Dr. Brian Helfand (NorthShore)
Prostate cancer is one of the most heritable of all cancers. As such, the risk factors that are most associated with prostate cancer are first degree family history (father, brother, uncle, etc) and race (e.g. African Americans). Based on statistics, your husband is almost 2x likely to be diagnosed with prostate cancer than a man without a family history. Although there is some debate regarding the routine use of PSA screening, I am a firm believer that your husband should start undergoing annual PSA screening at the age of 40.

Dr. Brian Helfand (NorthShore)
It sounds like you had a very successful treatment for your prostate cancer. The chance of recurrence is hard to quote because it depends on many factors including your Gleason score, whether any lymph nodes were positive, whether there was a postie margin, etc. With surgical intervention, your chances (even with an aggressive prostate tumor) of having a recurrence are significantly lower. In order to follow you in the post-operative period, you should have an initial post-operative PSA about 4-6 weeks, and then every 3-4 months (based upon your urologist's preference). After 2 years of having an undetectable PSA, I get PSAs on my patients every 6 months.

Dr. Brian Helfand (NorthShore)
There are several things that you should know when evaluating the meaning of your PSA. 1. It is important to realize that most men your age will have a PSA <0.7ng.ml. So a value of 4.3ng/ml is at face value is too high for your age. This does not mean that you have prostate cancer, but it means that we should pay attention to the value over time or consider a biopsy. However, see #2. 2. Not all men with elevated PSAs have prostate cancer. PSA is NOT a perfect test, but it is still THE BEST test for prostate cancer screening. Sometimes, the value of PSA can be elevated because of an enlarge prostate, infection, inflammation, sexual activity, etc. Therefore, it is important to pay attention to trends over time (whether it fluctuates or not) Based upon #2, I would recommend that you either consider a biopsy or repeat the PSA in 1-2 months to make sure that it is going down. Also, being overweight increases your risk of many medical problems.

Dr. Brian Helfand (NorthShore)
You may have several reasons for your urinary flow problems. One of which may be an enlarged prostate, or perhaps even more rare, it could be prostate cancer. As such, you should be evaluated for this problem by a health care professional, and they should make sure that you are emptying your bladder well, that you don't have a urinary tract infection and check a PSA. The most common reason for urinary problems is an enlarged prostate, and there are many medical therapies that can be given (with low side effects) to help relieve these symptoms. Finally, since you recently had back surgery, there is a probability that you were taking narcotic pain medications. These may make you constipated. Constipation can also impact your urinary symptoms, and treating the constipation can actually help with urination.

Dr. Brian Helfand (NorthShore)
No dietary supplement has been shown to prevent prostate cancer when studied in a systematic fashion. However; it is possible that a heart healthy diet, low in fats and simple sugars may help prevent prostate cancer. However; this remains to be determined. It has been shown that medications used to shrink the prostate (called 5 alpha reductase inhibitors) can actually prevent up to 1/4 of prostate cancers. However; these are NOT approved by the FDA for this purpose because in the large studies of these drugs, the men who were on the medications that ultimately developed prostate cancer had a tendency to have more aggressive forms of the disease. As such, we do NOT routinely use these medications for prevention.

Dr. Brian Helfand (NorthShore)
I tell my patients that your post-operative sexual function is significantly related to your age and pre-operative function. In general, treatment for prostate cancer (whether radiation or surgery) has never improved a man's erectile function. However; if a man is young, is not diabetic or obese and has good erectile function prior to surgery, then he has a very good chance of having normal erections post-operatively. Sometimes, men can have some problems after treatment that respond to simple medical therapies (e.g. Viagra, Cialis, etc). I believe that good nerve sparing surgery significantly helps with the recovery of erectile function. This can be done by a urological surgeon who is trained in the technique and frequently performs the operation. In addition, I believe that all men should start (at minimum) a rehabilitation program before and immediately after surgery that helps to recover the nerve function. This could involve taking drugs like Cialis before and after surgery.

Dr. Brian Helfand (NorthShore)
There are many different things that are available for treatment of sexual dysfunction after surgery. Unfortunately there is not a universal solution for every man. It should include an assessment of psychological function and desire for sexual activity following surgery. This is often overlooked as many men get nervous about intimacy following surgery and often getting evaluated by a trained professional can help relieve a lot of this anxiety. From an erectile dysfunction standpoint, there are many oral medications (Cialis and Viagra, etc) that can be used to rehabilitate erections. This is often a starting point. If you fail to respond to these therapies, then other interventions such as a vacuum erection device, or injection therapies can be used to obtain an erection. As always, regular exercise and a heart healthy diet helps improve and increases your chance of successful recovery.

Dr. Brian Helfand (NorthShore)
I always tell my patients that you should compare your PSA to what is "normal" for your age counterparts. Most men age 50 have a PSA below 0.7ng/ml. For simplicity, you could use a cutoff of 1.0ng/ml. Just because you have a value that is above your age cohort, does NOT mean that you have prostate cancer. However, it means that you are statistically at slightly increased risk of being diagnosed with the disease. As such, you should continue to get screened with PSA at least on an annual basis. However, other factors should go into the interpretation of PSA before deciding to perform a prostate biopsy. These include whether the PSA values have been rising over time, whether you have a family history of prostate cancer, African American race, whether you have a history of BPH, whether you have many other medical problems, etc. Remember, PSA is not a perfect test, but it is currently still the best test we have for prostate cancer screening and has inevitably saved many lives!

Dr. Brian Helfand (NorthShore)
I think the answer is surgeon experience. There are many urologists who can perform open surgery with excellent outcomes (great cancer control, erectile function and continence). Similarly, there are many urologists who can perform robotic surgery with similar outcomes. Therefore, it is most important to be treated by a urologist who is comfortable and experienced with a radical prostatectomy. Having said that, robotic surgery has recently become the most commonly used surgical intervention for prostate cancer. Compared to the open approach, robotic surgery offers significantly less blood loss and a shorter hospital stay. Although not proven, it is likely that the robotic surgery offers increased visualization which provides an opportunity to perform better nerve sparing and a nice connection between the bladder and urethra. These latter should be associated with increased erectile function and increased continence.

Dr. Brian Helfand (NorthShore)
Great question. We have come to a "new era" of prostate cancer and we have realized that many times men have prostate tumors that may not harm patients during their lifetime (benign type prostate cancer). This is because many prostate tumors grow very slowly and other medical problems may ultimatley harm a man before the prostate cancer spreads. Unfortunately, there is currently no diagnostic test that can tell you whether you have a lethal prostate cancer or a more benign type tumor. As such, we have developed a program of surveillance in which we avoid treating patients with prostate cancer until there is evidence that it has an aggressive component. This involves ACTIVELY following men (PSA tests and prostate biopsies). While this seems to increase the number of times that a man is evaluated by a urologist, it avoids being overtreated with surgery or radiation that may also cause erectile problems or incontinence. NorthShore currently has the largest program in the Midwest