Contemporary Urology Point/counterpoint | Dr. Catalona (2022)

Introduction

Since the 1990’s, several new techniques of performing radical prostatectomy have become available. Although the standard open operation is still the most widely used technique, laparoscopic or robotic-assisted laparoscopic techniques have gained popularity, due in part to aggressive marketing inducing consumer demand. In the senior author’s opinion, the laparoscopic and robotic prostatectomy have not been proven to be as effective as the traditional open operation. More specifically, they are not as effective as the traditional open prostatectomy for simultaneously accomplishing the sometimes-competing goals of complete removal of cancer and preserving potency.

Goal

The goal of laparoscopic or robotic prostatectomy has been to attempt to apply “minimally invasive” techniques that have been used successfully in other surgical operations to the treatment of prostate cancer.

Invasiveness

Enthusiasts of the laparoscopic or robotic procedure claim it is less invasive and has a quicker recovery time. However, laparoscopic prostatectomy – particularly when performed transperitoneally- is really more invasive than an open extraperitoneal approach. Entering the peritoneal cavity may complicate future intra-abdominal surgery, and carries with it greater risks for injury to the bowel, major blood vessels and the ureters, as well as urine peritonitis and later intestinal obstruction from adhesions.

Furthermore, the physiologic response to the “minimally invasive” techniques does not appear to differ considerably from that of the standard open operation. Fornara et al. compared the serum levels of acute phase reactants, such as C-reactive protein and interleukin-6, between laparoscopic and open prostatectomy and found no significant difference.

(Video) Individualizing therapy for the prostate cancer patient: a growing set of options

Cosmetic Results

A laparoscopic or robotic prostatectomy typically involves 5 or 6 ports, each requiring an incision of about 1 inch in length. By contrast, an open radical prostatectomy involves one vertical or horizontal incision, currently usually 4 to 5 inches in length, depending upon the patient’s body habitus. A perineal prostatectomy involves a small incision in a region that is seldom visible. The effect of these differences on patient quality of life is unproven.

Postoperative Pain and Return to Normal Activity

Differences in the size and number of incisions also do not appear to translate into significant differences in postoperative pain, duration of hospitalization or return to normal activities.

Visualization of the Operative Field

Another often-cited advantage of laparoscopic or robotic prostatectomy is improved visualization through greater magnification than can be achieved with open surgery. However, excellent magnification can be provided with open surgery through the use of surgical loupes, and the small difference between them has not been shown to have a material effect on the surgical outcomes. Some proponents of laparoscopic approaches have argued that better visualization facilitates the preservation of potency and urinary continence or makes it easier to perform a secure vesicourethral anastomosis. However, the potential advantages are offset by the objective disadvantage of the more limited access provided by laparoscopic approaches. Overall, laparoscopic and robotic prostatectomy have not been shown to significantly improve potency, continence, or anastomotic leak rates as compared to open surgery.

Preservation of Urinary Continence

In the senior author’s series and that of Walsh et al., urinary continence was preserved in 93% of men. Although differences in surgeon experience and patient characteristics can confound direct comparisons of surgical series, most studies to date have shown either similar or inferior continence results with laparoscopic techniques.

In performing the vesicourethral anastomosis, it is generally more difficult to place the anastomotic sutures in the urethral stump using laparoscopic techniques. It is also more difficult to dissect the bladder neck free from the prostate and to reconstruct the bladder neck than it is with open surgery, where the ability to palpate the junction of the bladder and the prostate and the ready ability to place reconstructive sutures is far greater. Accordingly, nearly all laparoscopic or robotic surgeons have adopted a bladder neck-sparing approach to avoid having to reconstruct the bladder neck. Because it is more difficult to identify the bladder neck laparoscopically, the laparoscopic bladder neck-sparing approach carries a greater risk for leaving prostate tissue behind on the bladder neck and may increase the risk for positive surgical margins, both of which can cause troublesome postoperative elevations of PSA levels.

