Your Questions Answered
Answers To Your Questions!
The below content is not a substitute for professional medical advice. Be sure to contact your doctor with any questions you may have about your medical condition.
Q. I had a biopsy done this year. The tests came back negative. My question is: how soon should I have another biopsy done ? I am 62 years of age and last PSA level was 4.6.
A. Whether and/or when to do another biopsy depends on findings at the initial biopsy and on changes in the PSA thereafter. If the first biopsy shows no cancer or atypia, then a repeat biopsy is usually not necessary unless PSA rises by 2ng/ml per year or more.
Q. I am a 62 yr. old with several PSA readings: 6/08-4.4, 4/09-3.9, 6/09-3.5 and 10/09-4.3. A negative biopsy on 11/08. FPSA in in 4/09-15.6, current FPSA 10.9. Do I need another biopsy or should I wait for a future PSA? All DRE's have been negative.
A. Depending on your general health, a repeat biopsy may be worth considering. A 3T MRI can be helpful in this setting. An evaluation can be arranged through our center; if you would like to make an appointment, please call 617-735-2100.
Q. A lot of calcium was found in my prostate, what does this mean?
A. Calcium is common in the prostate, it is not a sign of any problem.
Q. I recently went to my primary with a urinary pressure problem and had my prostate finger-probed and told that it "felt squechy" and was put on bactrim and reacted after a week and taken off. I had a psa blood test as well as follow up and the original test was a 2.6. The second (just 2 days ago) was a 4.4. I am a fairly healthy male of 62 1/2 yrs. With these figures I have been referred to a urologist. Any ideas as what this might be and what is the reason for the increase in the psa?
A. This might be a case of low grade prostatitis (inflammation of the prostate). This can cause urinary symptoms as you are describing. It is appropriate to be seen by a urologist who will examine you and evaluate your urine for signs of inflammation or infection. Options for treating this include a course of antibiotics. One sign of inflammation is an elevation in PSA, this should go back down but it can take several months and should be monitored to make sure it does go back down.
Q. Sixteen years ago at age 53 I had a radical prostatectomy with affected my continence & ability to have a normal erection. Have any surgical procedures been developed over the past 16 years to correct these problems? I use pads daily for the incontinence and viagra for the erecticle dysfunction, however, it would be great to return to normal. Having lost a brother to prostate cancer I consider myself very fortunate and I am not complaining.
A. Incontinence after prostatectomy is either mild or severe. If mild (1-2 thin pads/day) then sollagen infections to the bladder can help. Alternatively, a male "sling" procedure can help. If the incontinence severe (more than 2 pads/day), then often an artificial sphincter can be placed to make you dry. You should ask your urologist abut both or go to an incontinence specialist (ours here at BIDMC is Dr. Andy Das).
As for the ED, if you can get erections with viagra then you are doing quite good and I wouldn't recommend any other treatments. For men who can't get any erections even with viagra, we receommend vaccuum pumps or penile injections.
Q. I had radiation in 1993. Since then my PSA (May 2009) was 1.08. I have had lupron shots the last couple years, but skipped last May because of hot flashes and testosterone near 0. I do not want another lupron shot this November. What is your advice? I am 87.
A. If your testosterone is near 0 then the lupron has worked. There is a good chance that the testosterone will take months or years to rise to levels that could be dangerous so I would hold off on the lupron for now and carefully monitor your PSA. I would recommend a prostate cancer oncologist monitor your PSA and help guide your decision regarding future shots.
Q. My Dad died from this disease. Should I get checked? There is cancer in my family (my mom died from lung cancer).
A. For men with a family history of prostate cancer, screening is advisable beginning between the ages of 40-45.
Q. Can I rely on the new 3T MRI for accurate diagnosis of my current prostate cancer progression, as opposed to a third biopsy (which I totally oppose)?
A. Daniel, depending on the rate of rise in your PSA, and on the results of your prior biopsies (totally negative or suspicious areas), there may be a role for MRI as long as it is done at an institution (like BIDMC) which has a dedicated prostate-MRI team. This technology does NOT replace a biopsy however, it only gives us added information about where to better target the biopsy for a more accurate result.
Q. What are the symptoms of prostate cancer that I, as a layman , should note?
Donald, Chestnut Hill
A. Prostate cancer usually does not cause symptoms until it has spread, when it can cause bone pain or weight loss. Symptoms of urinary difficulty are more commonly due to non-cancerous enlargement of the prostate than to prostate cancer, although in some advanced cases, prostate cancer can also cause difficulty with urination. Absence of symptoms at early stages of prostate cancer are why it can be useful to undergo screening for prostate cancer via the PSA blood test.
