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Clicking on the questions below will provide you with the corresponding answer. Dr. Catalona has answered all questions.


All questions are answered by Dr. William J. Catalona.

I just noticed on my final pathology report that it stated “Perineural Invasion: Present.” Is this common? How often do you see this versus not, and how does it affect long-term prognosis? I'm assuming this was in regard to prostate cancer that had invaded nerves inside the prostate, since it was organ confined.

“Perineural invasion” refers to tumor cells surrounding nerves on the inside of the prostate that regulate the amount of prostatic fluid secreted. It is always present if the pathologist looks through the entire prostatectomy specimen. However, if it is seen in the biopsy specimen, it is associated with an increased risk that the cancer has spread microscopically outside the prostate. However, it does not have the same adverse connotation in the prostatectomy specimen. All of these nerves have been removed with the removal of the prostate.

I have chronic low-back issues that flared up right after my prostatectomy. What can I take to relieve the pain, and how long would you expect it to last?

It is perfectly normal for patients with pre-existing spine issues to have a severe back ache for about 72 hours after their prostate cancer surgery because we have their back arched on the operating table. Heat (especially in the shower) and walking are most effective in relieving this kind of pain. What makes it worse is lying in bed. Torodol is hard on the kidneys and cannot safely be continued. Tylenol is hard on the liver, but less dangerous in moderate doses. Therefore, I would recommend Tylenol 325 mg every 4-6 hours, heat, walking, and patience.

While going through a 24-hour urine collection my urination was unevenly distributed in time. The volume I urinate during the day is about 400 mL while during the night I urinate 2,000 mL. On a normal night I get up to urinate five to six times. The only times I urinate during the day is after a nap, if I take one. It seems like for my bladder to fill, my body has to be horizontal.

This is called “nocturnal polyuria.” It is uncommon in children in whom urination occurs mainly during the day when they are drinking more fluids and less at night when they are not. It occurs in about 3% of the older population in whom fluids tend to accumulate in the lower part of the body during the day and at night, when they are horizontal, the fluid gets “dumped” into their kidneys, and they have to urinate frequently. Also, it can be caused by diseases such as diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnea. The management may include avoiding fluid intake during the evening, taking any diuretic medication in the afternoon rather than the morning, or taking a medication called desmopressin at bedtime under the regulation of a primary care physician, internist, or endocrinologist.


Click on the category of your question or concern.

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


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