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.
Ryan Berglund, MD:
You hit on an important topic here. Older men do not like to talk about their health problems. The description you give leads me to believe he is keeping the details to himself.  Without knowing those details, it is hard to say but if he is in poor health, that certainly could be the case. Continue to try and engage your father through this difficult time. You may find he opens up to you.
8. My brother in-law was diagnosed with prostate cancer 1 month ago his psa was 86,he has since had bone scan and mri to see if there is cancer anywhere else, they say they didn't find any but cannot be sure that there isn't cancer somewhere else. What is the likelihood of there being cancer somewhere else????? He goes in to have his prostate out next week, what does this entail? What does a psa of 86 tell you?  Thank you!
Ryan Berglund, MD:
With a PSA greater than 20, your brother-in-law is by definition a high risk patient.  He will likely need additional therapy down the road regardless of his pathology report.  That being said, he may have locally confined disease that can be controlled with surgery and/or radiation.
I've been experiencing restricted urine flow due to scarring of urethra after radiation treatment for prostate cancer.  I'm interested in possible treatment options, like surgery, balloon, etc.  What are the risks, pluses and minuses for each.  I'm especially not wanting any incontinence risks - I have an active life. The prostate cancer treatment itself (in 2010) has been successful so far, with my PSA down from the teens, currently at 2.89 and trending down.
Ryan Berglund, MD:
As long as you are more than 1 year out, with proper urodynamic and cystoscopic evaluation, you may be a good candidate for TURP or laser photovaporization.  That being said, you will be at higher risk over the general population of developing incontinence.  It is a risk/benefit analysis.
I was diagnosed with advanced and aggressive prostate cancer 8 years ago (I am now 75) with gleason score 9 (5+4)  42 radiations were done with Lupron shots.  At the time of diagnosis PSA was 4.7.  After radiation it came down to <0.1.  Sine t5hen PSA goes up and down with continued Lupron shots and Casodex.  Very recent total bone scan showed no metasatsis to bone.  Cat scan of pelvis, chest and abd is also fine.  Current PSA is 2.7.  It goes up by 0.5 every month.  What would ypou recommend please   Thanks.
Ryan Berglund, MD:
If the PSA really starts to take off, you may be a candidate for second line therapy such as Taxotere, Provenge or Zytiga. My guess is your PSA remains low enough that your physician would rather follow for now.
My husband takes the blood test every year to see if he is at risk for Prostate Cancer.  How reliable is this test?
Ryan Berglund, MD:
PSA is the male mammogram. It has very similar sensitivity and specificity as a screening test to the mammogram. Interestingly, men with low PSAs (less than 1) have about a 9% chance of having prostate cancer.  Men with a PSA above 4 have about a 50% chance of having prostate cancer.  So the test is not perfect, but higher levels represent increasing risk.
If there is no trace of cancer in the lymph nodes(after prostate was removed) then how long does the cancer  residue
   remains stay in the prostate area( before they spread to some other place) if the margins were positive? In other words;
   how long should you wait before seeking adjuvant therapy?
Ryan Berglund, MD:
Interestingly, men with low risk prostate cancers have only moderately increased risks of recurrrence with a positive margin.  Intermediate and high risk patients are often better served with upfront radiation therapy.
My father had his prostate removed in 2006.  His PSA levels post prostate removal have been steadily increasing.  He is now at 0.6 and is experiencing pains in his hips.  He has never fully recovered from the surgery and still experiences issues with his bladder.  My question is, at the current level should we be concerned and push for him to seek further treatment as he is stubborn and doesn't think it is anything to worry about or is he right?
Any advice would be much appreciated.
Ryan Berglund, MD:
By definition, he has had a biochemical recurrence of his prostate cancer.  While it would be unlikely to have bony metastases at such a low PSA, he should be evaluated radiographically and should consider salvage therapy with radiation.
I had a radical prostatectomy 7 years ago at the age of 51. My annual PSA's have been 0.0 since my surgery.  I am able to obtain a partial erection and have orgasms, and produce a small, varying amount of semi-viscous fluid when i do. What is the source of this fluid...could my prostate have grown back?  
Ryan Berglund, MD:
Some men experience climacturia which is the expression of a small amount of urine with orgasm.  There are also some small glands in the membranous and pendulous urethra that can produce small amounts of fluid.
