How Is Prostate Cancer Treated

After a diagnosis of prostate cancer, there are several treatment options you may want to consider. However, there is no single option that is right for all men with prostate cancer. Some prostate tumors grow very slowly or don’t grow at all, so you may never even need treatment if you have such a tumor. Then there are tumors that grow rapidly and spread quickly to different areas of the body. Either way, you should work with your doctor to decide what is best for you. As you discuss your treatment with your cancer care team, it is important that you weigh the benefits of every option against the possible side effects and risks.

The factors to consider when choosing treatment for prostate cancer include:

  1.  Stage of your cancer (how far it has spread).
  2. Severity of the tumor (how large in size and how serious the symptoms are).
  3. How quickly the cancer is growing or spreading.
  4. Your age, state of health, lifestyle and expected lifespan.
  5. Any other serious conditions you may have.
  6. What every treatment involves.
  7. Possible side effects of the treatments.
  8. The possibility that the treatment will cure the tumor or help in some way.
  9. How the treatment chosen may affect other treatment options later should the cancer recur or spread.
  10. Your personal feelings about each treatment option.
  11. Practical issues such as nearness to hospital.

The most common treatments for prostate cancer include:

1. Active surveillance

The doctor keeps an eye on the cancer to make sure it can be treated should it begin to spread or grow aggressively. This option is appropriate if you have a small, localized, slow-growing tumor. The doctor will wait until symptoms appear in order to begin treatment. During active surveillance, the progress of the tumor is monitored through regular PSA blood tests, ultrasounds, rectal exams and biopsies. The tests help to check whether the cancer is getting worse so appropriate treatment can be administered as soon as it begins to grow or spread.

2. Radiation therapy

Radiation is aimed at the cancer to destroy the cells and treat the tumor. Image-guided radiotherapy ensures that prostate cancer can be treated with minimal effect on healthy cells. However, radiation therapy is still often considered more ideal for older men and those who have other serious health problems and less so for younger men. You also may undergo radiotherapy after surgery to help get rid of any cancer cells that remain behind or to treat cancer that has reached the bones. There are two forms of radiotherapy: external beam radiotherapy that is applied by a machine placed outside the body and internal radiotherapy (brachytherapy) that involves inserting small radioactive “seeds” into the body either near or into the cancer.

3. Surgery

If you are healthy and have a localized cancer, you may choose to have an operation to remove the prostate gland or to remove the gland and surrounding tissue. But surgery for prostate cancer is often associated with problems getting an erection and controlling urine, so you should speak with your urologist before the procedure to find out if measures are in place to protect your nerves and minimize such effects.

4. Hormone therapy

Prostate cancer cells require the hormone testosterone to keep growing. Hormone therapy, also called androgen deprivation therapy, is when the urologist applies treatment to ensure the cancer cells can’t get the hormone. The treatment either may lower the body levels of testosterone and other male hormones or block the way testosterone works.

5. Chemotherapy

Your urologist may prescribe drugs to kill prostate cancer cells or shrink the prostate. The drugs can be taken orally or may be injected directly into your bloodstream. Generally chemotherapy isn’t given for men with early-stage prostate cancer. But when the cancer is advanced or has spread to other areas of the body, then chemotherapy may be ideal. Apart from using drugs, the urologist may give the prostate cancer vaccine to boost your immune system in order to fight the cancer cells. The vaccine is often given to men who haven’t been successful with hormone therapy and it can help you live longer.

Surgery vs. radiotherapy: Which one is ideal for you?

While some men with low-risk localized prostate cancer and some with medium-risk cancer may find watchful waiting (active surveillance) appropriate, others with localized cancer may want to begin treatment right away. And in that case, either radiation therapy or surgery may be the suitable treatment.
Both radiation therapy and surgery work well for localized prostate tumors, limiting the possibility of the cancer spreading outside the prostate. Both treatments have side effects too, including bowel, bladder and erection problems. With radiation therapy, you are more likely to have bowel problems. But with surgery, you are more likely to have erection problems or leaking of urine. So the choice you make between radiation therapy and surgery should primarily depend on your treatment goals.

For example, if the goal is to treat the cancer by removing the prostate, then surgery is the proper treatment. Of course, there are men who just want to get the cancer out and they wouldn’t mind removal of the prostate too. Then there are some who want to avoid radiation so surgery suits them well. If the goal is treating cancer while also avoiding the risks associated with a major surgery, then radiation therapy is the ideal choice. Having radiation instead of surgery also will help to avoid erection problems and preserve your sexual function.

One form of treatment may be more appropriate for you than the other because of how you feel about it, other health problems you have and your life expectancy. For instance, young men do well after surgery while older men tend to respond well to radiotherapy. That is why you should discuss your options with your doctor before you make a decision.

Treating advanced-stage prostate cancer

For advanced prostate cancer — a cancer that has spread beyond the prostate and into other parts of the body — treatment may not cure the cancer, but will keep it in check and relieve symptoms. The treatment options for advanced prostate cancer include hormone therapy, chemotherapy plus hormone therapy and prostate cancer vaccine. Usually, hormone therapy is given for advanced-stage prostate cancer to help keep the cancer under control. But if after some time the cancer begins to grow again, other treatments may be administered along with the hormone therapy to control the cancer and alleviate the symptoms, though the hormone therapy regime is kept because it ensures that your testosterone level is low.

