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Prostate Cancer Archive Questions

Below are Dr. Heather Mannuel’s answers to Prostate Cancer questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 76.

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Q : 1

I have an ileostomy and have been experiencing symptoms of prostate cancer. I've read that patients with prostate cancer should avoid calcium, yet calcium is something that I need for my ileostomy. Do you have any suggestions?

There isn't any definitive data in the medical literature that suggests that calcium should be avoided in patients with prostate cancer. In fact, we often prescribe calcium supplements to counteract some of the side effects of typical prostate cancer therapies. Given that your ileostomy has altered your dietary needs somewhat, I'd recommend that you speak with a nutritionist with some experience in treating patients with cancer and/or ostomies, as they could hopefully provide better insights into any recommended changes.

Q : 2

I developed a low sex drive after laser treatment for prostate cancer. What is the best treatment for this symptom?

Unfortunately, many treatments that address prostate cancer can lead to erectile dysfunction and an impaired sex drive. I'd recommend discussing this issue with your primary care physician as well as your urologist. They'll likely want to check certain hormonal levels such as testosterone and thyroid function to be certain there isn't a different reason behind your decreased sex drive, as well as checking for any cardiac or circulation issues. If everything appears normal from that perspective, there are several different types of drugs and devices available that can help improve your symptoms.

Q : 3

I am a prostate cancer patient who has had TURP, orchiectomy and received IMRT. I am presently having hot flashes. How long should I expect them to last? Is there something I can do to prevent them?

In men with prostate cancer, hot flashes generally occur due to the significant decrease in testosterone levels that occurs when the mechanism that produces testosterone is disrupted. I'd suggest increasing the amount of soy in your diet (there are lots of supplements on the market as well as soy milk). Additionally, some antidepressants such as Effexor (generic name venlafaxine) can be helpful in decreasing the intensity of hot flashes in some men.

Q : 4

I had a radical prostatectomy in 2007. Since then, my PSA has been .04. Last week my PSA was .1. I understand that a PSA, in my situation, of .2 means the cancer has come back. Should I be concerned that my PSA is rising?

Although an increasing PSA suggests the presence of active cells, the rate at which the cells grow and become more active (and the increase in the PSA level) can vary greatly in different men. I'd recommend that you have the PSA rechecked in 6-8 weeks to see if it's still 0.1 or higher (or if it's dropped back down again, which is also possible). If the number is unchanged or improved, it's fine to continue with scheduled PSA checks every few months to watch for any trend in increasing levels. If the number is already higher, you may want to consult with a radiation oncologist about the potential for radiation to the pelvis and prostatectomy site. This "salvage radiation" technique is generally well-tolerated and has a very good success rate in preventing recurrence.

Q : 5

Does Androcur (antiandrogen) cause weight loss and reduced urine output?

Androcur, also known as cyproterone, can cause weight changes in some patients (either weight gain or loss); it generally doesn't cause decreased urine output. Are you experiencing any nausea, vomiting or decreased appetite on the drug? If you are then your body may be holding on to as much fluid as it can and thereby decreasing your urine output.

Q : 6

Post-hormonal treatment, when do side effects, specifically hot flashes, dissipate? I received my last Trelstar injection last December.

Generally the hot flashes, libido changes and other side-effects start to resolve within 3-4 months of discontinuing hormonal shots, but occasionally men will experience side-effects for six months or longer, depending on how often the shots were being given (i.e. a six-month shot would be expected to wear off more slowly than a 3-month shot). If you're still experiencing significant symptoms, your doctor can check your testosterone level to see if it's still suppressed from the hormonal therapy; once the testosterone starts to return to normal levels most men notice a significant improvement in their hot flashes and other symptoms.

Q : 7

According to what I read on your website, my husband has stage 4 prostate cancer. He is being treated with a second chemotherapy drug in an attempt to stop its spread. Some centers test an individual's cancer outside of the body to determine resistance before administering the drug to the patient. Do you do this at your center ?

This molecular profiling/targeting approach is now part of the routine evaluation of many patients with breast and colorectal cancers. It may ultimately prove useful in the treatment of prostate cancers, but at this time there is no definite data that it's beneficial in choosing the best chemotherapy, and we generally don't utilize them for prostate cancer patients outside of specific clinical trials.

Q : 8

I had a prostatectomy in January with pathology analysis of T3b-seminal vesicle invasion. My doctors are recommending 3 months of Lupron injections followed by radiation to the prostate bed. Is treatment with hormones and radiation standard for my condition?

Several large clinical trials have indicated that radiation is the best treatment for men with T3 disease post-prostatectomy. Hormonal therapy such as Lupron is a bit more controversial as there is less data, but many institutions do recommend this. You don't mention your Gleason score, but at our institution we generally offer combination hormones/radiation to men whose Gleason score is 7 or above, so adding Lupron to radiation in your case may certainly be a reasonable consideration.

Q : 9

Who should I contact if I have a question regarding taking finasteride pills with black tea? My doctor said it's not advisable to drink black tea while receiving chemotherapy for prostate cancer. I'm taking finasteride for my hair loss, but is this drug usually used for treating prostate cancer?