Anastomotic urine leaks and vesicourethral anastomotic strictures are more common with laparoscopic or robotic approaches, particularly during the learning curve phase. The running anastomotic suture technique frequently used with laparoscopic or robotic techniques to avoid leaks may result in ischemia in the urethral tissues and result in vesicourethral anastomotic strictures.

(Video) NZUSI Webinar 3rd May 2020

Pelvic Lymph Node Dissection

Pelvic lymph node dissection is more difficult to perform with laparoscopic or robotic surgical techniques. Consequently, laparoscopic surgeons frequently do not perform a staging pelvic lymphadenectomy as a part of the radical prostatectomy.

Preservation of Erectile Function

The senior author believes that with the robotic or laparoscopic prostatectomy, the surgeon is often forced to make a more stark choice between removing all of the cancer and preserving the neurovascular bundles to maintain potency. A greater likelihood of accomplishing both goals simultaneously is provided with the increased access of the open approach. In the senior author’s open RRP series, potency was preserved in 76% of preoperatively potent men who underwent bilateral nerve-sparing surgery. This included 93% of men younger than age 50 years, 85% ages 50 to 59, 71% ages 60 to 69, and 52% ages 70 and above. Using the same criteria (preoperatively potent, bilateral nerve-sparing) in a laparoscopic series, Rassweiler et al. reported potency rates of 78% for men younger than 55 years old, 60% for ages 55 to 65, and 43% for men over age 65.

An important limitation of laparoscopic and robotic approaches in preserving potency is gaining adequate hemostasis in the neurovascular bundles without using electrocautery or thermal energy. With open prostatectomy, the prostate is sharply dissected away from the neurovascular bundles without electrocautery or thermal energy, and bleeding vessels can be readily secured with fine, precisely placed hemostatic clips or absorbable, delicate sutures. The sutures are absorbed after several weeks, leaving the neurovascular bundles viable and able to recover from minor surgical trauma.

By contrast, with the laparoscopic or robotic approach, it is far more difficult to quickly and accurately apply hemostatic clips or place hemostatic sutures. Therefore, many laparoscopic surgeons unfortunately resort to bipolar or unipolar electrocautery or a harmonic scalpel for hemostasis when bleeding from the neurovascular bundles becomes troublesome. As a result, the prostate gland and the adjacent neurovascular bundles often become charred and desiccated from the high temperatures, irreversibly damaging them and resulting in permanent erectile dysfunction.

Attempts to instead dissect the prostate further away from the neurovascular bundles by establishing the plane of dissection more medially and/or anteriorly (as with preservation of the “Veil of Aphrodite”) could potentially result in dissecting into and through the prostatic capsule, with a risk of spilling tumor cells into the periprostatic tissues and having positive surgical margins.

Some laparoscopic surgeons also have reported topical application of hemostatic agents to the neurovascular bundles, but the efficacy and safety of these agents has not yet been demonstrated convincingly. Nevertheless, it is possible that future modifications and improvements to laparoscopic technique may help to improve the preservation of potency.

Tactile Feedback

Another significant limitation of laparoscopic and robotic prostatectomy is the lack of tactile feedback, which is an important component of open surgery. The robot lacks the “human touch” and it is not possible for the surgeon to appreciate how the prostate gland feels and how readily it separates from the neurovascular bundles or other surrounding tissues. Because with laparoscopic or robotic surgery, the surgeon largely forgoes the primary sense of touch, he or she must learn to rely more heavily on the sense of sight.

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Furthermore, with the robot or with laparoscopic instruments, the prostate gland cannot be retracted and manipulated as gently as with the human hand. Thus, the robot and other laparoscopic instruments that do not provide fine tactile feedback may inadvertently puncture the capsule of the prostate, leading to spillage of tumor cells and positive surgical margins. Furthermore, the prostate may be unintentionally torn away from the neurovascular bundles in a rough manner producing a stretch injury-related nueuropraxia.

Researchers from the Cleveland Clinic have suggested the use of intraoperative transrectal ultrasonography as a way to help offset the lack of tactile feedback in laparoscopic cases. They have reported that it is useful both in neurovascular bundle preservation and to examine for hypoechoic areas or abnormalities in the prostate contour that might be suggestive of extracapsular tumor extension. Despite their encouraging preliminary results, there is no real substitute for human touch. Furthermore, other steps such as retraction, dissection, suturing and knot tying are all facilitated by the familiar tactile sensation.