With prostate cancer, there is no perfect treatment for every patient. All definitive treatments come with side effects, which tend to vary depending on the patient and the actual treatment. As urologists, we are always endeavoring to minimize these effects by picking the appropriate treatment for each patient. We make sure that the treatment can effectively eliminate the cancer while also preserving the patient’s quality of life during and after therapy. For further information on treatment of prostate cancer, visit the “Advanced Urology Institute” site.

What is Immunotherapy for Prostate Cancer

Immunotherapy is a beneficial treatment for men with prostate cancer, particularly those with incurable advanced-stage or recurrent form of the disease. The treatment works by activating your immune system to attack the cancer cells, shrinking the tumor or causing it to disappear altogether. Used alone or in combination with other treatments, like chemotherapy, hormone therapy or radiation therapy, immunotherapy is able to reverse the growth of prostate cancer after the other treatment options have failed.

How does it work?

Like many other tumors, prostate cancer evades the immune system by deactivation of T-cells, the blood cells that attack foreign materials and abnormal cells in the body. So immunotherapeutic approaches are designed in a way to enhance the response of the immune system to cancer cells by reactivation of the T-cells.

During immunotherapy, immature immune cells are obtained from a man with prostate cancer. This is done to allow the cells to get out of the environment where they can be detected and deactivated by the cancer cells as soon as they are mature. The immature cells then are re-engineered by combining them with an artificial version of PAP, the antigen expressed by 95 percent of prostate cancer cells. After re-engineering, they are supplied with a factor (GM-CSF) that boosts their survival, growth and maturity once they are infused back into the body.

Meticulously re-engineered, activated, trained and matured T-cells are infused back into the body — now with the ability to attack and destroy cancer cells. They act as antibodies against the cancer cells and are able to detect and eliminate the cancer cells. The infusion of re-engineered cells or antibodies against prostate cancer is done three times. But as the treatment goes on, you still will be on the treatment or drugs you were already taking prior to immunotherapy. That will allow your body to produce enough activated, trained and matured T-cells to fight the prostate cancer without ever again being deactivated or bypassed by the cancer.

Why should you consider immunotherapy for prostate cancer?

Immunotherapy is an amazing and highly effective treatment for the cancer. During treatment, your cancer treatment team can use a wide variety of immune-based strategies to develop antibodies against the tumor, killing the cancer cells and preventing its recurrence. It offers excellent results in men with advanced-stage hormone resistant prostate cancer and reduces the risk of cancer recurrence in men with high-risk, localized tumors when it is administered in combination with hormone therapy. The treatment increases the survival rate from prostate cancer and enhances life expectancy by several years.

At Advanced Urology Institute, we are offering immunotherapy as a treatment option for prostate cancer, particularly tumors that have spread beyond the prostate or become resistant. And as our understanding of how cancer cells relate with the immune system deepens, we are tapping into that knowledge to help improve treatment outcomes for our patients. So if you have been diagnosed with prostate cancer, find out from your urologist if immunotherapy may be of help in your situation. Want to know more about the treatment options for prostate cancer? Visit the “Advanced Urology Institute” site.

Can females see a urologist?

There is a misconception that urologists only see male patients. In fact, over 40 percent of patients seen by urologists are female. Urologists are specialists in treating disorders of the urinary tract — the system of tubes, muscles and organs that process, convey and eventually expel urine from the body. So when women develop urological issues, such as loss of bladder control, pelvic organ prolapse and incontinence, the best doctor to treat them is the urologist. Warning signs of issues involving the urinary system include:

  1. 1. Frequent urge to urinate.
  2. Leaking urine.
  3. Frequent urination, particularly at night.
  4. Pain in the side or back.
  5. Discomfort or burning sensation when urinating.
  6. Pelvic pain
  7. Blood in urine

Apart from treating kidney stones, urologists frequently tackle the following issues in women:

1. Loss of bladder control

Dr. Chad HubsherFemales may have bladder control problems at any age. Also called urinary incontinence (UI), loss of bladder control is a common problem in women and they are twice as likely to have the problem as men. There are different types of urinary incontinence. For example, women who can’t hold urine as they cough, sneeze or exercise are said to have stress incontinence. This type of UI occurs when the muscles supporting the bladder are weakened by pregnancy, childbirth, aging or other factors.

Overactive bladder is another type of urinary incontinence that is characterized by a strong, sudden and uncontrollable urge to urinate even when the bladder is not full. Apart from the need to reach the bathroom quickly and to pass urine 8 or more times within 24 hours, overactive bladder can cause embarrassing urine leaks and compel women to avoid certain activities and things they would like to enjoy.

2. Recurrent urinary tract infections

Women are more susceptible to recurrent urinary tract infections than men because of anatomical differences. Most women will have a urinary tract infection at a certain point in their lives. The infections occur when bacteria get into the urinary tract and are often characterized by burning sensation or pain during urination, sudden urge to pass urine, blood in urine or trouble urinating. Recurrent UTIs can lead to complications and require prompt, proper treatment.

3. Fallen bladder

In women, the bladder is kept in position by tissues called pelvic muscles. But in cases where these tissues (wall between bladder and vagina) are too stretched or weakened to hold the bladder in position, the bladder may fall into the vagina — a condition known as bladder prolapse or cystocele. A fallen bladder may be caused by aging, childbirth, lifting heavy objects, menopause, chronic coughing, obesity or previous pelvic surgery, and may lead to urinary incontinence, urinary tract infections or overactive bladder if not treated. Surgery is typically required to correct a fallen bladder.

