Ask Dr. Myers

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This information and the products and media advertised on this site or in any of Dr Myers’s publications are advisory only; please consult your physician for specific medical or therapeutic advice.

1. Dr. Meyers, I am a 13 year survivor who is facing a rapidly rising PSA (12 week doubling time) and doctors who now feel that the repeated intermittent hormone therapy (zoladex) contributed to numerous heart blockages. My RCA is 100% blocked(failed bypass) and not treatable. I am being see by David McLeod and Jim Gulley at CPDR at Walter Reed. My PSA was 8.2 last week and I will see Dr Gulley nest week, I just don't know what to ask at this point. They have said that they do not want to do further ADT because of the heart risk and the latest plan is to treat symptoms rather than try to slow the disease any more.

2. I am 45 years old. My father died of metastatic prostate cancer. My psa scores the past six years have been: 1.4, 1.3, 1.43, 1.74, 1.7, and 1.5. (Unfortuntately, these were not all at the same lab or using the same assay). I am generally in good health. I gather than my family history and significantly above-normal psa for my age puts me at an increased risk for prostate cancer. Would you recommend that I take finasteride or dutasteride to reduce my risk of prostate cancer? I saw two reputable urologists, both of whom are familiar with the reported results of the REDUCE trial -- one said "probably should take it" and the other said "I would not take it." What do you recommend? (And if I should take one of them, which one?). Thank you!

3. Dr. Myers, I was told Monday my biopsy is positive for PC. I just turned 64 and I am fit, trim, healthy and sexual(every day). I hike, bike, jog, and walk a lot and occasionally ski. I currently have no ED and my erect penis is the same size as it was in my teens. By Internet standards it is larger than norm, (14.5cm circumference 17.5cm length) so I would think the muscles, blood supply and nerves must be in good shape to still have no problem getting it all the way up. My urologist has recommended radiation therapy. He said they don't recommend surgery for patients over about 55yo because the outcome isn't good leading to incontinence and ED. Do you agree? He says they have very good outcomes with few side effects from radiation therapy, but progressively over a period of a few years the side effects of radiation causes ED. He was not specific as to how I would cope with the ED and I really didn't ask. Any thoughts? I asked is I should try to go the our NIH designated Cancer Center at UCSD and he said their experience at their hospital based Cancer Center with their radiologist was very good and the equipment is state-of-the-art. It is an Accredited Hospital based Cancer Center but not our NIH designated. He was very negative about robotic da Vinci and said after a few years they have to do a lot of artificial sphincter replacements trying to control incontinence and those patients usually also end up with about the same ED as they see from radiation - particularly when they are over 60yo. He was a bit more positive about the open procedure with a really good surgeon, but still implied that long term patient response was iffy regarding ED and incontinence. Do you agree? He did get me referral to a surgeon and radiologist (both next week). The surgeon he referred me to has been recognized as one of the best urologist in San Diego County (Dr. McIntyre) and he has done some 500 da Vinci procedures plus open. These doctor practice at a Sharp Healthcare, a very large community network with several mega hospital complexes and numerous patient clinic throughout the county, but their hospital based Cancer Centers are not NIH designated - So, do you recommend I try to go to the NIH CCC at UCSD? Also should I be exploring Proton Therapy or is IGRT/IMRT Photon Therapy still considered about equivalent? Thank you

4. I am 58 y.o. and have recurrent PCa; 93 mos. post-RP my PSA is now 6 and I am probably about to start ADT. My uro suggests "Lupron" monotherapy until PSA goes undetectable and then off until some target level, and so on. Is this the current protocol of choice?

5. Hello. I have heard of you via the various cancer survivor boards. I have consulted online with Dr Strum. I am gathering as much information from learned doctors as I can. My husband had radical prostectomy on 7/14. Gleason 4+3, 2mm focal + margin. Some debate about extraprostatic extension. Husband had taken Propecia for years, but no one accounted for this by doubling his PSA score. Accordingly, had them do an unltrasensitive test, rather than regular PSA. Fortunately, this returned less than 0001. Dr Strum and surgeon in Detroit recommend monitoring PSA. Dr Strum says with ultrasensitive assay not much ground would be lost in the event of a recurrance. Oncologist in Columbus Ohio is strongly pushing adjuvant radiation. My husbands diet is good; we've eliminated red meat, processed foods, etc. He is 59. He is taking POM pomegranite capsules, 5mg citrus pectin,cayenne/tumeric blend and vit amin D daily. We are stuck/stymied re the radiation question for a variety of reasons, largely quality of life related. Given his situation, do you have an opinion about course of action? Thank you Claire

