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Treating and Living with Prostate Cancer

September 14, 2011 2:29 PM with Dr. Michael McGuire

September is Prostate Cancer Awareness Month. Join Michael McGuire, MD, Chief Division of Urology, as he answers your questions about diagnosing, treating and living with prostate cancer. Learn more about active surveillance and other treatment methods. Your participation and questions are welcomed.

Catherine (Moderator) - 2:23 PM:
Welcome! Today’s chat: Treating and Living with Prostate Cancer will begin shortly. Please start submitting your questions and Dr. Michael McGuire will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Prostate Cancer section to obtain more information. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

Dr. Michael McGuire (NorthShore) - 2:29 PM:
Good Afternoon, I am Dr. McGuire, Chief of Urology at NorthShore and a urologist with specialty training in cancer. I am looking forward to your questions

  Richard (Chicago, IL) - 2:29 PM:
Does smoking increase my risks for prostate cancer?
Dr. Michael McGuire (NorthShore)
Not prostate cancer but other forms of urologic cancer- bladder and ureter Also at least 1/2 of men with prostate cancer ultimately die of heart disease so smoking is never a good idea

  Kit (Streamwood, IL) - 2:31 PM:
What is the normal number of nodes removed during a prostate biopsy, and what is the determining factor for having a patient leave with a catheter v. having an emergency develop where a catheter needs to be inserted?
Dr. Michael McGuire (NorthShore)
Typically we now take 12 cores at the first prostate biopsy, but repeat biopsies may have more cores While the inability to urinate can occur after biopsy, it is actually rare and catheters are not routinely placed

  Paul (Oak Park, IL) - 2:33 PM:
My brother just got diagnosed with prostate cancer, am I at risk too?
Dr. Michael McGuire (NorthShore)
All men are at risk for prostate cancers. Having a brother with prostate cancer increases your risk at least 2-4fold, but most cases of prostate cancer are not due to family genetics

  Jonathon (Naperville, IL) - 2:35 PM:
How often should men be screen for cancer? I'm 49 and I just had my first one.
Dr. Michael McGuire (NorthShore)
This is controversial but the American Urologic Association recommends a rectal exam and psa annually for men over 50 unless they are African American or have a family history They should start at age 40 Prostate cancer screening should stop when even if a patient has prostate cancer, it is unlikely to impact on their life

  Roger (Shawinigan, Quebec, IL) - 2:37 PM:
After a successful chemiotherapy, with a PSA around 1 to 3, how long it will take before the cancer will become virulent again?
Dr. Michael McGuire (NorthShore)
Impossible to say, best to discuss this with your oncologist

  Michael (Evanston, IL) - 2:41 PM:
What are the typical symptoms of prostate cancer?
Dr. Michael McGuire (NorthShore)
In this day and age, prostate cancer usually has no symptoms as it is found either with an elevated psa or abnormal digital rectal exam. Advanced prostate cancer typically presents with weight loss or bone pain

  Stephanie (Skokie, IL) - 2:44 PM:
Is there a way to slow down the rate of prostate cancer?
Dr. Michael McGuire (NorthShore)
This is another controversial question. Many prostate cancers are very slow growing and don't need to be slowed down. There is one study which reports that medicines such as avodart or proscar may slow the slower growing cancer. The FDA, however, just released a statement that these drugs also might cause more aggressive cancers so I would not use unless in a study

  Parker (Chicago, IL) - 2:47 PM:
I was treated with external radiation about 3 years ago. The cancer is gone, but I've gained a lot of weight since, experienced depression, and have a loss of libido. Is there treatment I can take to help with the affects of prostate treatment?
Dr. Michael McGuire (NorthShore)
You need a complete evaluation including a Testosterone level. WHile treatment with Testosterone for a man with a documented low Testosterone in a man with a history of prostate cancer is again controversial, it is becoming more common

  Craig (Chicago, IL) - 2:50 PM:
Are there any vitamins you can take to help prevent prostate cancer?
Dr. Michael McGuire (NorthShore)
There was a large study to evaluate Vitamin E and Selenium to prevent prostate cancer- so far there is no proof of any benefit

  Brian (Evanston, IL) - 2:51 PM:
Are there different stages of prostate cancer? And which ones are curable?
Dr. Michael McGuire (NorthShore)
Stage run from 1- confined to the prostate and usually found due to an elevated psa 2. Abnormal rectal exam confined to the prostate 3. Outside of prostate but limited to the area around the prostate 4. into other organs or wide-spread Typically we think stages 1 and 2 have a good likelihood of cure, stage 3 can sometimes be cured, and stage 4 can be treated successfully but unlikely to be cured

  Jason (Highland Park, Il) - 2:55 PM:
I have prostate cancer with bone mets, and my chemo has stopped responding. Should I go about receiving alternative treatments?
Dr. Michael McGuire (NorthShore)
I would discuss with your medical oncologist the new drugs and treatments which have recently been approved that are better at blocking testosterone or use other methods to treat your type of prostate cancer

