of climate change. Surging water rushing into buildings often causes immediate harms, such as drowning deaths, injuries sustained while seeking shelter or fleeing, and hypothermia after exposure to cold waters with no shelter or heat.
But long after news trucks leave and public attention moves on, flooding continues to affect communities in visible and less visible ways. Among the less visible threats is a higher risk of respiratory health problems like asthma and allergic reactions. Fortunately, you can take steps to minimize or avoid flooding, or to reduce respiratory health risks after flooding occurs.
Flooding may bring water contaminated with toxic chemicals, heavy metals, pesticides, biotoxins, sewage, and water-borne pathogens into buildings. Afterward, some toxic contaminants remain in dried sediments left behind. When disturbed through everyday actions like walking and cleaning, this turns into microscopic airborne dust. Anything in that dried flood sediment — the toxic chemicals, the metals, the biotoxins — is now in the air you breathe into your lungs, potentially affecting your respiratory health.
Buildings needn't be submerged during flooding to spur respiratory problems. Many homes we studied after Hurricane Ida suffered water intrusion through roofs, windows, and ventilation ducts — and some were more than 100 miles away from coastal regions that bore the brunt of the storm.
Another common hazard is mold, a fungal growth that forms and spreads on damp or decaying organic matter. Indoor mold generally grows due to extensive dampness, and signals a problem with water or moisture. Damp materials inside buildings following a flood create perfect conditions for rapid mold growth.
Mold can be found indoors and outdoors in all climates. It spreads by making tiny spores that float through the air to land in other locations. No indoor space is entirely free from mold spores, but exposure to high concentrations is linked with respiratory complications such as asthma, allergic rhinitis, and sinusitis. Thus, flooding affects respiratory health by increasing the risk of exposure to higher concentrations of mold spores outdoors and indoors.
For example, after Hurricane Katrina in New Orleans in 2005, the average outdoor concentration of mold spores in flooded areas was roughly double that of non-flooded areas, and the highest concentrations of mold spores were measured indoors. A study on the aftermath of Hurricane Katrina and the flooding in the UK in 2007 showed that water damage accelerated mold growth and respiratory allergies.
Children are especially vulnerable to health problems triggered by mold. All respiratory symptoms — including asthma, bronchitis, eye irritation, and cough — occurred more often in homes reporting mold or dampness, according to a study on the respiratory health of young children in 30 Canadian communities. Other research demonstrates that mold contributes to development of asthma in children.
Our research in New Orleans, LA after Hurricane Ida in 2021 identified common factors — both in housing and flooding events — with great impact on respiratory health. Preliminary results suggest two deciding factors in whether substantial indoor mold appeared were the age of a building's roof and how many precautionary measures people took after flooding from the hurricane. The impact on respiratory health also varied with flood water height, days per week spent at home, and how many precautionary measures were taken after Ida swept through.
Informed by this and other research, we offer the following tips — some to tackle before flooding or heavy rains, and some to take afterward. While you may not be able to entirely prevent flooding from hurricanes or major storms, taking these and other steps can help.
The Environmental Protection Agency recommends limiting contact with flood water, which may have electrical hazards and hazardous substances, including raw sewage. Additionally:
Taking steps like these — before and after a major storm — goes a long way toward protecting your respiratory health.
Read Flooding Brings Deep Trouble in Harvard Medicine magazine to learn more about the health hazards related to floods.
[enclosures] => Array ( ) [categories] => Array ( ) [uid] => b906fc318a0d1200daa30e41bde1fa6675861b7a ) [3] => Array ( [uri] => https://www.health.harvard.edu/blog/swimming-lessons-save-lives-what-parents-should-know-201806151630 [title] => Swimming lessons save lives: What parents should know [timestamp] => 1719439200 [author] => [content] =>Before going any further, here's the main thing parents should know about swimming lessons: all children should have them.
