Ask the doctor

Editors of Harvard Medical School publications often receive questions from readers and the general public about prostate cancer and other prostate disorders. A sampling of questions on various topics, answered by Harvard physicians, follows:

Prostate cancer

Risk and prevention
• Does frequent ejaculation help ward off prostate cancer?
  
  
• I've been thinking about getting a vasectomy, but a friend says that this can increase my risk of developing prostate cancer. Is this true?

Screening and diagnosis

• What is the difference between PSA and free PSA? Do I need to have both tests?
  
  
• I am an avid bicyclist, and I am having a prostate biopsy in a few weeks. How long do I need to wait after the biopsy before I can start biking again?
  
  
• Even if my father takes antibiotics beforehand, could he develop a serious infection when he has a prostate biopsy later this year? Are the other possible complications we should be on the lookout for?

Treatment

• I had a radical prostatectomy a year ago and thought I was cured. But now my PSA is rising rapidly, making me think I have an aggressive form of prostate cancer. Is there any reason to believe that radiation therapy might help?
  
  
• I am currently undergoing hormone therapy with leuprolide (Lupron) injections to shrink an enlarged prostate. I believe I’ve noticed some muscle loss. Is this possible?
  
  
• Three years ago, my husband was diagnosed with prostate cancer and non-Hodgkin’s lymphoma (NHL). He had a radical prostatectomy followed by radiation, but his PSA has continued to rise; it is now 2.9 ng/ml. He was given the drug rituximab (Rituxan) for the NHL, but he had an allergic reaction to it. What should we try next?

BPH (benign prostatic hyperplasia)

• I take Flomax (tamsulosin) to manage my BPH. The commercials say something about having cataract surgery. What’s the connection between the drug and cataracts? If I’m taking Flomax, do I have to forgo having my cataracts removed?
  
  
• For the past several years, I used finasteride (Proscar) to treat my BPH. Although the drug reduced the size of my prostate, my body’s production of semen has diminished considerably. After talking with my urologist, I recently started taking dutasteride (Avodart) instead. Will the switch help?
  
  
• What are the pros and cons of treating BPH (an enlarged prostate) with Botox injections?

Sexually transmitted diseases

• I had a nerve-sparing prostatectomy a year ago and can usually get an erection. Do my girlfriend and I still need to use condoms to protect against sexually transmitted diseases even though I no longer ejaculate when I reach orgasm?

Because of the volume of correspondence we receive, we can't answer every letter or message, nor can we provide personal medical advice.