This Prostate Cancer Awareness Month, Remember This Important “Point”

New Public Awareness Campaign from Advanced Urology Institute

During September’s Prostate Cancer Awareness Month, Advanced Urology Institute (AUI) wants to stress an important point—0.75.

If your prostate-specific antigen (PSA) level increases by more than 0.75 in one year, it could be prostate cancer.

“Your PSA number is important, and so is the rate at which it changes,” said Dr. Scott Sellinger, an Advanced Prostate Cancer specialist at AUI. “There are men with a PSA of 20 who don’t have prostate cancer and men with a PSA of 2 who do.”

High levels of PSA do not always mean cancer and normal levels of PSA do not guarantee cancer is not present.

“What’s crucial for men is having a baseline. Know your normal PSA level and have it tested annually to alert you to any unusual changes. Finding and treating prostate cancer early, when treatment might be more effective, saves lives,” said Dr. Sellinger.

Both noncancerous and cancerous prostate cells make PSA, but cancerous cells tend to produce more: the PSA blood test measures and screens for this. A PSA test, along with a digital rectal exam, remains the best way to detect prostate cancer.

If it’s been over a year since your last PSA test or you’ve never had your PSA level tested, now is the time to get it done.

By: Kristina Buscaino, D.O., M.S.

Sometimes, men can be pretty bad at talking about stuff that matters. For example, did you know that 44% of men are worried about erectile dysfunction, but only two in five will seek professional help?

Don’t worry, at Advanced Urology Institute we talk about this every day! Managing your sexual health is essential to protect your physical, mental, and overall long-term health. As physicians, we’re comfortable talking about sexual health issues with you, and we want to help you resolve them. So, today, let’s talk about some common male sexual health issues and treatments.

Erectile Dysfunction (ED)

What is it? ED is the inability to get or maintain an erection firm enough to have sex.

Who is at risk? Approximately 1 in 5 American men over 20 years old will experience ED in their lifetime. About 1 in 4 men face chronic health conditions, which can impact erectile function, too. These include diseases like diabetes, heart disease, hypertension, and obesity.

Common treatment options?

• Oral medications – Take about 1 hour to work and last for 4-36 hours
• Injections – Self-injected medications directly into the penis, which typically begin working within 5 to 20 minutes
• Penile prosthesis – The physician implants a bendable or inflatable device that can create an erection.
• Vacuum device – A hand or battery-powered pump creates a vacuum that pulls blood into the penis. Once an erection is achieved, an elastic tension ring is placed at the base of the penis to help maintain the erection.
• Low-intensity Shockwave Therapy (LiSWT) – Clinically validated to stimulate better blood flow.

Low Testosterone (Low-T)

What is it? A man’s body is not making enough testosterone, the primary male sex hormone.

Who is at risk? It is more common in men who are over the age of 80, have diabetes, high cholesterol, high blood pressure, or are overweight.

Common treatment options?

• Oral medications
• Topical agents such as gels or creams
• Injections
• Testosterone pellets placed under the skin

Peyronie’s Disease

What is it? A condition that causes penile curvature, indentation, or loss of length upon erection.

Who is at risk? It’s estimated that 10-15% of adult men experience some form of Peyronie’s disease. It is more common in men over the age of 40, and it can be caused by microscopic trauma that occurs during intercourse. The trauma leads to inflammation and then a penile scar or lump.

Common treatment options?

• Oral medications
• Penile traction
• Injections – Introducing injectable collagenase into penile plaques to break them up has dramatically broadened the options for safe and effective office-based treatment
• Surgery remains highly effective for correcting more severe or S-shaped curvatures.

The bottom line is that it is okay (and healthy!) to talk about sexual health. Talk about it with your partner and, most importantly, a physician. As urologists, we receive the most extensive training available in physiology, anatomy, and treatments associated with men’s sexual health issues. We can help you enjoy a more fulfilling sex life.

Find an AUI location near you and schedule an appointment today.

By: Matthew Sorensen, M.D.

Fun fact: Your bladder can extend from just two inches to more than six inches as it fills up. For those who have overactive bladder, each of those inches could feel like a yard.

That’s because overactive bladder (OAB) makes you feel like you have to go even if your bladder isn’t full. The tell-tale symptoms include the urgent, hard-to-control need to urinate, along with waking up having to go three or more times a night, and sometimes not making it to the bathroom on time (leakage).

If you’re experiencing these symptoms, you could be among the 40% of women and 30% of men who live with OAB. But you don’t have to “just live with it.” There are ways to manage your OAB and feel in control again, an inch at a time.