4. Painful bladder syndrome

Also called interstitial cystitis (IC), painful bladder syndrome is an uncomfortable and upsetting condition accompanied by lower belly and bladder discomfort. Patients tend to feel that their bladder is always full and often feel the urge to pass urine several times per day, even up to 60 times in one day. The condition can badly interfere with daily activities, forcing affected women to avoid traveling far away from home and to skip social events. It also can make sex painful or uncomfortable.

As urologists, our job is to figure out what kind of bladder problem a woman has, its underlying cause and the appropriate treatment for it. With the right treatment, which may include pelvic muscle strengthening exercises, medication, injections, implanted devices and surgery, most women are able to regain their bladder control and recover from their condition. And even for conditions that have no cure, such as interstitial cystitis, treatment tends to ease symptoms and boost the quality of life.

At Advanced Urology Institute, we see women with many different urological issues. Our aim is always to help them enjoy life and all activities they’d want to engage in by eliminating awkward urine leaks and the pain and discomfort associated with these conditions. If you are a woman who is tired of having embarrassing accidental urine leakage, check with us about effective treatment. For more information on the diagnosis and treatment of urological issues in women, visit the “Advanced Urology Institute” site.

Bay Regional Cancer Center Closing Down

We regret to inform you that due to Hurricane Michael, we are no longer providing Radiation Treatment and forced to close our facility at Bay Regional Cancer Center.

Your health and well-being are of utmost importance to the staff at Advanced Urology Institute/Bay Regional Cancer Center. Dr.Steven Finkelstein is still in our community and is currently practicing at Florida Cancer Affiliates North Florida. If you wish to keep him as a provider, please call his new office staff at (850) 763-0036. If you do not wish to continue your care with Dr.Finkelstein, we encourage you to choose another provider as soon as possible to ensure timely care for your medical needs.

Your medical records are confidential and will remain on file with Advanced Urology Institute. A copy of your records can be released to you or your new provider with your written permission. Please note, by law we cannot share your medical information without your written consent. You may sign this form at our office located at 80 Doctors Drive Panama City, FL 32405 or give us a call at (850) 785-8557.

Please be assured that my staff and I will do everything we can to make the transition smooth and stress free. Thank you for trusting Dr.Finkelstein and our wonderful staff with your healthcare needs. It has been a pleasure to provide your care, and we wish you the best in the future.

Miriam Williams
Chief Administrative Officer

What is MRI with Transrectal Ultrasound Fusion-Guided Prostate Biopsy

Prostate cancer has a new standard of care in MRI-guided fusion biopsy with transrectal ultrasound. While a prostate biopsy has been the only way to get a definitive diagnosis of prostate cancer, it has only been working if cancer cells are identified in the sample tissue. But in some cases, such as when the tumor occurs at the top surface of the prostate or other unusual locations, a biopsy may not give a correct diagnosis. For instance, the standard TRUS (transrectal ultrasound) guided biopsy in which tissue samples are collected from the prostate in a systematic pattern gives a negative result with tumors located in unusual areas of the prostate. About 15-20 percent of tumor locations can be missed by the biopsy needle.

What makes the MRI-ultrasound fusion biopsy more definitive?

The MRI-ultrasound fusion approach is an improvement on the traditional 12-core TRUS, which involved taking biopsies from twelve prostate areas where the cancer is considered more likely to occur. With the TRUS biopsy, about 70 percent of men who have a negative biopsy result are not essentially free of the cancer. The MRI-ultrasound fusion technology blends the superior imaging capability of the high-definition multi-parametric (mp) MRI with real-time ultrasound imaging. There is better visualization of the suspicious areas of the prostate where the cancer may occur that may not be visible on ultrasound alone. The fusion-guided biopsy detects almost twice as many prostate cancers in all stages as the standard TRUS biopsy.

The ability of MRI-ultrasound fusion-guided biopsy to create a three-dimensional (3D) map of the prostate ensures that doctors are able to see the targeted areas of the prostate better and perform more precise biopsies. The technology uses a machine known as UroNav developed by Invivo, which is supplied with sophisticated software to produce super-detailed MRI images and fuse them with the ultrasound images generated by a transrectal probe administered on the patient in an outpatient setting. The resulting images enable the examining physician to direct biopsy needles with pinpoint accuracy and to easily access any lesions or suspicious areas revealed by MRI. The technology allows the urologist to hit the target spot more accurately and improves cancer detection rate. In fact, it is primarily used for men who have an ongoing suspicion of prostate cancer, such as those with consistently elevated PSA, but whose TRUS biopsy results are repeatedly negative.

Fewer biopsies, more accurate detection

The fusion-guided biopsy is a very targeted approach in which biopsies are performed only in highly suspicious areas of the prostate appearing in the MRI image. As a result, significantly fewer biopsies are done with the MRI-ultrasound fusion than with the traditional TRUS technique, minimizing the adverse effects that often accompany repeat biopsies. Multiple prostate biopsies can lead to complications such as bleeding, infection, urinary retention problems, sepsis or even death.

In spite of fewer biopsies, the MRI fusion approach increases the rate of detection of aggressive prostate cancer. The extensive MRI images obtained before the biopsy helps highlight both high-risk and intermediate-risk cancers often missed by traditional TRUS biopsy. With MRI-ultrasound fusion, the likelihood of detecting cancer increases as the grade of the tumor increases. The use of MRI fusion biopsy helps to avoid metastatic disease by finding cancer before it spreads to other areas of the body.

