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 56.

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Q : 1 05/27/2009	What long-term side effects to the body's major organ systems might be experienced after an orchiectomy? An orchiectomy cuts off the production of the male hormone testosterone, which is responsible for maintaining muscle strength and sexual function. When you lose testosterone (either through removal of the testicles or through hormonal injections that prevent the formation of testosterone), you may experience common "menopause" type symptoms. These symptoms include hot flashes, breast tenderness, fatigue and loss of sexual function or libido. Many of these symptoms can be treated with medications, so let your doctor know if you're experiencing them.
Q : 2 04/20/2009	How long after prostate cancer surgery does incontinence last? It has been two months now, and does not seem any better. The degree & duration of incontinence varies with individual patients, depending on surgical technique, the extent of disease and the patient's individual anatomy. Although many men recover from their incontinence completely within a few months, some men will unfortunately continue to experience difficulties with urinary control. I would encourage you to discuss this further with your urologist, as there may be medications or exercises they can suggest to try to improve continence.
Q : 3 04/06/2009	My dad is 75 and has advanced prostate cancer. He had surgery to stop the testosterone 3 years ago. His PSA was 523 when he first found out, and after surgery went down to 0.85. The past 6 months it has climbed up to 1.85. He has been taking 30mgs a day of lycopene the past 3 years and would like to add pomegranate supplements. He takes Lovastatin 40 mg per day and lisinopril 20 mg per day for high blood pressure. Would this be something to consider? Pomegranate has been in the news lately and hormone therapy and chemo are his only options when the PSA rises to a certain level. Could there be any interactions? Pomegranate and lycopene are increasingly being touted for possible chemoprevention of prostate cancers, and in literature searches I have been unable to find any warnings or contraindications for his using the two supplements together and no interactions with the lovastatin or lisinopril. If your father ultimately needs to be treated with additional hormonal therapy or chemotherapy, be sure you keep a full record of his prescribed meds as well as his supplements and share that info with his oncologist, as some of the standard therapies may interact or require different doses.
Q : 4 02/16/2009	I had my prostate removed 3 years ago, but my last PSA count was 0.88. Is this something to be concerned about? Generally when your prostate is removed, the PSA will drop down to nearly undetectable levels, so the 0.88 does raise some concerns that there may be some active prostate cancer cells in your system. However, it's very difficult to make this determination based on a single PSA level. Some men have rapidly rising PSA and need to be treated aggressively for recurrent cancer, whereas other men may have PSA levels that take months or even years to rise, and can be managed by "watchful waiting" without resorting to any specific therapy other than close surveillance. It will be most important for you to have close follow-up with the doctor who is monitoring your PSA levels. Ideally, you should have your PSA checked within a month or two after the 0.88 level. Based upon the repeat PSA level your doctor can determine how closely they need to monitor your PSA and whether any action is warranted.
Q : 5 02/05/2009	My father was recently tested and his PSA score was 4.3, a little higher than in the past. His doctor recommended a biopsy which revealed four spots showing cancer. The doctor has recommended use of the Vantas Hormone implant for nine months. After they remove the implant, they plan to insert radiation seeds directly into the prostate. They feel this will eliminate his existing cancer. From what I read, this method of treatment seems to be standard. Is there anything I should be asking his doctors? The combination of hormonal therapy (the Vantas) and some form of radiation (either daily radiation treatments or the brachytherapy seeds) is a pretty common treatment method, particularly in older men who may not tolerate surgery to remove the prostate. Although the method suggested for your father is well-tolerated in most men, as with any therapy there can be side effects (hot flashes and fatigue with hormonal therapy, occasional urinary discomfort and bleeding with the seed implantation). You and your father should be sure to discuss the risks & benefits of each therapy with his doctors.
Q : 6 01/11/2009	I am 62 years old and in reasonably good health. I have been diagnosed with early prostate cancer with a PSA score of 7.5. My doctor wants to do brachytherapy. Is this a good treatment option? Brachytherapy is definitely a good option for men with early-stage prostate cancer. Whether or not you're an appropriate candidate for this therapy will depend on several factors including the Gleason score of the disease, how localized the cancer is in the prostate, and any other medical conditions for which you're currently being treated. Brachytherapy is generally tolerated well with few side effects, but as with any cancer therapy there are potential risks involved. You should ask your surgeon and radiation oncologist to discuss these side effects in detail with you before having brachytherapy.