Blood Loss

An advantage of laparoscopic or robotic prostatectomy is that the pneumoperitoneum should assist with hemostasis, theoretically leading to less intraoperative blood loss. Nevertheless, the clinical significance of this is unclear, since autologous transfusions are seldom required using open or laparoscopic techniques, and studies have failed to demonstrate a significant difference between them. For example, in the comparative study by Rassweiler et al., intraoperative autologous transfusions were given in 8.9% of laparoscopic and 6.6% of open cases. With an experienced surgeon, few patients require blood transfusions from another person using either technique.

Complications

The complications with laparoscopic or robotic prostatectomy tend to be more serious than with open prostatectomy, and anecdotal evidence suggests that postoperative emergency room visits, repeat hospitalizations, and re-operations are all more common in laparoscopic cases.. In one study, Rassweiler et al. reported on a comparison of complication rates in 1243 open and 1243 laparoscopic radical prostatectomies in Germany. Major complications occurred in 10.7% and 12.3% of cases, respectively. In another series, Hu et al. compared the complications among 358 laparoscopic and 322 robotic radical prostatectomies. They reported perioperative complications in 27.7% of laparoscopic and 14.6% of robotic prostatectomies, including intraoperative ureteral, rectal, vascular, and nerve injuries. Postoperative ileus delaying discharge was reported in 28 patients, and there were 7 cases of rectourethral fistula.

Cancer Control

Surgical Margins

Because follow-up is not yet mature to evaluate cancer cure rates with laparoscopic or robotic surgery, surgical margin status has been used as a surrogate pathological marker to compare cancer control between laparoscopic and open techniques. Indeed, positive surgical margins are associated with significantly higher rates of biochemical progression, clinical progression and death.

Particularly early in the learning curve, positive margin rates in several laparoscopic prostatectomy series are concerningly high. For example, Atug et al. reported a positive margin rate of 45.4% in the first 33 of 100 consecutive robotic prostatectomies, including 10 of 26 patients (38.4%) with pathologically organ-confined disease. In the next 33 patients and the final 34 patients, the positive margin rates decreased to 21.2% and 11.7%, respectively. Nevertheless, as Baumert pointed out in an editorial comment, “the positive margin rate of the first group of patients is difficult to accept in this day and age. All teams new to robotic or laparoscopic surgery should initiate their programs with mentors to avoid ‘sacrificing’ the first patients.”

(Video) The Last 25 Years of PSA

The learning curve involved in laparoscopic prostatectomy is a well-described disadvantage of the technique. According to one estimate, it takes at least 40 to 60 cases for an experienced open surgeon to become proficient. Proponents of robotic prostatectomy have shown that the robot may decrease the learning curve for inexperienced laparoscopic surgeons to become proficient with the technique. Nevertheless, there is clearly an inherent compromise of the initial patients being treated with these techniques.

Fortunately, the current endoscopic equipment is useful in the instruction of these techniques, such that even the second assistant has an excellent magnified view of the anatomy and technique. Unfortunately, for practicing urologists who are adept in open radical prostatectomy, participation in such hands-on training courses requires a sacrifice of time and finances. Moreover, formal training in such complicated urological procedures is not yet uniformly available in residency training programs.

Long-Term Cancer-Free Survival Results

Most importantly, the laparoscopic and robotic prostatectomy have no track record in terms of long-term cancer control. The surgical specimen is generally removed from a port site within an entrapment sac and no port site recurrences have yet been described. Nevertheless, the positive margin rates are concerning, and if small amounts of cancer are left behind, it may not become apparent for years. Thus, long-term cancer cure rates are needed to adequately evaluate the effectiveness of the operation. These questions have been well documented for open prostatectomy.