Improved cancer differentiation

Through MRI fusion, doctors are able to more accurately differentiate cancers that require treatment from the ones that should undergo watchful waiting (active surveillance). Fusion technology is able to show higher-risk cancers and does not highlight the insignificant low-grade tumors, making it less likely for urologic oncologists to over-treat indolent and low-grade cancers. A number of prostate cancers are low-grade, non-aggressive and do not cause problems at all and treating them through chemotherapy, radiotherapy or surgery can impair the quality of life or even cause death. MRI fusion effectively saves patients from the adverse effects of treating low-grade tumors. Fusion technology eliminates up to 50 percent of prostate cancer treatments that are unnecessarily administered on low-grade cancers.

At Advanced Urology Institute, we have adopted the MRI-ultrasound fusion biopsy and changed the way we screen, evaluate and diagnose prostate cancer. It has become our standard for detecting prostate cancer and we believe in the next few years it will be the gold standard for detecting the cancer. We are proud that it offers a higher detection rate, superior accuracy and reduces the rate of repeat biopsies — making our practice one of the best places for detection and monitoring of the cancer. It helps us deliver the best treatment outcomes for our patients.

If you think you are at high risk of prostate cancer or already have started experiencing some symptoms, let us show you how the precision of our high-definition MRI fusion machine, the expertise of our skilled physicians in MRI fusion biopsy and the know-how of our radiologists proficient in multi-parametric MRI imaging can help you. For more information on the treatment and diagnosis of prostate cancer, visit the “Advanced Urology Institute” site.

What is a Vasectomy?

A vasectomy is a simple and safe minimally-invasive surgery done by a doctor in a clinic, office or hospital. During the procedure, the small tubes called vas deferens that carry sperm are blocked or cut off to prevent sperm from leaving a man’s body and causing pregnancy. The sperm cells remain in the testicles and are reabsorbed into the body. So after about 3 months following a vasectomy, the semen doesn’t contain any sperm and can’t cause pregnancy. Of course you’ll still produce the same amount of semen as before except that there will be no sperm in them.

Quick and highly-effective

A vasectomy is a quick, 15-to-30-minute procedure and you can return home the same day. Designed to be a permanent form of contraception, a vasectomy is extremely effective in preventing pregnancy — nearly 100 percent. It is one of the most effective methods of birth control you can find. Vasectomy — also called male sterilization — is meant to protect against pregnancy permanently, so it’s super effective once you are past the first three months following surgery when the semen has become sperm-free.

After the procedure, pregnancy is prevented round-the-clock for the rest of your life. Once the doctor confirms that you no longer have sperm in your semen, then you don’t to do anything else to prevent pregnancy.Of course there is a very slim chance of the cut ends of the tubes growing back together after the procedure, making it possible to cause a pregnancy. That, however, very rarely happens.

Types of vasectomy

The vasectomy procedure involves cutting and blocking or partially removing both ends of the vas deferens (the sperm duct). Once that is done, sperm traveling from the testes can no longer reach the semen and form part of the ejaculate. Two types of vasectomies exist: the no-scalpel method and the incision method. The no-scalpel (no-cut) technique has a lower risk of infection and complications and generally requires a shorter recovery time. Because it’s classified as a minor surgical procedure, a vasectomy is often done in the doctor’s office with the patient under local anesthesia. It’s only in a small percentage of men where the procedure is performed in the operating room with general anesthesia or sedation — either due to the results of a doctor’s physical exam or patient preference.

Doesn’t hurt as much as often perceived

Vasectomy is a safer, minimally-invasive birth control method and a more effective procedure compared to tubal ligation. Guys generally tolerate it better than women do with tubal ligation. While you will experience a sharp sensation when the numbing medication is applied with a small needle, there should be no further pain after that. If you experience any further discomfort, inform your doctor so more of the numbing medication may be given or action is taken to alleviate the discomfort. Most men find vasectomy less painful than they anticipated, although a mild swelling and soreness may be experienced after the procedure.

Recovery after a vasectomy

Some mild swelling and discomfort is to be expected for a few days after the procedure, but almost always is gone completely by the end of the first week. It’s recommended that you take 1-2 days off work to reduce your activity level and get ample time to recover — although men with physically strenuous jobs may require a longer break from work. For the first 48 hours after the procedure, keep your activities limited and apply cold packs to your scrotum 3-4 times a day, with each application lasting for about 20 minutes. Wear supportive underwear until the discomfort subsides or for at least a week. Avoid sexual activity and exercise until the discomfort disappears, usually after around one week. Don’t soak in a pool, open water or hot tub for at least 3 weeks to ensure your wound heals quickly — you may just shower and dab dry. Return to normal activity slowly, building up your activity level gradually.

At Advanced Urology Institute, we do vasectomies in the office, using the no-scalpel, no-needle procedure. However, if you’re squeamish about it then you can have the procedure in a surgical room — although for most guys, doing it in the office is alright. The procedure takes about 20 minutes and is not bad in terms of pain. Recovery is also very fast. Most men schedule it on Friday and are back to work on Monday. As long as you don’t engage in strenuous activities such as a heavy lifting kind of a job, you can resume work quickly.

