Health Chats
Prostate Cancer: Early Detection and Proper Treatments
Friday Sep 30, 2011, 12:00PM - 01:00PM (EST)
Prostate cancer is the most common cancer in men. Every year, about 185,000, new cases of prostate cancer will be diagnosed in the U.S. About one in six men will be diagnosed with prostate cancer during his lifetime, but only one in 35 men will die of it. More than two million men alive in the United States have been diagnosed with prostate cancer.<br><br> Early detection and choosing the appropriate treatment are key components of a successful outcome for patients with prostate cancer. Take this opportunity to chat with an expert to learn about screening and how to evaluate treatment options.<br><br> The Cleveland Clinic Glickman Urological & Kidney Institute has been ranked second in the nation for urologic care by U.S. News & World Report for the past ten years. Our urologists are recognized around the world as leaders in innovative treatments. Dedicated to enhancing patient care, we offer pioneering procedures that minimize risk and enhance recovery.<br><br> Ryan Berglund, MD, is a urologist in the Glickman Urological & Kidney Institute. His specialty interests include prostate cancer, bladder cancer, kidney cancer, and robotic and laparoscopic surgery. Dr. Berglund has been on staff at Cleveland Clinic since 2009.
Hello everyone and welcome to today's Prostate Health Chat with Dr. Ryan Berglund. We'll be starting at 12:00PM (EDT) but please feel free to submit your questions now.
The doctor will be joining momentarily. Thanks for your patience.
Welcome Dr. Berglund!  We are all so happy to have you here today.
Ryan Berglund, MD:
Hello everyone.  Thank you for joining us today.
How much does the PSA factor into recurrences?  Is any rise in it a sure sign that a recurrence has happened?
Ryan Berglund, MD:
PSA is the most commonly used tool in determining prostate cancer recurrence after treatment, whether radiation or surgery. After surgery, PSA should remain undetectable and after radiation it should remain stablely low.
Ryan Berglund, MD:
There are defined criteria for determining recurrence.
If my father had prostate cancer, how likely am I to have it and at what age should I start getting checked regulary?  I'm 29 yrs old now.
Ryan Berglund, MD:
Prostate cancer is recognized to have a strong genetic component. I would recommend screening in your 40's.
Hi!  My dad is 83 years old and was diagnosed with prostate cancer.  His urologist has suggested we "watch and wait".  Is this a good idea?  I mean this is CANCER - shouldn't my Dad be having some kind of treatment?
Ryan Berglund, MD:
Without knowing all the details, many men in their 80's can safely be watched knowing that the treatment for prostate cancer may often prove to be worse than the disease. For many men in their 80's, this is a reasonable recommendation.
I had advanced prostate cancer diagnosed 8 years ago gleason 9.  Radiation was done with Lupron shots.  PSA went down to <0.1.  Lupron stopped.  .When it started to go up Lupron restarted with Casodex 50 mg. Still continuing.  Yesterday's total bone scan shows no metastasis.  Now PSA goes up every month by 0.3-0.4 points.  Though recommended, I cannot take ketakonazole due to severe stomach problem.  I am 75.  What's your advice please.  John
Ryan Berglund, MD:
In this setting, you may be a candidate for second line therapies such as Taxotere, Provenge, or Zytiga. Those decisions can be made in conjunction with your urologist.
My uncle had radiation therapy for prostate cancer and it left him incontinent.  Are there any new treatments that might help him?  Clearly his quality of life is almost non-existent since he cannot be more than 10 feet from a bathroom.
Ryan Berglund, MD:
Depending on the severity of his incontinence, he may be a candidate for an intervention ranging from Botox or Interstim to male sling or artificial urinary sphincter. A diagnosis needs to be made to determine the specific cause of his incontinence.
How does pathology read when there is a definitive diagnosis of PC?
Ryan Berglund, MD:
A Gleason score will be given. High grade PIN or ASAP are not considered true prostate cancer and are merely risk factors.
Is the treatment of prostate cancer going to destroy a man's sex life?
Ryan Berglund, MD:
A recent article in JAMA shows that about 50% of men with normal erectile function before surgery or radiation have decreased sexual quality of life after treatment. That being said, there are many men in this category that can be assisted with erectile dysfunction treatments. Clearly though, these patients are unsatisfied after treatment.
i had my robotic surgery 9/13 and all went well. my catheter came out Tuesday, 9/20. I was not prepared for the non-stop ''leaking''. can anyone tell me what to expect as far as bladder control and the slowing done of the drainage? I understand everyone is different but and idea may ease my frustration. i'm 170lbs, 5'9'' and in good overall health.
Ryan Berglund, MD:
About 10-20% of men report long term decreased urinary quality of life after surgery for prostate cancer. This is usually related to incontinence. We tend to see improved urinary function up to a year and you are very early on in the recovery process.  Incontinence this early on often does not represent a long term problem.
A friend of mine  had his  prostrate  removed  about  5 months now and still  has not healed, he is still using his catheter, doctors talk about  a special case , and of  re constructive surgery. Can  you shed some  light? What options do we have?
Ryan Berglund, MD:
While not knowing the details, some men have difficulty with scar tissue or poor contractility in the bladder. Some of these men can have this corrected through conservative means over the first year post-op. As far as reconstruction, I would wait until the 1-year mark until making any decisions to proceed.
My question is; my father is now 84, 8 years ago he had treatments for prostate cancer.  I would like to know once the treatements are successful, is their a chance of this cancer coming back?  Is this cancer common among men of a certain age group?  Is this a concern since this is in the family?  I have a 16 yr old son.
Ryan Berglund, MD:
There will always be a risk that the cancer returns, but being 8 years cancer-free at age 84 is certainly a good sign! The bigger concern is the family history and I would recommend the son to start screening for prostate cancer at age 40.
My dad was recently diagnosed with prostate cancer and we wanted to know the possible treatment choices and if there is one that you recommend most often to your patients?  Thank you in advance.
Ryan Berglund, MD:
There are a number of treatment options available and they differ based on the stage, grade and health of the patient. So without much in the way of details, it is hard to determine what is best for him.
My husband had a radical prostatectomy in January.  His post-op
Psa blood test was 0.34.  6 weeks later it rose to 33.5.  A repeat Psa blood test confirmed this rise.  He now has bloody stool and his doctor suggested a colonoscopy.  Can you tell me if his cancer was not confined and had penetrated the capsule and invaded the seminal Vesicles (surgical margins were positive) if it's possible cancer has spread to rectum or colon?
thanks and best to all out there suffering from this awful disease .
Ryan Berglund, MD:
This rapid rise in PSA post-op is concerning for systemic disease. A colonoscopy is mandatory in this setting as the bloody stool could represent local extension of prostate cancer or a colorectal cancer.
Hello Doctor. I had 37 sessions of radiotherapy treatment from October to November 2008. My PSA went from 84.20 to 0.04. Since then I had regular check every 6 months. My PSA started increasing from 0.05, 0.10 & the last of June 2011 was 0.15. Can you please advise me what should I do if this increment goes up to 5.00 for example.
Ryan Berglund, MD:
According to the ASTRO Phoenix criteria, you technically have not had a prostate cancer recurrence yet. That being said, the rise is a bit concerning and your pre-treatment PSA was very high. I would recommend continued close follow up of your cancer and I am assuming your imaging studies were negative.
My dad was recently diagnosed with prostate cancer, and they said he had an aggressive form, and that remission was unlikely.  Then they also said that something else will likely be his cause of death, and not prostate cancer.  Do you understand what that means?  He's hesitant to discuss this with his children as it involves his genitals (don't ask, he's in his 70s).