Every year, over 4,500 people die from drowning in the United States — and, in fact, drowning is the leading cause of death for children ages 1 to 4. Swimming lessons can't prevent all of those deaths, but they can prevent a lot of them. A child doesn't need to be able to swim butterfly or do flip turns, but the ability to get back to the surface, float, tread water, and swim to where they can stand or grab onto something can save a life.
As you think about swimming lessons, it's important to know:
1. Children don't really have the cognitive skills to learn to swim until they are around 4 years old. They need to be able to listen, follow directions, and retain what they've learned, and that's usually around 4 years old, with some kids being ready a little earlier.
2. That said, swim lessons between 1 and 4 years old can be useful. Not only are some kids simply ready earlier, younger children can learn some skills that can be useful if they fall into the water, like getting back to the side of a pool.
3. The pool or beach where children learn must be safe. This sounds obvious, but safety isn't something you can assume; you need to check it out for yourself. The area should be clean and well maintained. There should be lifeguards that aren't involved in teaching (since teachers can't be looking at everyone at all times). There should be something that marks off areas of deeper water, and something to prevent children from getting into those deeper areas. There should be lifesaving and first aid equipment handy, and posted safety rules.
4. The teachers should be trained. Again, this sounds obvious — but it's not always the case. Parents should ask about how teachers are trained and evaluated, and whether it's under the guidelines of an agency such as the Red Cross or the YMCA.
5. The ratio of kids to teachers should be appropriate. Preferably, it should be as low as possible, especially for young children and new swimmers. In those cases, the teacher should be able to have all children within arm's reach and be able to watch the whole group. As children gain skills the group can get a bit bigger, but there should never be more than the teacher can safely supervise.
6. There should be a curriculum and a progression — and children should be placed based on their ability. In general, swim lessons progress from getting used to the water all the way to becoming proficient at different strokes. There should be a clear way that children are assessed, and a clear plan for moving them ahead in their skills.
7. Parents should be able to watch for at least some portion. You should be able to see for yourself what is going on in the class. It's not always useful or helpful for parents to be right there the whole time, as it can be distracting for children, but you should be able to watch at least the beginning and end of a lesson. Many pools have an observation window or deck.
8. Flotation devices should be used thoughtfully. There is a lot of debate about the use of "bubbles" or other flotation devices to help children learn to swim. They can be very helpful with keeping children safe at the beginning, and helping them learn proper positioning and stroke mechanics instead of swimming frantically to stay afloat, but if they are used, the lessons should be designed to gradually decrease any reliance on them.
9. Being scared of the water isn't a reason not to take, or to quit, swimming lessons. It's common and normal to be afraid of the water, and some children are more afraid than others. While you don't want to force a child to do something they are terrified of doing, giving up isn't a good idea either. Start more gradually, with lots of positive reinforcement. The swim teacher should be willing to help.
10. Just because a child can swim doesn't mean he can't drown. Children can get tired, hurt, trapped, snagged, or disoriented. Even strong swimmers can get into trouble. While swimming lessons help save lives, children should always, always be supervised around water, and should wear life jackets for boating and other water sports.
The Centers for Disease Control and Prevention website has helpful information on preventing drowning. The American Red Cross offers an online water safety course for caregivers and parents and water safety videos for children. Many public pools and organizations like Boys & Girls Clubs and the YMCA offer swimming classes for all ages.
[enclosures] => Array ( ) [categories] => Array ( ) [uid] => 627363ad1035c167d3b5460460f4b7c5fc2918e5 ) [4] => Array ( [uri] => https://www.health.harvard.edu/blog/wildfires-how-to-cope-when-smoke-affects-air-quality-and-health-202306232947 [title] => Wildfires: How to cope when smoke affects air quality and health [timestamp] => 1749074400 [author] => [content] =>As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.
Wildfire smoke contributes greatly to poor air quality. Just like pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.
Smoke carried by weather patterns and jet streams can cross state and national boundaries, traveling to distant regions.
The small particles in wildfire smoke –– known as particulate matter, or PM10, PM2.5, PM0.1 –– are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.
