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Suggest Ways To Diagnose Prostate Cancer
Question: what is the cost of this online consult?
Brief Answer:
SPC may be best option for his B.P.H., at this age,with high risk.
Detailed Answer:
Hello xxxxxxxxxxx and welcome to HCM.
As an Urologist,i can understand your concern.
SPC or suprapubic catheterisation,is better in long term,than foley's catheterisation.
The chances of infection are far less than foley's catheter.
Surgery shouldn't be considered at all,as he has a high risk for anesthesia.
To know if there's a malignant change,he'll need to do a PSA first.
Then if needed,a prostate biopsy.
The treating Urologist,can opine about feel of the prostate gland on examination.
The only other option is, to carry out intermittent catheterisations,4-5 times/day.
You may send his reports,including scan,for an expert opinion.
Wishing him well.
Dr.Matthew J. Mangat.
SPC may be best option for his B.P.H., at this age,with high risk.
Detailed Answer:
Hello xxxxxxxxxxx and welcome to HCM.
As an Urologist,i can understand your concern.
SPC or suprapubic catheterisation,is better in long term,than foley's catheterisation.
The chances of infection are far less than foley's catheter.
Surgery shouldn't be considered at all,as he has a high risk for anesthesia.
To know if there's a malignant change,he'll need to do a PSA first.
Then if needed,a prostate biopsy.
The treating Urologist,can opine about feel of the prostate gland on examination.
The only other option is, to carry out intermittent catheterisations,4-5 times/day.
You may send his reports,including scan,for an expert opinion.
Wishing him well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you for your response. I do have one pressing thought " Are stents an option" or is that considered a difficult surgery with anesthesia necessitated ? The current urologist based on a digital exam said the prostate is 5x larger than normal. The assumption is that it is CA due to its size. Is that a reasonable assumption? The feeling at this age is not to do any aggressive cancer treatment. but if this is CA would stents with androgen/ hormone therapy decrease the size of the prostate?. Or would the side effects from the androgen therapy be problematic ie cardiac. breast enlargement hot flashes or other side effects? Would radiation decrease the size of the prostate. Also how long does it take for the hormone or radiation to be effective in shrinking the size of the prostate if it would be effective? I appreciate you helping to educate me about the options.
Brief Answer:
A biopsy is the only confirmatory test to diagnose cancer prostate.
Detailed Answer:
Hello xxxxxxxxxxxx,
No Urologist will assume a cancer in prostate gland,without doing PSA and biopsy.
Size is never a criteria,to label a prostate gland as malignant.
So first,one has to do these tests, to establish the prostate is cancerous.
If cancer is diagnosed,then you need to consider the least aggressive treatment.
If biopsy does prove to be cancerous,hormonal treatment would be best option.
There's minimum interaction with the medical treatment he's taking.
In his case,a stent is not recommended.
Once again,a biopsy is the ONLY way to confirm cancer.
Wish him well.
Dr.Matthew J. Mangat.
A biopsy is the only confirmatory test to diagnose cancer prostate.
Detailed Answer:
Hello xxxxxxxxxxxx,
No Urologist will assume a cancer in prostate gland,without doing PSA and biopsy.
Size is never a criteria,to label a prostate gland as malignant.
So first,one has to do these tests, to establish the prostate is cancerous.
If cancer is diagnosed,then you need to consider the least aggressive treatment.
If biopsy does prove to be cancerous,hormonal treatment would be best option.
There's minimum interaction with the medical treatment he's taking.
In his case,a stent is not recommended.
Once again,a biopsy is the ONLY way to confirm cancer.
Wish him well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much . Kim
Brief Answer:
Remain in good health.
Detailed Answer:
Hi XXXXXXX
You're welcome.
Feel free to ask questions anytime.
Wishing you well.
Dr.Matthew J. Mangat.
Remain in good health.
Detailed Answer:
Hi XXXXXXX
You're welcome.
Feel free to ask questions anytime.
Wishing you well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Mangat, I have a few more questions and need a few clarifications on the noninvasive treatment of prostate ca vs bph.
1. What would an MRI show about the prostate. Does it differentiate between bph tissue and cancerous tissue. or would a PET scan do that? I know the MRI would show if a cancer has spread to other areas.
