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Prostate Cancer: Diagnosis, Treatment and Recovery

September 4, 2013 10:29 AM with Dr. Brian Helfand

Prostate cancer is the second leading cause of cancer death in men. If detected and treated early, prostate cancer survival rates are high and are associated with good functional outcomes. As part of National Prostate Cancer Awareness Month, Brian Helfand, MD, PhD, Urologist at Northshore, will answer questions on prostate cancer, from early symptoms and recommended screenings to current treatment options and life and recovery after diagnosis and treatment.

Dr. Brian Helfand (NorthShore) - 9:42 AM:
Getting ready for the prostate cancer chat coming soon at 10:30 AM!

Brenna (Moderator) - 10:07 AM:
Our chat Prostate Cancer: Diagnosis, Treatment and Recovery will begin in approximately 30 minutes. You can submit questions now or at any time during the chat. For more information, go to The John and Carol Walter Center for Urological Health

  Renee (Chicago, IL) - 10:32 AM:
My husband's father had prostate cancer. Could my husband be predispositioned to getting this? Thank you.
Dr. Brian Helfand (NorthShore)
Prostate cancer is one of the most heritable of all cancers. As such, the risk factors that are most associated with prostate cancer are first degree family history (father, brother, uncle, etc) and race (e.g. African Americans). Based on statistics, your husband is almost 2x likely to be diagnosed with prostate cancer than a man without a family history. Although there is some debate regarding the routine use of PSA screening, I am a firm believer that your husband should start undergoing annual PSA screening at the age of 40.

  Jerome (Macon, GA) - 10:36 AM:
I had surgery for prostate cancer on January 4th. With 30% cancer, the medical team use a Da Vinci machine. After the 6 hour procedure, I was told it was successful. My question is what is the percentage rate of the cancer returning ? Or how often should I get a check up , now that I live in a different state?
Dr. Brian Helfand (NorthShore)
It sounds like you had a very successful treatment for your prostate cancer. The chance of recurrence is hard to quote because it depends on many factors including your Gleason score, whether any lymph nodes were positive, whether there was a postie margin, etc. With surgical intervention, your chances (even with an aggressive prostate tumor) of having a recurrence are significantly lower. In order to follow you in the post-operative period, you should have an initial post-operative PSA about 4-6 weeks, and then every 3-4 months (based upon your urologist's preference). After 2 years of having an undetectable PSA, I get PSAs on my patients every 6 months.

  Antonio (IL) - 10:41 AM:
My PSA was elevated 4.3; what can I do about this? What are the steps to have a healthy prostate? I am 43 years and I weight 230 lbs. Thank you
Dr. Brian Helfand (NorthShore)
There are several things that you should know when evaluating the meaning of your PSA. 1. It is important to realize that most men your age will have a PSA < So a value of 4.3ng/ml is at face value is too high for your age. This does not mean that you have prostate cancer, but it means that we should pay attention to the value over time or consider a biopsy. However, see #2. 2. Not all men with elevated PSAs have prostate cancer. PSA is NOT a perfect test, but it is still THE BEST test for prostate cancer screening. Sometimes, the value of PSA can be elevated because of an enlarge prostate, infection, inflammation, sexual activity, etc. Therefore, it is important to pay attention to trends over time (whether it fluctuates or not) Based upon #2, I would recommend that you either consider a biopsy or repeat the PSA in 1-2 months to make sure that it is going down. Also, being overweight increases your risk of many medical problems.

Dr. Brian Helfand (NorthShore) - 10:51 AM:
In continuation of the last response; Being overweight is thought to contribute to many medical problems, including cardiovascular disease and diabetes. It is also thought that obesity contributes to prostate problems including urinary symptoms related to prostate enlargement and prostate cancer. There is emerging evidence that obesity is a driving factor for benign growth of the prostate (referred to as BPH or benign prostatic hyperplasia), and as such, it causes men to get up at night, have a slow urinary stream, etc. Obesity also contributes to prostate cancer. It may increase the risk of developing the disease or the extra weight may make it harder to detect the disease until it is advanced. Obesity also is thought to contribute to prostate cancer recurrence. As such, it is important for men to realize that a heart healthy diet, low in simple carbohydrates also helps the prostate!

  Douglas (Rockford, IL) - 10:51 AM:
I'm 42 years old and recently I've had a problem with the pressure of my urine flow. Could this be because my prostate is enlarged, causing complications? I recently injured my lower back and thought this may be the issue, but my back is better and I still have the urine issue. I have no pain or discomfort in the area, just the issue of of lack of pressure. Could it be a sign of prostate cancer?
Dr. Brian Helfand (NorthShore)
You may have several reasons for your urinary flow problems. One of which may be an enlarged prostate, or perhaps even more rare, it could be prostate cancer. As such, you should be evaluated for this problem by a health care professional, and they should make sure that you are emptying your bladder well, that you don't have a urinary tract infection and check a PSA. The most common reason for urinary problems is an enlarged prostate, and there are many medical therapies that can be given (with low side effects) to help relieve these symptoms. Finally, since you recently had back surgery, there is a probability that you were taking narcotic pain medications. These may make you constipated. Constipation can also impact your urinary symptoms, and treating the constipation can actually help with urination.

