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William J. Catalona, M.D., answers your questions...


Professor of Urological Surgery at Washington University Medical Center in St. Louis, MO.  Dr. Catalona has received the Benhamin Stockwell Barringer Medal from the American Association of Genito-Urinary surgeons for his cancer research.  He was also designated  by American Health magazine as one of the Best Doctors in America. Dr. Catalona edits QUEST, published by the Urologic Research Foundation.

Q. What does it mean when there is blood in the semen and what should be done to treat it?

A. The most common causes of blood in the semen are irritation, inflammation, and/or infection in the prostate gland (prostatitis).  There may be associated symptoms of pain or burning in the urinary tract, urinary frequency, slow urinary stream, or urinary urgency.  However, in some cases, bleeding may be the only symptom.  In most cases, the bleeding will eventually clear as the inflammation or infection is handled by the body's natural immune defenses, but in most cases taking antibiotics will hasten the return to normal. 

Blood in the semen can also occur with prostate cancer, but this is an unusual cause.  In our study of men who underwent biopsy because they had a PSA higher than 4 or suspicious findings on digital prostate exam, if they had not other symptoms, 24 percent had biopsies that showed cancer.  If they also had blood in the semen, 36 percent had biopsies that showed cancer.  This indicates that blood in the semen is more common in patients with cancer, but it is important to point out that these men also had other evidence of cancer (PSA ore rectal exam abnormalities). (Reference: Catalona et al. J Urol 151:1283, 1994.).

I recommend that men with blood in the semen be treated with a two to four week course of antibiotic therapy.  If the bleeding persists, I recommend that the patient undergo cystoscopy (looking into the urine channel with a small flexible scope) and biopsy of the prostate to rule out the presence of prostate cancer.

Q. Are there measures that can be taken to prevent the development or progression of prostate cancer?

A. Prostate cancer is influenced by both heredity and environmental factors.  Prostate cancer is almost certainly caused by changes (mutations) in the DNA that affect the regulation of the growth of normal prostate cells.  It is probable that several mutations have to occur before a full-blown cancer occurs.  These mutations can accumulate over time, causing the gradual progression to prostate cancer.  Some mutations may cause a precancerous condition called prostatic intraepithelial neoplasia (PIN), others may cause a slowly growing form of the cancer, and still others may cause a rapidly progressive form of the disease.  It may take decades for some prostate cancers to develop, while others may develop more rapidly if a more serious mutation occurs.  Some men may inherit one or more of these mutations from either his mother or his father.  In this case, fewer additional mutations would be needed before cancer occurs.  Nevertheless, it is possible that preventive measures might prevent the development or progression of prostate cancer.

Chemoprevention is treatment that prevents the development and/or the progression of cancer.  Some potential chemopreventive agents for prostate cancer may be medicines, herbs, or food supplements.  Recently, considerable attention has been focused on nutrients as possible prostate cancer preventive agents.  The most promising are soy products (called phytoestrogens and isoflavones), vitamin D, vitamin E, selenium, and lycopene.

Some researchers have speculated that the high ingestion of soy products is responsible for the lower death rate from prostate cancer in Japan, where the death rate is 4-5 times lower than in the United States.  Some studies have suggested that prostate cancers develop and progress more slowly in Japan.   It has been shown that soy slows the proliferation of prostate cells, and part of this effect may be mediated through lowering the levels of male hormones.  Soy contains steroid-like chemicals that may alter the chemical reactions in prostate tissues.

Soy proteins are changed by intestinal bacteria to produce estrogenic and antiestrogenic compounds.  This increases the levels of binding protein levels in the blood that tie up the male hormone, testosterone, which normally stimulates prostate cancer cells to grow.  Soy proteins also have numerous other potential actions.  They alter enzyme functions, alter protein synthesis, alter the action of growth factors, directly affect the growth rate of prostate cells, and alter the production of blood vessels that allow tumors to grow. 

Genistein is one of the most prominent components in soy.  Genistein has been shown in animal prostate cancers to slow the rate of tumor growth.  There is sufficient experimental evidence to justify the use of soy proteins in clinical trials for preventing prostate cancer, and these studies will provide important information in the future.