Guillonneau et al. reported three-year biochemical progression-free survival rates for LRP of 92% for pT2a, 88% for pT2b, 77% for pT3a, and 44% for pT3b, for an overall rate of 90.5%; however, for prostate cancer, 3-year biochemical recurrence-free rates are not meaningful. For comparison, in 2404 men treated by RRP, Han et al. reported 5-year isolated PSA, local, and distant recurrence-free survival rates of 92%, 99%, and 96%, respectively. It remains to be demonstrated whether laparoscopic and robotic techniques afford similar long-term survival results.

Costs

Although the robot may facilitate the operation for urologists without advanced laparoscopic experience, it is extremely expensive, potentially limiting its widespread applicability. In addition to the cost of the equipment, laparoscopic and robotic techniques are associated with a considerably longer operative time. Van Appeldorn et al. reported an operative time of 292 minutes in the first 20 patients, which was reduced to 191 minutes once they reached patients 130-150. Although increasing experience with the technique does reduce the operative time, it remains at the upper limit of what is typically reported in open prostatectomy series.

Finally, Lotan et al. estimated that conventional laparoscopic and robotic prostatectomy increase the cost by $487 and $1726, respectively, over open radical prostatectomy. Based on the data to date, laparoscopic approaches are associated with a similar short-term recovery to open prostatectomy, a higher proportion of major complications, and uncertain long-term cancer control outcomes. To warrant such a significant increase in cost, laparoscopic approaches should offer a clear advantage over open prostatectomy, and the existing evidence does not show this to be the case.

Summary

The senior author does not believe that laparoscopic or robotic prostatectomy prostatectomy is as safe a cancer operation as open radical prostatectomy, or that nerve-sparing can be as readily or safely accomplished. The overly hasty and widespread adoption of this technique could set the field of early prostate cancer detection and treatment back 15 years as did the early application of ineffective open brachytherapy techniques in the 1970s.

(Video) Prostate Brachytherapy - EMPIRE Urology Lecture Series

Keeping all of the above in mind, the most important factor in the safety and efficacy of radical prostatectomy is the surgeon and not necessarily the technique.

FAQs

What is a high PSA level for prostate cancer? ›

Men with a PSA level between 4 and 10 (often called the “borderline range”) have about a 1 in 4 chance of having prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50%.

Is robotic prostate surgery better? ›

Most studies show no major differences between the procedures in terms of patient survival or their ability to control prostate cancer over the long term. Robotic prostatectomies ostensibly offer quality-of-life advantages for urinary function and sexual health.

Is prostate cancer genetic? ›

Prostate cancer seems to run in some families, which suggests that in some cases there may be an inherited or genetic factor. Still, most prostate cancers occur in men without a family history of it. Having a father or brother with prostate cancer more than doubles a man's risk of developing this disease.

What happens after prostate surgery? ›

The major possible side effects of radical prostatectomy are urinary incontinence (being unable to control urine) and erectile dysfunction (impotence; problems getting or keeping erections). These side effects can also occur with other forms of prostate cancer treatment.

What are the signs that prostate cancer has spread? ›

Prostate cancer can spread to the lymph nodes in the groin area, or to other parts of the body. The most common symptoms are swelling and pain around the area where the cancer has spread. Cancer cells can stop lymph fluid from draining away. This might lead to swelling in the legs due to fluid build up in that area.

Can you have high PSA and no cancer? ›

Elevated PSA levels can indicate the presence of cancer, but high PSA levels can also be a result of non-cancerous conditions like benign prostatic hyperplasia (BPH), or an infection. PSA levels also rise naturally as you age. Elevated PSA levels do not necessarily mean that you have prostate cancer.

What are the disadvantages of robotic surgery? ›

Disadvantages of robot-assisted surgery are:
  • Only available in centers that can afford the technology and have specially trained surgeons.
  • Your surgeon may need to convert to an open procedure with larger incisions if there are complications. ...
  • Risk of nerve damage and compression.
Dec 15, 2021

What is life expectancy after robotic prostatectomy? ›

Based on the natural history of localized prostate cancer, the life expectancy (LE) of men treated with either radical prostatectomy (RP) or definitive external-beam radiotherapy (EBRT) should exceed 10 years.