Your Bladder, Explained

The bladder is a hollow, muscular organ that stores urine until it’s full – typically, about two cups of urine.

As the bladder fills to that six-inch mark, your brain sends updates to a cluster of nerves (the sacral nerves) that control the bladder when it’s time to go. Ordinarily, the bladder muscles will squeeze when you are ready. But for people with OAB, the muscles start contracting before the bladder is full, triggering the sudden need to urinate.

OAB can be caused by complications from an underlying condition, such as diabetes, a urinary tract infection, a bladder obstruction, or nerve damage. With aging, your bladder muscles might weaken. Or OAB might be a communication error between your sacral nerves and your bladder.

Regaining “Full” Control, in 6 Steps

If you’re trying to manage OAB symptoms, read on. These following practices could help to eliminate triggers and strengthen your bladder.

1. Drink fewer stimulating beverages – When choosing your eight daily glasses of fluids, opt for water over caffeine, alcohol, and artificial sweeteners. Don’t drink anything two hours before you go to sleep.
2. Say “no” to acidic and spicy dishes – Avoid hot peppers, tomatoes, oranges, grapefruits, lemons, and limes. Research suggests these foods (and their juices) can irritate the bladder.
3. Make your pelvis stronger – Your pelvic muscles help hold in your urine, so the stronger they are, the more control you have. Try to perform five sets of 10 Kegels each day: squeeze like you’re trying not to pee, hold for a few seconds, then release.
4. Chronicle details of your “trips” – Write down all you eat and drink, how soon afterward you have urinate, and what you’re doing at the time. These details, including leaks, can reveal patterns and potentially be shared with a doctor.
5. Resist the urge to hurry – Don’t rush to the bathroom the moment you have to pee; the stress could make its worse. Instead, perform a few Kegels or do something soothingly distracting, like a puzzle.
6. Put bathroom breaks on a timetable – As you get better at waiting to go, you can start training your bladder to follow a schedule. Plan the times of day go, maybe once every two hours, and add more time as your gain control.

Your Doctor’s Office Is a Safe Place for OAB

Inch by inch, the above practices could relieve your OAB symptoms. If you don’t notice improvements, it’s probably time to talk to a urologist about treatment options.

Several medications can block misfired signals to the bladder, for example. Nerve stimulation treatments can modulate the nerves that control the urge to urinate, and Botox bladder injections can relax bladder contractions.

Together, you and your doctor can find the treatment that is right for you and your circumstances. Remember, OAB is not something you just have to live with.

Still have questions about managing OAB? Visit our OAB website to learn other causes and what to expect, or read our blog featuring the latest OAB treatments we offer.

By: Carlos Ramos, MD, FACS

Most Floridians know how to make a “go” bag in case of a hurricane. But what’s in your “go” bag in the case of prostate cancer?

In Florida, 113 of every 100,000 men are diagnosed with prostate cancer. It is the second most common cancer in men following skin cancer – a condition for which Floridians know how to prepare.

Sure, few men want to get ready for any cancer, including that of the prostate. But if you are among those men recently diagnosed, there are steps you can take to better adapt to your treatment and recovery.

Here’s what you can expect, and why.

Why Prostate Cancer Can Be Cured

Your prostate is a 1-ounce gland that helps make the fluid that carries semen. It’s located in an active part of your body, beneath your bladder and around the urethra.

Cancer occurs when an abnormality makes the cells grow out of control, without stopping, until they form a tumor. When this happens in the prostate, the cancer tends to grow slowly, so it is usually caught before spreading to surrounding tissue and bones.

Symptoms include difficulty urinating, blood in your urine or semen, unexplained weight loss, and pain in the groin area. If the cancer has spread, your bones might hurt.

Your chances of developing prostate cancer can vary based on age, race, family history, and lifestyle, but overall prevalence has risen 3% a year since 2014. The good news is that 99% of men diagnosed with localized prostate cancer today survive.

Choosing the Right Treatment for You

If you are diagnosed with prostate cancer, you’ll have a choice of treatments based on the stage and aggressiveness of the disease. In 40% of localized cases, men have their prostates surgically removed (prostatectomy). Other options include radiation therapy and, if the cancer is low risk, surveillance with repeat testing.

In cases where the cancer has spread beyond the prostate, your doctor could advise immunotherapy, chemotherapy, radiation, or hormone therapy to block testosterone production and slow the cancer.

Life After Prostate Cancer: Changes to Expect

During and after your treatment, you will experience some differences in your body and lifestyle. Following are the most common.

Scheduled time off of work – Men who have prostate surgery should plan to take three to four weeks off from work, depending on job physicality. If you work from home, you could return sooner.

