Weight Loss Troubles Otherwise Healthy Prostate Cancer Patient

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.

Malabsorption, especially celiac sprue but many other kinds, usually comes with gastrointestinal symptoms, but not always. Chronic infections like tuberculosis and HIV can hide and need to be looked for. Psychiatric disease, especially depression, often shows up as weight loss. High thyroid levels and diabetes usually have other symptoms.

All that having been said, I still think the change in diet (less red meat, salt, sugar and dairy) absolutely could still be causing the weight to drop further. The fact that you feel well and are exercising makes diet a more likely cause than hidden disease.

Dr. Roach Writes: In a column in August, I wrote that the cause of fecal incontinence often is not found. Many readers wrote to tell me about causes that could be looked for. Celiac sprue headed the list, but other readers mentioned lactose and fructose malabsorption, carcinoid tumor, collagenous colitis, C. diff infection, Giardia infection, sugar alcohols (such as mannitol or sorbitol), too much coffee, bile dumping and bacterial overgrowth.

Some people found relief by making changes in their diet. One approach is an “elimination diet,” removing as many possible causes as you can, then adding them back in one by one (if you have obtained relief). Grains and dairy are the most common culprits.

Some people got relief from medication. Probiotics (healthy bacteria) and prescription bile acid-binding medication (such as cholestyramine) were mentioned by many people. One person suggested physical therapy or Kegel exercises.

A group of people often has more collective wisdom than any of its individual members.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.