Archive 2005 2006 2007 2008

Q: Should a man avoid sex before a PSA test for prostate cancer? I was told it can affect the results—or is that a myth?

A: Though studies don’t all agree, several have shown that ejaculation can falsely increase PSA levels, at least in men 50 and older (the age group most screened), thus misleadingly indicating increased cancer risk.

Avoiding sex for 48 hours before a PSA test is thus prudent, says Dr. Jacek Mostwin, a prostate cancer specialist at Johns Hopkins Hospital. "Otherwise you might have to face more testing if the results do come out elevated—and worry in the meantime."

PSA (prostate-specific antigen) is a protein produced in the prostate gland and found at high concentration in semen. The PSA test detects how much is spilling into the blood—there should be very little. Elevated blood levels may be a sign of cancer, but also of an enlarged prostate or a prostate infection. Levels also rise with age.

Not just sex: Some drugs used to treat an enlarged prostate can falsely lower a PSA reading. If you are taking finasteride (Proscar or Propecia, also used to treat hair loss) or dutasteride (Avodart), tell your doctor before having a PSA test. Despite earlier reports, the prostate herb saw palmetto does not appear to affect PSA, however.

Q: I heard about a new FDA-approved laser comb for baldness. Does it work?

A: Maybe, but we’re not convinced. Of the many laser devices on the market, the Hair-Max LaserComb is the only one "cleared" by the FDA for use in men with the most common form of balding. This means it has been deemed safe and that there is some research behind it. But the FDA based its decision largely on unpublished research and on the fact that the technology is similar to that of laser devices already on the market used for other purposes and shown to be safe. Only one study using the comb has been published, and it was small and of questionable quality.

According to the company, most people who use the LaserComb three times a week can expect to see some benefits by 16 weeks. But it’s impossible to judge these claims, since so little research has been published. And it’s hard not to be skeptical because there have been so many scam products promoted over the years for hair loss. On the other hand, some research does suggest that low-level lasers may increase blood supply to hair follicles or help in other ways. If such laser devices work at all, they might be better for early hair loss, or at least may help stop or minimize further loss in some people—just don’t expect miracles.

If you want to try the LaserComb, the biggest drawback is its price. If it doesn’t work, you’ve wasted $395 to $545. It has not been cleared for women or people with dark skin (for lack of research). Like minoxidil (such as Rogaine) and finasteride (Propecia), the only other FDA-sanctioned treatments for hair loss (with limited benefits), the comb must be used indefinitely to maintain any results. How the LaserComb compares to other laser devices promoted for hair loss is anyone’s guess.

Q: What do the grades—Prime, Choice, Select—on beef mean? Is there a health difference?

A: All beef is "inspected for wholesomeness" by the USDA, but grading, an indication of quality, is voluntary. Carcasses are graded by government inspectors at beef packing plants based on the degree of marbling (intramuscular fat) and the animal’s age. The purple USDA shield on the package indicates the grade.

Prime beef, the highest grade, has abundant marbling, making it the most tender, juicy, and flavorful. From a health standpoint, however, it is the least desirable because it is the fattiest. It also costs more, with supplies limited to upscale restaurants and some specialty markets.
Most beef sold in the U.S. is Choice (high-quality with moderate marbling) and Select. Although Select is less juicy and flavorful, it is the leanest, healthiest, and cheapest of the top three grades.

Lower grades are Standard (often sold as "store brand"), Commercial, Utility, Cutter, and Canned (used for ground beef and processed products such as frankfurters), though you’ll rarely see them labeled.

Keep in mind, however, that the fat content depends more on the cut than the grade. While Select has less fat than Choice or Prime beef of the same cut, it may well have more fat than a piece of Choice or Prime of another cut. Top or eye round, London broil, filet mignon, and sirloin tip are among the leanest cuts, while brisket, rib roast, and short ribs are among the fattiest. Whatever the cut or grade, trim all external fat before cooking.

Note: "Prime rib," a beef cut, is not necessarily "Prime" grade.

Q: I take medication to lower my high blood pressure, which is now under control. Are my risks for heart attack and stroke as low as if I never had hypertension?

A: Reducing high blood pressure (hypertension), by whatever means, will lower your chances of developing cardiovascular disease. Studies suggest that lowering blood pressure by even 5 or 6 points substantially reduces the risk of stroke and heart disease.

It’s difficult to say if reducing your blood pressure to normal levels will bring you back to "low risk." If you had uncontrolled hypertension for many years, you would still be at higher risk for cardiovascular disease than someone who always had normal blood pressure. It also depends on how high your blood pressure was and how well you keep it under control.

It’s great that you have lowered your blood pressure—that’s a huge step in protecting your health. Remember, however, that many people with hypertension also have other risk factors for cardiovascular disease, such as high cholesterol. You should discuss these risks with your doctor.

UC Berkeley Wellness Letter, September 2007