The health effects of wildfire smoke include eye and skin irritation, coughing, wheezing, and difficulty breathing. Other possible serious health effects include heart failure, heart attacks, and strokes.
Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.
If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.
If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:
These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:
In the world of nutrients, minerals, vitamins, and supplements, magnesium seems to be having a moment. Perhaps it’s long overdue: in many ways, magnesium has been overlooked, underappreciated, or even forgotten. That may be ending.
But why is magnesium getting so much attention lately? Are claims about its benefits true? Are you getting enough magnesium, or should you join the rising number of people who take magnesium supplements every day? If you have these questions, this post is for you.
Magnesium is a mineral the human body needs to function properly. It’s especially important for a healthy cardiovascular system, nerves, muscles, and bones. It helps regulate the body’s calcium and blood sugar levels, and it’s vital for the body’s production of protein. And that’s just the short list: more than 300 chemical reactions in the body rely, at least in part, on magnesium.
Most of us don’t need to fret over how much magnesium we’re getting. The recommended daily amount of magnesium — 320 milligrams (mg) a day for women and 420 mg a day for men — isn’t difficult to take in through a healthy diet.
But getting extra magnesium is important for people with magnesium deficiency, and those who have complications of pregnancy known as preeclampsia and eclampsia.
More limited evidence suggests that extra magnesium could also be helpful for people with:
There are even studies suggesting that magnesium supplements might help with brain health and smoking cessation.
Many studies of the potential benefits of magnesium are quite small, and some have inconsistent results. Despite the shaky evidence for many claims, this large and expanding list of proposed health benefits is one reason magnesium supplements have been increasingly popular in recent years.
A blood test can measure whether you’re getting enough magnesium. The normal range for blood magnesium is 1.7 to 2.2 milligrams per deciliter (mg/dL).
In general, the body does a great job of regulating the blood levels of magnesium. If levels rise, the kidney dumps excess magnesium into the urine; if levels fall, the kidneys hold onto more magnesium, bones release the mineral into the circulation, and the intestinal absorption of magnesium from the diet increases.
The symptoms of too little magnesium (hypomagnesemia) include nausea, fatigue, and reduced appetite. Of course, these symptoms can be due to many other conditions, such as a stomach bug or medication side effects.
When severe, low magnesium may cause numbness in the arms and legs, muscle cramps, and an abnormal heart rhythm.
Some common causes of magnesium deficiency are:
Studies also suggest that magnesium deficiency is common among adults over age 70. The reasons include low intake of magnesium, poor absorption in the digestive tract, use of certain medicines, and kidney disease.
The symptoms of too much magnesium (hypermagnesemia) include nausea, headache, muscle weakness, and trouble breathing.
Hypermagnesemia is quite rare. Most people with higher-than-normal blood levels of magnesium have kidney failure. Others may be taking too much magnesium in supplements or taking certain medicines (such as magnesium-containing laxatives).
Magnesium-rich foods like green, leafy vegetables (such as spinach), beans, nuts, and whole grains will help you get there. Pumpkin seeds, soy milk, bananas, and dark chocolate (in moderation!) are also good sources.
Eating one serving of spinach, an ounce of almonds, and a banana provides 190 mg of magnesium. That’s nearly 60% of the daily recommendation for women and 45% for men. Fortunately, magnesium is found in many healthy foods, so a good diet (such as the Mediterranean diet) will usually provide all the magnesium that you need.
Unless you have a diagnosed or suspected magnesium deficiency, or a condition with clear evidence of benefit such as preeclampsia or Crohn’s disease, there’s no compelling reason to routinely take a magnesium supplement.
For some conditions, such as insomnia or migraine headaches, a magnesium supplement may be worth a try. But it’s a good idea to run this by your doctor first. All supplements come with a risk of side effects. In the case of magnesium, this includes nausea and diarrhea. Magnesium supplements can also interact with other medicines and supplements you’re taking.
Magnesium found in foods is usually the best choice. When needed, magnesium supplements are available in several different forms, including:
All of these can provide extra magnesium. So the choice mostly comes down the reason you’re taking it, whether you experience side effects, cost, and personal preference.