  Winston (Skokie, IL) - 10:56 AM:
Are there any preventative measures aside from check-ups & testing that could also help to lower the chance of developing prostate cancer? Things like supplements, diets, or natural herbs, medicines or products? Thank You!!!
Dr. Brian Helfand (NorthShore)
No dietary supplement has been shown to prevent prostate cancer when studied in a systematic fashion. However; it is possible that a heart healthy diet, low in fats and simple sugars may help prevent prostate cancer. However; this remains to be determined. It has been shown that medications used to shrink the prostate (called 5 alpha reductase inhibitors) can actually prevent up to 1/4 of prostate cancers. However; these are NOT approved by the FDA for this purpose because in the large studies of these drugs, the men who were on the medications that ultimately developed prostate cancer had a tendency to have more aggressive forms of the disease. As such, we do NOT routinely use these medications for prevention.

  Nathan (Chicago, IL) - 11:02 AM:
How likely am I to recover sexual function after a prostatectomy? What surgical options result in the best possible outcome as far as recovering sex life?
Dr. Brian Helfand (NorthShore)
I tell my patients that your post-operative sexual function is significantly related to your age and pre-operative function. In general, treatment for prostate cancer (whether radiation or surgery) has never improved a man's erectile function. However; if a man is young, is not diabetic or obese and has good erectile function prior to surgery, then he has a very good chance of having normal erections post-operatively. Sometimes, men can have some problems after treatment that respond to simple medical therapies (e.g. Viagra, Cialis, etc). I believe that good nerve sparing surgery significantly helps with the recovery of erectile function. This can be done by a urological surgeon who is trained in the technique and frequently performs the operation. In addition, I believe that all men should start (at minimum) a rehabilitation program before and immediately after surgery that helps to recover the nerve function. This could involve taking drugs like Cialis before and after surgery.

  Matthew (Skokie, IL) - 11:08 AM:
If you do suffer from sexual dysfunction after prostate cancer treatment, what can you do to aid/improve recovery? Medications you can take? Diet changes? Exercise?
Dr. Brian Helfand (NorthShore)
There are many different things that are available for treatment of sexual dysfunction after surgery. Unfortunately there is not a universal solution for every man. It should include an assessment of psychological function and desire for sexual activity following surgery. This is often overlooked as many men get nervous about intimacy following surgery and often getting evaluated by a trained professional can help relieve a lot of this anxiety. From an erectile dysfunction standpoint, there are many oral medications (Cialis and Viagra, etc) that can be used to rehabilitate erections. This is often a starting point. If you fail to respond to these therapies, then other interventions such as a vacuum erection device, or injection therapies can be used to obtain an erection. As always, regular exercise and a heart healthy diet helps improve and increases your chance of successful recovery.

Brenna (Moderator) - 11:14 AM:
There are 15 minutes left in this chat. Please submit your final questions. We apologize if we are unable to get to all our questions today.

  Antoine (Chicago, IL) - 11:15 AM:
What is a normal PSA for a younger man (under the age of 50)? How do you determine what is normal or not?
Dr. Brian Helfand (NorthShore)
I always tell my patients that you should compare your PSA to what is "normal" for your age counterparts. Most men age 50 have a PSA below 0.7ng/ml. For simplicity, you could use a cutoff of 1.0ng/ml. Just because you have a value that is above your age cohort, does NOT mean that you have prostate cancer. However, it means that you are statistically at slightly increased risk of being diagnosed with the disease. As such, you should continue to get screened with PSA at least on an annual basis. However, other factors should go into the interpretation of PSA before deciding to perform a prostate biopsy. These include whether the PSA values have been rising over time, whether you have a family history of prostate cancer, African American race, whether you have a history of BPH, whether you have many other medical problems, etc. Remember, PSA is not a perfect test, but it is currently still the best test we have for prostate cancer screening and has inevitably saved many lives!

  Laura (Chicago, IL) - 11:21 AM:
What are the differences between robotic laparoscopic surgery and conventional open prostatectomy in terms of recovery? If a doctor can do a robotic surgery, would there be a good reason to go with conventional open surgery instead?
Dr. Brian Helfand (NorthShore)
I think the answer is surgeon experience. There are many urologists who can perform open surgery with excellent outcomes (great cancer control, erectile function and continence). Similarly, there are many urologists who can perform robotic surgery with similar outcomes. Therefore, it is most important to be treated by a urologist who is comfortable and experienced with a radical prostatectomy. Having said that, robotic surgery has recently become the most commonly used surgical intervention for prostate cancer. Compared to the open approach, robotic surgery offers significantly less blood loss and a shorter hospital stay. Although not proven, it is likely that the robotic surgery offers increased visualization which provides an opportunity to perform better nerve sparing and a nice connection between the bladder and urethra. These latter should be associated with increased erectile function and increased continence.

  Chuck (Chicago, IL) - 11:27 AM:
What does active surveillance involve? Why would someone choose do that instead of actively treating their cancer?
Dr. Brian Helfand (NorthShore)
Great question. We have come to a "new era" of prostate cancer and we have realized that many times men have prostate tumors that may not harm patients during their lifetime (benign type prostate cancer). This is because many prostate tumors grow very slowly and other medical problems may ultimatley harm a man before the prostate cancer spreads. Unfortunately, there is currently no diagnostic test that can tell you whether you have a lethal prostate cancer or a more benign type tumor. As such, we have developed a program of surveillance in which we avoid treating patients with prostate cancer until there is evidence that it has an aggressive component. This involves ACTIVELY following men (PSA tests and prostate biopsies). While this seems to increase the number of times that a man is evaluated by a urologist, it avoids being overtreated with surgery or radiation that may also cause erectile problems or incontinence. NorthShore currently has the largest program in the Midwest

Brenna (Moderator) - 11:36 AM:
Thank you everyone for your participation in our chat today. We apologize if we were unable to reach your question today. A transcript of this chat will be made available shortly. Go to John and Carol Water Center for Urological Health for more information on prostate cancer and urological health.

This chat has ended.

Thank you very much for your participation.