DEAR DR. ROACH: I am 90 years old. About 20 years ago, I had prostate cancer and went through 43 weeks of radiation. My PSA level in the past year has risen slightly from .03 ng/mL to .09 ng/mL. My internist has suggested that I get a PET scan. Do you think this is necessary? -- H.L.

ANSWER: When the PSA level rises after radiation treatment for prostate cancer, there could be some prostate cancer cells that survived the treatment and are growing. The usual threshold to be concerned about is 0.2 ng/mL, which you would be expected to get to in about one to three years if your PSA keeps rising. (It may not.) This situation is often called a "biochemical recurrence."

If the PSA level is rising quickly, or you had a very aggressive tumor (determined by pathology called the Gleason score; your internist or urologist should know this information), this would be more worrisome. On the other hand, since your PSA level is still quite low, and it has been 20 years, the risk of prostate cancer getting big enough to bother you during your lifetime is small.

I certainly recommend that you go back and see your urologist, who probably has more experience than an internist like me. Some urologists do get PET scans in this situation once the PSA is above 0.2 ng/mL, but I am not sure that you need it. Much depends on your PSA level when it's next checked in 6-12 months.

DEAR DR. ROACH: My otherwise-healthy 65-year-old wife takes large amounts of vitamins and supplements a day. Her doctor says this is fine, but it looks to be a lot more than a dozen. Do large amounts of vitamins and supplements actually have a beneficial effect? I know vitamins are necessary, but to this extent? Could large amounts be detrimental? -- S.W.

ANSWER: Many studies have been designed to determine whether supplemental vitamins and minerals lead to a benefit in healthy people. As a group, they have consistently failed to show any benefit in the quality or length of life, so I do not recommend vitamin or mineral supplementation for healthy people.

Some people prefer to treat symptoms with dietary supplements, and there are a few supplements that may be effective. But it sounds like your wife is taking hers just to be healthier, and I don't think they are effective at doing so.

It is unusual to get serious side effects from vitamins and minerals unless the doses are far above what is recommended. Still, she's probably wasting money on these supplements. Most of my patients I tell this to are reluctant to stop, as they have often been taking them for many years. Or they're convinced that the supplements are helpful, and it can be hard to change people's minds with new information.

DEAR DR. ROACH: I got the two doses of the shingles vaccine. Is this enough? Do I need the chickenpox one, too? I do not remember if I got chickenpox when I was young. -- S.R.E.

ANSWER: Two doses are all you need for the Shingrix vaccine, which is the vaccine given to people who have either had chickenpox or the chickenpox vaccine. This includes more than 95% of people over the age of 50, whom the shingles vaccine is designed for. It is not recommended to get the chickenpox vaccine or even test for immunity before getting the shingles vaccine.

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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 send mail to 628 Virginia Dr., Orlando, FL 32803.

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