Daily supplements of less than 350 mg usually are considered safe. But when people have certain health conditions such as kidney disease, it can be tricky to get the right amount of magnesium, and monitoring blood levels is important.
It’s safest to check with your doctor if you’re wondering whether to start taking a magnesium supplement, or unsure which one or how much to take.
Most people are fine without paying too much attention to their magnesium status. If you have concerns about whether you’re getting enough magnesium and whether you should take a supplement, ask your doctor about it. But don’t be surprised if you get some familiar advice: Choose a healthy, well-balanced diet. Your body will take care of the rest.
[enclosures] => Array ( ) [categories] => Array ( ) [uid] => 9e1e44028e3b200e1860f948e0792f40c35efd86 ) [6] => Array ( [uri] => https://www.health.harvard.edu/blog/how-is-metastatic-prostate-cancer-detected-and-treated-in-men-over-70-202505273099 [title] => How is metastatic prostate cancer detected and treated in men over 70? [timestamp] => 1748296800 [author] => [content] =>National guidelines on prostate cancer screening with the PSA test are set by the US Preventive Services Task Force (USPSTF). This independent panel of experts in preventive and primary care recommends against screening for prostate cancer in men older than 70.
Why? Prostate cancer tends to be slow-growing. Men in this age group are more likely to die with the disease rather than from it. And in the view of the USPSTF, survival benefits from treating PSA-detected prostate cancer in older men are unlikely to outweigh the harms of treatment.
Still, that leaves open the possibility that men could be screened for prostate cancer only after their disease has advanced to symptomatic stages. For a perspective on PSA screening and advanced prostate cancer treatment in older men, we spoke with Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases.
Q. How often should men over the age of 70 be screened for prostate cancer?
Such testing is performed outside of guidelines, and generally following a discussion with the patient’s physician. It's not unusual for us to find advanced metastatic prostate cancer in older men flagged by a PSA test. The disease might spread asymptomatically, but some men get a PSA test only after they have advanced prostate cancer symptoms such as trouble urinating, fatigue, or bone pain.
The USPSTF's PSA screening guidelines are long overdue for an update — they were last published in 2018. And with life expectancy increasing overall for men over 70, we are all anxiously awaiting the new guidelines, which are generally updated every six years.
Q. What sort of other tests follow after a positive result with PSA screening?
Typically, a prostate needle biopsy. And I also recommend a digital rectal exam (DRE) to feel for any abnormalities in the prostate gland. President Biden was having urinary symptoms at the time of his PSA test, and he was reported to have had a nodule noted on his DRE. We do not know what his PSA score was.
Recently, we've been moving toward magnetic resonance imaging scans of the prostate that provide more diagnostic information, and can serve as a guide to more precisely identify abnormalities in the prostate gland that we can sample with a biopsy.
Q. How do we know if the cancer is likely to spread aggressively?
The more aggressive tumors have cells with irregular shapes and sizes that can invade into adjoining tissues. A time-honored measure called the Gleason score grades the two most common cancer cell patterns that pathologists see on a biopsy sample.
That system has now undergone some labelling changes. To simplify matters, doctors developed a five-tier grading system that ranks tumors from Grade Group 1 — the least dangerous — to Grade Group 5, which is the most dangerous. These Grade Groups still correlate with Gleason scores. For instance, a Gleason score of 3+3=6 correlates with Grade Group 1 for low-risk prostate cancer, whereas a Gleason score of 4+5=9 for high-risk disease correlates with Grade Group 5.
We can also evaluate how fast cancer cells are dividing — this measure is called mitotic rate — or order genetic tests that provide additional information. We know that men who test positive for inherited BRCA1 and BRCA2 gene mutations are at risk for more aggressive disease, for instance. BRCA test results also have implications for family members, since the same mutations elevate risks for other inherited cancers including breast cancer and ovarian cancer.
