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Prostate Cancer

Prostate Cancer

April 3, 2012
12:00 p.m. – 1:00 p.m. (EST)

  • William Gans, MD - Urologists

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Prostate Health/Cancer" with William Gans, MD. We are having some technical difficulties at the moment but we should be up and running in a few minutes.

Cleveland_Clinic_Host: Please continue to submit questions for Dr. Gans.

Cleveland_Clinic_Host: We are happy to announce that our technical issues have been fixed. Dr. Gans will start answering questions now.

tcline52: Is there any evidence or knowledge that would suggest that periodic ejaculations reduce the incidence of prostate cancer or disease? If so, is there a recommended frequency?

Dr_Gans: This was discussed in the past but, there are no well-done studies to indicate that the frequency of ejaculations will affect the incidence of benign prostate disorders or prostate cancer.

dliving41: A PSA of 5 suggested a biopsy which I had in December of 2010. One core sample showed prostate Adenocarcinoma, Gleason 6, and 5% of tissue. Perineural invasion was indicated. My PSA has stayed at 5 but a biopsy in December of 2011 was similar (1 core sample and approximately 5% of the surface area), but the Gleason score was 3+4=7. Perineural invasion was not seen. I am a white male, age 71, who is otherwise in good health and I exercise daily. My Urologist recommends that I continue my active surveillance program. Can you comment? Thank you.

Dr_Gans: It is difficult to comment regarding treatment since I do not have access to all of your medical information. The higher grade of cancer on the second biopsy is concerning although it is present in only one core. The decision regarding treatment of prostate cancer is one that is made by the patient and physician. If your physician is recommending surveillance for you but you are uncomfortable with that option, then you should discuss other options with him.

GroKenHaMMer: Has the PSA test not been found to lead to unnecessary surgeries?

Dr_Gans: The psa test does suffer from a significant amount of false positive tests, meaning that patients undergo prostate biopsies and no cancer is found.

GroKenHaMMer: What are the treatments for an enlarged prostate?

Dr_Gans: There are medications as well as surgical interventions that can be utilized for noncancerous "enlarged prostate." There are also in-office procedures that are available as well.

robtoby: Are there any dietary 'changes' or suggestions for someone who had already had prostate cancer and has been treated by robotic laparoscopic prostatectomy?

Dr_Gans: There are no dietary changes after treatment for prostate cancer surgery in regards to the prostate cancer. However, heart disease is always a concern so I would recommend a heart healthy diet and lifestyle.

gm3: At age 70.5 my PSA is at 2.4 as of February 2012. In 2006, the reading was 1.1, in 2007, 1.2, in 2008, 1.3, in 2009, 1.8, and in 2011, 1.7. Is the 2.4 reading average for my age? Also, can sex several days before the PSA test affect the readings?

Dr_Gans: Sex several days before the test should not affect the PSA. The PSA is within the normal range but it has risen since last year. There is some debate in the urologic community regarding the significance of the rise of PSA elevation. You should speak to your physician about this.

SkeletonKey: Is there any scientific evidence to support the taking of certain over-the-counter supplements to help reduce the possibility of getting prostate cancer or preventing its return?

Dr_Gans: There is little evidence regarding the use of over the counter supplements.

wmslyhog: What is indicated by lack of prostatic fluid on ejaculation?

Dr_Gans: The lack of fluid during ejaculation can be due to a variety of reasons including, but not limited to, medication side effects and side effects from certain types of surgery.

AdamF: My most recent PSA score came back as a 1.6. Where should my score be to stay within a safe level? I am 53 years old.

Dr_Gans: Ideally the PSA will remain relatively stable and not change much.

HensleyJam: My father (deceased) had prostate cancer in his 60s and I think that I should get screened early. I am an African-American male, age 37. What do you recommend?

Dr_Gans: The current recommendation for a patient with a family history of prostate cancer or African American is to start screening at 40 years old. I usually follow this recommendation but I would consider earlier screening based on patient preference.

chutkhanjohn: How reliable is the PCA3 urine test regarding the need to re-biopsy?

Dr_Gans: the PCA 3 test is somewhat reliable regarding the need to re-biopsy. It has a better negative predictive value and positive predictive value than the PSA test.

tcline52: How uniform are the different PSA methodologies? Would it be reasonable to expect that the Bayer Chemiluminescent method would give the same result as the Siemens Luminescent method?

Dr_Gans: The results can differ with different methodologies so if possible; try to go to a lab with the same "method" to remove this variable in case a change is found in serial testing.

SkeletonKey: Has the "robotic" procedure to remove the prostate become the standard "gold" procedure or is the "long incision" method still the standard?

Dr_Gans: Open radical prostatectomy is still the "gold standard."

HerseyKiss: What Gleason score determines the difference between aggressive and mild cancer? Can you give a numeric example of what the differences would be?

Dr_Gans: The Gleason grade ranges from 1-5. A grade of 1-3 is considered less aggressive and a grade of 4 or 5 is considered aggressive. The most predominant cancer pattern on a biopsy is given a grade and the second most predominant pattern is given a grade as well. The Gleason score is devised by adding the two grades. This is why a Gleason score is listed as (a+b) on the report and not just a single number.

wmslyhog_1: Are there specific exercises that are more beneficial to prostate health?

Dr_Gans: There are no exercises of which I know that are beneficial to prostate health.

Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

Joyceandtom: I'm on Lupron, aka leuprolide. Could Avodart, aka dutasteride, and finasteride have fewer long term side effects?

Dr_Gans: Dutasteride/finasteride have different side effects than leuprolide, but these medications are prescribed for different reasons so a change would probably not be feasible.

joyceandtom: My husband just had a DRE exam and was told his prostate was slightly enlarged, but for his age it was normal. He is 57; PSA was 4.01. Is this considered very high? I understand 4 is considered normal.

Dr_Gans: A psa of 4.01 is not very high. However, I generally do not recommend making any treatment suggestions based upon one test. The current PSA of 4.01 needs to be compared to other values as well as whether or not there is a family history of prostate cancer.

Oliver: I understand that robotic surgery is performed for prostate cancer procedures. What are the advantages and disadvantages? Also, is there a criterion for who is a candidate for robotic surgery?

Dr_Gans: There is a lot of debate in the urologic community regarding the advantages and disadvantages of robotic surgery compared to radical prostatectomy. Proponents of each approach have good arguments for their positions. Most patients are candidates for either, although some preferences can arise based on previous surgeries, body size, or medical history. The most important aspect of prostate cancer surgery is not the robot, but rather surgeon experience.

Cleveland_Clinic_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.

PilotPete: Please explain the PIN assessment and what it determines.

Dr_Gans: PIN is an abbreviation for prostatic intraepithelial neoplasia. There are different grades of PIN, low or high. High grade PIN was considered to be a precursor to prostate cancer development so re-biopsy was always suggested after this diagnosis was given. The practice of automatic re-biopsy has been questioned lately. In my opinion, the significance of high grade PIN depends on the whole patient clinical picture so it is difficult to give a general answer.

HensleyJam: Is there a probability of any type of incontinence following a prostate cancer biopsy? Or does this normally occur after surgery?

Dr_Gans: There typically is no incontinence following a prostate biopsy. Incontinence can occur after radical prostate cancer surgery or surgery for benign prostate growth as well.

Cleveland_Clinic_Host: I'm sorry to say that our time with William Gans, MD is now over. Thank you again, Dr. Gans, for taking the time to answer our questions today about Prostate Health/Cancer. To make an appointment with Dr. Gans, or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.