Q. Should Kegel exercises be done if you have a Foley catheter in place?
A. Tom, the answer is a simple "no." Thanks for your question.
Q. Post radiation therapy, 3 years of -0.1 PSA...now PSA up to 0.4. What is causing this increase?
A. A small rise in PSA after radiotherapy in unlikely to represent prostate cancer recurrence unless the PSA rises to higher than 1.0. Normal prostate tissue can continue to make some PSA after radiation; this is the likely source of PSA when levels are between 0 to 1 ng/ml after radiotherapy.
Q. I'm a 76-year-old male. I had prostate surgery 14 years ago. PSA climbing since 1st year and is now 10. What options are there? I have decided to use watchful waiting. Also had bladder cancer and bladder is gone.
A. Unfortunately, this likely means your prostate cancer has recurred. At this point, most prostate cancer docs would suggest you get imaging to make sure the cancer is not spreading to bones or lymph nodes. If there is no obvious spread then options include external beam radiation to the pelvic area, hormone ablation shots, or waiting (as you are doing). There is no definite answer to this very tough problem. For starters you need to visit with a urologic oncologist who can help explain some of these options to you and guide you through the process.
Q. I had my first checkup in a long time with a new physician and was surprised that they didn't do a PSA test. I thought men should have a baseline at some point (I am 49). I asked about it, but she seemed put-off by the idea; she said that I didn't have a family history so it wasn't necessary. Also, she didn't do a rectal exam (happy about that, but wondered about it). Should I insist on the PSA test?
A. Some primary care doctors do not believe the PSA is a helpful test and instead believe it leads to unecessary procedures. In fact, since PSA has been used, the death rate for prostate cancer has decreased steadily, likely due to earlier detection of cancer and better treatments. Most of us who treat patients with prostate cancer (urologists, oncologists and many primary care doctors) believe the PSA allows us to detect cancer earlier and treat it effectively. In fact, it is not the PSA which detects cancer, but a simple, 5 minute prostate biopsy done in the doctors office.
We recommend men get a PSA and rectal exam beginning at 40-45 years of age. If the result is very low there is little to worry about, however if the result is borderline or high, a visit to a urologist to discuss all the options is helpful. Often times we simply monitor the PSA for changes over time, as these changes can be more accurate in detecting cancer than any single value. Moreover, a rectal exam is a very quick and simple way of screening for prostate cancer and should be done yearly on every man after 40.
If you decide that after learning about the pros and cons of the rectal and PSA tests, you would like them, then I would suggest specifically asking your primary doctor for these tests.
Q. I keep getting prostate infections. Doctors put me on antibiotics (Bactrim, doxycycline) which end the infection temporarily but allow me to get thrush infections in my mouth and penis tip. They then stop the antibiotics and give me fluconazole. By the time that's over, my prostate infection roars back. How can this vicious cycle be ended? I'm miserable: I'm always either subject to prostate pain or penis pain. There's no let-up. I need help!
A. This is a difficult problem with no simple answer. Chronic prostatitis is usually best treated with a long (up to 3 months) course of antibiotics. If you are not able to do this due to thrush, I suggest a visit to an infectious disease doctor who may be able to tailor a specific antibiotic regimen to meet your needs. Another avenue to pursue is imaging of your prostate to make sure you don't have an abcess (infectious collection which may need surgical drainage). This can be an ultrasound, CT scan, or MRI.
Q. My initial PSA reading was 7.2 in March. Seeding was agreed as the best option to address the cancer. During that time I was taking 20mgs of Tamoxifen and 50 mgs of Bicalutamide daily. My next PSA reading in early September was 4.2. Would you suggest waiting or going forward with the operation?
A. It is not possible to make recommendations on PSA results alone, other considerations like extent/type of cancer on biopsy, prostate size and whether or not urinary symptoms are present need to be taken into consideration . If you are in Boston then you may want to arrange for a visit to our multidisciplinary clinic (617-735-2100) to help determine what is advisable.
Q. I'm scheduled for a prostate biopsy because of an elevated PSA score. It has been confirmed by the rectal exam that I have BPH. Is there any other option than biopsy to determine the possibilty of cancer?