Lycopene is found in tomato products.  It belongs to a type of chemical called a carotenoid.  Lycopene has one of the greatest capacities for preventing mutations in DNA. Chemicals that have these properties are called antioxidants, and lycopene is one of the stronger antioxidants.  In addition, lycopene has other biological activities related to cell-cell communications and growth control.  Experimental animal studies show that lycopene can slow the growth of prostate cancer cells.

Epidemiologic studies have shown that consumption of lycopene is associated with a lower risk of prostate cancer.  In one important study, lycopene was the only antioxidant found in significantly lower levels in prostate cancer patients than in men without prostate cancer.  There are also studies suggesting that taking lycopene before prostate cancer surgery may result in more favorable treatment results.  Lycopene concentrates are available at pharmacies and health food stores and can be purchased over the counter without a prescription.

Vitamin E
Vitamin E is a fat-soluble vitamin that also has the potential to decrease DNA damage through its antioxidant effects.  In addition, vitamin E affects the immune system.  Vitamin E deficiency is associated with decreased immune function that increases the susceptibility to cancer and infections. Vitamin E may not only prevent the development of prostate cancer but also may slow its progression, especially in smokers.  Vitamin E may also lower the activity of some cellular signals that increase cell growth.  Studies suggest that vitamin E may be especially important in inhibiting the growth of prostate cancer cells induced by a high-fat diet. 

Many fat-soluble vitamins such as vitamin E can cause side effects if taken in large doses. Some (but not all) studies suggest that too much vitamin E may interfere with blood coagulation and lead to post-surgery bleeding due to its effect on platelet function.  Vitamin E exists in several forms; 200 to 800 of the alpha tocopherol form of vitamin E are well tolerated. 

Selenium may also act as an anticancer agent due to its antioxidant properties.  Selenium suppresses cell growth and enhances the immune response - thus functioning similarly to vitamin E.  Studies have suggested that prostate cancer risk was reduced by 60% among those who take supplemental selenium.  Selenium may also exert its antitumor effects by other mechanisms, such as inducing programmed death in cancer cells, and affecting important enzyme systems.  The recommended dose of selenium is 200 ug/day, which is 2 to 3 times the recommended daily allowance. 

Vitamin D.
Vitamin D is important primarily for bone and mineral metabolism.  It induces differentiation of prostate cancer cells into normal cells and blocks the growth of prostate cancer cells.  Vitamin D may act by blocking the progression of cells through the cell cycle and initiating programmed cancer cell death.  Prostate cancer cells have receptors for vitamin D.   Vitamin D may be important in preventing prostate cancer and is also being studied as an agent for the treatment of advanced prostate cancer.  The recommended daily dose is 10 ug/day.  Higher doses may cause high blood calcium levels.

Q. What do you do when Lupron stops working?

A. Hormonal therapy can be divided into two phases, primary and secondary. Primary Hormonal Therapy

Most prostate cancer cells either die or go into a dormant phase when the blood male hormonal level (testosterone) level is dramatically lowered. Male hormone levels can be lowered or rendered less effective by either removal of the testicles (called castration or orchiectomy) or by injections (called Lupron [leuprolide], Zoladex [goserelin], or by antiandrogen pills, such as Megace (megestrol), Eulexin (flutamide), Casodex (bicalutamide), Nilandron (nilutamide), by estrogens (diethylstilbestrol, estrace), by inhibitors of androgen synthesis, such as ketoconazole, by antiestrogens, such as tamoxifen, by herbal estrogen compounds, such as PC spes, or by glucocorticoids (such as prednisone or dexamethisone).   The phase of so-called "androgen-dependent" prostate cancer can be quite variable, lasting from only a few months to as long as 18 years, in my experience.

