Luisel Ricks-Santi, University of Florida

“Me encontraron càncer en la pròstata,” my father told me. “They found cancer in my prostate.”

As a cancer researcher who knows very well about the high incidence and decreased survival rates of prostate cancer in the Caribbean, I anguished over these words. Even though I study cancer in my day job, I struggled to take in this news. At the time, all I could muster in response was, “What did the doctor say?”

“The urologist wants me to see the radiation oncologist to discuss ‘semillas’ (seeds),” he said. “They are recommending treatment.” Many men, including former President Joe Biden, whose case is advanced, do choose with their doctors to treat prostate cancer.

However, I understood from my work that not undergoing treatment was also an option. In some cases, that is the better choice.

So I took it upon myself to educate my father on his disease and assist him with the life-changing decisions he would need to make. Our journey can give you a preview of what a cancer diagnosis can be like.

Prostate cancer diagnosis

Prostate cancer was not a new topic for my father and me. His battle with his prostate health started over 10 years ago with an initial diagnosis of benign prostate hyperplasia, or BPH.

The prostate gets bigger with age for a number of reasons, including changing hormone levels, infection or inflammation. Two of the most frequent symptoms of BPH are difficulty urinating and a sudden, urgent need to urinate, both of which my father experienced.

Although research suggests that the factors that contribute to BPH similarly contribute to prostate cancer, there is no evidence that an enlarged prostate will necessarily develop into cancer.

Upon my father’s initial BPH diagnosis, I asked about his PSA levels, the amount of prostate-specific antigens in his blood. PSA is a protein that both normal and cancerous prostate cells produce, and elevated amounts are considered red flags for prostate cancer. When combined with a digital rectal exam, a PSA test can allow doctors to more accurately predict a person’s risk of having prostate cancer.

My father said his PSA levels were elevated but that the doctors would begin active surveillance, what he called “watchful waiting,” and monitor his PSA every six months to see if it rose.

After several years of monitoring his PSA, doctors found my father’s PSA level had doubled. He then got a biopsy that indicated he had intermediate-risk prostate cancer.

Cancer risk categorization

After his diagnosis, my father was faced with the decision of how to proceed with treatment. I explained that categorizing how aggressive the cancer is and how far it has spread can help determine the best course of treatment.

Prostate cancer can be grouped into four stages. Stages 1 and 2, when the tumor is still confined to the prostate, are considered early-stage or intermediate risk. Stages 3 and 4, when the tumor has spread beyond the borders of the prostate, are considered more advanced and high risk.

Some patients with early-stage or intermediate-risk prostate cancer undergo additional treatment, including surgery, radiation or radioactive seed implants called brachytherapy. Patients with late-stage prostate cancer typically undergo hormone therapy along with surgery or radiation, or chemotherapy with or without radiation.

Although I was not surprised by my father’s diagnosis, given his advanced age and his battle with prostate disease over the past decade, I still struggled emotionally. I struggled with our conversations about what “curing” his cancer meant and how to explain his treatment options to him. I wanted to ensure he would have the best outcome and could still live his best life.

Our initial inclination was to undergo active surveillance. That meant we would monitor his PSA every six months instead of immediately starting treatment. That is appropriate for patients with early-stage and less aggressive tumors.

Prostate cancer screening problems

My father was leaning on me to help him decide how to proceed. I felt overwhelming anxiety because I did not want to fail him or my family. Even with all my expertise studying cancer genetics and working with cancer patients, I couldn’t help second-guessing our decisions, and I sometimes questioned our decision not to immediately treat his cancer.

Some people diagnosed with prostate cancer don’t immediately start treatment, because many of the tumors found through PSA testing grow so slowly that they are unlikely to be life-threatening. Detecting these slow-growing tumors is considered overdiagnosis, because the cancer ultimately will not harm the patient during their lifetime. Nearly half of all patients with prostate cancer are overdiagnosed, often leading to overtreatment.

Research suggests that many prostate cancer patients undergo unnecessarily aggressive treatments, which are often associated with significant harms, like urinary and bowel incontinence, sexual impotence and, in some cases, death. Several studies in the U.S. have shown that patients with early-stage prostate cancer generally have a good prognosis, and the cancer rarely progresses further. With careful observation, most will never need treatment and can be spared the burdens of unnecessary therapy until there are clear signs of progression.

Overdiagnosis and overtreatment of prostate cancer led the U.S. Preventive Services Task Force to recommend against PSA-based screening in 2012, with caveats for high-risk groups including African American men and those with a family history of prostate cancer. The recommendation was updated in 2018 to make screening a personal choice after discussion with a clinician.

