prostatediaries

In the end the statistics give you a number and the patient is still left with whether to do a biopsy for an elevated PSA or not. How  big a boy are ya?

Your situation, your disease and your personality has a lot to do with the decision you'll make regarding treatment of "your" prostate cancer.

Extension of prostate cancer into the prostatic capsule as noted in the surgically removed prostate on pathological examination is a bad prognostic finding. The importance of the prostatic capsule in prostate cancer is explained. 

Just as a vasectomy involves removal of a segment of the vas and destroying both ends and a prostatectomy involves removing the prostate and reconnecting the urethra to the bladder, not much has changed in the "concept" of these procedures.

However as it pertains to the prostate there are several advantages to the robotic removal of the prostate and I outline these in this podcast.

I feel that one now may now comfortably state that if done in the right hands and for the right reasons, that the robotic removal has finally become the "gold standard" for the surgical management of prostate cancer.

A prostate nodule back in the day was the number one reason to biopsy the prostate. Today the number one reason is an abnormal PSA and the most common finding on rectal exam for the patient with prostate cancer is...a normal exam. Dr. McHugh's podcast on the subject sheds a bit of light on this subject and frustrating concept that some patients have difficulty grasping.

Patients will often choose to have their prostate removed for prostate cancer because, " I can always have radiation after having the prostate removed but not vice versa." True...but does it matter. In this podcast some of the caveats of this very nuanced disease as it pertains to this line of reasoning and whether it matters or not is discussed by Dr. John McHugh a prostate cancer survivor and author of "The Decision" which is in the top five for paperback and Kindle on Amazon.com for the subject of prostate cancer. He was also chosen as the number one Online Influencer for Prostate Cancer by Sharecare Now for 2012.

Although my marriage was strengthened by all the issues surrounding the treatment of my prostate cancer and the attendant aftermath as it pertains to sexual function, I have friends and patients in whom their prostate cancer culminated in divorce. "Baby Please Come Home" is a weak attempt at making light of this situation in which the prostate cancer patient post treatment pleads for the wife of the man with "damaged goods" to come back.

That the psa goes down after a course of antibiotics is encouraging...but not definitive. A better messure of things is the trending of the value of the psa over period of time. Your urologist will know how to advise you on this and the timing and necessity of a prostate biopsy.

Since the needle that takes the prostate speciment at the time of a biopsy goes through the rectal mucosa first the possibility of an infections exists. This historically has been a low risk issue but recently and nationally it is becoming more prevalent. There is not a good answer as yet to this other than a heightened sense of awareness on the part of the patient to recognize that something is not right and to contact the urologist at the earlies sign of fever or difficulty voiding. In addition, it is making the point that a patient should thoroughly evaluate the need for the biopsy in the first place, i.e. if cancer were found would you treat it. If the answer is no and there are risks associated with the biopsy then maybe don't consent to it.

The most common questions that arise at a pre-vasectomy consultation with a urologist.