Who is the best robotic prostate surgeon? ›

Dr. Razdan is recognized as one of the highest volume and most experienced robotic prostate surgeons in the world. He has performed over 9,000 Robotic Surgeries and is considered by many to be one of the best in the world.

What is the major cause of prostate cancer? ›

The underlying factor linking diet and prostate cancer is probably hormonal. Fats stimulate increased production of testosterone and other hormones, and testosterone acts to speed the growth of prostate cancer. High testosterone levels may stimulate dormant prostate cancer cells into activity.

Who gets prostate cancer the most? ›

Risk of prostate cancer

Prostate cancer is more likely to develop in older men and in non-Hispanic Black men. About 6 cases in 10 are diagnosed in men who are 65 or older, and it is rare in men under 40. The average age of men at diagnosis is about 66.

What chemicals can cause prostate cancer? ›

The researchers say benzene, toluene, xylene and styrene - all of which are classified as monocyclic aromatic hydrocarbons - are all suspected or known carcinogens. They say their research is an important first step in better understanding the relationship between occupational agents and prostate cancer.

Can you get an erection without a prostate? ›

About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs. However, they are not for everyone, including men who take medications for angina or other heart problems and men who take alpha-blockers.

Can you still get an erection if prostate is removed? ›

Most men who have normal sexual function and receive treatment for early prostate cancer regain erectile function and can have satisfying sex lives after robotic prostatectomy.

What is the success rate of prostate surgery? ›

Overall, the outcome following surgery is favorable, with disease-specific survival rates of 90% or more at 10 years.
...
Table 1.
Progression-Free*
Finding at Radical ProstatectomySurvival at 10 years (%)
Positive margins55
Gleason score
2–496
7 more rows

Can stress and anxiety raise PSA levels? ›

One hospital-based study found that higher anxiety increased PSA screening rates in men, particularly for those with a family history of PCa seeking reassurance from a normal test result.

What causes a sudden increase in PSA? ›

Besides cancer, other conditions that can raise PSA levels include an enlarged prostate (also known as benign prostatic hyperplasia or BPH ) and an inflamed or infected prostate (prostatitis). Also, PSA levels normally increase with age.

What can cause a false high PSA reading? ›

High PSA? Here are 7 common things that can affect your PSA level
  • Age. Older men's normal PSA levels run a little higher than those of younger men. ...
  • Prostate size. ...
  • Prostatitis. ...
  • Benign prostatic hyperplasia (BPH) ...
  • Urinary tract infection or irritation. ...
  • Prostate stimulation. ...
  • Medications.
Sep 6, 2018

What is the success rate of robotic surgery? ›

The positive success rate of robotic surgical procedures is also spurring innovation in this field. According to published data on robot-assisted pyeloplasty, success rates range from 94% to 100%.

Is robotic surgery painful? ›

There are several types of pain associated with robotic surgery: incisional port site pain, pain from the peritoneum being distended with carbon dioxide, visceral pain, and shoulder tip pain.

Is robotic surgery covered by insurance? ›

Yes, health insurance plans in India cover the cost of robotic surgery. According to the guidelines issued by the Insurance Regulatory & Development Authority of India (IRDAI) in 2019, all health insurance companies have to mandatorily provide coverage for robotic surgeries.

Can you live 20 years after prostatectomy? ›

Our study shows that with long-term follow-up RP provides excellent oncological outcomes even at 20 years. While most men do require a multimodal treatment approach, many men can be managed successfully with RP alone.

Is Gleason 8 a death sentence? ›

There is a perception among a lot of patients — especially when they get diagnosed — that having a high Gleason score of 8, 9, or 10 is essentially a “death sentence”, regardless of how they get treated. This is not actually the case at all. Plenty of men with Gleason 8 to 10 disease actually do well after treatment.

Is it better to have prostate removed or radiation? ›

Both radiation and surgery are equally effective treatments to cure prostate cancer." The choice of which treatment is best is up to individual patients and their care teams, Dr. King says. "Make sure you talk with a surgeon and a radiation oncologist before you make your decision.

