Archive for the ‘Ask the Doctor’ Category

Question:

“My husband had radical prostatectomy in 2000. PSA levels remained below .001 until last week; now he has a level of 11.4. What is most likely cause?”

Answer:

“A PSA that has gone above 0.4 after radical prostatectomy is a concerning sign and may represent a cancer that has returned. Your husband needs to be evaluated by a urologist as soon as possible. Thank you.”

Dr Alan Nieder,
Miami urology

HDR (high dose rate) brachytherapy is performed at  our Miami urology center at Mount Sinai Medical Center as an adjunct to shorter courses of external beam radiation therapy specifically for patients with localized but large or advanced cancers of the prostate gland.
This computer controlled technique enables us to deliver radiation dose more efficiently to the regions adjacent to the prostate gland while limiting exposure to the rectum and bladder. This treatment requires a brief in-hospital stay.

For more information on treating prostate cancer please go to our Treatment for Prostate Cancer website.
Miami urology

Question:

I had a prostatectomy in 2007.  I heard about growing a new prostate using stem cells and it is functional now.  Do you know about this procedure?

Answer:

It is a very interesting question; however, it sounds a little bit futuristic at this time.
There is no research in humans right now that has been published and shown that prostate can be regrown and in fact implanted into individuals and the prostate  will have the similar function that then it had  originally.
While the concept is feasible, however, the technology has not caught up, but we do know at this point that the prostate stem cells have been used to grow in mice and they have been able to be differentiated into glans tissue and this has been done what is called in vitro, which is in the laboratory.

This is a promising research that has been published by investigators in San Francisco recently and those investigations showed that some of the markers in those mice stem cells are shared in human stem cells, therefore it is possible that in the future we could grow those prostate stem cells and hopefully down the road organs, but that is not feasible at the present time.

by Dr Fernando J Bianco
Miami urology

Question:

“I had my prostate removed six weeks ago, now I seem to pass some blood, is this a problem?”

Answer:

Without knowing how the prostate was removed makes specifics a little iffy, however what usually happens when the prostate is removed, a Foley catheter is left in the bladder. This is to relieve some of the tension that is exerted when the bladder contracts, as it pulls into what is called the urethrovesical anastomosis, which is the technical term that we use for sewing together the bladder neck or the bladder opening that was close to the prostate with the urethra on the other end.
Occasionally, there will be a scab there, it may fall, and that is why you may see some blood in the urine. This should subside.

The other common source for this could be urinary tract infection. Therefore, urine should be checked with urinalysis to rule out the presence of bacteria.  If that is the case, a culture should be taken and an antibiotic treatment should be considered.
This is important because one of the potential problems from infections early after surgery is developing urethral strictures, which are problems that are really hard to treat down the road and they are pervasive in the quality of life of individuals.

by Dr Fernando J Bianco
Miami urology

Question:

“My dad was diagnosed with prostate cancer and the doctor said the bacteria is really bad. We can’t touch it or open it to see where it has spread. If we do the bacteria will spread quickly throughout his body and he can die. So what stage does this mean my dad is in and is this treatable?”

Answer:

It is a very interesting question regarding Bacteremia.  What we assume was Bacteremia after the prostate biopsy and what happens now is that a lot of bacteria are becoming resistant to the most common antibiotic used to prevent infection, which are the group of antibiotics called quinolones and when this occurs, the patients may have bacteria in the bloodstream. This may require intravenous antibiotics and long-acting antibiotics.  Now, this has nothing to do with the prostate cancer and in fact, what needs to be done about the situation is to treat the inflammation, and after the inflammation is controlled and the infection is controlled, then the prostate cancer can be treated.  In general, prostate cancer tumors are slow-growing, they take time to grow, and they may take months to years to spread out.  Thus, when we see the patients, we always tell them that there is no hurry to treat the prostate cancer unless there are tumors found.

by Dr Fernando J Bianco
Miami urology

Question

“I am a postmenopausal female. I have had bleeding for over a year. I thought it was vaginal, as I only see it upon urinating. I would also get a little pink on the tissue paper. Had a recent urine test done and needed to go on antibiotics. Took meds for 5 days and now the bleeding is back. The blood stopped while I was on meds. Could this be another bladder infection?”

Answer

Vaginal bleeding can be most likely due to menses and in postmenopausal woman; it can be due to fibroids in the uterus or other conditions.  When there is suspicion that this could be coming from the bladder, a urine test should be performed and if the urine test indeed shows the presence of blood, then the patient requires some formal workup for the symptom of blood in urine, which is called hematuria. A complete hematuria workup will require a cystoscopy, which means using a cystoscope or fiber optic instrument to inspect the bladder, obtain an imaging test to visualize the kidneys and the uterus, which are the tubes that connect the kidneys to the bladder, and also studies of the cells of the bladder, to rule out the carcinoma in situ.  In addition to this, those urine samples should be cultured to identify whether there is presence of bacteria and if they grow, an antibiotic treatment would then be more appropriate.

by Dr Fernando J Bianco
Miami urology