Bathroom issues – A prostatectomy requires removal of one of the urinary valves (sphincters), resulting in incontinence in 6% to 8% of patients. This typically lasts a few months to a year. In some men, radiation therapy weakens the bladder. Kegel exercises can help.

Reduced drive in bed – Some procedures could affect the nerves and blood vessels that help you get an erection, but this could be treatable. Hormone therapy might temporarily weaken your sex drive. If the prostate is removed, you can still achieve orgasm, but will not ejaculate.

Limited activity and fats – You’ll have to take it easy after surgery – no strenuous exercise and heavy lifting for a month. You should be able to do Kegels and low-impact activities. And what you eat matters more: reduce fatty foods and red meat in favor of fruits and vegetables.

Therapy side effects – If you undergo chemotherapy, you might experience nausea, hair loss, and fatigue. Side effects of hormone treatments include thinning bones, hot flashes, and weight gain.

Get Your Prostate Cancer “Go” Bag Ready

Above all, your life after prostate cancer will require steps to remain cancer free. Expect to see your doctor every few months for a prostate exam and prostate-specific antigen (PSA) test, which detects cell abnormalities.

The better prepared you are now, physically and emotionally, the sooner you can enjoy the calm after the storm.

You can read more about our prostate cancer diagnostics and treatments on our website. Learn about clinical trials at AUI.

By: Scott Sellinger, MD, FACS

Although 1 in 8 men in the U.S. will be diagnosed with prostate cancer during their lifetime, Black men are 76% more likely to be diagnosed with prostate cancer than White men, and 2.2 times more likely to die from it compared to White men.

Get the facts about prostate cancer:

• About 6 in 10 prostate cancers are diagnosed in men aged 65 or older. Average age of diagnosis is 67, and it’s rare in men younger than 40.
• Prostate cancer is the second-leading cause of cancer death in American men, behind only lung cancer. About 1 in 44 men will die of prostate cancer.
• Ask your doctor when you should begin getting screened. But if your risk is higher (which it is for Black men), you should begin at age 40.
• Screenings include a prostate specific antigen (PSA) blood test. It’s simple, and it can make a difference in survival. When caught early, the survival rate is nearly 99%.

Follow these cancer-prevention tips, regardless of race:

• Pay attention to what you eat. Aim to eat primarily fruits, vegetables, and other foods from plant sources — such as whole grains and beans. Limit your intake of processed meats, refined sugars, and fat from animals.
• Eliminate bad habits. Don’t use tobacco, and if you drink alcohol, do so only in moderation.
• Exercise often. If you exercise regularly, you have a slightly lower risk of developing prostate cancer. Your chances improve with vigorous workouts. Plus, you’ll strengthen your bones if you exercise often, which is important if you have prostate cancer and are being treated with hormone therapy.
• Does it run in your family? If your father or a brother are diagnosed with prostate cancer, you’re twice as likely to be diagnosed with it, regardless of race. You should be tested regularly beginning at age 40.
• Don’t shy away from screenings. Ask your urologist when you should begin regular screenings for prostate cancer, and then be sure to follow your doctor’s advice.

If you are diagnosed with prostate cancer, know that there are many treatment options available and your urology team at AUI will work closely with you to determine the best treatment for you.

Remember, early diagnosis will improve your treatment’s success. Learn more about prostate cancer, prevention, and PSA screening options. Click to request an appointment to schedule your annual PSA screening.

By: John Lynam, DO, FACOS

Nocturia is not restful. It’s a condition that causes you to wake up twice or more each night to go to the bathroom. Nocturia impacts men and women and can be caused by anything from drinking too much before bed to certain medications that contain diuretics.

For men, one of the most common causes of Nocturia is a growing prostate.

The Prostate

The prostate gland sits at the base of the bladder, behind the penis. Through its center runs the urethra, the tube that carries urine out of the body. A man’s prostate grows throughout his life, but if it grows too large, it compresses the urethra and makes it hard to urinate.

About half of all men by age 60 will experience this issue, known as benign prostatic hyperplasia (BPH). In fact, BPH is the leading reason men visit a urologist.

Benign Prostatic Hyperplasia (BPH)

The good news for men is that BPH is not cancerous, hence the word “benign.” The bad news is that BPH causes many irritating symptoms, including:

• A frequent need to urinate both day and night
• A weak or slow urinary stream
• A sense that you cannot completely empty your bladder
• Difficulty or delay in starting urination
• An urgent need to urinate
• A urinary stream that starts and stops

Untreated BPH Can Progress

BPH is more than a nighttime nuisance. Untreated, it can progress with serious health consequences.

