Dear Dr. Roach: Five years ago, I added five to six minutes of easy yoga, mostly sitting exercises, to my daily exercise routine. My PSA has gone down to the 0.9-1.1 range, from 4.3. This is for someone who has had two prostate biopsies through the years. My doctor now says that the odds of me having prostate cancer are about 1,500 to 1. A few others who have started doing the exercises also have seen their PSA number drop.
A: I have two important comments about your story. The most significant is that there is pretty strong evidence that regular exercise, especially regular vigorous exercise (one study looked at men with at least three hours of vigorous exercise per week), decreases the risk of prostate cancer. The magnitude of the effect varies depending on the study, from 31 percent to almost 70 percent. However, the effect you have seen in your PSA result is much better than usual: In a study on exercisers versus non-exercisers, the PSA dropped by 4 percent in the exercise group (who had other lifestyle interventions as well), compared with an increase of 6 percent in the control group.
However, exercising right before getting your PSA drawn can lead to a spurious elevation in the result. This just has to do with the activity releasing premade PSA: Sexual activity can do this as well.
I'm also concerned that your doctor may have overstated the case somewhat. For men (average age of 65) with a low PSA, the rate of cancer is roughly 1 per 500 men per year. It's certainly lower than those with high PSA, but it's still possible to develop prostate cancer with a low PSA.
I am a big believer in the many beneficial effects of exercise, and reducing cancer risk is one more reason to exercise. Unfortunately, cancer still can happen, even to people who do everything possible to reduce risk.
“Wide pulse pressure” a concern
Dear Dr. Roach: My husband's blood pressure shows a big difference between his systolic and diastolic readings, such as 141/49 and 155/43. His pulse is in the 40s or 50s. Is this OK, or should he go to a doctor? He takes no medicines, is 78 years old and is active.
A: A big difference between the systolic and diastolic numbers is called a "wide pulse pressure" and is commonly the result of stiff blood vessels. When the blood vessels get stiff, often due to calcium in the vessel wall, the normal amount of blood released by the heart causes a higher-than-expected systolic pressure. Since your husband's pulse rate is slow, the blood has a longer time to flow into the smaller blood vessels, lowering the pressure more than expected.
A wide pulse pressure does mean a higher risk of developing heart attack or stroke, so I recommend he visit a doctor. Even though his systolic blood pressure is not very high, he still might benefit from treatment.
The other reason to visit a doctor is that there is a less-common cause of a wide pulse pressure, and that is called "aortic insufficiency." In this case, the aortic valve, which separates the left ventricle from the great blood vessels of the body, leaks. This allows blood to flow backward into the heart, causing a rapid drop in pressure in the blood vessels. But it also makes the heart work extra hard to pump out again the blood that leaked in. Repair of the valve may be necessary. This condition usually can be diagnosed by a careful exam, confirmed by an echocardiogram.