November 6, 2011                Issue #3

Dear Friends,

     The topic for today’s newsletter is Prostate Cancer. I chose this topic because it’s one that is near and dear to my heart (my father passed away from an aggressive form of prostate cancer at the age of 62) and also because of the recent controversy in the news over the PSA. The controversy isn’t anything new… it’s something that seems to pop up every once in a while when the newsmakers run thin on things to report.

     The prostate is a gland found only in men located at the base of the bladder. It surrounds the urethra and, when enlarged, it can partially obstruct the outflow of urine. Cancer of the prostate gland is a common form of cancer and, according to the American Cancer Society, prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 6 will develop prostate cancer and 1 man in 36 will die of prostate cancer.

     If discovered early, prostate cancer is usually quite amenable to treatment. The type of treatment would depend on the stage of the cancer. It is my goal as a family physician to discover this form of cancer as early as possible as I believe the chances for successful treatment are enhanced by initiating treatment in the early stages.

     What is the best method of discovering prostate cancer in the early stage? It is not prudent to rely on “waiting for symptoms to develop”. Frequently, the patient won’t notice significant symptoms like decreased urination or urinary dribbling until he’s already in the advanced stages, if at all. In fact, oftentimes a patient will come in with back pain (from metastasis of the cancer to the backbone) as the initial physical complaint and will exhibit little or no urinary symptoms. Obviously, if the cancer has spread to the backbone, that patient is already in a higher stage of his cancer.

     So we shouldn’t rely on “waiting for symptoms”. What about the digital prostate (rectal) exam? It is an embarrassing part of a man’s yearly exam, but is it useful and reliable? In my opinion, no. Here’s why: the prostate is a gland about the size of a walnut. When a doctor performs a rectal exam to feel for the prostate, he/she is able to feel the lower pole (approximately 25%) of the gland. If that patient has a cancerous nodule that is located in the upper pole of the prostate, the doctor will never be able to feel it, and the patient will go home with a false sense of security thinking that he doesn’t have anything to worry about. The digital exam is good for telling if the gland has benign enlargement (BPH-Benign Prostatic Hypertrophy), but it will not detect most prostate cancers until they are much much larger (and therefore in a more advanced stage).

     So that leaves us with the only other practical screening test for prostate cancer: the PSA (Prostate Specific Antigen). It is a simple blood test which looks for a protein made by the prostate. If the prostate gland is enlarged or cancerous, it makes more of the protein and will make the blood levels higher. Most experts recommend checking the PSA on all men age 50 and older on a yearly basis. A normal PSA value is 4.0 or lower. A PSA level above 8 usually indicates a cancer is present. A reading between 4 and 8 is in the gray zone… it might be cancer, but it also could be benign enlargement of the gland. Herein lies the controversy. Critics say that a moderately elevated reading causes men to have “unnecessary” testing (i.e. ultrasounds or prostate biopsies, looking for a cancer that may not be there). A prostate biopsy is not an easy procedure to go through and does carry some risk for bleeding and infection. A moderately elevated reading may also cause undue stress and worry upon the patient who now fears he may have a life-threatening illness when it’s really just BPH. Critics also say that just because we may find these cancers early, we may not be saving any lives.

     I won’t deny that the points raised above aren’t possibly valid, but I still believe that the PSA test is a useful screening tool. The PSA has discovered cancer in many men in my practice who have gone on to have successful prostate cancer treatments and are still with us today. I can’t know what would have been in store for these men if they HADN’T received treatment no more than I can know what would have happened if my dad had had a PSA level done yearly (despite having two doctors in the family, my dad chose not to have yearly physicals or routine blood work performed). I still believe, based on my knowledge of medicine and my experience with cancers, that finding this particular form of cancer early (and treating it early) is likely to make a positive difference in the overall prognosis. Therefore I am an advocate of the PSA test and do recommend it yearly for all men age 50 and over. Some may think I’m biased since I have a close family member succumb to prostate cancer, but I can honestly say that I had the same opinion of the benefits of the PSA long before my dad was diagnosed with his cancer.

     If you are a male over 50, especially if you have a family history of prostate cancer, and if you haven’t had your PSA drawn within the last year, I urge you to make an appointment to discuss getting the test done.

PATIENT PORTAL UPDATE:

     A lot of my loyal patients have been asking about the Patient Portal and are excited about gaining access to the Portal as soon as possible. I really appreciate the interest and enthusiasm. I apologize that it’s taken a while to get it up and running. Some of it has been due to ironing out the inevitable computer glitches that occur when setting up a new network. Some of it has been waiting for the software vendor to “turn on” the features and establish the secure linkup that is necessary to minimize the risk of any health information being compromised.

