Dear Doctors: I heard there will be a saliva test to see who has a high risk of getting prostate cancer. I don’t see how saliva would have anything to do with your prostate gland. How does the test work, and how can I get access to it?

Dear Reader: A test that analyzes bodily fluids is known as a liquid biopsy. The most common are the blood and urine tests many of us are familiar with. Recently, though, thanks to advances in genetic research and medical technology, saliva is being explored as a diagnostic tool. The fluid that we produce by the pint each day and rarely think about is 98% water. However, that remaining 2% turns out to be a trove of valuable information.

Saliva contains proteins, electrolytes, hormones, peptides, free fatty acids, mucus, antibacterial compounds, RNA fragments and nucleic acids that come from throughout the body. Researchers are exploring how these can be used as biomarkers to pinpoint the presence of a disease or condition. Existing saliva tests screen for HIV, Cushing’s disease, hepatitis C and even pregnancy. Salivary analysis can also help diagnose certain oral diseases. Researchers are now exploring saliva as a tool in identifying Huntington’s disease, Parkinson’s disease, Alzheimer’s disease, COVID-19 and a range of cancers.

You are correct that a saliva test that flags a high risk of prostate cancer is under development. Unlike a blood test, a saliva test can be completed at home. The person spits into a specially prepared tube, then mails the sample to a lab for analysis. The prostate cancer test you asked about works by identifying genetic variants that are known to signal a significant risk of developing the disease.

Initial research suggests this saliva test can be more accurate at identifying men who are at high risk of cancer than the prostate-specific antigen blood test. Also known as the PSA test, it measures blood levels of a protein that is produced by cancer cells. However, that protein is also produced by noncancerous cells. Several factors unrelated to cancer can lead to elevated PSA levels. This includes having an enlarged prostate, vigorous exercise, having a urinary tract infection, recent ejaculation, certain medications and being older. As a result, PSA tests can yield false positives, which can lead to unnecessary medical interventions and procedures.

In the most recent clinical trial of the saliva test, researchers analyzed samples from 6,000 men between 55 and 69 years old -- the age at which prostate cancer risk begins to rise. Those who tested positive for the genetic variants repeated the saliva test, and also underwent a PSA blood test. When the results were compared, the saliva test identified a higher proportion of aggressive cancers than the PSA test. It also yielded fewer false positives.

At this time, the test you are asking about is still in the research stage and is not yet in use. However, clinical trial results have been promising, and the hope is the test will become available soon.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: The yoga teacher at our local Y is always talking about the pelvic floor and how keeping it strong is important for staying healthy. Is that the same as your core? What would be the symptoms if your pelvic floor was weak?

Dear Reader: When someone talks about the pelvic floor, they are referring to the muscles and connective tissues that form a kind of hammock at the base of the abdomen. They form a strong yet flexible framework that keeps the organs and tissues located in the pelvis in their proper place. This includes the large intestine, also known as the colon, the bladder and the rectum. In women, the pelvic floor helps support the uterus and vagina. It aids in urination, urinary control and bowel movements. It is also important to sexual function. During pregnancy, the pelvic floor supports the growing baby.

Although it is not part of the abdominal muscles known as the core, the pelvic floor does contribute to core strength. It plays a role in supporting the spine as someone sits, stands and bends, and it helps ease and distribute the pressure caused by lifting, certain types of exercise and even coughing and laughing. As you can tell from the crucial functions it carries out, your yoga instructor is correct that maintaining a strong pelvic floor is important to good health and well-being.

Over time, the pelvic floor can begin to weaken. Aging, inactivity, hormonal changes, illness and being overweight or obese can weaken the muscles. Pregnancy and vaginal delivery also take a toll on the framework. When the muscles of the pelvic floor are no longer performing as they should, it is a condition known as pelvic floor muscle dysfunction. One of the most common symptoms is loss of urinary control. This often begins with leaks that occur during a cough, sneeze or laugh, or while exercising or lifting. With a weakened pelvic floor, it can be a race to reach the toilet in time. It can also become difficult to either control or complete bowel movements.

In women, a weakened pelvic floor can lead to passing wind through the vagina, a loss of a sensation in the vagina, a feeling of persistent heaviness in the vagina and an increase in the frequency of urinary tract infections. A more serious problem is something known as pelvic organ prolapse. That is when a portion of the uterus, bladder or bowel drops below the base of the pelvis and protrudes into the vagina. This requires an immediate medical evaluation.

Anyone who experiences symptoms of pelvic floor dysfunction should check with their health care provider. These are common enough to be caused by several different conditions. If you are diagnosed with a weakened pelvic floor, be sure to follow through with the treatment plan you are given. This may include losing weight, changing your diet to prevent constipation and facilitate easier bowel movements, medications to address bowel movement issues and a variety of specific exercises. Sometimes, surgery is the best option. The good news is, when addressed early, pelvic floor dysfunction is a treatable condition.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I’ve heard there’s a test that’s more accurate than BMI. Do you know what that is? My daughter is 17 years old, plays tennis, lifts weights and has a sporty build. She’s not overweight, but her BMI of 26 says she is. It upsets her, and it really doesn’t make sense.

Dear Reader: The BMI is a measure known as the body mass index. It is a ratio of a person’s height and weight and is used to estimate body fat percentage. This, in turn, is used to indicate if someone is underweight, overweight or obese.

While fine in theory, in the real world, the BMI falls short. That’s not too surprising, considering the method dates back to 1832, when a Belgian mathematician set out to create a metric to define a “normal man.” Over the decades, the original calculations underwent subsequent tweaks, each time using data based solely on the male body. Those adjustments gradually led to the modern-day BMI and its role as a factor in assessing overall health, well-being and disease risk.

Using only height and weight to estimate body fat percentage leaves out important variables. These include muscle mass, bone density, frame and overall body composition. As has happened in your daughter’s case, someone who is athletic can register higher on the BMI scale. That’s because muscle tissue is denser than fat and weighs more by volume. That’s not a distinction BMI calculations can make. Also excluded are factors such as age, sex and ethnicity, each of which play a role in body fat percentage.

Another important variable regarding body fat is its location. Fat that sits deep in the body, surrounding the organs contained within the abdomen, is known as visceral fat. It is metabolically active in a way that contributes to chronic and systemic inflammation. Visceral fat, which results in a rounded belly and a large waistline, is associated with metabolic disease, insulin resistance, diabetes risk, cardiovascular complications and an increased risk of certain cancers.

The many health risks associated with abdominal fat, as well as the significance of body fat distribution, have led to the update to the BMI that you are asking about. Known as the body roundness index, or BRI, it shifts the focus to visceral fat. Instead of a ratio of someone’s height and weight, the BRI calculation uses their height and their waist circumference. The resulting measurement, which ranges from 1 to 15, reflects how round someone is around their middle.

A recent study analyzed two decades of health data gathered from 33,000 adults. It found the BRI to be more accurate than BMI at assessing whether someone is overweight, obese or underweight. Each of these is associated with an increased risk of disease and death. When BRI scores reached 7 and higher, the risk of developing cardiovascular disease, cancer and metabolic disease increased. People with low scores -- 3.4 and below -- were also at higher risk for illness and death.

Although an improvement over the BMI, the body roundness index is also just an estimate. It should be used alongside blood pressure, blood sugar and blood lipid levels, important metrics of good health.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)