If one has had many kidney stones are they more likely to get prostate cancer?
Ryan Berglund, MD:
There is no evidence to suggest that.
I'm 52 and have had a radical prostate removal 4 years ago, since then my psa level has never gone to 0 and has risen to 2 then 3. so then we went and did the radiation treatment 2 years ago and all seemed fine. psa going from 0.4 to gradually rising to 1.6 in February this year. in June this year after the 4 month check it shot up to 7.8 and thinking it was an error had it redone at the hospital at checkup time 2 days later was 8.4. the doctors don't seem to worried about this but it's scaring me to death. should i seek a second opinion? i was involved in a small plane crash in march and i didn't get hurt or anything but there was a sudden stop and seat belt trauma, could this cause a rise in psa level?
Ryan Berglund, MD:
You have had a biochemical recurrence of your prostate cancer after salvage radiation therapy.  Given the rate of rise, I think it would be in your best interest to get a full radiologic evaluation and consider starting hormonal therapy.
1. I have been recently diagnosed with prostate cancer  (biopsy gave a gleason score of 7 ), and the doctor said I could be scheduled for a radical prostatectomy in 3 to 6 months. I am 64.  Is there a normal and maximum recommended wait time for this type of surgery?
Ryan Berglund, MD:
While many prostate cancers are slow growing, it is hard to predict the effect that waiting 3-6 months will have.  I am very comfortable following my lowest risk patients for that length of time, but without knowing the details in your case, it's hard to answer.
3. Dear Dr., I had surgery in March 2009, and my first PSA test in May 2009 was 0.1, the second in November 2009 was 0.2, and now the third in February 2010 is  0.3. My doctor recommended that I take Casodex 50mg for three months and then take another PSA test; however, I am worried about the increase. Should I be? What other options do I have?
Ryan Berglund, MD:
You have evidence of a biochemical recurrence. If you had negative lymph nodes at surgery, you may be a good candidate for salvage radiation therapy.
What are the symptoms of possible Prostate Cancer?  What actually causes this type of cancer?
Ryan Berglund, MD:
Symptomatic prostate cancer is often locally advanced or metastatic and much more difficult to treat. Most prostate cancer these days is detected through screening with PSA and digital rectal exam. Common symptoms with advanced disease are pelvic and bony pain and obstructive voiding.  Please remember that most obstructive voiding is caused by benign prostatic enlargement.
Are blood clots normal after a prostate biopsy?
Ryan Berglund, MD:
In our own series at Cleveland Clinic, about 2.7% of patients have a complication after prostate biopsy.  These are typically infection or bleeding.  In many cases, bleeding like that resolves and everyone has some degree of bleeding after biopsy.  In some cases, patients need to have a Foley catheter placed and rarely a blood transfusion.  Most will resolve without this.
Carol 1:
My husband had robotic surgery to remove his prostate. On the post-op report his Gleason score was a 3+4=7, negative margins, negative nodes, negative semivescular invasion.However, he had a small spot that did escape the capsule.His doctor told him to come back in 6 weeks for his PSA test.I am concerned that he will have a recurrence.Should he have radiation to limit his chances of recurrence or just keep getting PSA rechecks and hoping the cancer never returns? What are his chances of recurrence? Thanks.
Ryan Berglund, MD:
Excellent question. Extracapsular extension does increase his risk of recurrence and there is some debate about the role of adjuvant radiation therapy in these patients.  That being said, with negative margins, he has a good chance of having been cured.  The decision is whether to improve his cure rate with the upfront costs of radiation as compared to possibly avoiding radiation in the majority of patients in his situation.  There is no right or wrong answer.
Thanks for taking time to be with us today, Dr. Berglund.  Does diet play a role .. red meat, fruit and/or obesity ?
Ryan Berglund, MD:
All of the above, yes.  We know that obese patients and people who eat our terrible Western diet suffer from systemic inflammation and metabolic derangements which increase our risk of developing cancer.  
My father had scar tissue blocking his urethra from treatments, and took Fosomax.  Shortly after, he had some irregularities in his blood pressure - it was going up and down, and was all over the place.  He is now self-cathing.  Will he have to do this forever?  He is 75.