     I had a meeting with the vendor on November 1^st and I am pleased to report that the Portal does appear ready for general use. I hope there will be no major glitches, and, if there are some bumps along the road, I hope you will be understanding and will give me feedback so that I can make sure the portal is serving both yours and my needs. I am confident that it will be a nice tool to facilitate communication between you and me.

     Just a few reminders regarding the Portal:

1. It is NOT intended for emergency communication. If you have an emergency, please call 911 on your telephone rather than posting a message on the Portal.
2. The Portal is NOT monitored 24 hours a day. It allows you 24-hour access to information and allows you to post messages at times that may be more convenient to you, but if you post a message at 3AM, I won’t be seeing it until the next business day.
3. It is not intended to take the place of an office visit. If you have a significant problem, it’s best to make an appointment.
4. What the Portal DOES allow is another avenue of communication: you can use it to ask simple, non-emergent questions, request refills on medications, request appointments, view/print blood test/x-ray results, review your demographic data/medical history data so that you may alert me if there has been a change in your address or if another doctor has stopped or added a medication, etc.
5. It is intended for use with patients who regularly check their emails. If you don’t regularly check your email, please don’t sign up for the service.
6. It is completely voluntary. If you don’t like computers, or worry about your health information being somehow compromised on the Internet, you don’t have to sign up. I respect your right to choose to not participate if you don’t want to.
7. You have to read and sign the Patient Portal Authorization Form. We can’t sign you up until you have read and agreed to the Authorization Form. It can be found online on the “Forms” page at www.parisfamilyphysicians.com. You will soon be able to choose to sign it electronically on my website as well. The website designer has already built the webpages to accomplish signup electronically several months ago, but we currently have them hidden and have a temporary page up right now as we were waiting for the software vendor to complete the Portal hookup. The website designer has indicated to me that they should be able to switch on the appropriate web pages during the week of November 7^th. When this portion of the site is “turned on”, you can sign the authorization form electronically and pay the registration fee online (a one-time $10 registration fee), and then we will sign you up. You will receive an email: usually within 2 business days with your password/sign-in information. I will send out a message to subscribers once the web designers have finalized those changes on the website.
8. There is one aspect of the Portal that is not working how I had envisioned. The software vendor had told me that patients can schedule their own appointments through the Portal and I did advertise that feature on my website previously. However, when I have done test runs with test patients, I have not been able to get it to consistently schedule appointments. Many times, it tells my test patients that there are no appointments available, even though there are. I am hopeful they will work out this bug soon, but while we wait for that, there is an alternative method to accomplish the same goal: You may “request appointments” (as opposed to “schedule appointments”) on the Portal. The “request appointment” feature is working perfectly. If you request an appointment, it will send an electronic message to us and it will be the first thing we look at every morning. Anyone who requests an appointment over the Portal by 8am each weekday will be able to be seen the same day. We will get the message at 8:30 when we come to work and we will call you soon thereafter to give you your appointment time. While the “schedule appointment” bug is being worked out by the software vendor, I am going to “turn off” the “schedule appointment” feature (since it’s not working properly and I don’t want anyone to be frustrated thinking there are no openings when there really are). I will keep the “request appointment” feature turned on, though. I promise that any Portal user who has a problem at 3am and needs to be seen the next day, if you log on to the Portal and “request an appointment” before 8AM, my staff will call you that morning and give you an appointment time, which, in effect, will be the same as being able to schedule your own appointment, just with a slight delay in finding out the exact time for the appointment. I hope this will still be acceptable to everyone. I did want to let everyone know before anyone signs up so there are no misconceptions about it since previous advertisements I made on my website did state you would be able to schedule your own appointments.
9. Another thing everyone should keep in mind: I’ve only been open for barely over a month. At first, there may not be much data for you to review. If I have your old records I am happy to post your old blood tests and x-rays for you if you request it. However, any new x-rays/blood tests from the moment you sign up for the Portal will be posted automatically as we go forward.

     If you have read and understand these simple reminders and are ready to sign up for the portal, we are ready to sign you up. You will soon be able to do it all electronically at www.parisfamilyphysicians.com or you can do it now in person at the office. Please give me feedback on your experience with the Portal as well as the Newsletter itself. If you have a health topic you’d like to learn more about and think it would pertain to a large number of patients, let me know and I’ll consider it for a future issue. Thank you. I look forward to serving the health needs of you and your family.

                                                                        Sincerely,

                                                                        Jeffrey Green, MD