So if you want freedom from the fear of having unwanted children and want to enjoy your sexual relations without worrying about a pregnancy, a vasectomy is the ideal contraception for you. For more information on vasectomy, visit the “Advanced Urology Institute” site.

When Should You Get A PSA Test?

The prostate gland is a critical component of the male reproductive system. Located just underneath the bladder and in front of the rectum, the tiny walnut-sized gland helps to make semen — the fluid that carries sperm. But as men age, the prostate increases in size, becomes enlarged and begins to cause problems.The most common prostate problems include:

  1. Bacterial infection
  2. Dribbling after urination
  3. Increased need to pass urine (especially at night)
  4. Enlarged prostate, called benign prostatic hyperplasia (BPH)
  5. Prostate cancer

One of the most common cancers

The second most frequent cancer in American men, after skin cancer, prostate cancer typically grows slowly and shows very few early symptoms. So doctors usually recommend that men go for screening to ensure the cancer is spotted early even before symptoms arise and prior to the cancer getting more advanced. During screening tests, doctors perform prostate exams to detect any abnormalities that may indicate an issue, such as cancer. But the exams are not recommended for everyone and are often only necessary when the benefits outweigh the risks.

The PSA (Prostate-Specific Antigen) Test

The prostate-specific antigen test, simply called PSA, is a blood test for detecting prostate cancer and one of the most frequently used screening tests for the cancer. When there is an elevated level of the PSA in the blood, it might indicate that you have cancer. However, it’s not always that straightforward. In fact, there is a raging controversy about the PSA test, with many people questioning whether or not it’s necessary for younger men who are otherwise healthy. For instance, there is the argument that if there is a false positive PSA result, it may cause a lot of unnecessary anxiety and could even cloud a person’s decision regarding future treatment. False positive results are relatively low with the PSA test, but they may still occur.

The biggest argument against the PSA test is that treatment isn’t necessary for many prostate cancers. The cancer tends to grow and spread slowly and rarely causes serious effects during a man’s lifetime. While, in some cases, the cancer can be really aggressive and the PSA test may detect it when it’s still small and easier to treat, the side effects of cancer treatment are monetarily and physically too costly. So a lot of precaution is necessary when deciding who should or should not get treatment — there is no reason for treating a cancer that has little or no chance at all of progressing.

So when should you get your first PSA?

It is important to discuss the benefits, risks and uncertainties of the PSA (prostate-specific antigen) test with your doctor before getting it. If you are a man of average risk, you should get your first PSA at the age of 50. But for men at high-risk of developing prostate cancer, such as African-American men, men of Caribbean descent and men with a first-degree relative (brother, father or son)
who had the cancer before age 60, then the first PSA should be at 45. And for men who are at higher risk, such as those who have more than one first-degree relative who had the cancer at an earlier age (younger than 50), the first PSA test should be at the age of 40.

Establishing the baseline with first PSA

At Advanced Urology Institute, we recommend that men get their first PSA test before the age of 50 so that a baseline can be established and used to make the decision as to whether or not they’ll need further tests. If it’s very low, then your regular PSA tests can be put off. But in cases where the PSA is elevated, we conduct other tests to ensure that it is prostate cancer we’re dealing with and not a prostate infection or an enlarged prostate. Depending on the PSA test result, we may repeat your PSA every 6 months to assess whether the first was a false positive or there is an upward trend.

The main thing with the PSA test is the changes in the level of PSA. Some men can have normal PSA but still have prostate cancer. So monitoring the changes and trends in your PSA is critical for cancer diagnosis. That’s why we encourage people to get their first PSA test early to establish a baseline for monitoring their PSA level. You don’t have to undergo a prostate biopsy just because you have done a PSA. If it’s found that your PSA is where it should be, you’ll not need a biopsy. That’s why we always want to be sure of the trends in your PSA.

Are you at high-risk of prostate cancer? Or are you experiencing symptoms of what could be a prostate problem, such as painful or frequent urination or blood in urine? At Advanced Urology Institute, we exhaustively discuss the pros and cons of the PSA test with our patients before making any decisions. We understand that PSA screening has both benefits and risks and we try to make the best possible decisions for our patients. For more information on the PSA test, prostate exams, diagnosis and treatment of prostate cancer, visit the “Advanced Urology Institute” site.

Diagnosis and Treatment of Urologic Cancer

Urologic cancers are on the rise and here at Advanced Urology Institute we are seeing more and more cases every year. A urologic cancer is one that occurs in any organ of either the urinary system or the male reproductive system. It is a term that encompasses cancers such as adrenal, bladder, kidney, penile, prostate, testicular and ureter cancer. While a diagnosis with urologic cancer can be devastating and traumatic, the good news here at AUI is that with prompt screening and diagnosis, we can catch the cancers early and partner with our patients throughout their treatment and recovery to follow-up care. We always want our patients to understand that we are in it together and we want to work with them and their families to ensure quick recovery and high quality of life throughout their battle with the disease.

Diagnosis of urologic cancers

Diagnosis of urologic cancers usually starts with symptoms, although some patients don’t show symptoms and their tumors are detected during routine imaging. At AUI, our approach to cancer diagnosis includes patients’ symptoms, personal medical history, family medical history, physical examination, screening and diagnostic testing. The symptoms of urologic cancers tend to vary with the type and location of the tumor, but may include abdominal pain, blood in urine, elevated hormone levels, swollen abdomen and enlarged prostate. In terms of diagnostic tests, we often use biopsy, blood tests for hormone levels, digital rectal exam, liver function tests, pelvic exam, renal arteriography, bone scan, ultrasound, urine test, CT scan and MRI scan.

