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FRIDAY, Aug. 8 (HealthDay News) -- The standard screening test for prostate cancer may not be accurate for obese men, leaving them more vulnerable to the disease, and surgery is less likely to be effective for them, a new pair of studies found.

"Obese men are more likely to be diagnosed with an aggressive form of the disease," said Dr. Stephen Freedland, an associate professor of urology and pathology at the Duke University Prostate Center, and an author of one of the studies.

The reason: The blood test that looks for elevated levels of the protein prostate-specific antigen (PSA), indicating a heightened cancer risk, doesn't seem as reliable for obese men, Freedland said.

"Our assumption is that these men have more blood volume, so PSA gets diluted, he said. "By the time obese men get to elevated levels, the cancer is more advanced."

The study, published online Friday in the journal BJU International included nearly 3,400 men who had PSA tests. The researchers found that the risk of an aggressive cancer was doubled in obese men diagnosed because of high PSA levels. No such association was found for obese men diagnosed by a digital rectal examination, in which the physician feels for an abnormally large prostate gland.

Prostate cancer is suspected when the PSA reading is 4 or higher. The current recommendation is for men aged 50 and older to be offered an annual PSA test, with explanations of its possible risks and benefits. A federal preventive medicine committee this week said that PSA screening should not be done for men aged 75 and older because the risks outweigh the benefits.

"I'm not sure that we should check obese men more often," Freedland said. "But we should have a higher [PSA] index of suspicion of what is not normal -- 3.4 rather than 4; for really obese men, 3.2."

The Duke study measured obesity using body-mass index, which is a ratio of weight to height. Obesity is defined as a BMI of 30 or more.

A second report from Duke in the same issue of the journal found that excess weight influenced the outcome of surgery for prostate cancer. Men with a BMI of 35 or higher were nearly 60 percent more likely to have a recurrence of the cancer than thinner men, the study of 1,434 men found.

One reason is "the difficulty of operating on obese men in general," said study author Dr. Jayakrishnan Jayachandran, a urology oncology fellow at the Duke Prostate Cancer Center. "The prostate is a narrow thing to operate on, and when there is a big wad of fat in your way, if the abdominal wall is thick, it becomes a technical issue."

The result is that not all the cancer may be removed, which means a recurrence after time, Jayachandran said. "The only thing we can think of is that when you operate on obese people, you have to be more careful," he said.

The studies results apply to men who might not regard themselves as obese, Freedland said. "We can't forget that when we use the term, we are not just talking about very large men," he said. "A man who is 5 foot 9 and weighs 203 pounds would be considered obese."

Jayachandran added, "We are not screening these obese men effectively and are not doing as good a job surgically as could be done."

More information

To learn more about prostate cancer, visit the U.S. National Cancer Institute.

MONDAY, July 14 (HealthDay News) -- Men who thought they had a lower risk of dying from heart disease turned out to be right over the next 15 years, no matter what their conventional risk factors showed.

The death rate for men who had the optimistic point of view was only one-third that of those who listed themselves as being at average risk, said the report in the July/August issue of the Annals of Family Medicine.

But the happy result of an upbeat outlook was not seen among the women in the study. The cardiovascular death rate was the same for women who listed themselves as having below-average risk as for those who said they were at average risk.

The lesson of the study isn't that men can cheerfully ignore what their doctors tell them about risk factors such as cholesterol, smoking and obesity, said Dr. Robert Gramling, who led the study while at Brown University. He now is assistant professor of family medicine at the University of Rochester, in New York.

It does say that physicians could do a better job of describing risk factors and what to do about them, Gramling said.

"In medical systems, we often have a pessimistic bias," he said. "We use normative language, telling people their risk might be high. Using the Framingham Heart Score places a fair amount of people into the categories of high or very high risk. After the age of 40, 80 percent might be viewed as at high risk."

That is how a physician would see it, but it is a question "of how we communicate uncertainty to patients about different aspects of medical care," he said.

A high-risk classification often strikes fear, "and I would suggest that fear-based prevention, meaning making changes based on fear, is not as helpful as holding an optimistic view," Gramling said. "We should focus on helping make changes easy to do, rather than on making people more fearful."

The failure to see a similar effect in women can be explained by the era in which the study was started -- the early 1990s, when the focus was entirely on the risk of cardiovascular disease for men, he said.

Today, it is widely known that cardiovascular disease is the leading cause of death for American women as well as men, Gramling said. "So, in men, you got more of a fear response," he said. "In women, being at higher risk was not as threatening. That might not be true any more."

Gramling is working along the same lines at Rochester. "The next step is to test under what conditions holding an optimistic view is most helpful and under what conditions it is not helpful," he said.

Meanwhile, there is no harm in feeling cheerful about cardiovascular health, as long as you follow the advice about the value of a good diet, exercise, blood pressure control and the like, Gramling said.

Another report in the same issue of the journal described a helpful outcome of combined treatment for high blood pressure and depression. A study of 64 adults found that those who had drug therapy for both conditions simultaneously achieved lower blood pressure level and were more likely to take their antidepressant drugs on schedule, according to physicians at the University of Pennsylvania.

More information

A scale for determining your individual cardiovascular risk is provided by the National Cholesterol Education Program  .