  Kyle (Schaumburg, IL) - 2:57 PM:
Which diets work best for people with prostate cancer, and which diets/food items are bad?
Dr. Michael McGuire (NorthShore)
While there are no definitive studies, certain dietary modifications seem prudent. 1. Cut dietary fat to at least 30% of your diet, if not less 2. Soybeans have an effective psuedoestrogen component which may be beneficial 3. Keep your overall calories as low as possible to keep your overall weight under control- obesity makes prostate cancer be more aggressive

  Peter (Glenbrook, IL) - 3:01 PM:
How is radiotherapy used for prostate cancer?
Dr. Michael McGuire (NorthShore)
Radiation causes to prostate cancer cells to die. It can be delivered in pellets placed directly in the prostate(called seeds or brachytherapy) or from outside the body(External beam therapy). There are many forms of external beam using different agents(protons, electrons) and different ways of targeting the radiation at the prostate Radiation can also be used in men whose cancer has spread to the bones to treat the cancer in the bones

  Chris (Evanston, IL) - 3:05 PM:
I’ve heard of a radical perineal prostatectomy, what exactly is it and what are the risks/side effects of this procedure?
Dr. Michael McGuire (NorthShore)
This involves an incision between the scrotum and the anus to remove the prostate. There are very few urologists who do this surgery any more, but those that do say it has less pain and incontinence than any other form of surgery for prostate ca. That being said, it still has risks of bleeding, infection, impotence, incontinence and all the other risks of any prostate cancer surgery

  Sean (Boilingbrook, IL) - 3:09 PM:
How long must I remain inactive following surgery?
Dr. Michael McGuire (NorthShore)
After a standard prostatectomy, you can walk that night. We usually recommend no lifting more than 10 pounds for a month after to surgery to allow the wound to heal and nothing more strenuous than walking for the same amount of time

  Chris (Evanston, Il) - 3:11 PM:
I know there are a lot of different treatments for prostate cancer, but what are the benefits of a multidisciplinary approach?
Dr. Michael McGuire (NorthShore)
We often say "if all you have is a hammer, everything looks like a nail." By having a multidisciplinary approach, we make sure we approach your cancer with a full toolbox so we use the proper tool to treat your specific prostate cancer

  John (Chicago, IL) - 3:14 PM:
Which is better, surgery or seed implants?
Dr. Michael McGuire (NorthShore)
It's never that simple Just like the last question about a multidisciplinary approach, we have to evaluate the specifics of your cancer and your overall health and desires to develop the proper treatment for you

  David (Skokie, IL) - 3:17 PM:
Does diet or sexual activity affect my risk of prostate cancer?
Dr. Michael McGuire (NorthShore)
There are some studies which suggest the absence of sexual activity may be more associated with prostate cancer The dietary recommendations to decrease likelihood of prostate cancer are decreased red meat, decreased calories, more whole fruits and vegetables, and increased soybean intake

  Bob (Evanston, IL) - 3:20 PM:
I've heard that active surveillance can be a good option for some men. What does it entail and how do I know if I am a good candidate?
Dr. Michael McGuire (NorthShore)
NorthShore has the Largest series of Active Surveillance in the Chicagoland area. Active Surveillance involves blood tests, rectal exams and periodic biopsies to make sure your cancer is slow growing and not progressing. People who are good candidate for Active Surveillance have low volume, low grade prostate cancer. If you call 847 676 2400 and say you are interested in the Active Surveillance program, we will get you in for an analysis.

Catherine (Moderator) - 3:21 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

  Scott (Chicago, IL) - 3:23 PM:
My PSA has been pretty steady for the past few years, but I have an abnormal dre. My doctor recommends a biopsy, is there an alternative?
Dr. Michael McGuire (NorthShore)
At this time, no. We are investigating the use of MRI in prostate cancer, but currently a biopsy is the correct next step. At least 20% of men diagnosed with prostate cancer annually have a low psa, so the dre remains important

  Marty (Elgin, IL) - 3:24 PM:
Are there local support groups for men with prostate cancer?
Dr. Michael McGuire (NorthShore)
THere are USTOO groups throught Northern Illinois Our Chapter meets at Glenbrook hospital. If you google the USTOO website, you might find one closer to you or you could come to Glenbrook Hospital

  Paul (Evanston, IL) - 3:27 PM:
At what age should I start getting screened for prostate cancer?
Dr. Michael McGuire (NorthShore)
40 for men with a family history or if you are African-American 50 for others

Catherine (Moderator) - 3:30 PM:
Thank you again for participating in our chat today. For more information please visit our Prostate Cancer pages.

Also, a transcript of this chat will be available shortly.

Dr. Michael McGuire (NorthShore) - 3:30 PM:
Thank you for a nice session I have to go take care of patients now

This chat has ended.

Thank you very much for your participation.