Secondary Hormonal Therapy
There is a second phase in which the tumor can grow even though the male hormone level is level is low.  During this phase, the tumor cells still can be controlled by discontinuing some drugs that were being taken previously or by switching to a different drug.  This administration and withdrawal of hormones is called secondary hormonal therapy.  The principle behind secondary hormonal therapy is that while the patient is taking a hormone (such as Eulexin) that blocks the growth of the cancer, the cancer cells can mutate or change in a way that makes the Eulexin stimulate their growth.  In this situation, simply stopping the Eulexin can have a beneficial effect and may lower the PSA for a period of 3 to 9 months in 20% to 50% of cases. 

After a while, the PSA will again begin to rise.  When this occurs, other similar drugs of the antiandrogen family, such as Casodex, Nilandron, Megace, may be started and the PSA will again decrease for a period of time.  If the cancer cells again mutate and again become stimulated to grow by the new drug, the new drug may be stopped and again, in some cases, the PSA will again decrease.  In this way, it is sometimes possible to use a variety of drugs, switching from one to another, to achieve an additional response. Megestrol acetate should be avoided in patients with heart disease, high blood pressure, or diabetes.

When antiandrogen drugs no longer work, it is possible in some cases, to achieve additional responses with other hormonal agents, such as Nizoral (ketoconazole), Cytadren (aminoglutethimide), Stilphostrol (diethylstilbesterol diphosphate), PC Spes (Chinese herbal estrogen preparation).  Some of these drugs, such as Nizoral and Cytadren require the additional use of cortisone-like medications, because they suppress the production of cortisol by the adrenal glands.

Hormone-Resistant Prostate Cancer
Even after prostate cancer cells reach the stage at which they are no longer responsive to hormone therapy, they still may be sensitive to treatment with radiation, chemotherapy or experimental drugs.  Patients may not develop symptoms of metastatic prostate cancer (such as pain or weight loss) until the PSA has reached a level of 100 to 300.  Some patients with very advanced disease have PSA levels in the thousands.  Each tumor is somewhat unique in its behavior, as is each patient.  Measurement of PSA levels is the best way of determining the response of therapy.  In general, if the PSA level can be decreased by 50%, there is usually a prolongation of survival.

Significant responses can be achieved with chemotherapy, although, in general, chemotherapy is less effective and has more side effects than primary hormonal therapy.  However, there are some regimens that are very well tolerated and offer reasonable prospects for benefit.  One such regimen is mitoxantrone plus prednisone.  This regimen may improve the quality of life, but does not appear to prolong survival.  Another combination that is also sometimes effective is estramustine in combination with vinblastine.  Other combinations include etoposide, doxorubicin, and cyclophosphamide.

Recently taxol drugs (docetaxel) have been combined with estramustine and hydrocortisone for men with hormone refractory prostate cancer.  One regimen combines these drugs with thalidomide, which works as an antiangiogenesis agent that blocks the growth of blood vessels that feed the tumor.

Spot radiation therapy can be effective is reducing pain from bone metastases and protects against the development of pathologic fractures.  Biphosphonates (pamidronate and etidronate) inhibit bone resorption and may also be used to prevent fractures and to treat bone pain.

The goals treating advanced prostate cancer are to maintain a high quality of life, relieve symptoms, and prolong survival.  These goals can require the use of other medications such as nonsteroidal anti-inflammatory agents as well as stronger narcotic medications.

Several new drugs and approaches are under investigation.  Further research will certainly bring new and more effective treatments for hormone-refractory prostate cancer.

Q. What should I do when my PSA level begins to rise after radical prostatectomy?
I believe it is unknown where the cancer cells reside in my body. If they lie outside of the prostate bed or pelvis, the radiotherapy will not benefit me.  How often does recurrence in the prostatic bed occur?  How many patients have lifelong chronic problems with the rectum or bladder, including bleeding?   Would a lesser dose of radiation eliminate all of the malignant cells and completely avoid complications?  Is there any way of avoiding loss of sexual relations after surgery and/or radiotherapy?

A.  Depending upon the stage and grade of the tumor, and the preoperative PSA level, a rising PSA occurs after radical prostatectomy within 7 years in about 20% of patients who were thought to have cancer that was contained within the prostate before surgery.  In about 70% of these patients, the PSA level will return to the undetectable range following radiation treatment to the bed of the prostate.  Based on our data, the PSA has remained in the undetectable range in about 70% of those patients for as long as we have followed them (70% of 70% equals about 50% overall long-term favorable response). These findings suggest that the cause of the rising PSA is tumor cells remaining in the bed of the prostate in about 70% of patients.  About half of all patients with a rising PSA level either have the tumor cells that are outside the pelvis or have tumor cells in the pelvis that are resistant to the doses of radiotherapy that can be safely given.

