Q: My husband is desperately trying to make a decision about whether to do careful watching, get radiation or have surgery for his localized prostate cancer. They caught it early, and we know we can beat it -- if we make the right decision. How do we decide? -- Sheryl W., Lexington, Kentucky
A: I cannot tell you what to do -- you need to rely on your oncologist and get a second opinion to help clarify your options. But I can update you on the latest findings so that you can have an informed discussion with his doctor and find the option that you and your husband feel best about.
A remarkable study just came out in the New England Journal of Medicine that tracked 1,642 men ages 50 to 60 years old who were diagnosed with localized prostate cancer: 545 were given active monitoring, 553 had a prostatectomy, and 545 received radiotherapy. The researchers looked at outcomes for around 15 years and compared results between the three groups.
In the active monitoring group metastases developed in 51 men, long-term androgen deprivation therapy was given to 69 men, clinical progression occurred in 141 men and 17 men died from prostate cancer.
In contrast, in the prostatectomy group metastases developed in 26 men, long-term androgen deprivation therapy was initiated in 40 men, clinical progression occurred in 58 men and 12 men died from prostate cancer.
And in the radiotherapy group, 27 men developed metastases, 42 men had long-term androgen deprivation therapy, clinical progress occurred in 60 men and 16 men died from prostate cancer.
The researchers concluded that the risk of death after 15 years was low for all options -- that's great news. But it means patients need to evaluate the risks and benefits of each and decide what's best for them. To explore the potential risks, go to www.cancer.gov; the Prostate Cancer Foundation at www.pcf.org; and the American Cancer Society at www.cancer.org -- then ask your doc about how to counter them.
Q: I have a stiff neck and can't turn my head easily, and my back and shoulders are starting to hurt. Massage helps, temporarily, as does heat and ice, but it never goes away completely. Could it be something more serious than stress or computer/phone neck? -- Chandra W., Urbana, Illinois
A: Stress and addiction to digital devices are common causes of tech-neck and immobility. It's estimated that Americans spend around five hours a day on their phones and even more time at a computer screen. A 2017 study found a connection between texting and neck and upper back pain. Also, a recent study found that long-term stress, lack of social support, anxiety, and depression "are important risk factors for neck pain."
The pain from stress or from overuse of digital devices can go from acute to chronic if there is a pinched nerve in the neck, arthritis of upper spine or discs, or inflammation that won't fade away.
If you see a spine doctor, you can find out if your discomfort is acute (temporary) or chronic. If it is acute, you may be offered a cervical collar (for short-term use; wearing it for too long causes more problems than it solves), sent to physical therapy (always helpful), or get an injection of a local anesthetic. But if your neck pain has become chronic, then to break that cycle, you may need a combination of pain relievers, heat, massage/physical therapy, and if a disc or other injury or arthritis is the cause, a specific injection. In rare circumstances, surgery may be needed.
However, if your neck pain is accompanied by a fever and headache, pain traveling down one arm, inability to control your neck movements, swollen glands, or lack of control of bladder or bowels, call your doctor pronto or go to the emergency room for blood work, a scan, and a diagnosis. It could indicate an infection, serious nerve damage or even a tumor.
Health pioneer Michael Roizen, M.D., is chief wellness officer emeritus at the Cleveland Clinic and author of four No. 1 New York Times bestsellers. His next book is "The Great Age Reboot: Cracking the Longevity Code for a Younger Tomorrow." Do you have a topic Dr. Mike should cover in a future column? If so, please email [email protected].
King Features Syndicate