Web Chat on Prostate Cancer with Dr. Jeffrey R. Gingrich, M.D., Urologist (The following is an edited transcript of questions and answers from a web chat held on Wednesday, February 27, 2002 on News Channel 3)

Hello, my name is Dr. Jeff Gingrich. I am a urologist with an interested in urologic cancers and male infertility. Today our topic is prostate cancer.

Q: Are the side-effects of cryosurgery bad?

Dr. Gingrich: Cryosurgery is not performed too frequently. In the past, the side effects have been quite significant. However, in good hands, today the side effects have been minimized. It is still unclear how good the long term cancer control will be. It is particularly good for patients who have not been cured by radiation therapy.

Q: At what age should a man begin to have a routine prostate exam?

Dr. Gingrich: We recommend that men begin to be screened at the age of 50, unless they are African American or have a strong family history of prostate cancer and then begin at age 40.

Q: How would a guy know if he is having prostate problems?

Dr. Gingrich: If your urinary stream is becoming slow, if you're having to get up frequently at night to urinate, or you fell like your bladder is not emptying very well, those are signs of an enlarging prostate. Prostate cancer does not usually have symptoms separate from simple enlargement of the prostate.

Q: What is a PSA exam?

Dr. Gingrich: PSA is a blood test that can be drawn by any doctor's office. It stands for prostate specific antigen. It's a substance released into the blood by prostate cells.

Q: What is the percentage of men who develop Prostate Cancer?

Dr. Gingrich: Approximately 1 of 6 men is estimated to be diagnosed with prostate cancer during their lifetime (estimates from the American Cancer Society).

Q: Is the PSA a sufficient test at age 45?

Dr. Gingrich: About 25% of men who have surgery for prostate cancer have a normal PSA. Therefore, it's important to have both the blood test and the rectal exam.

Q: How long after prostate surgery do you have urine leakage?

Dr. Gingrich: You can continue to have some improvement in urinary control up to 12-18 months after the surgery. If significant leakage is still occurring, the you should see a urologist.

Q: When should one try sex after prostate surgery?

Dr. Gingrich: I recommend waiting for about 6 weeks after the surgery before trying to have sexual activity. You might not have any spontaneous erections for up to 12-18 months after the surgery. We frequently recommend trying some Viagra or other options during the 12-18 months after the surgery.

Q: Is it a sign of prostate cancer if you pass blood from your anus?

Dr. Gingrich: Prostate cancer rarely causes blood in the urine. Blood from the anus or rectum is usually a hemorrhoid, but may be a sign of rectal cancer and should be evaluated by a doctor.

Q: I have enlarged prostate, hit the bathroom aver. four times per night with urge, but not much to pass. Had biopsy four years ago, also two months, clear on cancer, PSA jumps all over the place. medication to save getting up at night didn't help so I dropped it. MD wants me back in six months this round. Would drinking more water help me to pass at a night better?

Dr. Gingrich: I would suggest trying some other medications to help with this. If your prostate is quite large, you may need to consider surgery or other treatments such as laser or microwave treatment.

Q: Is surgery (removal) still better than radiation, chemicals, or other treatments?

Dr. Gingrich: Overall, surgery is still considered to have the best success rates, but there are some increased risks of complications with surgery compared to radiation.

Q: What is the function of the prostate?

Dr. Gingrich: We don't really know. It isn't really necessary for sexual function or reproduction. It does add a small amount of fluid to the semen.

Q: At what ages do you suggest which type of rectal exam?

Dr. Gingrich: The rectal exam for prostate cancer is with a finger. Sometimes we use an ultrasound machine to look at the prostate.

Q: Is prostate cancer hereditary?

Dr. Gingrich: We believe about 10% of prostate cancers are inherited.

Q: I had prostate removal surgery five weeks ago, tests at that time showed the cancer was outside the prostate. I was started on the three-month shots that reduce testosterone. Should there be any other steps now in fighting this cancer?

Dr. Gingrich: No one knows for sure. We will be opening a trial soon in which men receive a year of hormone therapy with or without some chemotherapy. We are hoping that this aggressive treatment early after surgery will help prevent recurrences in the future. It is unclear whether radiation should be done now or not. Most doctors would wait until the PSA becomes detectable again before recommending radiation.

Q: For prostate cancer, does removing the prostate remove the likelihood of the cancer spreading, or does the patient also have to undergo radiation treatments?

Dr. Gingrich: It depends on what the pathology from the prostate specimen shows. We can generally predict which patients may have problems over the long run.

Q: About six months ago I was told by my MD I had enlarged prostate. I was using the bathroom at night more than usual. He gave me a medication called Terazosin 2mg and it appears to work. Does this means enlarged prostate is somewhat common?

Dr. Gingrich: Yes, it effects the majority of men as they reach their 60's. Our web site, www.utmem.edu/urology has links to several other web sites that might be useful.

Q: Going back to basics for early detection, isn't the self test affective? (turn your head and cough). Pardon the expression but I am not medically inclined.

Dr. Gingrich: We're discussing prostate cancer which is detected through a digital rectal exam and a blood test. Turn your head and cough is checking for a hernia.

Q: Is infertility a side effect of surgery for prostate cancer?

Dr. Gingrich: After surgery, a man may still be able to have erections and an orgasm, but does not have any semen expelled. Therefore, without other means, he would not be able to have children.

Q: My husband is 36 years old and sometimes he has extreme pain behind his groin area, to put it politely. I can't get him to go see a doctor about this. Does this sound like it would be a symptom? And do you have any suggestions on how to get him to go?

Dr. Gingrich: That type of pain is more likely a hernia or kidney stone. Not as likely from prostate cancer. Getting men to go to the doctor is very difficult!! I would ask him to do it for you.

Moderator: Thank you for joining us today for our chat with Dr. Jeffrey Gingrich, a board-certified urologist.

You can visit the UT Medical Group web site at www.utmedicalgroup.com.

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