Quest Spring 2013 : Page 4
All questions are answered by William J. Catalona, MD. Sometimes, the view can open up a new way of looking at things. Elevated PSA Q Could an elevated PSA ever indicate cancer elsewhere in the body when biopsies are negative? Surgical Castration, Hormonal Therapy and Radiation What would be the difference in effect on recurring prostate cancer between surgical castration, hormonal therapy and radiation? Surgical castration removes all male hormones produced by the testicles. Medical hormonal therapy can also inhibit the effects of male hormones produced in the adrenal glands and other body tissues as well. Radiation therapy works by an entirely different mechanism; it damages the DNA of prostate cancer cells, preventing them from dividing and growing. A No. For all practical purposes, only prostate cells produce PSA. So if the PSA is elevated, it indicates a prostate-related problem – usually prostate cancer, benign enlargement, or inflammation or any combination of these conditions. Q A Hormone Therapy With Radiation No Prophylactic Prostatectomy Would it be possible and advisable for a prophylactic or preventative prostatectomy on men with a strong family history of prostate cancer? Q My husband has been advised to start radiation and hormone therapy. One doctor says to start both now. Another says he should have hormone therapy for a while before starting radiation. What do you recommend and why? Q A No, this practice would be considered unethical, largely because of the potential side effects of radical prostatectomy. The current medical standards are that removal of the prostate is worth the risk only if it is performed to cure a proven prostate cancer. A In patients with “high-risk” prostate cancer (higher Gleason grades, tumor volumes, or PSA levels), studies show that hormone therapy given before, during, and after radiotherapy improves the results. It is believed that the hormone therapy kills many of the prostate cancer cells and also may make the remaining cells more vulnerable to the damaging effects of radiation. 4 Calcium in Prostate and PSA Levels After being told he had a high PSA, my 40-year old husband had a scope that showed a large amount of calcium in his prostate. Should he have a biopsy to also make sure he doesn’t have cancer? Usually calcium deposits in the prostate are the aftermath of prostate infection, which is the most common cause of an elevated PSA test. Your husband should be carefully evaluated by a urologist to rule out prostate inflammation as the cause of his elevated PSA before deciding to have a biopsy. Sometimes an empirical course of antibiotic therapy is helpful in bringing the PSA level back to normal. Alternatively, with time, it might return to normal spontaneously without specific treatment. Q A ©photo by Sandy Radom http://www.sradom.com
Q&A
William J. Catalona, MD.
All questions are answered<br /> <br /> Sometimes, the view can open up a new way of looking at things.<br /> <br /> Elevated PSA <br /> <br /> Q Could an elevated PSA ever indicate cancer elsewhere in the body when biopsies are negative?<br /> <br /> A No. For all practical purposes, only prostate cells produce PSA. So if the PSA is elevated, it indicates a prostate-related problem – usually prostate cancer, benign enlargement, or inflammation or any combination of these conditions.<br /> <br /> Hormone Therapy With Radiation <br /> <br /> Q My husband has been advised to start radiation and hormone therapy. One doctor says to start both now. Another says he should have hormone therapy for a while before starting radiation. What do you recommend and why?<br /> <br /> A In patients with “high-risk” prostate cancer (higher Gleason grades, tumor volumes, or PSA levels), studies show that hormone therapy given before, during, and after radiotherapy improves the results.<br /> <br /> It is believed that the hormone therapy kills many of the prostate cancer cells and also may make the remaining cells more vulnerable to the damaging effects of radiation.<br /> <br /> Surgical Castration, Hormonal Therapy and Radiation <br /> <br /> Q What would be the difference in effect on recurring prostate cancer between surgical castration, hormonal therapy and radiation?<br /> <br /> A Surgical castration removes all male hormones produced by the testicles. Medical hormonal therapy can also inhibit the effects of male hormones produced in the adrenal glands and other body tissues as well.<br /> <br /> Radiation therapy works by an entirely different mechanism; it damages the DNA of prostate cancer cells, preventing them from dividing and growing.<br /> <br /> No Prophylactic Prostatectomy <br /> <br /> Q Would it be possible and advisable for a prophylactic or preventative prostatectomy on men with a strong family history of prostate cancer?<br /> <br /> A No, this practice would be considered unethical, largely because of the potential side effects of radical prostatectomy.<br /> <br /> The current medical standards are that removal of the prostate is worth the risk only if it is performed to cure a proven prostate cancer.<br /> <br /> Calcium in Prostate and PSA Levels <br /> <br /> Q After being told he had a high PSA, my 40- year old husband had a scope that showed a large amount of calcium in his prostate. Should he have a biopsy to also make sure he doesn’t have cancer?<br /> <br /> A Usually calcium deposits in the prostate are the aftermath of prostate infection, which is the most common cause of an elevated PSA test.<br /> <br /> Your husband should be carefully evaluated by a urologist to rule out prostate inflammation as the cause of his elevated PSA before deciding to have a biopsy.<br /> <br /> Sometimes an empirical course of antibiotic therapy is helpful in bringing the PSA level back to normal. Alternatively, with time, it might return to normal spontaneously without specific treatment.<br /> <br /> Male-pattern Baldness and Prostate Cancer <br /> <br /> Q Are there any studies on correlation between male-pattern baldness and prostate cancer?<br /> <br /> A Yes. They suggest that men with male-pattern baldness have a higher risk for prostate cancer.<br /> <br /> Inflammation and free PSA <br /> <br /> Q Can inflammation of the prostate affect the free PSA level as well as the PSA level?<br /> <br /> A Yes, but because free PSA is a smaller molecule, it is cleared from the blood stream by the kidneys more quickly and thus its levels return to normal more quickly than PSA bound to proteins.<br /> <br /> Mirabegron <br /> <br /> Q I read about FDA approval of a new drug for incontinence, mirabegron (Mybetriq). Will the drug assist in regaining continence after a radical prostatectomy?<br /> <br /> A In most cases, incontinence after radical prostatectomy is due to a weak urinary sphincter muscle. This type of incontinence seldom responds to drug therapy. If incontinence is due to an overactive bladder, drug therapy sometimes is helpful.<br /> <br /> Treatment Options for Older, Healthy Men <br /> <br /> Q When a vigorous man in his early 80’s is diagnosed with prostate cancer, what are his treatment options?<br /> <br /> A Warren Buffet is a good recent example. In general the options are active surveillance or radiotherapy. I believe that external beam radiation is the preferred form.<br /> <br /> I do not think that proton beam or cyberknife are necessary. I usually recommend IMRT (intensity-modulated radiation therapy).<br /> <br /> “Seeds” (brachytherapy) are also an option, but they have to be inserted with perfect geometry and therefore are “operator dependent” and cannot be used if the prostate is too large or in men who have had a prior trans-uretheral resection of the prostate.<br /> <br /> We have a commitment to educate the public about prostate cancer. We send QUEST free to everyone who requests it. 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