Care after cancer diagnosis

Dr. Chad Hubsher of Advanced Urology InstituteAt Advanced Urology Institute, we understand that diagnosis with urologic cancer is shattering and distressing. So we speak with our patients soon after diagnosis to bring their emotions under control and give them hope. For us the goal is not just to cure cancer but also to prepare and help our patients to face the challenges that may come with the disease. That’s why we work collaboratively with clinicians, researchers, dieticians, nurses, radiotherapists, radiologists and other medical professionals to ensure optimal outcomes are achieved with minimal impact on our patients’ quality of life.

Treatment of urologic cancers

We follow a multidisciplinary approach when treating urologic cancers. That means a wide-range of certified medical experts evaluate a patient’s condition and develop a comprehensive, personalized treatment plan depending on the type, stage and location of the cancer and the patient’s overall health. In a number of cases, surgery may be the primary treatment for urologic cancer and we provide minimally-invasive laparoscopy, robotic surgery, percutaneous cryosurgery and reconstructive procedures that deliver optimal outcomes with reduced scarring, less pain and shorter recovery time. Every patient’s candidacy for surgery is evaluated after diagnosis or during first appointment, but we are always confident of taking on some of the toughest cancer cases and striving to provide the best surgical outcomes and patient experience.

AUI also provides a number of advanced urologic cancer therapies. We offer current and investigational treatments and provide advanced radiation therapies including prostate brachytherapy (radiation seed implants). Treatment options for urologic cancer may include chemotherapy, hormone therapy, immunotherapy and radiation therapy. For instance, we deliver targeted regimens of radiation that are sculpted to the shape and size of the tumor ensuring that their impact is focused on cancer cells while limiting exposure of adjacent normal tissues. Likewise, urinary diversion techniques, fertility-preserving options and drugs with fewer side effects are prioritized. And with our extensive team of survivorship and supportive care experts, who help patients and their caregivers to attain and maintain a better quality of life before, during and after treatment, we often achieve great outcomes for our patients.

Recognized leader in care for urologic cancers

Advanced Urology Institute has a urology oncology team that is a nationally recognized leader in the management of urologic cancer. We have state-of-the-art equipment, leading urologists in their field and imaging and pathology experts who are good at what they do. What that means is that our patients get the best possible care at every stage of their journey with cancer. We manage urologic cancers in an outpatient setting, allowing our patients to go home the same day. And when they go home early from our day cancer center, we monitor them very closely. We are proud that, in most cases, our cancer patients do really well.

At AUI, our goal is not just to cure cancer but also to prevent it from spreading and from coming back. We are also committed to working with the local communities and spreading the word for people to get tested early. For more information on the prevention, diagnosis and treatment of urologic cancers, visit the “Advanced Urology Institute” site.

Kidney Stone Causes, Symptoms, and Treatments

There are a lot of kidney stone cases in Florida, thanks to dehydration from the extremely hot weather and diets that include a lot of tea, meat, salt and other highly rich foods associated with the stones. While about 10 percent of Americans may expect to have a kidney stone at some point in their lives, the likelihood rises to 15 percent for people living in the South. Stones are formed when minerals and other substances found in urine crystallize, usually in people who are dehydrated or don’t consume enough fluids.

Symptoms of kidney stones

At Advanced Urology Institute, we see a lot of patients with kidney stones. A contributing factor is our location in Florida, with its massive heat and humidity which leads to dehydration and, unfortunately, to the formation of these painful stones in the kidneys. The stones commonly present with severe, intense pain — like something is stabbing you — and you can barely walk. Kidney stones are characterized by sharp pains in the side or back as they make their way to the bladder. Most of our female patients usually say the stones are more painful than labor pain. Other symptoms of kidney stones include vomiting, nausea, a constant urge to pass urine and blood in urine.

Pain from kidney stones is often sudden in onset, though it may get severe over a period of hours in some cases. The pain may be either intermittent (colicky) or steady and, depending on the stone’s location as it moves through to the bladder, it may begin in the back or flank area and radiate slowly downward to your inguinal ligament, urethra, bladder, testicles or penis. Urinary or bladder symptoms, such as frequency of urination and painful urination, may occur if the stone is located in the portion of your urethra found within the bladder wall. Not all stones cause pain and some of them are often discovered “incidentally” during pelvic or abdominal X-rays. But in patients who experience pain, they usually describe it as the worst pain they have ever experienced.

Diagnosis of kidney stones

Diagnosis of kidney stones is almost entirely based on the history of passing the stones or on occurrence of a stabbing pain in the side or back. We usually place emphasis on the patient’s clinical signs, familial disorders, presence or absence of any previous renal stones, or physical exam findings. We also perform a urinalysis to check the presence of white cells (pyuria) or blood (hematuria) in urine, a culture of urine to exclude infection, and use the presence of crystals in urine (crystalluria) to help identify the stone type. Patients are often required to strain their urine to obtain the stone for crystallographic analysis. Analyzing kidney stones for their mineral composition helps us understand your future risk and to recommend the right dietary habits and restrictions for preventing stones. But we also do a CT or CAT scan of the pelvic and abdominal area to evaluate the size, location, degree of hydronephrosis and density of the stone, all of which are important in determing how we treat and manage the stones.