6. My husband was diagnosed with prostate cancer in December of 2007. His PSA was 8.2 and his Gleason was 3+4. After the MRI he was told that there was possible extension in one place and probable extension in another. He chose to start with three months of Zolodex followed by 25 days of IMRT radiation at Virginia Mason hospital in Seattle. His Radiation Oncologist was Dr. Alex Hsi and his medical oncologist is Dr. Vucy. We also are working with Dr. Russell at the Cancer Care Alliance. After the external radiation he had a seed boost and has had shots of Zolodex every three months for almost two years. His PSA has stayed at less than 0.01 for the past two years, but I know that that is due to the hormone therapy. I am so afraid of what is going to happen after he comes off the shots. I forgot to mention that there was no sign of the cancer in other parts of his body, but there must be cancer that is not visible. His urologist keeps saying that we are working toward a cure, but it seems that all the literature suggests that that is not the case with locally advanced disease. I want to know if he has any chance of beating this and if the cancer does come back what new options are out there. We are willing to travel to another place to get the care he would need. I wish that he had had surgery followed by radiation, but he didn't want to do go that way. Do you think that his choice was a good one? Worried wife

7. For ADT, double blockage, Lupron and Casodex, should the Casodex dose be 50 mg. or 150 mg. daily? When on ADT, what labortory test level of DHT in my blood serum has to be achieved, so not to have to use Advodart?

8. I have been on Lupron injection and Casodex for 3 months. My initial PSA was 9.7, my stage is t3aN0M0, I am awaiting Proton treatment at Tsukuba in Japan. My first blood test after 3 months on these meds showed PSA .09 ; slightly elevated liver (forget which one exactly, but a 50 when top normal range is 45); cholesterol 255 LDL, higher than last t test several years a go. Bone density, in normal range but low in spine area. What does the low PSA # tell you? Does this mean the chance of metastasize is low? Any other comments on the ther numbers? I just turned 55, 200 lbs jog regularly albeit very slow. Am having hot flashes, some extra fatigue and redness in my eyes. I have been on an SSRI (remeron) for headaches for 10 yrs. 15 mg usually before bed, original prescription was for 60 mg. but I never take that much occasionally 30 mg. Thank You Steve S

9. What is the level of expression of PCA3 by PIN (HG & LG) relative to cancerous tissue? My understanding that all of these categories of tissue "over"express PCA3 but the relative extent by each category is something I cannot determine in my online research. I have had two TRUS biopsies (12 and 18 core), both negative. Have most recent PSA in the 6+ range, normal DRE, but PCA3 result of 86.9. I am due for another biopsy soon. My concern in that the urine testing was skewed by the presence of HGPIN (one core in first bipsy) and LGPIN (several cores in second).

10. Dr.Myers, I recently completed 43 treatments of IMRT and have my first post treatment exam one after the treatments end. Is this too soon. I have read on most sites that the doctor generally sees their patients 3 months after.

11. Dr Myers, what can be done if the prostate cancer has spread to the lymph system? Mine are in the abdomen and neck area. I'm already on Lupron,Prednisone and doing alot of good eating and natural stuff. What else can be done to the actual nodes that are there? Thanks Mario

12. Dr. Myers: Can you give me your opinion about ADT (Casodex/Finasteride) used ALTERNATEVILY, ...as in taking it until PSA goes down to say, 0.05 and then stopping until a predetermined say 2 or even 3 or 4 PSA. In my case there is Quote: "biochemical evidence for recurrence, likely metastatic rather than local based upon hi-grade nature of the cancer, (T3 at NOMO..Gleason 4 + 3 = 7) rather short doubling time (6 mos) and clean margins" I understand there is a point where ADT will be ineffective, so why hasten this end point..do you call it clinical failure? And at what point do PSA numbers indicate bone or tissue metastatic involvement? What I am trying to do...justify... is to stay away from the effects of ADT as long as possible and to hell with longevity if it involves sick and uselessness. I had prostectomy 5 years ago and 3 years after that PSA came back..started Casodex/Finasteride end of Mar 2009 at 2.1 PSA & stopped in 3 mos at .05 due to side effects that caused concern with my Urologist/Surgeon.. I value your opinion...Thank You Tom

13. My husband was diagnosed with Stage IV metastatic prostate cancer in September 2006 with a PSA of 3400! Treatment with Eligard broght PSA to .7. However, at 18 months PSA began to climb again.. Adding Casodex helped stabilize PSA for another 6-7 months. When that failed he began ketaconazole which helped for another 8-9 months. He is now consider hormone refractory. He began taxotere with prednisone 5 weeks ago. At 3 weeks his PSA had not dropped, but in fact had risen from 18 to 29. Complicating all this, about 15 months ago he suffered a severe bout of bacteremia which left him with a vegetation on his pulmonic valve. The fear of chemo was that the bacteremia would recur. This morning he is suffering chills and rigors, a clear indication that the bacteremia has recurred. What options are left?

