NetWellness Prostate Cancer

PSA Level of 2.69 8 Months After Removal

Lee Ponsky MD — Mon, 12 Sep 2011 23:09:00 EST

Question: I am 62. The PSA was 2.52 April `09 and 6.7 Nov `10 Because of the velocity of the PSA a biopsy detected cancer. The Prostate was removed Jan 18 `11. The margins were clear and the pelvic lymph nodes were clear. The PSA in April `11 was 1.91. My doctor expected a 0 and called the results unusual. Th . . .

Answer: The fact that your PSA is rising suggests there is residual cancer. This is often at the site of where the prostate was. The urologist may want to order a bone scan and CT scan of the pelvis. Radiation of the pelvis would be appropriate assuming the scans are normal. The hope is that the radiation w . . .

Ask an Expert: Lee Ponsky MD, Prostate Cancer

PSA 134 - 138

James Donovan, Jr MD — Fri, 13 May 2011 08:05:00 EST

Question: Biopsy shows prostate cancer. Doctor questions why PSA is 134 - 138 but MRI does not show cancer anywhere else. Enlarged bladder? Could this be the cause?

Answer: Prostate cancer associated with PSA > 20 ng/ml should be further investigated with Nuclear Medicine bone scan and CT (or MRI) imaging of the abdomen and pelvis. The extremely elevated PSA may reflect spread to either lymph nodes (CT or MRI) and/or bone (NM bone scan). Other causes of extreme elev . . .

Ask an Expert: James Donovan, Jr MD, Prostate Cancer

Prostate Cancer Degrees

Lee Ponsky MD — Thu, 05 May 2011 23:05:00 EST

Question: What does the "3 percent" mean when the doctor advised my father that he has 3 percent prostate cancer? Doctor did advise that he may have 10 more years to live. My father is 76 and has had several procedures done within the last 5 months and is unable to cease the plavix for even 7 days f . . .

Answer: I don't know for sure what his doctor was referring to but I assume he meant 3% of the biopsy had cancer. There are many options other than cryotherapy. In fact active surveillance may be a very resonable option in addition to radiation. I think it is important to discuss these options with you . . .

Ask an Expert: Lee Ponsky MD, Prostate Cancer

IMRT or Surgery - Effects on Urinary Problems

Lee Ponsky MD — Sat, 26 Mar 2011 15:03:00 EST

Question: Three years ago, my PSA was 6 but biopsy was benign. I had no urinary issues at that time. Three years later, I started to experience some urinary issues (frequent urination, low flow but no incontinence). Although I feel I am getting complete emptying, my average urination is between 100 and 200 ml . . .

Answer: Radiation will not improve your urinary symptoms, in fact they could worsen. While there is a risk of urinary in incontinence after surgery, this typically should improve within weeks to months. The frequent urinating and straining to void would not be an issue after surgery. Either treatment carrie . . .

Ask an Expert: Lee Ponsky MD, Prostate Cancer

Radical Prostatectomy & Pregnancy

Krishnanath Gaitonde MD — Fri, 25 Mar 2011 19:03:00 EST

Question: Is it possible for a woman to still get pregnant after a man has had a nerve sparing radical prostatectomy?

Answer: Radical prostatectomy routinely involves removal of the prostate and seminal vesicles (which contribute to the seminal fluid volume along with sperms from the testes) as well as division of the vas deferens (these are tubes which carry the semen containing the sperms from the testes, and fluid from . . .

Ask an Expert: Krishnanath Gaitonde MD, Prostate Cancer

Prostate Cancer Diagnosis

Lee Ponsky MD — Wed, 16 Mar 2011 13:03:00 EST

Question: My husband was just diagnosed with prostate cancer. His urologist ordered a bone scan. My question is: is this a standard procedure for a prostate cancer diagnosis or is it done only if there is suspicion that the cancer has already spread to the bones?

Answer: Bone scans are typically ordered if there is any risk of disease having spread to the bones. However, having said that, although not necessarily indicated very often, urologists will order bone scans in patients with low risk disease even though the chance of having metastatic disease to the bones i . . .

Ask an Expert: Lee Ponsky MD, Prostate Cancer

Elevated PSA

Lee Ponsky MD — Sat, 05 Mar 2011 13:03:00 EST

Question: 3 and 1/2 years ago I was examined by Urology for an elevated PSA and BPH, PSA was @ 6.7. Subsequent levels fluctuated and biopsy revealed adenocarcinoma, Gleason 7[3+4] bilateral lobes. Initial laparoscopic surgery attempt was converted to a radical prostatectomy, pathology revealed a Gleason 5[2,3 . . .

Answer: A detectable psa after a prostatectomy does indicate likely residual disease. I would agree with your oncologist you should be seen by a radiation oncologist for consideration for adjuvant radiation.

Ask an Expert: Lee Ponsky MD, Prostate Cancer

Impotence

Ahmad Hamidinia MD — Tue, 14 Sep 2010 20:09:00 EST

Question: I had radiation treatments for prostate cancer at JHopkins about 1 1/2 years ago. I have now become impotent. Is there anything that I can do?

Answer: There are many ways to treat your condition. These include medical mechanical and surgical theraies that you should discuss with your urologist. He will advise treatment based on your age, general health, cardiac status and your desire to go through more vigorous therapeutic procedures. Nowadays, tr . . .

Ask an Expert: Ahmad Hamidinia MD, Prostate Cancer

Night Sweats After Prostatectomy

Lee Ponsky MD — Mon, 23 Aug 2010 10:08:00 EST

Question: My husband had his prostate surgery almost 4 weeks ago and have since started having night sweats every night. His doctor did not prescribe any meds or hormone therapy. He only prescribed a very low dose of viagra .....he said to wake up the nerves. He is extremely moody also. I have asked him if he . . .

Answer: Prostate surgery does not/should not affect hormone levels at all. Some of your husband's symptoms may just be from having had surgery. Certainly make sure he notifies his physician regarding the night sweats.

Ask an Expert: Lee Ponsky MD, Prostate Cancer

Constipation as a Possible Side Effect

James Donovan, Jr MD — Sun, 15 Aug 2010 02:08:00 EST

Question: My 65-yr old husband has completed his 9 wk course of EBRT (3D-CRT) for Prostate Cancer and is experiencing the fatigue & gas mentioned, as well as urinary difficulties that have resulted in a temporary catheter for about 3 weeks... but he also seems to have problems with constipation 3-4 times . . .

Answer: Despite efforts to decrease collateral effects of radiation on adjacent organs (bladder, rectum) using CRT (conformal radiation therapy which places blocks to shape the radiation beam), some bladder and rectal irritation is quite common. Prostate swelling initially following CRT can increase difficu . . .

Ask an Expert: James Donovan, Jr MD, Prostate Cancer