With postoperative radiotherapy, there is concern that the bladder and rectum may be damaged, and this does occur to a chronic bothersome degree in about 3% to 4% of patients who receive the prescribed dose of 6400 cGy at 180 cGy per day.  Radiotherapy also significantly reduces erections in about half of patients and may decrease urinary continence in a small percentage as well.  However, current evidence suggests that a lesser dose that would completely avoid bladder and rectal complications would be less effective in eliminating all of the cancer cells.  Therefore, the "worst case scenario" could have the patient have chronic inflammation of the bladder and rectum with or without bleeding and still have the PSA rise and have to be treated with hormonal therapy as well.

For this reason, some patients who have a very slowly rising PSA after a long interval following surgery correctly assume that their tumor is not highly aggressive and elect not to receive radiation therapy, but rather opt for hormonal therapy either immediately or in the distant future, if necessary.  However, patients with slowly rising PSA long after surgery are the very patients who respond best to radiation therapy.  So, it is a difficult decision to make.  The patient must balance the potential benefits of the radiation therapy completely eliminating the cancer against the risks of long-term side effects.

Erections can be restored in nearly all patients.  This may be accomplished with oral Viagra, intra urethral MUSE suppositories, injections of prostaglandin into the side of the penis, a vacuum erection device, or a penile prosthesis (surgery required).  Although each of these options has its drawbacks, the ability to have sexual relations may outweigh the drawbacks for many patients and their partners. 

Q. How does the doctor determine how many samples to take in a prostate biopsy?

A. Initially, most doctors take six to eight samples.  However, it is known that the first biopsy procedure misses the cancer in 20% of patients.  Accordingly, in patients who continue to have a rising PSA level or other features that are worrisome for prostate cancer, more biopsies are taken during repeat procedures.  The exact number taken depends upon how uncomfortable the patient finds the procedure and may include 15 to 20 samples.

Q. .  Does the natural size of a man's prostate have any relationship to later development of an enlarged prostate or prostate cancer?

A. The normal prostate size for an adult male is 15cc to 30cc (one half ounce to one ounce).  Prostate size may increase because of swelling from inflammation, benign enlargement which usually begins at age 40-50, and cancer which also is unusual before age 40-50. Accordingly, men whose prostate gland is larger than 30 cc are more likely to be diagnosed with either benign hyperplasia (enlargement) or prostate cancer than those whose prostate is in the normal range.

Q. What is PIN and is it a precursor to cancer?  What is its relationship to cancerous tumors and to the prediction for such tumors developing?

A. Prostate cancer is caused by changes (mutations) in the DNA that affect the regulation of the growth of normal prostate cells.  It is probable that several mutations (at least 5 or 6) have to occur before a full-blown cancer occurs.  These mutations may accumulate over time, causing the gradual progression to prostate cancer.  It is likely that certain mutations may cause a precancerous condition called prostatic intraepithelial neoplasia (PIN).   PIN is also found as a satellite lesion surrounding a prostate cancer or elsewhere in a cancerous prostate gland.  Approximately 30% to 50% of men who have an elevated PSA level and high-grade PIN are subsequently found to have prostate cancer within four years.  Accordingly, repeat biopsies are routinely recommended in men with PIN. 

Q. Can the amount of selenium in a man's body predict if he is more or less likely to develop prostate cancer?  Is there a test for such predictions and how would the measurements be interpreted?

A. Selenium is a trace element that is not routinely measured in blood samples to predict prostate cancer risk.  Studies suggest a 50% to 66% reduction in risk for advance cancer in men with the highest selenium status as determined by the level of selenium in toenail clippings.(Yoshizawa K, et al.  Study of prediagnostic selenium level in toenails and the risk of advanced prostate cancer.  J Natl Cancer Inst.  1998; 90: 1219-1224).

