At age 60, men need both tests

Dear Dr. Gott: I am a 58-year-old male who just moved to another state and now has a new doctor. My former doctor did a digital rectal exam at my yearly physical along with a PSA test. My new doctor does a digital rectal exam only if symptoms appear, such as a difficulty in urinating, or if my PSA reading indicates a problem. I have heard that the digital exam can detect cancer that the PSA test does not. My new doctor is an internist and appears very thorough. Should I be concerned? How important is the digital rectal exam, and is the PSA test good enough by itself?

Dear Reader: Men over the age of 60 should have both the digital rectal exam and a PSA blood test annually. Neither test when used alone is 100 percent reliable, but the combination can help your doctor to discover prostate cancer, should you develop this common condition.

To give you related information, I am sending you a copy of my Health Report “The Prostate Gland.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: I hope you can give me some information and help with my problem. I am 79 and I need to take a diuretic, but all are sulfa-based, and I am allergic to sulfa. I have used Lasix, 40 milligrams a day, but it has caused red spots and itching on my feet and ankles. I have high blood pressure, and my doctor says I need it for that reason.

Dear Reader: You should certainly not use any medication that causes a rash or itching. And you are correct that many of the common diuretics used today can cause reactions in people sensitive to sulfa.

I urge you to follow your physician’s advice (and the advice given by your pharmacist) with respect to which drugs you can use safely.

In my practice, I have had good results from spironolactone, an old-fashioned diuretic that, to my knowledge, is not related to sulfa. In addition to being a satisfactory diuretic to lower high blood pressure, spironolactone (Aldactone) does not lead to excessive excretion of potassium, a vital mineral that can be depleted by the use of standard diuretics. Ask your primary-care physician about this, and let me know how your situation is resolved (or not).

To give you related information, I am sending you a copy of my Health Report “Hypertension.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.