• Adult diapers. If the urethra is closed off, the bladder must contract harder to push urine out. Over time, this weakens the bladder and can lead to incontinence.
• Urinary catheter. If your urethra becomes too obstructed or if bladder weakness becomes too severe, a catheter may be needed to drain the bladder fully.
• Urinary tract infections (UTIs) and kidney stones. If your bladder isn’t fully draining, the residual urine left increases the risk of UTIs and kidney stones.
• Kidney damage. The kidneys are attached to the bladder through two ureters, the ducts through which urine passes. If urinary retention causes pressure on the bladder, it could eventually damage the kidneys. Also, if the bladder is infected, that infection could spread to the kidneys.

BPH Can Be Treated

The first place to start treating BPH is with conservative management and behavior modifications. This includes steps like limiting beverages in the evening, limiting caffeine and alcohol consumption, avoiding bladder-irritating foods, and avoiding certain medications that can impact urination.

Your urologist can prescribe medications to help urine flow better and shrink the size of the prostate.

For more severe urinary symptoms, minimally invasive procedures like UroLift® and Rezum® can significantly improve your urinary health and quality of life.

Do not ignore the symptoms of BPH. You’ll sleep more soundly and live more fully when you prioritize your urinary health.

Wondering if your symptoms could be BPH? Learn more about BPH symptoms, diagnosis, and treatment at Advanced Urology Institute of Florida.

By: Nicole Szell, D.O.

Love may be blind, but when urinary issues get in the way of sex, it can be blindsiding.

This is the case with four in 10 women experience sexual problems at some point in their lives, thanks in part to urinary infections, pelvic inflammation, and muscle weakness. This includes 40% of the nearly 6.4 million adult women who live in Florida.

The sexual side effects of these conditions are blindsiding because many are just so sudden, such as an abrupt drop in sexual arousal or physical pain during intercourse. Many women take these symptoms personally, as if they are at fault. As a result, a lot of women become embarrassed to talk about it.

Yet like many unexpected events in our lives, the conditions behind these symptoms are common, natural, and often unavoidable. And they can be treated in a variety of ways.

Linking Urinary Wellness with Sexual Health

There are overall health reasons for women to enjoy an active sex life. Sex can reduce stress, improve sleep, and lower blood pressure. Women with active sex lives are less likely to have heart attacks, research suggests. Women with active sex lives later on in their “golden years” also usually live longer.

But when urinary wellness suffers, so can your sex life. Following are some of the urinary-sexual issues we treat for women:

Vaginal pain ­– Characterized by a chronic ache, itching, and burning, vaginal pain can result from nerve damage, an overreaction to yeast or inflammation, or muscle spasms. (Broader pelvic pain, meanwhile, can be brought on by fibroids or endometriosis.) Treatments typically start with pelvic-muscle exercises (Kegels) and medications, including nerve blockers. If the condition does not respond to these options, our team of urologists can perform reconstructive surgery.

Painful intercourse – Vaginal dryness is usually caused by a lack of the female hormone estrogen, which is commonly associated with genitourinary syndrome of menopause. However, some medications and breastfeeding can contribute to dryness as well. It can make intercourse painful, even producing blood with sexual activity. You can approach treatment by regularly applying lubricant or through regular use of maintenance vaginal estrogen therapy. If these options do not provide relief, ask your doctor about outpatient laser procedures that resurface the vaginal endothelium.

Interstitial cystitis (IC) ­– Also called painful bladder syndrome, IC describes symptoms that occur when the bladder lining breaks down. The pain can feel like a urinary tract infection, and women are 10 times more likely than men to develop IC. Your prescribed treatments will depend on the symptoms and can include Kegel exercises, bladder training, medications, nerve stimulation to block the pain, or even procedures that help to re-surface the lining of the bladder. This procedure is known as “hydrodistension” and is performed by our expert team of urologists.

Pelvic organ prolapse ­– When your pelvic muscles weaken due to childbirth, strain, or post-menopausal hormone changes, the body parts they hold in place can drop through the vagina. Nearly half of all women develop pelvic prolapse, which can cause vaginal numbness and pressure. Non-surgical approaches include Kegels and small silicone devices (pessaries) that hold the organs in place. More advanced cases could be treated with reconstructive surgery or a hysterectomy.

Urinary incontinence ­– Bladder problems can weaken your ability to control urine leaks, which can be a mood killer when it comes to sex, let alone achieving orgasm. We can determine the kind of incontinence to treat with a simple physical exam. Stress incontinence – when urine leaks during pressure-related activities – can be treated with Kegels, bladder training, pessaries, or a medication to strengthen the urethra. Urge incontinence – the hard-to-control need to urinate – can be treated with medications that calm bladder muscles, including Botox.

