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All questions are answered by Dr. William J. Catalona.
1 ) My blood tests indicate a low testosterone level. What is involved in getting testosterone-replacement therapy to bring it back to normal values?
Testosterone-replacement therapy can be given by injection, patch, gel, or underarm liquid (in increasing order of cost). While patients are receiving the therapy, they should be monitored at least annually—and often more frequently—for blood counts, liver function tests, cholesterol and lipid measurements, testosterone measurements, and PSA levels. Also, body weight should be monitored for fluid retention.
Patients on testosterone-replacement therapy become dependent upon it, because if the patient is receiving “external” testosterone, the pituitary gland does not normally stimulate the testicles to produce it. In such cases, the testicles often decrease in size.
2 ) I am being bothered by my enlarged prostate and was happy to learn from my biopsy procedure that at least there was no evidence of prostate cancer. Therefore, I am hoping to get my TURP (Trans-Urethral Resection of the Prostate). What is the recovery time, and how soon would I be able to return home?
The short-term recovery time from a TURP is usually about three to four weeks, but you should be able to return home within one week if all goes as expected.
However, after a TURP operation, you would have a larger new urinary channel that would improve your bladder’s ability to empty, but this channel would need to be “re-paved” with a smooth lining composed of cells that grow “down” from the bladder and “up” from the urethra. This part of the healing process can take three to four months.
3 ) Could you explain the old and new Gleason tumor grading systems and how they affect patient management options?
Here is the story on Gleason grading: in the 1960s, Dr. Donald Gleason introduced a grading system that included five patterns of cancerous cells, 1 through 5, with 1 being the least aggressive and 5 being the most aggressive. The first number is the “primary” or majority pattern and the second number is the “secondary” or minority pattern present in the biopsy specimen. Some patients have a “smidgen” (less than 5% of the cancer tissue) that is called the “tertiary” pattern as well. The primary and secondary pattern numbers were added together to give a Gleason Sum or Score that could range from 2 to 10. Over the decades, we learned that all Gleason scores of 3+3 or less behaved the same and were generally very mild (not aggressive).
About five years ago, an international group of pathologists modified and simplified the Gleason system into five different Gleason Grade Groups. Grade Group 1 is Gleason 6 or less; Grade Group 2 is Gleason 3+4; Grade Group 3 is 4+3; Grade Group 4 is 4+4; and Grade Group 5 is Gleason scores of 9 or 10.
The great majority of patients who are candidates for active surveillance patients will have Gleason 3+3=6 or less and therefore be Grade Group 1. A few with very small amounts of Gleason 3+4 (Grade Group 2) can also be potential candidates. Patients with more aggressive tumors require active treatment.
4 ) My biopsy revealed a Gleason grade 3+4=7 (Grade Group 2) prostate cancer. Could my MRI indicate any potentially higher grade cancer?
We cannot accurately determine from the MRI scan whether you have a higher grade prostate cancer. Your pathology results already show that your cancer is in the low end of the moderately aggressive category.
5 ) My post-operative PSA test result was 0.01. My previous results were 0.00. What PSA value would be considered a problem for which I would need radiation? Can 0.01 just be sample of how they analyze PSA differently by laboratory?
This difference is within the error limit of the assay. I consider a PSA value of 0.10 after surgery to be elevated.
5 ) I will be away from my regular home for the season. Where can I get a Prostate Health Index blood test performed?
Patients can get a PHI test through one of the reference labs listed below, as well as at Northwestern Memorial Hospital:
- Mayo Medical Laboratories: www.MayoMedicalLaboratories.com/phi-test or call (855) 516-8404.
- ACCU Reference: call (800) 766-8378.
- ARUP Laboratories: call (800) 522-2787 or email firstname.lastname@example.org.
- StageZero Life Sciences (formerly Innovative Diagnostic): www.stagezerolifesciences.com or call (855) 420-7140
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