2. You have indicated that the supra pubic tube is the best way to deal with the prostate enlargement which is causing the urinary retention. And that the only way to diagnose cancer is with a PSA test and biopsy. The reason for getting this differential diagnosis would be to be able to "non invasively" treat the cause of the prostate enlargement. If it is CA then the benefit of androgen hormone therapy would be to prevent the spread of the CA to the bone and hopefully shrink the size of the prostate? Would radiation/ radiation seeds cause more problems than they help prevent?
3. If this enlargement is due to BPH, which non invasive therapies work best ? I have read about many different treatments , for example: laser vaporization of damaged tissue or microwave therapies, green light etc. I am not familiar with these. How long would it take these therapies to have an effect on shrinking the prostate.
4. Dependent on the cause of the prostate enlargement , treatment used, and response to treatment (reduction in the size of the prostate) , is it realistic to think that there might be a return to normal voiding and that that the supra pubic tube might be reversed?
Thankyou for your time.
1. What would an MRI show about the prostate. Does it differentiate between bph tissue and cancerous tissue. or would a PET scan do that? I know the MRI would show if a cancer has spread to other areas.
2. You have indicated that the supra pubic tube is the best way to deal with the prostate enlargement which is causing the urinary retention. And that the only way to diagnose cancer is with a PSA test and biopsy. The reason for getting this differential diagnosis would be to be able to "non invasively" treat the cause of the prostate enlargement. If it is CA then the benefit of androgen hormone therapy would be to prevent the spread of the CA to the bone and hopefully shrink the size of the prostate? Would radiation/ radiation seeds cause more problems than they help prevent?
3. If this enlargement is due to BPH, which non invasive therapies work best ? I have read about many different treatments , for example: laser vaporization of damaged tissue or microwave therapies, green light etc. I am not familiar with these. How long would it take these therapies to have an effect on shrinking the prostate.
4. Dependent on the cause of the prostate enlargement , treatment used, and response to treatment (reduction in the size of the prostate) , is it realistic to think that there might be a return to normal voiding and that that the supra pubic tube might be reversed?
Thankyou for your time.
Brief Answer:
Only biopsy can diagnose a cancer. PSA is a tumor marker only.
Detailed Answer:
Hi XXXXXXX
Your interesting questions shall be answered,one by one.
1. If biopsy diagnosis of cancer prostate is made,then the first test is a bone scan.
A MRI scan is done after that. It'll show the gland with surrounding pelvic area.
Suspicious malignant areas can be made out,in the pelvic area.
On an ultrasound scan done through rectum (TRUS),a cancerous prostate gland
may be suspected.
2. Only a biopsy can diagnose a cancer,not PSA.
Without a cancer diagnosis,don't start thinking about it's treatment.
SPC is better than a foleys catheter,is well documented fact.
But,it's not the treatment for prostate gland with retention.
3. Prostate gland is surgically removed with an operation.
It's not shrinking of prostate gland.
Laser treatment has good results in experienced hands.
4. Surgical treatment removes the obstruction,hence person can pass urine with
free flow. There's no residual gland left to remove.
If surgery is planned,don't remove foleys catheter.
Hope all your questions have been answered.
Wish you well.
Dr.Matthew J. Mangat.
Only biopsy can diagnose a cancer. PSA is a tumor marker only.
Detailed Answer:
Hi XXXXXXX
Your interesting questions shall be answered,one by one.
1. If biopsy diagnosis of cancer prostate is made,then the first test is a bone scan.
A MRI scan is done after that. It'll show the gland with surrounding pelvic area.
Suspicious malignant areas can be made out,in the pelvic area.
On an ultrasound scan done through rectum (TRUS),a cancerous prostate gland
may be suspected.
2. Only a biopsy can diagnose a cancer,not PSA.
Without a cancer diagnosis,don't start thinking about it's treatment.
SPC is better than a foleys catheter,is well documented fact.
But,it's not the treatment for prostate gland with retention.
3. Prostate gland is surgically removed with an operation.
It's not shrinking of prostate gland.
Laser treatment has good results in experienced hands.
4. Surgical treatment removes the obstruction,hence person can pass urine with
free flow. There's no residual gland left to remove.
If surgery is planned,don't remove foleys catheter.
Hope all your questions have been answered.