14. My dad has prostate cancer with bone mets. His chemo has stopped responding. I' m wondering what to expect from now on.

15. My psa started out at 179 in March 2009. With hormone treatment of Lupron and Flutamide. My last psa in October 2009 was 0.05, at what point is your cancer considered in remission?

16. I had Prostate surgery via the de-vinchi method June 1, 2009. I liked my speed of recovery. I have not had an erection since surgery. Is this normal and could I still become sexualy active in time? I was given a prescription and used one pill with no results. Any suggestions?

17. Looking for information on prostate Cancer metastases to the brain My dad’s prostate cancer has spread to his left frontal lobe. He had a radical prostatectomy, radiation, hormone therapy (Lupron and Casodex)plus he has been undergoing Zometa infusions for the past five months. We have known for a little over 18 months that his cancer metastasized to his bones and even though his PSA level is not extremely high (currently 2.86) his cancer is still spreading rapidly. An MRI done just this past week shows (regardless of all these treatments and the lowish PSA) his cancer is now in his brain and is putting pressure on his brain. It was also discovered that he now has Hydrocephalus in the inner brain. He is now having minor seizures and memory issues because of the pressure the cancer is causing on the brain. Does anyone know of any treatment options? Or where can I find some info to educate myself. I am having a really hard time finding out info and treatment options for prostate cancer metastases to the brain. My father is only 65 and was diagnosed only three years ago this month. I can’t understand why we are getting such little time on all our treatments. We are currently waiting on an appointment with a neurosurgeon to see if this is operable, but in the mean time I am trying to research what options might be out there. - Desperate Daughter

18. Dr. Myers, Could you tell us your opinion on the right time to begin androgen deprivation therapy after the failure of primary treatment by surgery or radiation. Should ADT begin: 1. As soon as a recurrence is confirmed? 2. After some PSA threshold is crossed (2.0, 4.0, 10.0, whatever)? 3. After metastasis is confirmed? 4. Just before the onset of symptoms is anticipated? 5. Only after symptoms have actually appeared? 6. Whenever the patient wants it? Doctors seem to have different opinions about this and I don't know whether it's because we don't have enough information to make a judgment, or because many doctors aren't keeping up with the latest research.

19. Dear Dr. Myers, I have an advanced case. High PSA. 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.

20. I was diagnosed 8 years ago and had 40 external radiation treatment. For years I had PSAs around 0.5, but not so long ago it rose to 1.1 and 3 months later to 1.8. My oncologist felt I should do the brachytherapy. I had CT and bone scans (all clear) and then a biopsy. Showed tumor in same place as before, still small, but Gleason of 7. My urologist felt that watchful waiting would be much better. I am 82, in excellent health otherwise, climb a local mountain three times a week, lift weights for upper body strength. I am not really happy with watchful waiting, as my father and uncle died of prostate cancer. Both doctors agree that waiting for 3 to 6 months is OK, so I''ll do another PSA in 3 months. Meanwhile, am drastically changing my diet and taking some supplements. Any advice?

21. I am a 69 yr old white male, diagnosed in Feb 2008. My prostate is 1 1/2 times normal size and I have gleason score 8. I took Lupron shots and had IMRT. My oncologist told me to stay with the Lupron shots for 3 years. If the ADT therapy fails my Doc said there was no alternative therapy. 16 months out my PSA is 0.2. I am awaiting more psa results this week.

22. I am 7 years past seeds plus external radiation. I go between two doctors for my psa tests. My psa has been undetectable or less than .04 for two years. My radiation doctor says I can go a year between psa tests now but my uro doc wants it done every six months. I have more faith in my rad. doc. but I would like to know the standard time for people like me between tests.

23. I was diagnosed in 7/06, Gleason was 6 and psa 4.2. I had 1 core positive 5%,1 millimeter of cancer. I chose to do active surveillance. I have my psa checked every 3 months . It has been going down steadily.My last psa was 0.88 (in fact, 1.76 since I take avodart). I should also tell you that 5 months after I was diagnosed I had another biopsy (14 hits- all samples negative). I had an MRI in 10/06 which showed very little cancer in prostate-no indication that cancer had spread beyond the capsule.Does it make sense now to have another biopsy 31/2 years after being diagnosed when my psa is not doubling but in fact halving.

24. Hi Doctor Myers. At 62 I had robotic surgery at NY Cornell and was T3CN0M0, clean margins. 4 months after surgery my PSA increased form <0.04 to 0.22. After 8 months I had IMRT together with 7 months of Lupron at MSKCC. For the last 2 1/2 years my PSA is at <0.05 (MSKCC lowest value). Considering my high risk situation should I consider taking Avodart or Finasteride (I believe you prefer Avodart)? How often should I take it and how much? More impotent, I have 2 sons , 32 and 38. Would you recommend for them to consider starting taking Avodart? At what age? At what age should they have their first PSA test?

