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Clicking on the questions below will provide you with the corresponding answer. Dr. Catalona has answered all questions.
RECENT Prostate Cancer 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.
My lab results did not come back as “undetectable.” The PSA lab result says < 0.06. In the past, the result was always equal to something, but this time it just says less. How much less would be good to know. 0 falls in the range of < 0.06. The optimist in me is saying that maybe 0.06 is their cutoff, so they just say < 0.06. I wish the result was more specific.
When the result has the “<” sign, it means that the PSA level is lower than their assay has the ability to detect—essentially zero.
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.
What are your thoughts about the supplement saw palmetto? I've seen some research advising this supplement can help with an enlarged prostate as well as urinary incontinence and some of the very negative effects with taking prostate- related medications. However, it was also noted that saw palmetto could possibly have a negative effect relating to blood pressure. What are your thoughts about my trying this this supplement as opposed to silodosin?
There has been a prospective, randomized trial published in the New England Journal of Medicine that showed that saw palmetto extract is not effective. Silodosin and tamsulosin are both safe and effective, although they can lower the blood pressure and cause some patients to feel lightheaded.
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.
FREQUENTLY ASKED Prostate Cancer QUESTIONS & ANSWERS
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