Health Chats
Prostate Cancer Surgery
Friday May 15, 2009, 03:00PM - 04:00PM (EST)
Ash Tewari, MD, M.Ch.Blank
Professor of Urology
Weill Cornell Institute of Prostate Cancer
Urology, NY, NY
Prostate cancer is the leading cancer in men with an incidence rate of .16%. It is rare in men under the age of 45 but becomes more common with advanced age. Surgery is often used to treat prostate cancer along with radiation therapy, chemotherapy, cryosurgery, hormonal therapy, or a combination of different treatments. Which option is best depends on the stage of the disease, the Gleason score, and the PSA level, as well as the man's age, his general health, and his feelings towards the treatments and side effects. Learn more about prostate cancer surgery - what happens during surgery, who is best suited for surgery, and possible side effects - in this hour long chat with prostate cancer surgeon Dr. Ash Tewari.<br><br> Ash Tewari, M.D., M.Ch. is the Director of Robotic Prostatectomy and Prostate Cancer-Urologic Oncology Outcomes at Brady Urology Institute at the Department of Urology and an Associate Professor of Urology; he is also an Associate Professor of Public Health and Outcomes in the Department of Public Health and Outcomes at The Weill Medical College of Cornell University. He is an Associate Attending at The New York Presbyterian Hospital and he directs a fellowship program in Robotic Prostatectomy and Prostate Cancer- Urologic Oncology outcomes in Cornell.<br><br> Dr. Tewari is an internationally acclaimed expert on Robotic Prostatectomy and other minimally invasive robotic surgeries. His clinical interest involves urologic oncology and care of patients with prostate, bladder and other urological cancers. He performs open, laparoscopic and robotic surgeries. He is also involved in diagnosing prostate cancer by using PSA and modern ultra sound guided biopsy techniques. Using a dataset of 7000 patients with abnormal PSA, he has developed simple predictive models to calculate the risk of prostate cancer.
MedHelp:
Welcome to today's health chat on Prostate Cancer Surgery with Dr. Ash Tewari. The chat will begin in 20 minutes, but please feel free to start submitting your questions now.
Ash Tewari, MD:
Good afternoon everyone.
MedHelp:
Welcome, Dr. Tewari and thanks for joining us today.
rich77:
I had robotic radical prostatectomy Jan 23, 2009, and my incontinence is for the most part not a problem; no pads.  However, when I "ejaculate", I produce urine.  Of course I evacuate my bladder before I attempt to have sex, but sex does not always take a few minutes and, obviously, urine refills the bladder.  Will this ultimately resolve itself? Suggestions?
Ash Tewari, MD:
the phenomenon you are describing is known as climecturea. it is mainly due to healing of the "connection" of the urinary tract after removal of the prostate. it should resolve spontaneously. give it a few months
Ash Tewari, MD:
Janet_R_B, please post this question on the forums section. I will address it there. Thank you.
Michael:
How reliable is the PSA test in catching prostate cancer early? How often should men over 60 be tested if they have a family history of Prostate Cancer?  Are there any other more reliable indicators for prostate cancer?
Ash Tewari, MD:
For PSA values above 10, PSA is a good predictor of prostate cancer. However, often times, PSA gradually rises.
Ash Tewari, MD:
This is where the confusion arises. However, men over 50 should begin annual PSA screening, however men with over risk factors (positive family history, african american race) should begin at 40.
Ash Tewari, MD:
PCA3 has shown promise in detecting prostate cancer.
aneilljr:
My PSA went from 1.6 to 2.6 in 1 year.  Then it went to 3.2 in 6 months and measured 3.2 again in 3 months. Doctor recommended biopsy.  I canceled the appointment.  Was that a bad or good decision?
Ash Tewari, MD:
Biopsy is warranted as your PSA is rising.
sportster334:
What are some of the side effects of surgery and can they be avoided/helped?
Ash Tewari, MD:
The literature suggests that the major side-effects of surgical treatment of prostate cancer are urinary incontinence and sexual dysfunction. In the right patient, localized cancer, and in the right hands, these symptoms resolve themselves after surgery.
Ash Tewari, MD:
When looking for a surgeon, the key predictor for good outcomes is the number of cases they have done.
bigspark:
I had a PSA rating of  9.1   four years ago and had a  biopsy done which showed a 10%   positive reading. I went for the implant but was told there was a vein in the way and i was not a candidate for the implants. I decided to play the wait and see...and my rating has dropped to 5.3 but in the last two test it has been  up to 7.5 and 7.6.  
Ash Tewari, MD:
bigspark, please form your response in the form of a question.
rich77:
What is YOUR regimen for return to "normal" potency?  It's been 4 months since RPP, and I use 100mg sildenafil every other day with 800 mg of cimetadine, and have yet to have a spontaneous erection. Those I CAN produce are at best 75% hard of of dubious capcity for penetration. I had normal abilities before.  I must add that a casual attempt, out of curiosity, with Viagra did NOT A THING a few years before the surgery.    
Ash Tewari, MD:
rich777, can you clarify spontaneous erection.
BK2005:
What are the benefits of robotic surgery over the traditional radical prostatectomy?
Ash Tewari, MD:
Let's be clear and say that the robotic surgery, in the right hands and in the right patient, can result in a high return of potency, a high return of urinary continence, and a negative margin. Also, the blood loss is minimized as well as the duration of hospital stay.
BK2005:
How many prostate cancer surgeries do you do each year and can any patient opt for the robotic surgery, or are their requirements that a patient must meet to qualify for robotic surgery?
Ash Tewari, MD:
I perform 600-700 prostate surgeries a year. There are some requirements related to weight. However, patients with localized disease and who are healthy for surgery, are candidates for robotic prostate surgery.
bigspark:
When the rating is in the 7 - 7.6  should one be considering surgery or some other treatment?
Ash Tewari, MD:
I believe biopsy should be redone to assess the disease. Prostate cancer has been established. Simply put, you'll have to select a treatment modality after repeat biopsy.
BK2005:
600-700 prostate surgeries is impressive!  Do you do other types of robotic surgery?  Are you accepting new patients?
Ash Tewari, MD:
Please feel free to contact my office. Use our online portal: www.cornellroboticprostate.org
sportster334:
What's the deal with an enlarged prostate?  Both my dad and my grandpa had this and had some kind of surgery to correct it.  About 9 (?) years later, my dad found out that he had prostate cancer, what is the risk of my brother having and "enlarged prostate" and what would this mean for him?
Ash Tewari, MD:
What you are describing is Benign Prostate Hyperplasia (BPH) it's a process of aging. BPH is very common yet different from Prostate cancer. Your brother could get "enlarged prostate". Given the History of the disease in the family, your brother needs to start getting screened with PSA as of the age of 40.
rich77:
What is PCA3?  I had a rectal coil biopsy which noted a suspicious area, after having had three negative biopsies. The fourth - after the MRI was positive.  How reliable are rectal coil biopsies in dectecting PCA?
Ash Tewari, MD:
PCA3 is a tumor marker that is collected in the urine. Rectal coil biopsies are quite accurate.
LarryScav:
Dr. Tewari,  I had prostate cancer at age 46. My father & brother both had it also.  I had a PSA of 4.6 and no symptoms at all.  My biopsy showed  5% of the entire prostate that was involved. 2 of the 12 biopsy samples taken were positive with a gleason of 3 + 3=6. My question is..... it has been 22 days since my robotic surgery and I am holding my urine, and have 10 min erections & orgasm with absolutely no pills at all. I am pretty much back to normal and resuming minor activities. Is this quick recovery unheard of ?