Q. What is a TUR or TURP and what purpose does it serve?

A. Transurethral resection of the prostate is an operation performed to relieve symptoms of urinary obstruction caused by either benign enlargement of the prostate or prostate cancer.  It is performed through a scope and involves removing prostatic that is obstructing the flow of urine.  During this operation, the "resectoscope" is passed through the urethra into the prostate gland.  Then using an electrified wire loop, dozens to hundreds of raisin-sized pieces of the prostate gland are removed from the inside of the prostate gland and washed out through the scope.  This operation is often called a "Roto-Rooter" procedure or a "scraping" of the prostate.  It enlarges the urinary channel and allows the patient to urinate more freely.

Q. What is the pattern for return of sexual function after prostate surgery?

A. Usually erections return slowly beginning 3-6 months after surgery and continue to improve for 18-24 months.  There is a lot of variation.  Usually erections are not as firm as before surgery unless the patient had "perfect" erections to being with.  If the nerves can be partially or completely saved, Viagra usually improves the erections.  If not, prostaglandin injections, MUSE urethral suppositories, or a vacuum erection device must be used.  Some patients prefer to solve the problem with a surgically implanted penile prosthesis.

Q. Regarding my bladder incontinence, how much better control, can I expect to have and is it going to change in dramatic steps? (Question from someone operated on for prostate cancer)

A. About 92% of patients regain normal control.  Of the remaining 8%, most have mild stress incontinence that requires minimal protection (a pad).  Only 1 – 2% have severe incontinence or implantation of an artificial urinary sphincter to correct.  Usually, continence returns quickly, but sometimes it returns slowly, over a period of 18 months to two years.

Q. How do the exercises given after my operation work to help bladder incontinence

A.Exercises work by increasing the bulk and strength of the one remaining sphincter muscle.  This muscle helps to create a seal by approximating the walls of the urethra.  There is a fine line between being wet and being dry.  It is like a leaky faucet that can be fixed by replacing a washer that differs very little in appearance from the old washer.  It is just a little more plump and flexible, but that makes the difference between wet and dry.

Q. Please give sources for information about cancer

A. The Cancer Information Service (CIS) of the National Cancer Institute (NCI) provides up-to-date cancer information and can answer questions (in both English and Spanish) in nontechnical language.  To reach CIS, call 1-800-4-CANCER (1-800-422-6237) or visit, the NCI web site.  This site includes information on new and experimental therapies.
To contact the American Cancer Society (ACS), visit the ACS Web site at or call 1-800-ACS-2345 (1-800-227-2345).

Q. What about freezing of the prostate as a treatment for prostate cancer?

A. It's an unproven treatment.  One of the real worries is that the freezing process starts in the center of the prostate and goes out to the edge.  But most of the prostate cancers arise very near the edge of the prostate.  In order to protect the surrounding tissues (especially the rectum) from freezing, doctors don't freeze out to the edge in all area so many patients with the freezing treatment will have recurrences of the cancer out near the edge of the prostate.  Available studies would suggest that freezing is not as effective as surgery or radiation therapy.

Q. What could cause a PSA level to rise other than cancer?

A. Three things can cause the PSA to rise:  cancer, benign enlargement, and inflammation (prostatitis).  With cancer and benign enlargement the PSA goes up persistently; the slope is steeper with cancer.  With inflammation, the PSA can rise with a flare-up and come back down with resolution of the inflammation (with or without antibiotic treatment).  Interpreting the pattern is complicated because some patients have two or all three of these conditions at the same time

Q. Can frequent sex with a penile implant make a PSA level rise?

A. Sexual activity can cause a transient rise in the PSA level.  This rise is usually minimal and does not last for more than 6 – 24 hours.  Sex with or without a penile implant does not make a difference.  It is ejaculation that causes the PSA to rise.  It is ideal to avoid sex for 24 hours before PSA testing.