Don’t Feel Awkward About Good Health

If you’re experiencing a change in sexual enjoyment, it’s likely due to another health issue that you can seize control of. Talk about it with your partner, friends, and your doctor. You might just love the results.

The staff at Advanced Urology Institute are your partners in good overall health. You can read about all the women’s health conditions we treat, with symptoms and treatment options, on our website.

By: Nicole Szell, D.O.

Remember when being accident-prone meant you had a knack for tripping on uneven sidewalks? If you’re among the more than 33 million U.S. men and women living with overactive bladder (OAB) today, then accident-prone has taken on a potentially more awkward meaning.

OAB, a common condition characterized by the sudden and frequent urge to urinate, affects an estimated 40% of women and 30% of men. Yet many of them never seek a doctor’s help. Instead, they try to cope with OAB symptoms because they’re embarrassed, aren’t aware of available treatments, or just don’t know how to bring the issue up.

But we do know how to bring it up. OAB and incontinence are so common, in fact, that our urologists talk about it every day.

Why Your Bladder Becomes ‘Overactive’

OAB is a condition in which the bladder squeezes out urine at the wrong time; typically before it is full. While this issue becomes more common with age, OAB also can be brought on by illness or changes to your urinary system. Among them:

• Obstructions including bladder stones, tumors, constipation, or (in men) an enlarged prostate
• Hormonal changes from menopause (in women)
• Chronic, recurrent UTIs
• Pelvic floor dysfunction
• Diabetes
• Misfires by the nerves that control bladder muscles
• Neurological disorders including Parkinson’s disease, multiple sclerosis, or stroke

Getting Ahead of OAB: Your Treatment Options

The most common symptoms of OAB include needing to urinate more than every two hours, urine leaks (incontinence), and waking up more than twice a night to urinate. If you experience these symptoms, your doctor can help, starting with a physical exam and urinalysis to screen for OAB. Other possible tests include going to the bathroom to determine how much your bladder empties or to assess the strength of your urine stream.

If your symptoms require it, your doctor might also perform one of the following tests:

Cystoscopy – Examining the inside of the urinary tract using a slender, camera-equipped scope.

Urodynamics – Gauging bladder pressure using two scopes, in the urethra and the rectum.

Your Step-By-Step Therapy Options

Depending on the diagnosis, your doctor will likely advise non-invasive therapies first, such as:

• Liquid and diet restrictions –Reducing caffeine, alcohol, and artificial sweeteners (bladder irritants); keeping a healthy weight; and avoiding liquids two to three hours before sleeping.
• Kegels – Performing pelvic-strengthening exercises daily and at regular intervals.
• Bladder training – Holding off on going to the bathroom for as long as you can, then gradually extending the waits.
• Pelvic floor physical therapy – Performing physical therapy exercises to strengthen and tighten the pelvic muscles.
• Biofeedback – While sitting in a comfortable chair (fully clothed), two sensors are used to measure the activity of the muscles that control bladder functions. This technique is used to help train patients on how to properly perform pelvic floor therapy.
• EMSELLA Chair – Patients sit in a comfortable chair-like device (fully clothed) that uses high-intensity focused electromagnetic energy to strengthen the pelvic floor muscles.

If you do not respond to the above therapies, the doctor might suggest the following.

Medications

• Oral prescriptions – Muscle-relaxing drugs can ease involuntary bladder contractions.
• Botox – When injected into the bladder, Botox has proven effective in relaxing the bladder. Often, Botox is advised in cases where the patient does not respond to oral medications.
• Estrogen replacement therapy (for menopausal women) – Reintroducing hormones to strengthen genital tissue.

Nerve Stimulation

• Sacralneuromodulation – Think of this approach as the “pacemaker for the bladder.” The doctor implants a thin wire equipped with an electrode under the skin by the sacral nerve, which controls the bladder. The electrode delivers pulses to the nerve.
• Tibial nerve stimulation – Here, electric pulses stimulate the sacral nerve via the tibial nerve, near your ankle. Rather than an implant, the electrode is delivered through a needle, usually over 12 weekly sessions.

You Can Make Accidents a Memory

Your first step to skipping urgent bathroom runs can start now. Keep a “bladder diary” to record your symptoms, how often they occur, and the activities that cause leakage. Then share it with your AUI doctor. Together, we will find a solution.

Don’t spend another night with OAB on your mind. Explore our OAB treatments and a video that explains our surgical options.