Dear Dr. Myers, I have an advanced case. High PSA that on latest test came down, but still is high. There is a tumor mass on the ureter next to the right kidney; treated with medicine. I just had the original stent replaced. I still don’t understand why the tumor can’t be removed surgically. Can you enlighten me? Thanks so much for taking this on. Jack Gottlieb

Of course, I do not know all the details of your case. However, here are some of the problems. A cancer mass of that size does not just sit there; it is often attached to surrounding tissues. A mass at that location is sitting right on top of the aorta, a huge artery carrying so much blood that if it was nicked during surgery you could bleed to death in less than half an hour. Also, the vena cava sits there, and this vein carries all of the blood from the bottom half the body back to the heart. Damage to that vein would also pose a major bleeding risk.

What about radiation? The major problem there is that your intestines sit right over the top of the mass. The bowel is very sensitive to radiation and radiation damage to the bowel can be very unpleasant. This may change as the ability to focus radiation is improving rapidly.

For all of these reasons, it is standard practice to place a stent in the ureter to keep it open and hope that medications can shrink the cancer.

Ask Dr. Espinosa

Geo Espinosa, N.D., L.Ac, CNS, RH (AHG) is the Director of the Integrative Urological Center at New York University Langone Medical Center. Before joining NYU, Dr. Espinosa was a clinician, researcher and director of clinical trials at the Center for Holistic Urology at Columbia University Medical Center. He is a licensed naturopathic doctor, licensed acupuncturist, a Certified Nutrition Specialist and a Registered Herbalist. Dr. Espinosa is an author of the naturopathic entry in 1000 Cures for 200 ailments, by Harper Collins; March 2007 and “Prostate cancer – Nutrients that may slow its progression,” Food and Nutrients in Disease Management - Maryland: Cadmus Publishing, 2009.

Ask Dr. Myers

Medical oncologist and prostate cancer survivor, Dr Charles "Snuffy" Myers was a key player in creating AZT, Suranim, and Phenylacetate while working at the National Institute of Health. With over 250 research papers published, Myers is one of the leading developers of today's prostate cancer canon on both the research and treatment side of the test tube. Former Cancer Director at the University of Virginia, Myers opened the American Institute for Diseases of the Prostate in 2002 to provide men with the kind of comprehensive care that saved his own life. Dr. Myers has long been popular among prostate cancer patients as a speaker because of his ability to explain science and medicine in easy-to-understand language.

Ask Dr. Latini

Dr. Latini welcomes your questions about the psycho-social dimensions of Prostate Cancer, particularly those presented by Gay and Bisexual men. Dr. Latini is an assistant professor of urology at Baylor College of Medicine. Before joining Baylor, he spent six years in the Department of Urology at the University of California, San Francisco. Dr. Latini is a clinical health psychologist whose work concentrates on cancer survivorship and symptom management for persons living with genitourinary cancer.