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RECENT Prostate Cancer QUESTIONS
All questions are answered by Dr. William J. Catalona.
Recent Questions
The digital rectal exam of my prostate and the MRI both indicated no sign of tumor or cancer. Your note indicated that I should consider a biopsy. Why should I have an MRI if that was not going the determining factor? I have questions about some of my results. What do “Diffusely decreased T2 signal bilaterally, likely related to chronic inflammation/fibrosis” and “The urinary bladder is thickened and trabeculated, likely related to chronic bladder outlet obstruction” mean?
Decreased T2 signaling bilaterally means that there appears to be a process that involves the entire prostate gland. This pattern is most commonly seen with acute or chronic inflammation in the prostate and less likely that it is due to prostate cancer. “The urinary bladder is thickened and trabeculated, likely related to chronic bladder outlet obstruction” means that your bladder is having to work harder than normal to force out urine through your prostate gland that is chronically causing “obstruction.” This also can occur with prostate inflammation.
I ordered the MRI because, if it were to show a highly concerning region, I would “urge” you to have a biopsy rather than to advise you to “consider” having a biopsy. The MRI is not a perfect test, and some patients with a negative MRI scan are found to have a potentially life-threatening prostate cancer. Your family history of prostate cancer and a rising PSA also places you in a higher risk category, as could being a chronic smoker.
I received my prescription of Bimix 30-5 (papaverine 30 mg/mL & phentolamine 5mg/mL), but I am a little confused. I received five vials and have injected myself five times, as directed. I have stored the remainder of the medications in its vial in my refrigerator. Do I need to order again or am I supposed to use the leftover medication in each vial to inject again? Could reusing the vials a second time might lead to infections?
The vials are intended for multiple uses. You can use the leftover medication, but you should ensure that you use sterile precautions (carefully wiping the vial top and injection site with alcohol) in performing the injection.
I would rate my urinary continence about 99%. I get an occasional drop but nothing significant. I've made a habit of doing 10 Kegels every morning. My question is, do I need to do these for the rest of my life or was this just for rehabilitative purposes?
I am glad to learn that your continence is now nearly complete. Most patients stop doing the Kegel exercises once it is 100%, but some continue to do them for the rest of their life. With regard to return of spontaneous erections, the injections may speed up that process. Most patients do not begin to have spontaneous erections for at least a year, but it is best not to wait a year to begin the injections. Start them right away, as this way the chances for complete return are better.
I just wanted to let you know I stopped the injections a few months ago, because I don't feel comfortable doing it (having the scar tissue from when I was doing it wrong, along with some bleeding the last few times). If there is a second best alternative you can suggest, I would like to try it or at least consider it. Perhaps, Cialis, Viagra, etc., or something else.
The pills do not materially induce erections until you are beginning to have spontaneous erections, but they marginally increase the blood flow to the genital region. So for patients who don’t want to do the injections, I recommend either the intraurethral suppositories (MUSE – they are very expensive!) or a vacuum device. You can find more information about one such device and how to use it be pasting the following link into an internet browser: https://www.youtube.com/watch?v=hqTpzgcO9nI. Your Prostate Health Index results are trending favorably: i.e., your PSA and PHI are lower but still high, and your percent free PSA is higher (which is good) but not as high as desired. These results are the similar to those 2-3 years ago, so they do not suggest the presence of a continuously growing prostate cancer. I recommend that you repeat the PHI and prostate exam in 6 months.
I am using the Bimix (papaverine 30 mg/mL and phentolamine 3 mg/mL) injection for erectile dysfunction. I put the medication in the freezer while I was waiting for the injection training session. I am keeping one vile in the fridge as I use it for the three-per-week injections. Should I worry about the quality after freezing and refrigerating?
Freezing sustains the strength of the medicine longer than simple refrigeration. With refrigeration only, the Bimix becomes weaker after three months and you may need to inject a greater volume to get the same desired effect.
Last night, there was blood in my urine. On occasion, there is also blood in my ejaculate. All of my adult life, I have gotten up about three to four times at night to urinate. Should I be doing something about this?
Blood in the urine or ejaculate is usually caused by fragile blood vessels in the bladder or prostate gland. The “proper” evaluation includes a tri-phasic CT scan of the abdomen to visualize the entire urinary tract, followed by a look into the bladder by passing a small flexible scope up through the urethra to rule out a stone or tumor somewhere in the urinary or genital tract. It also includes sending urine samples for infection and to look for malignant cells. Usually, the results are negative. Then, we feel reassured that the blood may be due to transient inflammation or infection.
I received my prescription of Bimix 30-5 (papaverine 30 mg/mL & phentolamine 5mg/mL), but I am a little confused. I received five vials and have injected myself five times, as directed. I have stored the remainder of the medications in its vial in my refrigerator. Do I need to order again or am I supposed to use the leftover medication in each vial to inject again? Could reusing the vials a second time might lead to infections?
The vials are intended for multiple uses. You can use the leftover medication, but you should ensure that you use sterile precautions (carefully wiping the vial top and injection site with alcohol) in performing the injection.
A few months ago, my PSA score went from 0.01 to 0.02 ng/mL. I waited several months to re-test due to the pandemic. The new test results are a PSA of 0.00 ng/mL. I think you would agree it can't be any better than that, right? It will be five years since my radical prostate surgery. How long until I should get re-tested?
You should be tested for 10 more years. But so far, so good!
FREQUENTLY ASKED Prostate Cancer QUESTIONS & ANSWERS
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PSA
Biopsy, Digital Rectal Exam (DRE) & Gleason Score
Initial Treatments After Diagnosis of Prostate Cancer
Conditions After a Radical Prostatectomy
Continence (Urinary Concerns)
Sexual Potency After a Radical Prostatectomy
Post Operative Treatment and Treatment Upon Recurrence
Hormonal Therapy
Information About the Prostate Gland
Other Conditions of the Prostate
Prevention, Nutrition, & Lifestyle
Miscellaneous
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