Treatment

When patients complain of symptoms of kidney stones, we usually do physical exams and run tests to confirm that they actually have stones. But we often begin by getting the pain under control and calming the patients, to enable us to discuss with them available treatment options. The pain due to kidney stones is relieved using pain medication, drinking plenty of fluid to prevent dehydration, and ordering bed rest. In many cases once we have assessed that the stones can pass on their own, we allow about 7 days for them to pass spontaneously. In other instances, however, kidney stones may need to be broken down into tiny pieces or to be removed surgically.

At Advanced Urology Institute, we break up kidney stones using such techniques as percutaneous lithotripsy, cystoscopy or extracorporeal shock-wave lithotripsy. For renal stones less than 2cm in size, we generally treat them using extracorporeal shock-wave lithotripsy. During the procedure, high-intensity ultrasound (shock-waves) are passed through pouches of water placed on the skin and then directed toward the stone. The waves break the kidney stones into tiny pieces that can pass easily through the ureter. For stones located higher in the ureter or in the bladder, we often use cystoscopy to pull them out or break them up with electric energy or laser. During the procedure, the doctor passes a viewing tube with a crushing device into the ureter or bladder to pull the stone out or break it up with electric energy or laser.

For larger stones, percutaneous nephrolithotomy is a safe and reliable technique. For this procedure, you’ll be given medication to sedate you, then a viewing tube will be inserted through an incision made in your side. Once the stone is reached, it’s broken up using electric energy or ultrasound. In cases where this procedure doesn’t work, particularly when the stones are hard to reach or too large, surgery is often the preferred treatment. Surgery to remove kidney stones is performed under general anesthesia with the doctor making an incision into the side and another into the kidney or ureter to remove the stone. After the stone is removed, the incisions are stitched up.

There are many ways of treating kidney stones and the method chosen usually depends on the experience and judgment of the urologist, together with the patient’s preferences. At AUI, we prioritize the comfort of our patients, so we opt for the least invasive procedures before considering surgery. Want to know more about prevention, diagnosis and treatment of kidney stones? Find more information from the “Advanced Urology Institute” site.

Erectile Dysfunction Diagnosis and Treatment

Erectile dysfunction (ED), also called impotence, is a man’s inability to achieve or maintain an erection that’s hard or firm enough for sexual intercourse. Occasional ED is quite common among men, particularly during times of severe fatigue or stress. However, frequent erectile dysfunction can be a signal of serious health, relationship or emotional problems and requires treatment.

Major symptoms of erectile dysfunction include:

  1. Problem getting an erection.
  2. Diminished interest in sex.
  3. Difficulty maintaining a firm enough erection for sexual intercourse.

It’s important to speak with your doctor if you are experiencing any of these symptoms, particularly if they last 2 or more months. The doctor will determine if there is an underlying condition to your ED and whether or not treatment is necessary.

Medical history and physical exam

At Advanced Urology Institute, we usually begin with a medical history and physical exam so we can find the reasons for your ED. Erectile dysfunction can be due to stress, fatigue, anxiety, low testosterone, physical problems or other factors. When we take your medical history, we will ask you questions about your health and the symptoms you are experiencing. Then we perform tests to determine whether your symptoms have an underlying cause.

You should expect a physical examination where the doctor listens to your lungs and heart, measures your blood pressure and examines your penis and testicles. We also frequently recommend a rectal exam for checking your prostate. Likewise, urine or blood tests may be necessary to rule out conditions with similar symptoms.

Who needs treatment?

When making a diagnosis for erectile dysfunction, problems such as premature ejaculation and low libido are not considered. We basically focus on your failure to have or maintain a steady erection. Since most men have ED at one point or another in their lives, the most useful factor when determining whether or not to offer treatment is the frequency of your problem. From a medical standpoint, an erectile dysfunction occurring as often as 20 percent of the time isn’t considered a major concern. However, ED that occurs 50 percent or more of the time is likely to have an underlying psychological or physical cause and warrants treatment.

ED medications

For most men, the treatments offered for erectile dysfunction are quite similar. In most cases successful treatment depends on effective treatment of the underlying causes. At times it may even be necessary to use a combination of treatments. At Advanced Urology Institute, we often begin with medications, giving drugs such as Cialis (tadalafil), Stendra (avanafil), Caverject (alprostadil), Viagra (sildenafil), Levitra (verdenafil) or Androderm (testosterone). These drugs increase the blood flow in the penis and will help you to achieve an erection. The fact that some of these drugs now have generic forms means prices have gone down and most men can afford to use them when appropriate.

Pumps and injections

In some cases, treatment for erectile dysfunction may involve the use of vacuum constriction devices (erection pumps). These are mechanical or automatic devices that help men to achieve erection by increasing blood flow to the penis. Basically, an erection pump consists of a cylinder with a pump attached directly to the end of the penis. After the pump has made the penis bigger, a constriction band or ring is attached to the other end of the penis to keep the erection comfortably in place for at least 30 minutes. The main advantage of these devices is that no invasive or surgical procedures are involved. When it’s appropriate, we recommend these devices for our patients and make arrangements so that they are ordered and sent to them.