Those recommendations have resulted in reduced screening and increased prostate cancer diagnoses. Given that Black men are more likely to see the cancer progress to aggressive forms of the disease after initial diagnosis, this may worsen existing health disparities.

Developing tests that better identify patients at risk of dying from prostate cancer can decrease overtreatment. In the meantime, educating patients can help them decide if screening is appropriate for them. For underserved and marginalized communities, community outreach can help improve health literacy and enhance awareness and screening.

When I looked through my father’s stack of medical records, I found a beacon of light that eased my apprehension. His doctor had ordered a genetic test that estimates how aggressive a tumor may be by measuring the activity of specific genes in cancer cells. An increase in gene activity linked to cancer would indicate that it is likely to grow fast and spread.

The test predicted that my father’s risk of dying from the disease in the next five years was less than 5%. Based on these results, we both understood that he had adequate time to make a decision and seek additional guidance.

My father ultimately decided to continue active surveillance and forgo immediate treatment.

Surviving prostate cancer

I still worry about my father’s diagnosis, because his cancer is at risk for progression. So every six months, I inquire about his PSA levels. His doctors are monitoring his PSA levels as part of his survivorship plan, which is a record of information about his cancer diagnosis, treatment history and potential follow-up tests.

My father’s decision to undergo active surveillance was controversial among our friends and family. Many were under the impression that prostate cancer required immediate treatment. Several shared successful treatment stories, sometimes followed by stories of adverse treatment-related side effects.

To date, my father believes that active surveillance was the best decision for him and understands that this may not be the same for someone else. Talk to your doctor to see what the best options are for you or your loved ones.

This is an updated version of an article originally published on Aug. 8, 2023.

Luisel Ricks-Santi, Senior Associate Vice President Community Health, Education and Training, Old Dominion University; Associate Professor of Pharmacy, University of Florida

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Zhenbo Wang, University of Tennessee

Half a century after the Apollo astronauts left the last bootprints in lunar dust, the Moon has once again become a destination of fierce ambition and delicate engineering.

This time, it’s not just superpowers racing to plant flags, but also private companies, multinational partnerships and robotic scouts aiming to unlock the Moon’s secrets and lay the groundwork for future human return.

So far in 2025, lunar exploration has surged forward. Several notable missions have launched toward or landed on the Moon. Each has navigated the long journey through space and the even trickier descent to the Moon’s surface or into orbit with varying degrees of success. Together, these missions reflect both the promise and difficulty of returning to the Moon in this new space race defined by innovation, competition and collaboration.

As an aerospace engineer specializing in guidance, navigation and control technologies, I’m deeply interested in how each mission – whether successful or not – adds to scientists’ collective understanding. These missions can help engineers learn to navigate the complexities of space, operate in hostile lunar environments and steadily advance toward a sustainable human presence on the Moon.

Why is landing on the Moon so hard?

Lunar exploration remains one of the most technically demanding frontiers in modern spaceflight. Choosing a landing site involves complex trade-offs between scientific interest, terrain safety and Sun exposure.

The lunar south pole is an especially attractive area, as it could contain water in the form of ice in shadowed craters, a critical resource for future missions. Other sites may hold clues about volcanic activity on the Moon or the solar system’s early history.

Each mission trajectory must be calculated with precision to make sure the craft arrives and descends at the right time and place. Engineers must account for the Moon’s constantly changing position in its orbit around Earth, the timing of launch windows and the gravitational forces acting on the spacecraft throughout its journey.

They also need to carefully plan the spacecraft’s path so that it arrives at the right angle and speed for a safe approach. Even small miscalculations early on can lead to major errors in landing location – or a missed opportunity entirely.

Once on the surface, the landers need to survive extreme swings in temperature – from highs over 250 degrees Fahrenheit (121 degrees Celsius) in daylight down to lows of -208 F (-133 C) at night – as well as dust, radiation and delayed communication with Earth. The spacecraft’s power systems, heat control, landing legs and communication links must all function perfectly. Meanwhile, these landers must avoid hazardous terrain and rely on sunlight to power their instruments and recharge their batteries.

These challenges help explain why many landers have crashed or experienced partial failures, even though the technology has come a long way since the Apollo era.

Commercial companies face the same technical hurdles as government agencies but often with tighter budgets, smaller teams and less heritage hardware. Unlike government missions, which can draw on decades of institutional experience and infrastructure, many commercial lunar efforts are navigating these challenges for the first time.

