Lecture by Dr. Catalona, as reported by Richard DeLorenzo
July 16 2002 Poughkeepsie NY
Dr. Catalona, an upper echelon surgeon from St. Louis, subscribes to prostate removal surgery as the ultimate weapon in securing old age for PCa patients. He pioneered the use the PSA to give early diagnosis of PCa, and achieved his goal in 1991. He stated that the old 4.0 PSA trigger should be dropped to <2.5. He recommends a biopsy for 2.5 and above, particularly for the younger men. He further states that a man should not have a PSA above 2 that cannot be explained by prostatitis or BPH. BPH can be treated with Proscar and the inflammation (prostatitis) can be treated with antibiotics. He said that there have been cases of extended higher PSA's after using antibiotics ( for as long as 2 years+)...depends on the man's chemistry...but it will eventually go down to normal, i.e. <2.0. Treatments like Proscar for BPH can affect the readings of the PSA, i.e., PSA is lowered and PCa might be therefore overlooked if the PSA trigger-number doesn't indicate anything wrong. Dr. Catalona did not discuss the DRE, but I assume all of understand that this is also a part of the basic exam for the previously undiagnosed. The Dr. presented a set of 25 charts which included the marked improvement in early diagnosis, longer survival potential, and reduced relapse. One of Dr. Catalona's charts showed that the best overall results were from Surgery, then Radiotherapy, Hormones and Waiting. A query about the fact that radiologists suggest numbers that say they're the best, etc., was answered as follows: Each method has its own way of describing a baseline. He does not mitigate when defining his terms. Incontinence is ANY leakage, whether you use a napkin in your shorts or a diaper. When he measures PSA after surgery: 0 or negligible. PSA. for example, using seeds, it takes a while for the PSA to go down....thence to summarily climb again. A brachytherapist could pick a point on the timeline from when the PSA finally came down, but measure success from the date of implant all the way to a first upward climb some time later...you get the point ...it masks the real mean time to failure. ( If that wasn't clear enough, let me know and I'll try again). Suffice it to say, it's sort of like creative bookkeeping. He says he literally has piles of data to support all his claims, and says if a Dr. you are considering cannot give you ten names of patients to whom you can phone to discuss his qualifications, get another Dr. Dr. Catalona is a foremost nerve saving surgeon...his mentor was the pioneer of his procedure, Dr. Walsh. He described the operation as an open prostatectomy, incision beneath navel for about 5 inches from where he can lift the prostate out from above the nerve bundles, as opposed to the procedure from under the scrotum...which calls for pulling the prostate below the bundles and between them. He also discussed the laproscopic which called for 2 small incisions to operate and larger one to pull the prostate through. He favored the former method and uses it exclusively. I wanted to ask about the fact that when I participated in a BAYER test of the new Complex PSA test (CPSA), they said that if you cannot have a DRE before the blood test because it raises the PSA value. Someone asked the question for me: the answer--- PSA goes up for any trauma or PSA fooling around like the Digital Rectal Exam, bike riding, and of course sex. Interestingly, I had asked this question of the Dr who handles PSAs for the Albany Medical Center when he spoke at the Poughkeepsie Man to Man meeting, this past Spring....he said he'd never heard of such situation with respect to the DRE raising the PSA if done before blood was taken. While I am pleased to get the straight scoop on this, I am concerned the Albany Medical Ctr Dr. could so pointedly deny the possibility. But that is the adventure PCa, I guess. Dr. Catalona favors external beam, as it is more pervasive/thorough than seeds. He also said that if seeds fail the patient is not a good candidate for prostatectomy because all the tissues are weakened by the seeds, and surgery could damage colon, etc. He does not support hormones treatment BEFORE surgery because they create a cellophane-like coating around the prostate, and something like an adherence to the nerve bundles which makes it more difficult to both define the prostate margin, get at it and extract it. He said Dr. Walsh will not operate on anyone who has use hormones before surgery. Dr. Catalona talked about how he wired up the urethra years ago, opposed to what he does now. He felt he'd use a narrower opening to prevent leakage...turned out that caused stricture....he uses a normal/larger opening where he connects up and his patients do just fine. He mentioned the urethral stub which I believe contains one of the male sphincters (the other disappears with the operation). Both are used in the male to cut off the flow...when the prostate is removed and the 2d sphincter is gone, one muscle is doing the work 2 did before....and a by the way, women have only one. Another reason some continued extra urination’s per day/night, is that after years of the bladder working extra hard to force water through a tightened up urethra, it gets more muscular, i.e., rubbery and thicker, and there cannot contain as much water as it did before we started to age....so the bathroom treks continue. Dr. Catalona talked about the fact that biopsies are not foolproof. That an enlarged prostate makes "hitting" the cancer even more difficult...(one of our past speakers talked about multiple biopsies not finding cancer in a man with very high PSA...they finally found the tumor on the very top of the prostate. One question was about preventative removal of prostate BEFORE cancer is detected. Dr. Catalona said he will not do that. I don't remember if he said he knew of Drs. who did. Dr. Catalona also talked about nutrition when queried about it: He said the lack of significance. PCa in the Orient, says to him that we should emulate Oriental diets, vegetables, beans, fruits. Red meats and transfats/cheese are no good. Chicken, fish, olive oil are good. He said he had no real support for Flax Seed as preventative (it might be, but he doesn't know it to be so). However, he does support Soy products, and mentioned Lycopene (tomato), 400 IU Vit E, 200 mcg Selenium. Dr. Catalona was very candid.