How long does it take to fully recover from prostate robotic surgery? ›

It takes three to four weeks for the abdominal incisions to heal completely, so you should avoid heavy lifting during that time. You may have some swelling in the scrotum and penis after surgery, which will resolve with time.

What is the cost of robotic prostate surgery? ›

Results: Mean hospital cost per robot-assisted radical prostatectomy was $11,878 (95% CI $11,804-$11,952). Mean cost was $2,837 (95% CI $2,805-$2,869) in the low cost group vs $25,906 (95% CI $24,702-$25,490) in the high cost group.

What is the best hospital for urology? ›

Mayo Clinic in Rochester, Minn., is ranked No. 1 for urology in the U.S. News & World Report Best Hospitals rankings.

How quickly does prostate cancer spread? ›

This is because, unlike many other cancers, prostate cancer usually progresses very slowly. It can take up to 15 years for the cancer to spread from the prostate to other parts of the body (metastasis), typically the bones. In many cases, prostate cancer won't affect a man's natural life span.

Does stress cause prostate cancer? ›

Extreme stress can have an accumulative effect on the body's physiology, allowing prostate cancer to take root and grow.

At what age is prostate cancer not treated? ›

Men between 60 and 69 years of age were more likely to receive radiation therapy than radical prostatectomy. Men between 70 and 79 years were most likely to receive no therapy, and nearly all men over 80 years received no therapy.

What's the life expectancy of prostate cancer? ›

The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread.
...
Prostate cancer 5-year relative survival rates.
SEER Stage5-year Relative Survival Rate
Localized>99%
Regional>99%
Distant31%
All SEER stages combined98%
Mar 1, 2022

Can you live a long life after prostate cancer? ›

You can live a long time with prostate cancer. If you catch and treat it early, you might even be able to cure it. Staying as healthy as possible plays an important role.

Can you live 20 years with prostate cancer? ›

Survival for all stages of prostate cancer

more than 95 out of 100 (more than 95%) will survive their cancer for 1 year or more. more than 85 out of 100 (more than 85%) will survive their cancer for 5 years or more. almost 80 out of 100 (almost 80%) will survive their cancer for 10 years or more.

Is prostate cancer curable? ›

The short answer is yes, prostate cancer can be cured, when detected and treated early. The vast majority of prostate cancer cases (more than 90 percent) are discovered in the early stages, making the tumors more likely to respond to treatment. Treatment doesn't always have to mean surgery or chemotherapy, either.

Can you stop prostate cancer? ›

There's no sure way to prevent prostate cancer. Study results often conflict with each other, and most studies aren't designed to definitively prove whether something prevents prostate cancer. As a result, no clear ways to prevent prostate cancer have emerged.

What medications can cause prostate problems? ›

Decongestants. Decongestants, such as pseudoephedrine (Sudafed), are used to treat congestion often associated with a cold. These drugs, which are called vasopressor adrenergics, worsen BPH symptoms because they tighten muscles in the prostate and bladder neck.

Do nerves grow back after prostate surgery? ›

Nerve regeneration after radical prostatectomy (and the subsequent return of erectile function) usually does take some time, assuming that both nerve bundles around the prostate were able to be preserved by the surgeon. This is because the nerves and arteries that control erections need time to recover and heal.

How long can the average man stay erect? ›

“Naturally, without being on any medications, the average erection for an average person would be roughly 10 minutes,” says Simhan.

Should a 70 year old man have prostate surgery? ›

While few men older than 70 are treated with radical prostatectomy, the procedure is a safe option for the treatment of prostate cancer in otherwise healthy men up to at least age 75, according to a new Canadian study.

What is life like after prostate removal? ›

This is when the surgeon removes the entire prostate gland, seminal vesicles, and often, pelvic lymph nodes. The most common side effects of prostate cancer surgery are urinary incontinence (the inability to control your bladder) and erectile dysfunction, or ED (the inability to achieve a full erection).

What percentage of prostate cancers are aggressive? ›

Yet in 10 to 15 percent of cases, the cancer is aggressive and advances beyond the prostate, sometimes turning lethal.

