A diagnosis of prostate cancer can be accompanied by plenty of questions for patients, caregivers and loved ones. Here are expert answers to some such questions from the CURE Educated Patient Prostate Cancer Summit chaired by Dr. Kelly L. Stratton of Oklahoma University Health.
When giving hormone therapy following recurrence, does the doctor recommend starting with Casodex [Bicalutamide] to minimize the risk of testosterone [tumor] flare [as is often done prior to initial hormone therapy]?
That depends on the amount of disease that a patient has. If they don’t have documented metastases in the bone, sometimes we can start ADT without Casodex. Some agents, such as Orgovyx [relugolix], do not cause flare.
Is active surveillance appropriate for favorable intermediate risk [prostate cancer] [i.e., Gleason 3+4]?
This is based on several different factors, such as PSA, number of cores positive, cancer location, age and other health issues. Recently, more men have selected active surveillance, particularly those with good quality of life who want to avoid side effects. It is important to continue to monitor closely so additional treatment can be provided if it is needed.
Learn more from the CURE® Educated Patient® Prostate Cancer Summit
Having an enlarged prostate and prostate cancer, is a person more apt to fully empty the bladder after focal therapy?
Most men feel some improvement in stream after treatment. Occasionally it makes it harder to urinate or causes urge to urinate.
If you don't know if you want radiation or surgery or focal treatment, what doctor do you talk to? Won't a surgeon suggest surgery and a radiologist suggest radiology, etc.? Who can help you make a decision?
That happens sometimes, but usually a cancer specialist will provide all the possible options and the pros/cons of each.
Why would PSA results increase, but the MRI showed no sign of cancer?
There are several reasons that PSA may increase but are not caused by prostate cancer. One of the most common is an increase in the size of the prostate. Sometimes we pick this up on the MRI. Also, inflammation or infection can cause increased PSA.
If no cancer has been detected after 10-plus years of elevated PSA, does that mean it's unlikely to be detected?
That’s a great question. Men can have an elevated PSA and a rising PSA. And those can be caused by different conditions. Often a rising PSA could indicate a problem like cancer. A stable elevated PSA may indicate other causes, such as enlarged prostate or inflammation.
[What about] recurring prostate cancer gradual PSA rise over 16 years [of] treatment?
We [see] this happen, especially in men who have received treatment in the distant past. Not all men need additional treatment. Some can continue with observation and monitoring. The change in PSA over time and imaging findings can help guide next steps.
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