Successful landings and hard lessons for CLPS

Several lunar missions launched this year belong to NASA’s Commercial Lunar Payload Services program. CLPS is an initiative that contracts private companies to deliver science and technology payloads to the Moon. Its aim is to accelerate exploration while lowering costs and encouraging commercial innovation.

The first Moon mission of 2025, Firefly Aerospace’s Blue Ghost Mission 1, launched in January and successfully landed in early March.

The lander survived the harsh lunar day and transmitted data for nearly two weeks before losing power during the freezing lunar night – a typical operational limit for most unheated lunar landers.

Blue Ghost demonstrated how commercial landers can shoulder critical parts of NASA’s Artemis program, which aims to return astronauts to the Moon later this decade.

The second CLPS launch of the year, Intuitive Machines’ IM-2 mission, launched in late February. It targeted a scientifically intriguing site near the Moon’s south pole region.

The Nova-C lander, named Athena, touched down on March 6 close to the south pole. However, during the landing process, Athena tipped over. Since it landed on its side in a crater with uneven terrain, it couldn’t deploy its solar panels to generate power, which ended the mission early.

While Athena’s tipped-over landing meant it couldn’t do all the scientific explorations it had planned, the data it returned is still valuable for understanding how future landers can avoid similar fates on the rugged polar terrain.

Not all lunar missions need to land. NASA’s Lunar Trailblazer, a small lunar orbiter launched in February alongside IM-2, was intended to orbit the Moon and map the form, abundance and distribution of water in the form of ice, especially in shadowed craters near the poles.

Shortly after launch, however, NASA lost contact with the spacecraft. Engineers suspect the spacecraft may have experienced a power issue, potentially leaving its batteries depleted.

NASA is continuing recovery efforts, hoping that the spacecraft’s solar panels may recharge in May and June.

Ongoing and future missions

Launched on the same day as the Blue Ghost mission in January, Japanese company ispace’s Hakuto-R Mission 2 (Resilience) is on its way to the Moon and has successfully entered lunar orbit.

The lander carried out a successful flyby of the Moon on Feb. 15, with an expected landing in early June. Although launched at the same time, Resilience took a longer trajectory than Blue Ghost to save energy. This maneuver also allowed the spacecraft to collect bonus science observations while looping around the Moon.

The mission, if successful, will advance Japan’s commercial space sector and prove an important comeback for ispace after its first lunar lander crashed during its final descent in 2023.

The rest of 2025 promises a busy lunar calendar. Intuitive Machines plans to launch IM-3 in late 2025 to test more advanced instruments and potentially deliver NASA scientific experiments to the Moon.

The European Space Agency’s Lunar Pathfinder will establish a dedicated lunar communications satellite, making it easier for future missions, especially those operating on the far side or poles, to stay in touch with Earth.

Meanwhile, Astrobotic’s Griffin Mission-1 is scheduled to deliver NASA’s VIPER rover to the Moon’s south pole, where it will directly search for ice beneath the surface.

Together, these missions represent an increasingly international and commercial approach to lunar science and exploration.

As the world turns its attention to the Moon, every mission – whether triumph or setback – brings humanity closer to a permanent return to our closest celestial neighbor.

Zhenbo Wang, Associate Professor of Mechanical and Aerospace Engineering, University of Tennessee

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Jane Tavares, UMass Boston and Marc Cohen, UMass Boston

Republicans in Congress intend to cut about US$880 billion in federal health care spending.

One of their primary targets is Medicaid. That government program covers 82 million Americans with health insurance. Most of the people enrolled in the program are low income, have disabilities, or both.

Medicaid, jointly funded by the federal government and the states, is also the biggest funder in the U.S. of long-term care services, whether they are delivered in the patient’s home, another location where they spend part of their day or a nursing home. That makes it particularly important for older adults and those with disabilities. All states must meet the basic federal guidelines for Medicaid coverage. But 41 states have opted to take advantage of the Affordable Care Act provision that expanded eligibility to cover more people under the program.

We are gerontology researchers who study health and financial well-being in later life. We’ve been analyzing what the potential impacts of Medicaid cuts might be.

While the debate about how to reduce the budget focuses largely on dollars and cents, we believe that cutting federal spending on Medicaid would harm the health and well-being of millions of Americans by reducing their access to care. In our view, it’s also likely that any savings achieved in the short term would be smaller than the long-term increase in health care costs born by the federal government, the states and patients – including for many Americans who are 65 and older.

Weak track record

Wary of backlash from their constituents, Republicans have agreed on a strategy that would largely cut Medicaid spending in a roundabout way.