Q. How do you know if the cancer is metastasizing?
Traditionally, patients would get a computed tomography scan of the abdomen and pelvis along with a bone scan. These tests look for metastases in the lymph nodes and bones, but they are increasingly outdated. These days, doctors are more likely to scan for a protein called prostate-specific membrane antigen (PSMA) that can be expressed at high levels on tumor cell surfaces.
A PSMA scan is much better at detecting prostate tumors in the body that are still too small to see with other imaging tests. If the scans show evidence of metastatic spread, we classify men as having either high- or low-volume disease depending on the extent. Men with no more than three to five metastases are described as having oligometastatic prostate cancer.
Q. What treatment options are available for metastatic prostate cancer?
We generally don't begin with a single drug. Men with low-volume metastatic prostate cancer typically get doublet therapy, which is a combination of two drugs that each starve tumors of testosterone, a hormone that prostate cancer needs to grow.
One of the drugs, called leoprolide (Lupron), blocks testosterone production. The other drugs are drawn from a class of medications that prevent testosterone from binding to its cell receptor. Those drugs are called androgen receptor pathway inhibitors (ARPIs). They include enzalutamide (Xtandi), daralutamide (Nubeqa), apaludamide (Erleada), or another drug with a slightly different mechanism called abiraterone (Zytiga).
If the cancer progresses on doublet therapy, then we can add chemotherapy to the mix. This is called triplet therapy (Lupron + ARPI + chemotherapy). We may also recommend immediate triplet therapy depending upon the extent of the cancer spread.
Some men are eligible for other treatments as well. For instance, men with PSMA-positive disease (meaning their cells express the protein in high amounts) can be treated with an intravenously-delivered therapy called Lutetium-177. Known as a radioligand, this type of therapy seeks out PSMA-expressing cells and kills them with tiny radioactive particles.
Some men are eligible for metastasis-directed therapy (MTD). In such cases, we treat metastatic deposits with highly focused beams of radiation delivered from outside the body. MTD is generally reserved for patients with oligometastatic prostate cancer.
Q. What happens if a patient is positive on a genetic test for prostate cancer?
That opens up options for so-called targeted therapy — which is a term we use to describe treatments that target specific cell changes that cause tumors to grow. Patients with BRCA1 or BRCA2 mutations, for instance, can start on doublet therapy plus a targeted therapy called a PARP inhibitor. Two PARP inhibitors are approved for prostate cancer in BRCA-positive men: olaparib (Lynparza) and rucaparib (Rubraca). Men with a different gene mutation called microsatellite instability are eligible for a targeted drug called pembrolizumab (Keytruda).
Q. How is the outlook for metastatic prostate cancer changing?
It's improving dramatically! Metastatic prostate cancer used to carry a very poor prognosis. Today, it's not unusual for men to live 10 years or longer with the disease. We're even starting to treat cancer in the prostate directly — something we didn't do in the past since the cancer had already spread beyond the prostate gland. More recent studies have shown improvements from delivering radiation to the prostate gland itself in patients with metastatic cancer. We're including these treatments more often now, which is something we wouldn't have considered before.
Q. Any final notes?
I would advise men to undergo a cardiac evaluation prior to starting on hormonal therapy. Hormonal therapies can exacerbate cardiovascular risk factors, so these should be addressed before and during treatment.
Thanks for your insights!
You're very welcome, glad to help.
[enclosures] => Array ( ) [categories] => Array ( ) [uid] => ffb38eb05513df417444d324e19f5673f26225f4 ) [7] => Array ( [uri] => https://www.health.harvard.edu/blog/emsalmonellaem-is-sneaky-watch-out-202405293044 [title] => Salmonella is sneaky: Watch out [timestamp] => 1746568800 [author] => [content] =>Pop quiz: what is Salmonella? If you've ever had a run-in with this bacteria, you know it can cause a food-borne illness called salmonellosis, a form of food poisoning. But you may not know that Salmonella bacteria sicken an estimated 1.35 million people every year in the United States. What's more, it's the leading cause of hospitalizations and deaths due to food poisoning.
