Q. When I had my surgery for prostate cancer, I was not properly informed about the side effects and now need some information about how to cope with and treat incontinence. -- J.B., Boston, MA

A. You need to see a urologist or your surgeon about this. There are treatments which might be effective in your case. In some cases, using collagen to help support the bladder neck can provide some relief, or perhaps the urologist can recommend another option that will work for you. In some cases, continence is restored with time but, if its bothering you...get it checked.

Q. I am a 41 year old man with no family history of prostate cancer. During a recent physical exam I asked the doctor if I needed a prostate exam and a PSA test. He said this wasn’t necessary until I reach 50. Is this good advice? -- M.S., Los Angeles, CA

A. Yes, that is the current recommendation of the American Cancer Society and the American Urology Association.

Q. My husband (age 52, 6 ft. tall, 250 lbs.) was diagnosed with prostate cancer, and his doctor recommended radical surgery. First though, he wants my husband to lose 20 lbs. The surgery date has been set in five months, but I amconcerned about the long wait. It is likely that the cancer will spread during this interval? -- R.D., Richmond, VA.

A. We would need more information to provide a definitive answer to that question, but generally speaking, we see no real reason to wait for a weight loss to perform the surgery. In a man of your husband’s size, that amount of weight loss would not be significant to the outcome. Depending on the grade of the cancer, 5 months may not make any difference. In fact, there is probably a greater than a 50 percent chance that it will make no difference.

Q. I have heard that there are several PSA tests...regular PSA, PSA2 and Free PSA. What are their differences and are they all used to make a diagnosis? -- R.P., Houston, TX

A. PSA 2 and PSA Free are the same thing. Yes, they both can be used in the prostate cancer diagnostic process. The PSA Free version is used when an initial PSA test level is between 4 and 10, and may be helpful in some cases.

Q. I am 52 years old and in very good health. I went to a doctor recently and had a PSA test done and my PSA reading came back at 5.2, and I was advised to see a Urologist. This specialist, on the basis of my PSA being over 4.0, wanted to do a biopsy to see if there are any signs of cancer. My question concerns the PSA magic number of 4.0...should I spend a lot of money, experience intrusion of my body parts, pain, etc., based on this PSA threshold? -- M. L., NY, NY

A. Yes. We would certainly recommend that you complete the tests necessary to reach a conclusive diagnosis. The 4.0 PSA threshold may, in fact, turn out to be too high. There is ongoing research that suggests that men with PSA levels of between 2.5 and 4 might have the same risk as those with levels of 4 and above.

Q. I am 66 years old with no symptoms of prostate problems and with no family history of prostate disease. My PSA has been checked every 6 months for three years and it has risen steadily from 3.0 to 22.0, and I have had three biopsies in the last 18 months -- but no cancer has been found. My concern is that I do have cancer and it’s not being found. Are there any other tests that can be done to check out why the PSA level is rising so dramatically? -- A. T., Chicago, IL

A. Keep after it because , the steady increase in PSA levels over time should indeed be considered cause for concern. Ask the doctor about the lab performing the PSA analysis; can another lab be used to verify results? There are situations, however, in which false positives by PSA testing do occur. Consideration might be given to a different biopsy strategy or the use of color doppler ultrasound.

Q. I have heard a lot about Saw Palmetto and Lycopene which are supposed to be good for prostate health. What do you know about them, do they have any positive effects, and is there any medical evidence that they are useful for preventing or treating prostate disease?-- M. R., Seattle, WA

A. Saw Palmetto has been used as a remedy for urinary obstruction, but there are some reports that it can mask PSA and therefore produce an inaccurate test result. Lycopene, a powerful antioxidant that appears to stop cancer cells from proliferating, may have some real benefits. Preliminary studies have shown that a diet high in tomatoes and tomato products -- which are good sources of lycopene -- may help decrease the risk of prostate cancer and cancers in the stomach and colon.

Q. I hear that prostate cancer has various stages of aggressiveness, and that these levels are "graded" on a Gleason scale. What are they and how does this influence treatment options? -- W. G., Austin, TX

A. By definition, the Gleason Score is a subjective method of measuring the differentiation of cells to classify tumors by their microscopic appearance and in determining the aggressiveness of cancer cells and how rapidly they may multiply. This system divides prostate cancer into five histologic patterns ranging from 1-5. Patterns 1 and 2 represent well- differentiated tumors and are dealt with more easily; Gleason patterns 3 represents moderately well-differentiated tumor cells beginning to scatter; Gleason patterns 4 and 5 indicate poorly differentiated cells with the potential for fast growth. The total Gleason score is determined by adding a primary and secondary score pattern for each prostatic lesion i.e. 3+4=7. The most well-differentiated cancer cells would consist entirely of Gleason pattern 1 ( primary +secondary + 1+1 or Gleason 2 ) and the most poorly differentiated cancer cells would have a 5+5 or total Gleason score of 10.

Q. When it comes to prostate cancer, what role does the patient have in making treatment decisions? -- T. L., Jackson, MS

A. The final one...period.

Q. I am told that caffeine is an irritant to the prostate. Is this true? W.J., Atlanta, GA

A. It can be. Caffeine has a diuretic effect, so it depends on what your definition of "irritant" is, and people often react to caffeine differently. If you are concerned about this, and consume a lot of caffeinated beverages, ask your urologist or physician during your next appointment.

Q. I’ve heard there are several different treatment options for prostate cancer -- hormonal injections, radical surgery, radiation see implantation, cryoablative surgery, to name a few. I also understand that recommendation for treatment often depends on the hospital and the bias of the staff urologists. How do you know if the treatment option recommended for you is appropriate? How do you make the right treatment decision?-- R. L., Houston, TX

A. First of all, learn as much as you can about the disease and various methods of treatment. The more you know, the better equipped you will be to make informed decisions. Check the credentials of your physicians, and ask them about their experience treating this disease. If you are referred to additional specialists, confirm their credentials and experience, as well. If your recommended treatment involves a hospital stay, also check the accreditation of the facility. All this research will contribute to your peace of mind when it’s time to make the key decisions which -- in the final analysis -- is yours. You deserve to have a good relationship with your doctors, to have your questions answered candidly and comprehensively, and you are entitled -- even encouraged -- to seek a second opinion before reaching treatment and long-term care decisions.

Q. I am 32 years of age and have an enlarged prostate. I have been taking medication for three weeks to alleviate the problem, but I am still incontinent. This is a very embarrassing and frustrating problem. Any advice? -- P. D., Orlando, FL

A. Yes, go back to see your urologist and seek additional -- or alternate -- treatment. There are effective methods for treating this condition. Learn as much as you can about what is causing the incontinence in your case, and ask your doctor about other treatment options if this one continues to be ineffective.

Q. During a recent physical exam, the doctor said he thought my prostate was "a little hard," but said it was probably nothing to worry about. I have looked at a lot of prostate web sites, and nowhere can I find a mention of this particular problem. Should I see a specialist?-- H. L., Providence, RI

A. Yes, just to be on the safe side, schedule an appointment with a urologist for another exam and a PSA test. The phrase, "a little hard," has no specific medical meaning, it would be best to check this out.

Q. I have noticed blood in my semen several times recently. Does this mean I have prostate cancer? --F.S., Austin, TX

A. Hematospermia (blood in the semen) is a very common problem. In general, when the symptom occurs by itself a man should bring it to the attention of his urologist, but usually no further evaluation is necessary. If blood in the semen is accompanied by other symptoms (e.g., an abnormal rectal exam or blood in the urine), your urologist will determine if further tests are warranted.