Q. What is nerve-sparing surgery and how does it work?

A. The nerves are like railroad tracks and the prostate is like a boxcar on top of the railroad tracks.  In this surgery, doctors try to gently life the "box car" off the railroad tracks without damaging the "tracks".  If the cancer is detected early, then the prostate can sometimes be removed very nicely without disturbing the nerves.  The nerves usually get bruised and stretched somewhat during the operation which is why it can take 3 to 6 months for erections to begin to return after surgery and up to two years for complete recovery, but with time the nerves regenerate so it's very important to detect the cancer while still on the inside of the prostate before it grows out into those nerves. After it's grown out into the nerves, it's not safe to try to spare the nerves.

Q. What is so special about the PSA test?

A. The major problem with prostate cancer detection before the PSA test was that men would not come in for a rectal examination unless they were really having problems.  But the PSA blood test is acceptable to most men, and it's made prostate cancer detection more acceptable to men.  The PSA blood test is probably the most single accurate test we have for the detection of prostate cancer.

Q. Why should men come in for an examination if they take the PSA blood test?

A. There are some very early cancers that can be felt on the rectal exam before they cause PSA level to be elevated.  There are other cancers, which will elevate the PSA level before they can be detected on the rectal exam.  To maximize the accuracy of screening, it's best to have both the test and the examination.

Q. Can certain vitamins or foods lessen the risk for prostate cancer?

A. Vitamin E has been shown to improve the effectiveness of the immune system ad to lower the risk for prostate cancer.  Usually the dosage is 200 to 400 units a day.  Selenium, taken 200 micrograms a day, has been shown to lower the risk of prostate cancer. A low fat diet, especially a diet avoiding animal fat, specifically red meat fat, has been shown to have an impact on the risk for prostate cancer.  Eating fruits and vegetables is important and it's been shown that a diet rich in tomato products in also helpful in avoiding prostate cancer.  One of the substances in tomatoes is called lycopene and in order to get enough of this substance one would have to eat pounds of tomatoes each day.  But now lycopene has come into the market in pill form.  The above recommendations have been evaluated in published scientific studies.  Obviously, many other substances could be effective but they just haven't been adequately studied at this time to know if they are helpful or harmful.  All of the factors discussed above are believed to produce relatively minor effects, and it's still very important to get the PSA blood test and the prostate check.

Q. What is external beam radiotherapy and how are its effects different from those of a radical prostatectomy?

A.  In this method, X-ray treatments are given with a machine that sends high-energy x-rays through the patient's body, aimed at the prostate gland and sometimes the pelvic lymph nodes.  External beam radiotherapy is a totally non-invasive treatment used as an option for men who are considered too old or too ill for a prostatectomy or who just don't want surgery.  It is difficult to determine whether external beam radiation actually eradicates all of the prostate cancer, because many patients in whom progression of the tumor is slowed or halted have what appears to be persistent tumor on rebiopsy.  The best results are obtained when the tumors are less than 2 centimeters in size at the time of therapy.

Q. What is an abnormal PSA level and what are grade levels for prostate cancer?

A. Most doctors would say the PSA level is normal if it's below 4 and above normal if it's above 4.  We feel that the cutoff of 4 is to high and we have used 2.5 as the cut off in our PSA screening study since 1995.  We have proven that if the PSA is between 2.5 and 4, there is a 22 percent chance that the man will have prostate cancer.  We routinely recommend a biopsy if the PSA is above 2.5 and if the free PSA test confirms the advisability of performing a biopsy.  Prostate cancers when looked at under the microscope can look like almost normal prostate tissue or they can look very wild and disorganized. They are graded on a scale called the Gleason grade of between 2 and 10 where 2 is the best, i.e., a low grade, slow growing prostate cancer, and a 10 would e the worst, i.e., a rapidly progressing, very aggressive prostate cancer.  It turns out that grade level statistics for prostate cancer fall into a bell shaped curve.  Only about 10 percent of tumors are grade 2,3 and 4 and only about 10 percent of tumors are 8,9 and 10 with the vast majority being Gleason grades 5,6 and 7.