And Salmonella bacteria can be sneaky — not only by triggering unusual complications, but infecting people in startling ways, says Dr. Elizabeth Hohmann, an infectious disease specialist at Massachusetts General Hospital. One patient she treated showed up with an abdominal aortic aneurysm — a dangerous bulge in the lower section of the body's largest artery — that looked infected. Testing revealed a culprit some would find surprising: Salmonella.
"It's just an interesting organism and it can be kind of scary," she says.
Many of the foods Salmonella bacteria lurk in are raw or undercooked. Breaded raw chicken products like nuggets and chicken Kiev are one way it may reach your table. But a variety of foods have been implicated — including organic basil, cantaloupes, ground beef, nut butters, raw cookie dough, eggs, raw or unpasteurized milk, and flour.
Backyard poultry are another source of Salmonella outbreaks. Even small pets such as turtles and frogs, along with dog food, have contributed to multistate outbreaks in recent years.
You can also become infected by handling contaminated food and spreading the bacteria from your hands to your mouth. Additionally, you can spread it to others on your hands or even on your clothes without becoming sick yourself.
"It's a bug that's carried in stool and animal feces and is also present in the environment," Dr. Hohmann says. "So it can set up shop in lots of different inanimate objects, soils, and machinery, especially in moist environments."
Most of the time Salmonella infection leads to gastroenteritis, usually causing just an upset stomach, abdominal cramps, and diarrhea. These symptoms can start as soon as six hours after ingesting the bacteria. Typically, symptoms resolve on their own within two to three days.
Some people have such mild symptoms they're barely noticeable. "The classic case might be a college student who eats a burrito from a sketchy place, gets sick for a couple of days, gets better, and doesn't think anything of it," says Dr. Hohmann.
Sometimes symptoms are more serious, such as severe abdominal cramping and bloody diarrhea, or unexplained high fever and marked fatigue. These symptoms require a call to your doctor.
Most people will get better on their own without any medicines. Replacing lost fluids by sipping water or electrolyte drinks to avoid dehydration will help.
Call a doctor if you have
Treating the infection with medicine comes with an annoying paradox, Dr. Hohmann says. If doctors decide to prescribe antibiotics, the person taking the medicine may shed the organism for longer than if they were never treated. "Then that person may have the opportunity — either through poor personal hygiene, sex, or working as a food worker — to spread it to others," she explains. "It's challenging."
Some people get sicker with salmonellosis than others, with seemingly no rhyme or reason. But certain folks are especially vulnerable to serious infection, including:
A small percentage of those infected can have Salmonella in their blood, which can spread the infection to other parts of the body such as the urinary tract, bones, joints, or central nervous system (brain and spinal fluid).
And, like Dr. Hohmann's patient with the abdominal aortic aneurysm, on rare occasions Salmonella can lead to unusual blood vessel complications in people who already have atherosclerosis, blockage of the arteries caused by plaque buildup.
We all can take steps to avoid the food poisoning, illness, and hospitalizations that Salmonella exposure can cause.
Dr. Hohmann and the CDC suggest these strategies:
Take additional steps to help more vulnerable people stay healthy:
"You hate to make people paranoid, so that we're washing our lettuce leaves with soap, but it's worth thinking about these things, particularly if you have people in your household who are susceptible — which is an increasing number of people," Dr. Hohmann says.
[enclosures] => Array ( ) [categories] => Array ( ) [uid] => 221e5f1400ac26b0aa8d539f06fb5481e555ccc6 ) [8] => Array ( [uri] => https://www.health.harvard.edu/blog/two-jobs-may-lower-the-odds-of-dying-from-alzheimers-disease-but-why-202505063098 [title] => Two jobs may lower the odds of dying from Alzheimer's disease — but why? [timestamp] => 1746482400 [author] => [content] =>Alzheimer's disease (AD) is a devastating disease. Despite decades of research, science has not pinned down causes or discovered highly effective treatments. And while a healthy diet, regular exercise, and other measures can help people slow or avoid AD, we badly need more routes for preventing it.
