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:
He is probably taking Flomax.  Some patients have atonic bladders or profound blockages that require catheter management long term.  Only time will tell in his case.
My PSA level keeps getting higher than the last two times I was checked. There is no history of PC in my family but should I be concerned that the number is slowly increasing or is this natural with age?  My current age is 63.  How often should I keep getting it checked?
Ryan Berglund, MD:
You should undergo a PSA and digital rectal exam annually until you are 75.  While I don't know the numbers, I would recommend biopsy with a PSA greater than 4 or a rise greater than .35 per year.  There is some nuance here though.
My husband was 48 years old and diagnosed with prostate cancer in 2008. He opted for the robotic surgery and was told that all cancer cells were contained in the prostate and that they got it all. He didn't have to undergo radiation or chemo.

My husband has now come to me and told me that he has been in pain since the surgery or should I say a few weeks after the surgery in his lower back/hip area. There is a lump and it is very painful when I touch it. He is now having a hard time sleeping on that side as well. His doctor has scheduled him for a MRI to see if the prostate cancer spread to the spine. Also, for the past 2 years now his PSA level has been .1 and not 0 but he has been told that it's okay/normal for some men.

I am confused as the oncology dr said that the cancer was confined to the prostate. Could this be cancer causing this pain?
Ryan Berglund, MD:
It is hard to say if that is cancer and given the report and PSA you are describing, that seems somewhat unlikely.  That being said, in a man that age, a cause for pain like that needs to be vigorously pursued.  It may be related to some other serious health concern.
Unfortunately, we only have time for two more questions.
I am a 45 year old male with urinary issues since I was a child.  I was diagnosed with Interstitial Cystitis about 7 years ago and also have issues with my prostate.  It is usually irritated/boggy during DRE.  I had my first PSA level exam recently and my doctor is out of town.  I was given the results and I'm worried with the results.  The PSA Total +% Fre seems fine at 0.7 but the % Free PSA is only 8.6  According to the table provided if my Total PSA is between 4 and 10 ng/mL and % Free PSA is 0-10% and I were 50-64 years old I would have a 56% chance of prostate cancer.  My total is 0.7 though, well below the 4-10 range.  Is the 8.6 % Free PSA still an indication of prostate cancer?
Ryan Berglund, MD:
Percent free PSA unfortunately has little meaning at such a low PSA level.  As long as your digital exam is not suspicious for cancer, I believe you can safely watch with repeat PSA levels.
What is the link between fatal prostate cancer and smoking?
Ryan Berglund, MD:
Many cancers have a strong correllation with cigarette smoking, such as lung and bladder cancer. While an association with prostate cancer is not as strong, circulating carcinogens can certainly not be helpful in the prevention of prostate cancer.
Ryan Berglund, MD:
Thank you for this interesting dialogue.  Please remember to get your annual PSA and digital rectal exam.
Ryan Berglund, MD:
If you would like to make an appointment in our Glickman Urological and Kidney Institute, please call 800.223.2273 ext. 45600 or request an appointment online at  Thank you again for your participation today.
That's all the time we have today. Thank you everyone for participating in today's chat and a big thank you to Dr. Berglund for taking the time to answer everyone's questions.