Question 1

What is the value of PSA to say increased in a catheterized old patient, assuming 60 plus?

Dr. Nitin Shrivastava · Accepted Answer

There is no cut-off value for a catheterized patient. Slight PSA increase is expected, sometimes to 8, 9 or 10, or occasionally near 20. If the PSA remains rising, an MRI should be done to find out what's going on inside the prostate.

Question 2

What is the role of physical medicine and rehabilitation in the treatment of prostate cancer?

Dr. Nitin Shrivastava · Accepted Answer

Rehabilitation does not treat the prostate cancer itself, but it is an integral part of the treatment process. After prostate surgery, patients need to do Kegel exercises to regain continence.

Question 3

What factors should we consider when interpreting age-adjusted PSA levels, other than UTI?

Dr. Nitin Shrivastava · Accepted Answer

The rise in subsequent PSA levels, PSA velocity, and PSA density all give more clues when a reading is borderline, and these additional tests should be done before deciding on a biopsy.

Question 4

What is the time range that should be considered between two PSA measurements during screening?

Dr. Nitin Shrivastava · Accepted Answer

Routine mass PSA screening is not recommended. But for high-risk patients, yearly PSA is a good idea. If the PSA comes out abnormal, it should be repeated after four to six weeks.

Question 5

What is the best method of managing BPH?

Dr. Nitin Shrivastava · Accepted Answer

First make sure BPH is not causing damage to the kidneys. For mild symptoms, only lifestyle management is needed. For bothersome symptoms, a single alpha blocker is used. There is no one universal method; if it's damaging the kidneys, surgery is needed.

Question 6

Apart from PSA, what other hormones should be monitored in case of prostate cancer?

Dr. Nitin Shrivastava · Accepted Answer

None. PSA is the only one.

Question 7

What are the factors contributing to prostate cancer, and what are the staging parameters?

Dr. Nitin Shrivastava · Accepted Answer

The most important contributing factor is genetics and family history. Researchers point to some role of obesity and possibly a non-vegetarian diet, but these risk factors are not firmly established.

Question 8

What is a neobladder? What is an ileal conduit? How will treatment affect my quality of life?

Dr. Nitin Shrivastava · Accepted Answer

Neobladder and ileal conduit are treatments for bladder cancer, not prostate cancer. A neobladder is an artificial bladder made from the patient's intestine, stitched together so the patient continues to pass urine through their natural passage. An ileal conduit instead diverts urine to exit through a different passage into a bag. On quality of life: what matters most in the long run is that the cancer comes out of the body completely; patients adjust well to either option over time.

Question 9

Is there a limitation on the number of times TURP can be done on the same patient?

Dr. Nitin Shrivastava · Accepted Answer

About 10 out of 100 patients will require another TURP within the following 10 years. There is no fixed limit, sometimes the prostate regrows fast and requires re-intervention, and sometimes it's done in stages. The more times TURP is repeated, the higher the chance of complications. Personally, the doctor has done it twice at most on the same patient.

Question 10

CT scan is more accessible in our setup than MRI. Is there any place for CT to confirm prostate cancer?

Dr. Nitin Shrivastava · Accepted Answer

CT scan cannot be used to confirm prostate cancer diagnosis, only MRI can do that. But if MRI isn't available, CT scan is very useful for staging: once a cancer diagnosis is confirmed by biopsy, CT can tell you if it has spread outside the prostate.

Question 11

What is the value of PSA to consider dangerous: free PSA, total PSA, PSA ratio?

Dr. Nitin Shrivastava · Accepted Answer

PSA density above 0.15 is suspicious for cancer. A PSA rise of more than 0.75 per year is also suspicious. These are used alongside the age-adjusted PSA cutoffs (2.5 / 3.5 / 4.5 / 6.5 for the 40s / 50s / 60s / 70s age bands) when a single reading is borderline.

Question 12

In case of BPH, what age range is surgery recommended instead of just urine diversion or catheterization?

Dr. Nitin Shrivastava · Accepted Answer

It is not age but fitness for the procedure that matters. The doctor has operated on a 100-year-old patient, while some patients who are only 60 have too many other diseases and are too high-risk for surgery, and stay on a catheter instead. If a patient has a large prostate requiring long surgery and is high-risk, the choice to proceed with surgery understanding the risk ultimately becomes the patient's own.

Question 13

After removal of prostate cancer, there is urine leakage. What is the remedy?

Dr. Nitin Shrivastava · Accepted Answer

The most practical and best remedy is rehabilitation through Kegel exercises, pelvic floor muscle exercises. If these exercises don't help, an artificial urinary sphincter surgery is available, but that is the last resort.

Question 14

What are the nutritional considerations for people with BPH and prostate cancer, and how can urologists and dieticians better collaborate across facilities?

Dr. Nitin Shrivastava · Accepted Answer

The main risk factor for prostate cancer remains genetics and family history, but obesity is a genuine risk factor, alcohol's role is controversial, and there is some evidence linking red meat to prostate cancer, along with some supportive evidence for vitamin D, vitamin E, lycopene from tomatoes, and phytoestrogens like soy protein, though none of these are formal recommendations yet. A dietician should always be part of the urology team, since nutrition intersects directly with kidney stones, uric acid and hypertension, alongside a physical therapist to encourage exercise.

Diagnosis and Management of Prostate Cancer

Questions Doctors Asked Dr.Nitin Shrivastava