Dear Doctors: I am dealing with prostate cancer. I have a Gleason score of 8, which I understand makes me high-risk. I am undergoing hormone therapy, and brachytherapy is pending. Any wisdom you can share about this or advances in prostate cancer treatment would be greatly appreciated.

Dear Reader: We’re sorry to hear about your diagnosis. The prostate is a walnut-sized gland in men that sits in front of the rectum and just below the bladder. As men grow older, their risk of developing prostate cancer increases.

Once a cancer diagnosis has been made, additional tests are used to assess how the cancer cells are behaving in the body. This is known as staging. One of these is a numerical measure known as the Gleason grading system. It is determined by examining the cancer cells under a microscope, and it reflects how likely a cancer is to spread beyond its initial site. A lower Gleason score indicates the cancer is growing slowly and has not yet become aggressive. A Gleason score of 8 indicates the presence of what is known as a high-grade cancer. That reflects an increased risk that an existing cancer may begin to spread.

Your medical team is addressing this with brachytherapy. That’s a treatment in which a radioactive material is implanted within the prostate gland. This allows the energy from the radiation to remain localized, killing the cancer cells and minimizing damage to surrounding healthy tissues. In high-dose brachytherapy, which is often done in multiple sessions, a high-energy radiation source is put in place for just a few minutes and then removed. Low-dose brachytherapy involves the permanent placement of low-energy radioactive seeds, which are about the size and shape of grains of rice. Both forms of brachytherapy have been shown to be helpful in slowing or preventing the spread of a localized cancer.

A new treatment for patients with a certain type of metastatic prostate cancer has recently received Food and Drug Administration approval. Known as Pluvicto, it’s a radiopharmaceutical. That’s a drug that uses radiation to fight disease at the cellular level. In this case, the drug is administered by injection or infusion. As it travels throughout the body, the drug seeks out cells with a specific biomarker, which identifies them as being cancer cells. The drug then emits a microscopic amount of radiation. It’s enough to kill or damage the cancer cell but does minimal harm to the surrounding healthy tissues. The treatment consists of six doses, set six weeks apart.

There has also been encouraging news about another type of radiotherapy, known as metastasis-directed therapy, or MDT. This treatment uses recent advances in imaging technology to precisely train intense beams of radiation on tumors from multiple directions. This makes it possible to intensify the therapeutic dose of radiation, and at the same time spare healthy tissue. A study into the therapy, which included more than four years of follow-up, found the therapy improved outcomes in many of the participants.

If your cancer has begun to spread, you might ask your medical team to explore if any of these therapies might be appropriate for you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I broke my ankle about 18 months ago. Now, in the area just above the break, the skin on my leg has turned a dark color, like a bruise. It doesn’t seem to be going away. Is there anything I can do to lighten this up? Do you think that laser therapy could help?

Dear Reader: You have described a condition known as “hemosiderin staining.” The term refers to areas of discolored skin that usually affect the lower leg, typically on the ankle and the top of the foot.

Hemosiderin staining occurs when the smallest blood vessels, known as capillaries, begin to leak. This can be due to a wound, a broken bone, a surgical incision or other types of trauma. It is also associated with certain illnesses that affect circulation. The most common of these is chronic venous insufficiency. This is a condition in which structural changes to the one-way valves in the veins prevent blood from circulating efficiently.

Both trauma and venous insufficiency result in the localized pooling of blood, which the body quickly begins to break down into its components. As the red blood cells are dismantled, the iron that they contain is released. This leads to the formation of a type of protein known as hemosiderin, which stores iron in the body. It’s the presence of iron that gives hemosiderin a rusty, brownish-yellow color. Over time, areas of hemosiderin staining can change color and intensify, becoming dark brown or even black.

In most cases, hemosiderin staining that has been caused by physical injury will gradually disappear as the damaged tissues heal. Depending on the individual, their general health and the nature and severity of their wound, it can take weeks, months or more than a year for the collected hemosiderin to disperse. In some cases, the pigmentation will become permanent.

Some people have success lightening the discolored skin with the use of prescription creams that contain hydroquinone. This is a compound that lightens the skin by interfering with the production of melanocytes, which are cells that produce pigment. While topical creams can prevent existing discoloration from becoming more pronounced, they may not completely remove it.

Laser therapy has also proven to be helpful at fading the discolored areas. For hemosiderin staining, a device known as a Q-switched laser is often used. This is the kind of laser used in tattoo removal. The Q-switched laser delivers short pulses of energy that are precisely calibrated to penetrate into the lower layers of skin. There, they destroy the pigment-containing cells. Because the sensation can range from uncomfortable to painful, a topical anesthetic is used. This type of treatment requires a series of visits to a dermatologist. It’s important to work with someone who specializes in this type of treatment.

In and of itself, the accumulation of hemosiderin is not a threat to health. However, because this can be a sign of a more serious underlying condition, it would be a good idea for you to be evaluated by your health care provider.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: While stationed in Alaska more than 35 years ago, I experienced the tips of my fingers turning white in the cold weather. A doctor said it’s probably Raynaud’s syndrome. Does this condition slow down healing? I ask because a deep scratch on my shin still hasn’t healed after four weeks.

Dear Reader: Raynaud’s syndrome, also known as Raynaud’s phenomenon, is a condition in which the small arteries in the extremities suddenly contract and briefly become excessively narrow. This can occur in response to cold or stress. These spasms allow little or no blood to reach the surface of the skin. Raynaud’s phenomenon usually affects the fingers, but it can also involve the toes.

During an episode, the lack of blood flow causes the affected areas to turn white or a blueish purple. It can also cause numbness. When the episode has ended, normal blood flow resumes. This causes the affected skin to turn red and results in a throbbing pins-and-needles sensation. In severe cases, the repeated loss of blood flow can give rise to sores on the fingers or toes. It’s rare, but it can even lead to tissue death.

Raynaud’s phenomenon is estimated to affect 5% to 10% of the population. It is broken down into two categories -- primary and secondary. The primary form is the most common of the two, and is usually less severe. It typically arises between the ages of 15 and 25 and has no known cause.

Secondary Raynaud’s phenomenon is linked to other diseases. These are most often autoimmune or connective tissue diseases, such as lupus, scleroderma and rheumatoid arthritis. Thyroid disorders, certain blood disorders and pulmonary hypertension can also play a role. It has also been linked to tissue damage due to repetitive actions, chemical exposure, certain medications and hand or foot injuries.

The condition doesn’t usually cause permanent damage. However, it can be a symptom of an underlying illness. That’s why it’s important for someone with Raynaud’s phenomenon to see a doctor for tests. Microscopic examination of the blood vessels beneath the skin, known as nailfold capillaroscopy, can differentiate between primary and secondary Raynaud’s. If the diagnosis is primary Raynaud’s, the individual will be advised on how to limit episodes and how to care for the affected areas when they occur. When the diagnosis is secondary Raynaud’s, the next step is additional testing to identify the underlying disease or condition.

It’s possible for Raynaud’s phenomenon to interfere with healing time in a skin injury, but this is associated with severe disease. Additionally, it would affect areas of reduced blood flow. That would be unlikely to include the shin, where the scratch you are concerned about is located. But some of the underlying diseases involved in secondary Raynaud’s can have an effect on healing.

It sounds as though you have not yet had a definitive Raynaud’s diagnosis. We urge you to see your doctor. Whether it turns out to be primary or secondary Raynaud’s, they will be able to provide you with useful information and supportive care and help you determine the cause of your slow-healing scratch.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)