25. My doctor told me my PSA had gone down to 0.1. Is this possible to go from a PSA of 6.7 before treatment and 0.1 after 43 treatments.I also had one shot of Lupron approx. 90 days prior to treatments began.

26. I was recently treated for epididymitis . I took cipro for ten days and the symptoms were gone . Went back to my doctor about 4 days after the last pill and had a psa test run . I was also given uroxatral for suspected bladder problems . tDoctor called because my psa readings were extreamly high . my last psa was 2.8 , 15 months ago . this current doctor does not know that my last count was 2.8...... im 54 , non smoker , not overweight and active . Im really scared. thanks, Tony

27. dr.myers,i am 69 and have been diagnosed with advanced prostate cancer, they have me on lupron,[injection every 4 months] with the addition of zomata for the bones monthly .is this the best way?

28. My husband has been receiving Zoladex injections for advanced prostate cancer (every 3 mos) with good response since Oct 08. His local clinic here in the UK which administers the Zoladex has informed us that his next shot will be changed to a drug called Decapeptyl SR. Can you tell us why this change might be in place? Is it a less costly variant of the same drug? If not, why change?

29. How much does tumor size affect survival time? My husband's MRI showed a tumor 17.5 cm x 7.5 cm - which sounds massive, and is in fact termed only "bulky" in his records. He also has nodal involvement. He's on Zoladex and has completed 7 weeks of radiation, but are we unrealistic in assuming a tumor of this size can be lived with long term?

30. My urologist is recommending Degarelix for 3 months as my 3rd round of hormone rx. I was diagnosed in 1999, only rx is hormone rx and I'm 80. One concern is the different dosages given in the trials. Your opinion?

31. Dear Dr.Meyers, I am 64 yrs old. PSA was 6.9 and Gleason score of 6. My urologist estimates stage T2a to T2c. My seminal fluid has lost most of the red tinge after the biopsy. My question is somewhat delicate. I am a (passive) gay man living in a small town where it is not generally known that I am gay. I am reluctant to ask my urologist this question for privacy reasons: I will be travelling to another town at New Year to stay with my partner. Do you think that it is inadvisable or possibly dangerous for me to receive anal penetration by a penis or dildo? My fear is that this mechanical intrusion might (7 weeks after the biopsy) stir up or injure the recently insulted rectum and/or prostate, and possibly cause malignant cells to spread out of the prostate into my general system. I am due to have a retropubic radical prostatectomy. Also, do you think that leaving the operation for 3 months after the biopsy is a dangerously long time?

32. I have aggressive prostate cancer. I am 58 years old. My Gleason 3+4. I have decided on robotic surgery. I am having the surgery exactly six weeks after the biopsy. What is your prognosis on full recovery based upon the above information?

33. My husband is currently 9 treatments into a second round of taxotere and carboplatin. He is also taking emcyt the day of chemo and the day after. He takes calcitriol (70 pills) the night before chemo. The first round of chemo kept the cancer under control for 13 months. This time he started in Sept. and his PSA was 36. It has fluctuated up to 64, and for the last month and a half is staying around 50. He is 67 & has no other major health issues. He feels very tired afternoons & evenings, but otherwise he feels ok and eats well. His original dx was in 2006 with a PSA of 29 and a Gleason of 9. He had cryosurgery in 2006, has been on ADT, tried HDK. His oncologist is considering mitoxantrone, which would be new to my husband, or a combo of gemzar, alimta & sutent. We are moving into new territory here are are looking for further ideas and advice. (Additional meds he is taking are Lovenox, ethinyl estradiol, 125 mcg Leukine, Avodart, Proscar.)

34. I am taking proscar daily. I have not had prostate cancer. I am 70 yo. I just had a yearly PSA test and my PSA went from 1.1 to 1.3. My urologist wants to schedule me for a biopsy. He says that if I am taking proscar my PSA should never rise at all. I dont think the rise is that significant. Can I please have your opinion?

35. What would you say re:bisphosphonates and known bone lesion(s)? I am on ADT3, second round. Would you rx Zometa or start with fosomax? I am aware of the jaw necrosis side effect possibilty. My bone density has always been good, even with the first round of ADT3....lowest was a T score of +0.95, usually T=+ 1.2-1.4.

36. I had stage 2C Gleason 6, PSA 3.9 PCA late 2006. RP 1-24-07. Using the quest 6791N (immulite 2000) PSA/PAP test, my PSA was undetectable until a .02 in 3-09. It then went down to undetectable, then .01 and now .02. At the same time, my continence & ED have got much better. Could this be benign nerve recovery making PSA? Is there a PSA level where I should seek further treatment?

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