That's why a new study is so intriguing — and potentially game-changing. Researchers have found that the risk of death due to AD is markedly lower in taxi and ambulance drivers compared with hundreds of other occupations. And the reason could be that these drivers develop structural changes in their brains as they work.
In the past two decades, small studies demonstrated that London taxi drivers tend to have an enlargement in one area of the hippocampus, a part of the brain involved with developing spatial memory. Interestingly, that part of the brain is one area that's commonly damaged by AD.
These observations led to speculation that taxi drivers might be less prone to AD than people with jobs that don't require similar navigation and spatial processing skills.
A recent study explores this possibility by analyzing data from nearly nine million people who died over a three-year period and had occupation information on their death certificates. After accounting for age of death, researchers tallied Alzheimer's-related death rates for more than 443 different jobs. The results were dramatic.
One possible explanation is that jobs requiring frequent real-time spatial and navigational skills change both structure and function in the hippocampus. If these jobs help keep the hippocampus healthy, that could explain why AD-related deaths — but not deaths due to other types of dementia — are lower in taxi and ambulance drivers. It could also explain the older studies that found enlargement in parts of the hippocampus in people with these jobs.
And why aren't bus drivers, pilots, and ship captains similarly protected? The study authors suggest these other jobs involve predetermined routes with less real-time navigational demands. Thus, they may not change the hippocampus as much.
A single research study is rarely definitive, especially an observational study like this one. Observational studies can only identify a relationship — not establish a firm cause — between a protective factor and a condition like AD. There could be other explanations for the findings. For example:
And even if driving a taxi or ambulance could lower your risk of AD-related death, what's the impact of GPS technology now in widespread use? If these jobs now require less navigational demand due to GPS, will the protective effect of these jobs evaporate?
You might wonder if these findings can be applied to anyone who wants to lower their risk of AD. For example, could outdoor treasure-hunting activities that require complex navigational skills, such as orienteering and geocaching, help stave off AD? At least one small study found that orienteering experts had better spatial memory than orienteering novices.
Could puzzles, video games, or even board games designed to build spatial skills reduce the risk of AD? Think Rubik's Cubes and jigsaw puzzles, Minecraft and Tetris, chess and Labyrinth. A round of Battleship, anyone? And if these activities are actually helpful, how often would you need to play?
I look forward to the results of studies exploring these questions. Until then, it's best to rely on experts' recommendations to reduce your risk of AD, including high-quality sleep, diet, and regular exercise.
I find this new research about taxi and ambulance drivers having lower rates of AD-related death fascinating. Considering how often we hear about the risks of certain jobs, it's encouraging to hear about occupations that might actually protect you from disease.
If confirmed by other research, the results of this study could lead to a better understanding of Alzheimer's disease — and, more importantly, how to prevent it.
[enclosures] => Array ( ) [categories] => Array ( ) [uid] => 81ae1743f3778b5be8c5ecb1c0cb30b63799141e ) [9] => Array ( [uri] => https://www.health.harvard.edu/blog/how-and-why-to-fit-more-fiber-and-fermented-food-into-your-meals-202404263036 [title] => How — and why — to fit more fiber and fermented food into your meals [timestamp] => 1714082400 [author] => [content] =>An F may mean failure in school, but the letter earns high marks in your diet. The two biggest dietary Fs — fiber and fermented foods — are top priorities to help maintain healthy digestion, and they potentially offer much more. How can you fit these nutrients into meals? Can this help your overall health as well as gut health?
The gut microbiome is a composed of bacteria, viruses, fungi, and other microorganisms living in the colon (large intestine). What you eat, the air you breathe, where you live, and many other factors affect the makeup of the gut microbiome. Some experts think of it as a hidden organ because it has a role in many important functions of the body — for example, helping the immune system function optimally, reducing chronic inflammation, keeping intestinal cells healthy, and providing some essential micronutrients that may not be included in a regular diet.