Q : 7 12/22/2008	I had prostate cancer last year, and although it was detected early, it was located near one of the nerve bundles close to the surface, so I was treated with radiation, chemical castration and seed implants. It has now been 15 months since my last injection, and although I am cancer-free, I am having much trouble getting an erection, and drugs like Cialis give me major acid reflux. Do you have any advice on what else I can do? Congratulations on the excellent response to treatment! Unfortunately, it's not unusual for men to continue to have erectile dysfunction after the treatments you describe, both from the physical disruption of nerves and blood vessels by radiation/seeds and from the suppression of your body's natural testosterone production via the "chemical castration." The testosterone can often take months to return to normal levels, and this can leave you with an overall decrease in libido as well. It could be helpful to have a blood test to check your testosterone level to see how well it's recuperating at this time. In terms of alternatives to drugs like Cialis, there are several other options to treat erectile issues, including injections and even penile prostheses in some cases. Many urologists (including Dr. Andrew Kramer here at UMMC)specialize in the treatment of ED , so I'd recommend starting with a discussion with your urologist.
Q : 8 12/16/2008	I have been on testosterone therapy for 40 years without elevated PSA (2.85 or so). I started using Lasix and my PSA has jumped to over 3.0. Is there any connection? There's no firm evidence of any relationship between use of diuretics like Lasix and interactions with PSA levels or testosterone. I'd recommend having your PSA evaluated again in two to three months to be certain it's not climbing up any higher. Having an elevated PSA isn't always a sign of cancer, but it can be an important early warning sign when the level increases progressively.
Q : 9 06/20/2008	How common is prostate cancer in African American men in their late 30s? African Americans have the highest incidence in the world. In general, the risk for the disease increases with age. I am not aware of much data that has grouped prostate cancer by race in men in the 30s, although there is one provocative study from Dr. Sakr at Wayne State who looked at prostate cancer incidence in men who died in auto accidents in different age groups. He found that more than 10% of men in their 30s had incidental prostate cancer.
Q : 10 03/31/2008	My husband had a follow-up PET scan for his lung cancer which is in remission. The scan showed an uptake of 26 within the posterior and slightly left aspect of the prostate gland. Last July it had an uptake of 5.2. His urologist said he doesn't depend on PET scans, but digital rectal and PSA. Both were fine the past two years. His oncologist is recommending an ultrasound and biopsy of the prostate. What do you think? It is unusual for the prostate gland to have much activity on the PET scan, and therefore I am not sure what to make of this. Lung cancer, on the other hand, tends to be quite PET avid. Nevertheless, one form of cancer within the prostate, i.e. small cell cancer, which is quite rare, may potentially account for the high uptake. I think the threshold for doing a biopsy in this situation should be relatively low, just to make sure that there is nothing brewing.
Q : 11 03/17/2008	I just had a TURP and the biopsy result or diagnosis is Adenomatous Hyperplasia with Chronic Prostatitis. Is this cancerous? Would this go further to a prostate cancer? What should be my next treatment? This is consistent with benign disease. You need routine follow-ups with your urologist at this point.
Q : 12 06/07/2007	My husband has been diagnosed with prostate cancer. A biopsy has been done and bone scan and CT scan. Should we also see an oncologist? His doctor is suggesting a node biopsy. It may be potentially useful to get an oncologist's opinion, but the Gleason score, PSA values and results of the imaging studies would be useful to help guide which specialist could provide the best care.
Q : 13 05/29/2007	I am 75 years of age. I take coumadin for an irregular heart beat and atenolol/chlorthalidone for high bood pressure. I had PSA of 6 and a Gleason score of 8. I have consulted both a urolgist and a radiation oncologist and read much on the Internet about treatment. Would you advise surgery or radiation theraphy (IMRT) with hormonal treatment? If bone scan and CT scan of the abdomen and pelvis are negative, then I would recommend radiation with 2+ years of hormone therapy. If the bone scan or CT scan turn out to be positive, then I would recommend hormone therapy alone.
Q : 14 05/05/2007	How does cryosurgery compare to other procedures in prostate cancer treatment? Data and experience with cryosurgery are limited, and when first introduced several years ago, there were significant problems with complications; but the techniques/equipment have steadily improved. It should be done in experienced hands only. Cryosurgery is a potential option as salvage therapy after failure of radiation. I do hesitate to recommend it as first line therapy at this point, again due to more limited long term data regarding its efficacy.
Q : 15 04/22/2007	I had biopsy in late Feb. 07: Gleason 6 by one pathologist, Gleason 8 by another. Cancer in right apex only. 4.9 PSA, Stage T1C. Bone scan and MRI show no cancer outside of the prostate. I am scheduled for robotic prostate surgery in early June 07. My urologist thinks I cannot wait that long and if I do, should start on Lupron now. The surgeon thinks the wait 'til June is fine and that I should not start on Lupron. Your thoughts? There is no data that giving Lupron now and then doing surgery would be better than surgery alone. I tend to agree that you should not get the Lupron but rather see how the PSA behaves post surgery. I believe you can wait till June since this malignant process likely started a few years ago, and waiting a couple of extra months should not impact outcome.

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