Previous efforts by the GOP in some states, such as imposing work requirements for some people to get Medicaid benefits, have not greatly reduced costs. That’s largely because there are relatively few people enrolled in the Medicaid program who are physically able to be employed and aren’t already in the workforce. Nor have past efforts to reduce fraud, waste and abuse led to significant savings.

According to widespread media reports, Republicans are considering changes that would cut the amount of money that the federal government reimburses states for what they spend on Medicaid.

In May 2025, the nonpartisan Congressional Budget Office estimated that 8.6 million Americans would lose their health insurance coverage should the GOP proposal become law.

Historically, states have dealt with budget cuts by reducing their payments to health care providers, limiting eligibility or restricting benefits. These reductions all particularly affected home- and community-based services that many disabled and older adults rely on.

About 3 in 4 of the people with Medicaid coverage who receive long-term care through the program get that care at home, in their communities or both, rather than residing in a nursing home. States save an estimated 26 cents for every dollar spent on those services delivered outside nursing homes.

Losing coverage can be harmful for your health

We recently analyzed data from a nationally representative study of approximately 6,000 people who had Medicaid coverage but lost it when they turned age 65 because their income exceeded 100% of the federal poverty level. In 2025, that cutoff is about $15,560 for a single person and $21,150 for a couple.

Medicaid income eligibility generally drops from 138% to 100% of the federal poverty level at age 65 once Medicare becomes a person’s primary health insurer.

The people who participated in the study had lost their Medicaid coverage upon turning 65 between 1998 and 2020. Our team followed the experiences of these participants over a 10-year period starting at age 65 to see how they fared compared with people who continue to be enrolled in Medicaid after their 65th birthday.

What we found was both surprising and disturbing.

Fewer activities of daily living

Over the decade following that milestone, the people who lost their Medicaid coverage had more chronic conditions and could perform fewer activities of daily living, such as bathing and getting dressed, without any assistance as compared with those who still had Medicaid coverage. In addition, they were twice as likely to experience depression and be in fair or poor health.

As people’s health worsened, they also went to the hospital more often and stayed there longer. They also used outpatient surgery services more frequently.

These services are particularly expensive for the health care system. Depending on the service, it may also be costly for patients. Unlike the comprehensive coverage of Medicaid, the Medicare program fully covers only inpatient hospitalizations, short-term nursing facility care, hospice, some short-term home care, annual wellness visits, vaccines and some basic preventive care. Beyond that, Medicare requires the payment of premiums to help with uncovered services that can also include deductibles and copays.

This arrangement can lead to significant out-of-pocket costs that make health care hard for low-income older adults to afford unless they have both Medicare and Medicaid coverage.

We also found that older people who lost Medicaid coverage were less likely to see their primary care physician for routine and follow-up care, despite being enrolled in Medicare. This explains in part why they are going to the hospital more often, likely avoiding routine health care that may incur out-of-pocket costs and eventually utilizing Medicare-covered hospital care when needed.

In short, we found that exiting the Medicaid program upon turning 65 actually leads to an increase in the use of some of the most expensive health care services, such as inpatient hospitalization and outpatient surgery. So although Medicaid may no longer pay for these costs, the rest of the health care system does.

Just under 90% of older adults enrolled in Medicare have some kind of supplemental coverage that helps them pay for services that the program doesn’t cover. For 16% of the people with Medicare coverage, Medicaid covers those additional health care costs. The rest of that nearly 90% obtain supplemental coverage from private insurance companies or are enrolled in a Medicare Advantage plan that’s run by a private company instead of the government.

However, 11% of Americans covered by Medicare don’t have any additional coverage. It is likely that those who lost Medicaid benefits at age 65 may not be able to afford any other supplemental coverage options and fall into this group.

People who lose Medicaid coverage may die sooner

One of our more troubling findings was that people who lost Medicaid coverage at age 65 were 14% more likely to die within the next 10 years than were those who kept their coverage in addition to gaining Medicare coverage. This was true even though the people who lost their Medicaid access tended to start out in better health.

Roughly 12 million Americans are enrolled in both Medicare and Medicaid today. Much is at stake for them and other low-income people as Congress considers making major changes to the program to cut federal spending on it.

For some Americans, it’s a matter of life and death. For others, it’s a matter of healthy versus unhealthy aging that leads to costlier health care not just for themselves but for the U.S. as a whole.

Jane Tavares, Senior Research Fellow and Lecturer of Gerontology, UMass Boston and Marc Cohen, Professor of Gerontology, UMass Boston

This article is republished from The Conversation under a Creative Commons license. Read the original article.