Wish you well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
DR Mangat, I did just sent a reply but I do not know if it got lost in cyberspace. I do not see it on my screen. So to review: this is and 87 yr old male who is not a good candidate for surgery. He has had acute urinary retention and has had a foley x2weeks. He will have a supra pubic tube/ cap placed on 6/24. The etiology of the enlargement is not known. you indicated a biopsy would be necessary to diagnose correctly. I need two separate answers dependent on the etiology of this enlargement . If the diagnosis is CA and hormonal therapy is initiated would this shrink the prostate and inhibit spread to the bone. And then possibly enable a return to normal urinary functioning through the urethra without incontinence?. But if the differential diagnosis is bph ,what noninvasive treatments are available. ie( laser vaporization of tissue) and again would this shrink the prostate and enable someone to have a return to normal urinary functioning. thankyou>
Brief Answer:
Aetiology of prostate gland enlargement is an age related change.
Detailed Answer:
Hi XXXXXXX
Prostate gland enlargement is an age related change.
So at 87 years,a considerable enlargement is expected,similar to cataract in eye.
The prostate gland can be operated upon,if the cardiologist considers it alright.
That medical fitness must be given by a cardiologist,as you had stents placed.
Also,he used a pacemaker.
An operation will remove,not shrink the prostate gland.
Now on examination by Urologist,if he feels a biopsy is needed,that's done first.
The other changes suggesting a cancer,are a high PSA and changes seen on TRUS.
If the biopsy is negative for cancer,but the risk for surgery is high,you'll need to be on a catheter and medical treatment.
If cancer is noted,i've already advised about further treatment options.
In your case,hormonal or radiation treatment would be considered.
Radiation shrinks the gland and treats surrounding area having cancerous tissues.
Hormonal treatment slows down progression of the cancer.
These options are considered,depending on the stage of cancer,if present.
Hope your doubts are cleared.
Dr.Matthew J. Mangat.
Aetiology of prostate gland enlargement is an age related change.
Detailed Answer:
Hi XXXXXXX
Prostate gland enlargement is an age related change.
So at 87 years,a considerable enlargement is expected,similar to cataract in eye.
The prostate gland can be operated upon,if the cardiologist considers it alright.
That medical fitness must be given by a cardiologist,as you had stents placed.
Also,he used a pacemaker.
An operation will remove,not shrink the prostate gland.
Now on examination by Urologist,if he feels a biopsy is needed,that's done first.
The other changes suggesting a cancer,are a high PSA and changes seen on TRUS.
If the biopsy is negative for cancer,but the risk for surgery is high,you'll need to be on a catheter and medical treatment.
If cancer is noted,i've already advised about further treatment options.
In your case,hormonal or radiation treatment would be considered.
Radiation shrinks the gland and treats surrounding area having cancerous tissues.
Hormonal treatment slows down progression of the cancer.
These options are considered,depending on the stage of cancer,if present.
Hope your doubts are cleared.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes it is all becoming clear. You did state if the biopsy is negative for cancer , but the risk for surgery is high , he'll need the catheter and medical treatment. what medical treatments are available? laser? greenlight? microwave?
Do the nonsurgical treatments shrink the prostate enough to allow return to normal urinary functioning without incontinence?
Do the nonsurgical treatments shrink the prostate enough to allow return to normal urinary functioning without incontinence?
Brief Answer:
Laser and microwave energy are used in surgical treatment.
Detailed Answer:
Hi XXXXXXX
Let me make your understanding clearer still.
Laser and microwave energy is used in prostate gland surgery.
Medical treatment consists of non-surgical approach.
That's drugs or radiation treatment.
Radiation is used only in cancer prostate.
Drugs will help shrink the prostate gland, to a limited extent.
In a large sized gland,with retention of urine,medical treatment isn't very helpful.
Hope your doubts are cleared.
Wish you well.
Dr.Matthew J. Mangat.
Laser and microwave energy are used in surgical treatment.
Detailed Answer:
Hi XXXXXXX
Let me make your understanding clearer still.
Laser and microwave energy is used in prostate gland surgery.
Medical treatment consists of non-surgical approach.
That's drugs or radiation treatment.
Radiation is used only in cancer prostate.
Drugs will help shrink the prostate gland, to a limited extent.
In a large sized gland,with retention of urine,medical treatment isn't very helpful.
Hope your doubts are cleared.
Wish you well.
Dr.Matthew J. Mangat.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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