Q. What is the free PSA test?

A. One of the problems with PSA blood tests is that if the PSA level is elevated, only about 25 to 60 percent (depending on how high the PSA level is) of those men are actually found to have prostate cancer.  The flip side of that fact is that roughly 40 to 80 percent of men who have elevated PSA levels don't have prostate cancer and they go through the biopsy unnecessarily.  The free PSA blood test can eliminate at least 20 percent of these unnecessary biopsies and still detect 95 percent of these cancers.  Another new test is coming down the road in a year or two called the HK2 test which can further eliminate unnecessary biopsies, especially in men with PSA levels between 2.5 and 4.   A lot of medical research is being done to improve the accuracy of PSA testing to avoid biopsies in men who really don't have prostate cancer and so don't need a biopsy.  But it's always going to be an imperfect world, and it is better to accept some false alarms to save some lives than it would be to avoid all false alarms and not save any lives.

Q. Why do some men not get treated for prostate cancer?

A. Part of the reason is that they misunderstand some of the public information about prostate cancer.  Some studies have been presented in the media and lay press that suggest prostate cancer is a toothless lion, that more people die with it than of it, and that prostate cancer does not require treatment.  So, not wanting to be treated, some men latch on to the position of watchful waiting or diet therapy only.  Watchful waiting is appropriate in some patients, but it's generally only for older men with low-grade tumors that are not very threatening.

Q. Is the PSA reading different for a man before and after having a prostate cancer removed?

A. "1" is a low PSA reading for a man with a prostate, but it is a high reading for a man whose prostate has been removed.  It means there are cancer cells left behind that are producing PSA.

Q. Is it true that all men at some pointing their lives will develop prostate cancer?

A. No, even though that is often said.  It is true that if the prostate gland were removed and carefully examined under the microscope, up to 80 percent of men in their 80's would have some microscopic traces of prostate cancer, but only about 15 to 20 percent of men area actually diagnosed with prostate cancer during their lifetime.  Prostate cancer will be large enough to detect with a biopsy in only 10 to 15 percent of men.

Q. Do vasectomies have any effect on prostate cancer?

A.It was stated in the past that men who had vasectomies were at an increased risk for prostate cancer, but this subsequently has been disproved.  It was a myth.  What seems to be true is that vasectomies are more likely to be seen by a urologist and if a urologist sees them, then they are more likely to be screened and have early detection of prostate cancer.

Q. Is prostate cancer a fatal disease if not treated?

A.  rostate cancer kills more men than any other cancer except lung cancer.  In some patients, particularly elderly patients, the prostate cancer might progress very slowly, and they may not need to be treated right away, but most men who have a life expectancy of at least 10 years need to have treatment or they are risking death from prostate cancer.

Q. I went to see a urologist a couple of months ago for symptoms of enlarged prostate. After the PSA and rectal examination, my urologist told me that nothing needed to be worried about and all I need to do was to come back for yearly examination. My urination was not too bad and there is little inconvenience in daily life. However, the major impact is sex. For the past two years, there has been a rather quick deterioration. The sensation of ejaculation has mostly lost and the volume of semen has become quite reduced. I mentioned this to my urologist, but he told me that I should not get too concerned as long as I still can have sex. I am 51 and have a younger wife. I feel I should do something about it. Is it true that people with prostate enlargement normally have pretty bad deterioration in sex pleasure, even in pretty early stages? Is there anything I can do about it?

A. It is true that beginning around age 50, many men begin to develop overgrowth of the central part of the prostate gland, called benign prostatic hyperplasia. This can cause compression of the prostatic ductal system that carries the prostatic fluid from the glands located in the peripheral regions of the prostate to the urethra, which is fairly centrally located. Because 90% of the ejaculate is composed of prostatic fluid, it is common for the volume of the ejaculate to decrease in men with benign prostatic hyperplasia. This condition does not cause a decrease in sex drive or erections, however. There are hormonal, blood vessel changes, and other diseases such as diabetes or high blood pressure that can occur around age 50 that can cause decreased sexual function. Other possibilities are medications that may interfere with sexual function. The best advice you can be given is to find a urologist whom you have confidence in and follow your prostate closely with PSA tests and digital prostate examinations. 

William J. Catalona, M.D.,




Houston Real Estate


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