Dear Dr. Roach: I am a 65-year-old man. Two years ago, I was diagnosed with medium-grade prostate cancer. I read hundreds of articles as well as numerous studies relating to the effectiveness of treatment. However, it became obvious to me that the odds of any type of treatment curing prostate cancer is virtually zero, so I have chosen to do nothing.
Aside from the knowledge that I have cancer, my health is good, with one exception. I have lost 20 pounds in two years. Blood tests from two doctors have shown nothing, and I am told there is nothing more that can be done. I also was told that prostate cancer is highly unlikely to cause weight loss, so the cause must be something else. I exercise and feel generally good, none of which has changed in the past 10 years. I do eat less sugar, red meat, salt and dairy since my diagnosis. But I no longer believe that the diet is responsible for my weight loss, which is continuing. Can you please suggest other tests to try to diagnose my problem? — J.U.
Answer: John Ultmann, one of my oncology professors, told me that when someone with cancer has a new problem, you should first check if the cancer is causing it, then if the treatment for the cancer is causing it, before thinking about other causes.
The PSA test was intended to be used to follow the course of the disease, and it is pretty good at correlating with the amount of disease. Sometimes more-sophisticated tests, such as bone scans or CT scans, are needed to look for spread. However, since two doctors have said that the prostate cancer is not likely the cause of the weight loss, let’s think about the other options.
Chemotherapy, surgery and radiation all have their complications — but you didn’t take any of these. So what causes significant weight loss in a 65-year-old? Cancer is a possibility, and it is certainly possible to have more than one at the same time, so I would make sure your other cancer screenings, especially colonoscopy, are up-to-date.