The market for "nutraceuticals" (natural and herbal supplements with potential disease-fighting benefits) is growing every day, and unfortunately there's been very little interaction between nutritional and medical studies to confirm or deny the risks and benefits of taking many of these supplements while on active chemo. Finasteride is often used to treat prostate cancer, and our general philosophy is that it's best to limit herbal and caffeinated substances while on any kind of chemo or hormonal agent. However, when searching the current literature I was unable to find any data regarding the specific interactions of finasteride with black tea, either when treating hair loss or prostate cancer. If you have access to a dietitian or expert in herbal/natural supplements, this would be a good question to ask.

Q : 10

I had a radical prostatectomy in 1995 and had a PSA <.1. Fifteen months ago it was .2 and has been .5 for the last 6 months. I had shingles about 15 months ago , recently had diverticulitis and have now been diagnosed with mild Crohn's disease and will be taking mercaptopurine (50 mg). The next step is an MR prostate probe. The recommendation is radiotherapy, but we could just continue with monitoring. Could the PSA level be influenced by the infections and the inflammation in the small intestine?

PSA can be influenced by infections and inflammations, but generally this is seen when the GU tract is directly involved (such as with a urinary tract infection or trauma from use of a foley catheter). Given the slow but progressive trend of rising PSA, I suspect that this represents a true increase, and radiation and close monitoring are two feasible options.

Q : 11

My PSA has risen from 1.4 (a year ago) to 2.4 (3 months ago) and is now at 3.3. Is this an urgent prostate cancer flag?

The velocity of increase in the PSA level is concerning enough that I'd recommend seeing a urologist now. Benign issues like infections or inflammation can cause the PSA to increase, but it's true that this could also represent a growing prostate cancer. Your urologist will be the best person to determine your risks and the next steps of diagnosis or treatment.

Q : 12

Is it safe to have sex after having prostate cancer treatments?

Hormone therapy (injections or pills) may reduce a man's sex drive but there isn't any danger to having sex on this treatment. If a man is undergoing chemotherapy (intravenous drugs like Taxotere), I generally recommend that a condom is used as I've seen a couple of cases of burning and irritation when a sexual partner is exposed to semen - additionally, because of the potential for birth defects, we recommend against trying for pregnancy while either partner is undergoing chemo treatments. If you're undergoing radiation treatments (either the daily radiation or implantation of seeds), you should ask your radiation oncologist this question to see if they have any specific concerns.

Q : 13

I am being treated for aggressive prostate cancer. Most of the medications I take have implications for the liver. I have been told milk thistle might be helpful and as I read around on the web it appears this is so. However, according to your site, "People with a history of hormone-related cancers, including breast and uterine cancer and prostate cancer, should not take milk thistle." Unfortunately, you don't say why. Do you know why someone with prostate cancer might avoid milk thistle?

Milk thistle or sylibum is one of the more common "nutraceutical" agents that is being evaluated as a potentially useful agent in cancer treatment or prevention. Although there is data available to suggest that sylibum may have a chemoprotective effect in the case of prostate cancer, animal studies have also suggested that this and similar compounds may increase the growth rates of hormonally-sensitive cancers of the breast and prostate. Ultimately, it's best to check with your physician prior to taking any new nutraceutical or prescribed medication to be sure that the potential side-effects don't outweigh the benefits.

Q : 14

I have advanced prostate cancer and am being treated with Ketoconazole. I have what may be a silly question about milk thistle, which the UMM site ( says should not be used in cases of prostate cancer, while from the NCI says it could be. Which is correct?

As you can see from your online research, there's no such thing as a quick and simple answer when it comes to use of today's "nutraceutical" agents! Silymarin, the active component of milk thistle, has shown variable activity against cancer cells in the lab, although wide-scale trials in combination with chemotherapy drugs haven't yet been developed. Although I can find no hard data suggesting an absolute contraindication to using milk thistle in your case, I would recommend caution in combination with ketoconazole, as that drug tends to interact with a variety of other medications and in some circumstances it can lead to liver toxicity. If you opt to use the milk thistle, be sure to advise your medical team that you're doing so, so they'll be able to monitor your labwork carefully for any adverse reactions.

Q : 15

My father (56) had an elevated free-PSA, normal PSA ratio and increased prostate volume (180cc). After 3 negative biopsies (more than 20 specimens/each) and several ultrasounds, he decided to exclude the gland by suprapubic (transvesical) prostatectomy. In the pathology report he had <5% of total prostate volume adenocarcinoma and a Gleason score of 6 (3+3). What is likely to follow in terms of treatment?

Prostate cancer is generally considered at low risk for recurrence and metastasis if the Gleason score is below 7 and the PSA is less than 10. You didn't mention the PSA level, but given the lower Gleason score of 6 and the very small volume of disease found in the prostate itself, I suspect that he represents a low-risk patient. In that case, the most important thing he can do next is to continue to follow up closely with his urologist for regular check-ups and PSA checks. Now that the prostate has been removed his PSA levels should be close to zero; if the level begins to rise again, or if it remains persistently elevated despite having the prostatectomy, he may benefit from seeing a radiation oncologist to discuss possible radiation to the prostate bed.

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