What is a dangerously high PSA number? ›

What is a dangerous PSA level? PSA levels above 10 ng/mL are considered especially risky. Patients should consult their doctor immediately, as there is a chance of prostate cancer. Elevated PSA levels may indicate cancer or other types of infections or conditions.

What is an extremely high PSA level? ›

More than 50% of men with a PSA value higher than 10 ng/ml have extra-prostatic disease. Twenty percent of men with a PSA higher than 20 ng/ml and 75% of those with a PSA higher than 50 ng/ml are found to have pelvic lymph node involvement [4].

At what PSA level should I be concerned? ›

Decoding a PSA Test

For men in their 40s and 50s: A PSA score greater than 2.5 ng/ml is considered abnormal. The median PSA for this age range is 0.6 to 0.7 ng/ml. For men in their 60s: A PSA score greater than 4.0 ng/ml is considered abnormal. The normal range is between 1.0 and 1.5 ng/ml.

What is the highest PSA level a man can have? ›

0 to 2.5 ng/mL is considered safe. 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors. 4.0 to 10.0 ng/mL is suspicious and might suggest the possibility of prostate cancer. It is associated with a 25% chance of having prostate cancer.

How can I lower my PSA quickly? ›

Tips for Naturally Lowering PSA Levels
  1. If you've had your prostate-specific antigen (PSA) tested and your numbers were higher, you and your doctor may have discussed ways to lower it. ...
  2. Eat more tomatoes. ...
  3. Choose healthy protein sources. ...
  4. Take vitamin D. ...
  5. Drink green tea. ...
  6. Exercise. ...
  7. Reduce stress.

Can stress and anxiety raise PSA levels? ›

One hospital-based study found that higher anxiety increased PSA screening rates in men, particularly for those with a family history of PCa seeking reassurance from a normal test result.

What can cause a sudden rise in PSA? ›

Besides cancer, other conditions that can raise PSA levels include an enlarged prostate (also known as benign prostatic hyperplasia or BPH ) and an inflamed or infected prostate (prostatitis). Also, PSA levels normally increase with age.

What is the average PSA for a 70 year old? ›

2.5-3.5: Normal for a man 50-60 yrs. 3.5-4.5: Normal for a man 60-70 yrs. 4.5-5.5: Normal for a man 70-80 yrs.

What medications can raise your PSA level? ›

Official answer
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen.
  • Cholesterol-lowering statins, such as Lipitor (atorvastatin) and Zocor (simvastatin)
  • High blood pressure drugs known as thiazide diuretics.
Mar 15, 2022

What does a urologist do if your PSA is elevated? ›

After an initial test result of elevated PSA levels, a urologist will want to perform another PSA test and other tests to diagnose the issue. Prostate-specific antigen, or PSA, is a protein produced in cells of the prostate gland and a PSA test measures the level of PSA in a man's blood.

Can PSA go down? ›

PSA levels can be confusing. They can go up and down for no obvious reason. They can rise after treatment. And levels tend to be higher in older men and those with large prostates.

What should you not do before a PSA test? ›

Before having a PSA test, men should not have ejaculated during the previous 48 hours. Semen released during sexual activity can cause PSA levels to rise temporarily, which may affect the test results.

How much should PSA go up in a year? ›

In the overall study population, the mean change in PSA levels was 2.9% per year and the rate of change in PSA increased modestly with age (P < . 001). Overall, men who developed prostate cancer experienced a more rapid percent change in PSA per year than men who did not (P < . 001).

What foods can lower PSA levels? ›

Here's a look at the top five foods to eat for a healthy prostate:
  • Cruciferous Vegetables. This class of vegetables includes things like cabbage, bok choy, kale, cauliflower, and Brussels sprouts. ...
  • Berries. ...
  • Fish. ...
  • Cooked Tomatoes. ...
  • Coffee & Tea.