A. Other test results could help determine whether or not a biopsy is needed; these include % free PSA and an estimation of your prostate size to determine your PSA density. If these have not been made available to you as of yet, we can provide this information to you at BIDMC. Please call 617-735-2100 if you would like to make an appointment.
Q. Is robotic surgery generally better in terms of side effects?
A. The main benefit of robotic surgery is less blood loss during surgery, and therefore somewhat greater energy level in the first week or two after surgery. Robotic prostatectomy also has smaller incisions and therefore somewhat less pain at the surgery site, however even with open surgery the pain is less than most men anticipate. For these reasons, robot-assisted prostatectomy can be a better choice than open prostatectomy for many patients. However, urinary and sexual recovery is similar between robotic and standard open nerve-sparing surgery, because these side effects are due to removal of the prostate, not due to the type of incision used.
Q. I just learned about high intensity ultrasound from the WROR Website. Do you know how I can find more information on this form of prostate therapy?
A. Thank you so much for your question. According to Dr. Martin Sanda, head of the prostate program at BIDMC, HIFU is an experimental from of high energy (microwave) therapy that basically cooks the prostate much like how you might hard-boil an egg in your microwave at home. It is being evaluated in research studies to determine whether or not it is effective treatment for cancer. No studies have yet shown that the treatment is effective in appropriately controlled clinical trials, and side effects have not been fully characterized. Beware of marketing for HIFU treatment abroad that touts superiority over existing treatments, as such claims are not based on conclusive data, and if you buy it you may be buying side effects at substantial expense and without demonstrated benefit. However, bona fide U.S. clinical trials evaluating this therapy (without costs to participating patients) are a reasonable option for patients to consider, as US clinical trials are usually overseen to ensure safety and good ethics so as to ensure that provider profit is not the key motivation or result of the study.
Q. My husband is 52 and he tells me he's never been tested for prostate cancer. Not even by physical exam. He won't ask for it, either. Shouldn't his doctor test him? I thought this was routine?
Gladys, Bradford, MA
A. Your husband's doctor should discuss the pros and cons of checking for prostate cancer with him; the test is not done automatically but your doctor should discuss prostate testing with him. Many men are afraid that testing will lead to sexual side effects, but this is not true.
Q. Will prostate surgery restore my health regarding urinating urges and allow me not to worry about getting short when the need arises?
Thomas, Mattapoisett, MA
A. Prostate surgery can improve urinary symptoms for many men. You should ask your doctor to refer you to a urologist to discuss possible medications or procedures that could improve your situation.
Q. In a publication entitled "Ask the Doctors at Harvard Medical School", there was a statement that people suffering from paruresis can learn to self-catheterize their bladders to let out urine in an emergency situation. Can this also be used by men suffering from BPH, who can't use medications?
Joseph, Leominster, MA
A. Yes, self-catheterization can be used if medicaitons don't work for BPH. Typically you should see a urologist to discuss what is involved and what the other options are as well.
Q. At what age should you start worrying about your prostate?
Luc in Hyde Park, MA
A. Thanks for your question. Men should discuss the pros/cons of prostate cancer screening with their primary care doctors when they reach age 45, or earlier (ie, age 40) if they are at increased risk due to a family history of prostate cancer or other factors (such as having an African-American racial background) .
Q. My father and his father both had prostate cancer (50s). What are the chances I will get it?
Steve, Hudson, MA
A. That's a great question, Steve. Having 2 male relatives who had prostate cancer increases the risk that a man will get prostate cancer from about 10% (1 in 10) to about 30% (1 in 3) . Talk to your doctor about when and how often you should be screened for prostate cancer.
Q. I am a white male in my early 40s, and my father was just diagnosed with prostate cancer. Should I get screened as well?
A. In short, yes you should.
Men who have a family history of prostate cancer are more likely themselves to harbor prostate cancer and should be screened early (beginning at 40). Actually, for all healthy men in their 40s, who have at least a 10 year life expectancy, we advise at least one PSA and digital rectal exam to get a "baseline" picture of your prostate cancer risk. If the PSA is a bit elevated but not alarming, then we would watch you closely with yearly screening (PSA and digital rectal exam). If the PSA was very low (below average for age) , then it is probably safe to wait and recheck PSA in a few years.
This is a complicated question and different doctor groups disagree on the answer. Those of us who treat prostate cancer regularly (urologists and oncologists) agree that early screening is helpful, especially considering the improvements in surgical and radiation treatments over the last 5-10 years.