Your gut communicates with your brain through pathways in the gut-brain axis. Changes in the gut microbiome have been linked with mood and mental health disorders, such as depression and anxiety. However, it's not yet clear that these changes directly cause these types of problems.
We do know that a healthy diet low in processed foods is key to a healthy gut microbiome. And increasing evidence suggests that fiber and fermented foods can play important parts here.
Fiber's main job is to make digestion smoother by softening and adding bulk to stool, making it pass quickly through the intestines.
But fiber has other benefits for your microbiome and overall health. A high-fiber diet helps keep body weight under control and lowers LDL (bad) cholesterol levels. Research has found that eating enough fiber reduces the risk of heart disease, type 2 diabetes, and some cancers.
There are two types of fiber: insoluble (which helps you feel full and encourages regular bowel movements) and soluble (which helps lower cholesterol and blood sugar). However, recent research suggests people should focus on the total amount of fiber in their diet, rather than type of fiber.
If you're trying to add more foods with fiber to your diet, make sure you ease into new fiber-rich habits and drink plenty of water. Your digestive system must adapt slowly to avoid gas, bloating, diarrhea, and stomach cramps caused by eating too much too soon. Your body will gradually adjust to increasing fiber after a week or so.
The fiber formula is 14 grams for every 1,000 calories consumed. Your specific calorie intake can vary depending on your activity levels.
"But instead of tracking daily fiber, focus on adding more servings of fiber-rich foods to your diet," says Eric Rimm, professor of epidemiology and nutrition at Harvard's T.H. Chan School of Public Health.
Fruits, vegetables, legumes, nuts, seeds, and whole grains are all high in fiber. The Dietary Guidelines for Americans has a comprehensive list of fiber-rich foods and their calorie counts.
What about over-the-counter fiber supplements that come in capsules, powders that you mix with water, and chewable tablets? "If you have trouble eating enough fiber-rich foods, then these occasionally can be used, and there is no evidence they are harmful," says Rimm. "But they should not serve as your primary source of dietary fiber."
Fermented foods contain both prebiotics — ingredients that create healthy changes in the microbiome — and beneficial live bacteria called probiotics. Both prebiotics and probiotics help maintain a healthy gut microbiome.
Besides helping with digestion and absorbing vital nutrients from food, a healthy gut supports your immune system to help fight infections and protect against inflammation. Some research suggests that certain probiotics help relieve symptoms of gut-related conditions like inflammatory bowel disease and irritable bowel syndrome, though not all experts agree with this.
Many foods that are fermented undergo lacto-fermentation, in which natural bacteria feed on the sugar and starch in the food, creating lactic acid. Not only does this process remove simple sugars, it creates various species of good bacteria, such as Lactobacillus or Bifidobacterium. (Keep in mind that some foods undergo steps that remove probiotics and other healthful microbes, as with beer or wine, or make them inactive, like baking and canning.)
The exact amounts and specific strains of bacteria in fermented foods vary depending on how they are made. In addition to probiotics, fermented foods may contain other valuable nutrients like enzymes, B vitamins, and omega-3 fatty acids.
There is no recommended daily allowance for prebiotics or probiotics, so it is impossible to know precisely which fermented foods or quantities are best. The general guideline is to add more to your daily diet.
Fermented foods have a range of tastes and textures because of the particular bacteria they produce during fermentation or that are added to foods. Yogurt is one of the most popular fermented foods (look for the words "live and active cultures" on the label). Still, many options are available if you are not a yogurt fan or want to expand your fermented choices. Kimchi, sauerkraut, kombucha, and pickles are a few examples.
As with fiber, probiotics are also marketed as over-the-counter supplements. However, like all dietary supplements, they do not require FDA approval, so there is no guarantee that the types of bacteria listed on a label can provide the promised benefits — or are even in the bottle. "Therefore, it is best to get your probiotics from fermented foods," says Rimm.
To learn more about the value of fiber, fermented foods, and a healthy gut microbiome, listen to this episode of the Food, We Need to Talk podcast, "Understanding the Microbiome."
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