Dr. Catalona with Senator Bob DoleThe funds and energies of the Urological Research Foundation (URF) are directed to research for the prevention, detection, treatment and cure of diseases of the prostate and most specifically, prostate cancer.. Dr. Catalona, Medical Director of the URF, was the first to use the prostate specific antigen (PSA) blood test in early prostate cancer detection.. He retired in 2010 as President of E.W.. John has served on numerous corporate boards as well as community service boards.. Col. West served in the U.S. Army for 21 years.

This test helps to check kidney functions .. Cystoscopy is a procedure that is performed in women, which helps the urologist to check the urinary tract, mainly the bladder and the urethra.. This is a test that is performed to check the health of the ureters and the kidneys.. This is a procedure done to check for cancer , or to check for proper functioning of the kidney.. This is a radiology procedure that helps to study the functions and the structure of the patient’s kidneys and also about the blood flow to the tissues in the kidney.. The kidney ultrasound is an imaging test which involves the use of sound waves to check the patient’s kidneys.

Stone disease Voiding dysfunction/Urinary incontinence Benign prostate conditions Urologic infections Urologic reconstruction & Urologic trauma Prostate enlargement Urologic infections Urologic tramua and reconstruction. Kidney stones can cause other symptoms that include blood in the urine, nausea/vomiting, persistent urinary tract infections and urinary frequency.. When the bladder gets full and the situation is appropriate to urinate, the sphincter relaxes and the bladder contracts to allow urine to pass through the urethra without difficulty.. Bladder Botox Injection – Medication is injected into the bladder to help the muscle relax and reduce urgency, frequency and incontinence. Neuromodulation – implantable devices that prevent the transmission of impulses to the bladder Bladder Botox Injection – medication injected into the bladder to help relax the bladder muscle and reduce urgency Sub-urethral Sling – a procedure that restores the urethra to its normal position Urethral Bulking Agent Injection – Using a cystoscope, bulking materials are injected around the urethra to aid urethral closure Artificial Urinary Sphincter – an implantable device that replaces the function of the patient’s bladder sphincter. Bladder Augmentation – a procedure that uses a piece of tissue from the bowel, stomach or ureter (the tube that carries urine from the kidney to the bladder) to enlarge the bladder capacity Urinary Diversion – diverting the urine flow from the natural urethra to an abdominal stoma (opening). Symptoms include overactive bladder (frequent urination, loss of bladder control) or an underactive bladder (bladder becomes too full due to urinary retention, trouble starting to urinate, or unable to tell when the bladder is full).. Video urodynamic studies measure bladder capacity, bladder pressure, urine flow, and bladder emptying.. Small electrical stimulators are implanted to either help with bladder emptying in cases of urine retention or to help suppress the urgency waves in cases of urgency and frequency This is an outpatient procedure performed after a thorough testing period The device has been approved by the U.S. Food and Drug Administration to treat urge incontinence, urgency-frequency syndromes, and urinary retention in patients who have not responded to other therapies. However, there are medications that reduce bladder spasms or induce bladder muscle contractions that are effective in certain neurogenic bladder conditions.. Uses a bladder scope to inject Botox into the bladder wall to promote improved bladder function

Videos

1. Prostate Biopsy Techniques: Ways to Optimize Cancer Detection and Ensure Patient Safety
(Breakthroughs for Physicians)
2. Advancements in prostate cancer diagnosis: The role of medical imaging and AI
(Quibim)
3. Dr. Ronald Yap Show Ep 6 - Prostate Cancer, Surveillance and Surgery
(Ronald Yap)
4. Nephron Sparing Surgery for Large Renal Tumors
(Grand Rounds in Urology)
5. Dr. Albertsen's second lecture will address the current stat
(UVA - School of Medicine)
6. Prostate Health: What You Need to Know - Online Webinar
(Herbert Irving Comprehensive Cancer Center at Columbia)

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Name: Jonah Leffler

Birthday: 1997-10-27

Address: 8987 Kieth Ports, Luettgenland, CT 54657-9808

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Introduction: My name is Jonah Leffler, I am a determined, faithful, outstanding, inexpensive, cheerful, determined, smiling person who loves writing and wants to share my knowledge and understanding with you.