For some men with erectile dysfunction, we may recommend penile injections. It’s often amusing talking about penile injections with men, but they are very effective in treating ED. With a sharp needle that’s too small to cause much discomfort, medications such as papaverine hydrochloride, prostaglandin E-1 or phentolamine are injected into the penis tissue to stimulate an erection. When used, papaverine injection relaxes muscles of the arterial wall, dilates the vessels and increases blood flow; phentolamine blocks nerve signals for muscle contractions and promotes muscle relaxation; while prostaglandin E-1 relaxes penile muscles resulting in an erection. Once we prescribe any of these penile injections, we show you how the injection is done — the process is simple, not painful, and up to 90 percent of the patients are able to do it on their own after it’s explained to them.

Surgical treatment of erectile dysfunction

If these options don’t work, then we may recommend surgical treatment of erectile dysfunction. Surgery can be used to implant a prosthetic device into the penis that causes an erection; reconstruct penile arteries to increase blood flow and facilitate an erection; or block off the veins in the penis to allow blood to leave the penis, which helps in maintaining an erection. At Advanced Urology Institute, we usually discuss surgery as an option for treating ED with our patients before recommending it to them. We do a lot of penile implants and penile reconstruction operations and offer several other treatments for erectile dysfunction.

Is erectile dysfunction affecting your relationship? At AUI, we offer several effective treatments for the condition, including medications, pumps, penile injections and surgery. Talk with us about your condition and find help in getting it effectively treated. We are committed to providing treatment that restores sexual health and satisfaction to men with erectile dysfunction. For more information on how we treat ED, visit the “Advanced Urology Institute’” site

How are Kidney Stones Treated?

Kidney stones are a common cause of agonizing and debilitating pain in men and women. In the United States, the stones account for over one million hospital visits and more than 300,000 emergency room visits every year. When patients present with kidney stones, the treatment administered usually depends on the type, size and location of the stone and on the severity of symptoms. Apart from administering treatment, the urologist investigates the underlying cause of the stones and recommends ways of preventing a recurrence.

Spontaneous passage

Kidney stones smaller than 4 mm in diameter are often passed on their own in urine and may be treated at home. While such stones may be painful, the pain often lasts only a few days and usually disappears soon after the stone is passed. So, depending on how bad your symptoms are and how long you’ve had the symptoms, you may not be given any form of treatment and just wait for stones to pass in urine. It usually take up to six weeks to do so.

However, you should only do this if the pain is bearable, there is no sign of infection or kidney blockage and the stone is of a size that can pass on its own. As you wait for it to pass, you’ll need to drink plenty of water and take pain medication to help you manage the discomfort. If you suspect that you have a kidney stone, speak with your doctor to see if you need immediate treatment or if you can wait for it to pass spontaneously.

Medications

There are a number of medications that increase the chance of passing kidney stones. For instance, tamsulosin is commonly given to people with kidney stones to help relax the ureter and make it easier for stones to pass. Apart from medications to boost stone passage, your urologist may prescribe anti-emetic (anti-nausea) medication to reduce nausea and vomiting as you wait for the stone to pass. And if you are in severe pain, your doctor may give you 1-2 pain injections and then prescribe some painkillers and anti-emetics for you to take from home.

Surgical procedures

If the pain is so much that you can’t wait for the stone to pass in the urine, you’ll require a surgical procedure to remove it. Surgery is also necessary if the stone is too big to pass on its own or is hampering kidney function. Kidney stones may be removed surgically if they are causing repeated urinary tract infections or are blocking the normal flow of urine.

Surgical procedures to remove kidney stones include extracorporeal shock-wave lithotripsy (ESWL), ureteroscopy and percutaneous nephrolithotomy (PCNL). These procedures are usually chosen by urologists depending on the size, type and location of the stones.

1. Extracorporeal Shock-Wave Lithotripsy (ESWL)

This procedure is the most frequent way of treating stones that can’t pass spontaneously in urine. High-frequency waves (X-rays or ultrasound) are directed at the stone to break it into smaller pieces that can pass in urine. Often the tiny pieces require a few weeks to pass out in urine. While ESWL is 99 percent effective for kidney stones up to 20 mm in diameter, more than one session is usually necessary for the treatment to be successful.

2. Ureteroscopy

For kidney stones that are lodged somewhere in the kidney or ureter, ureteroscopy (also called retrograde intrarenal surgery) may be necessary. The procedure involves directing a long, thin telescope (called ureteroscope) through the urethra, into the bladder, then into the ureter or kidney where the stone is located. If the stone is stuck in the kidney or upper ureter, the urologist uses flexible telescopes for this procedure, but rigid telescopes are ideal for stones stuck in the lower parts of the ureter.

The ureteroscope helps the urologist to reach the stone without making an incision. After reaching the stone, the doctor either can use another instrument to remove it or direct laser energy on it to break it into smaller pieces that can pass naturally in urine. A stent (plastic tube) may be inserted temporarily into the bladder to drain out the stone fragments.

3. Percutaneous nephrolithotomy (PCNL)

For kidney stones that are too large (21-30 mm in diameter), percutaneous lithotripsy is the treatment of choice. During the procedure, a half-inch incision is made in the side or back, just big enough to allow passage of a telescopic instrument (called nephroscope) into the area of the kidney where the stone is located. The nephroscope is used either to pull out the stone or break it up with pneumatic energy (or laser) and suction out the pieces. In fact, it’s the ability to suction out tiny stone pieces that makes this procedure ideal for larger stones.

Kidney stones also can be removed through open surgery, laparoscopic surgery or robotic surgery. But this is only done when the less-invasive procedures fail. Routine surgical procedures for kidney stones require shorter recovery period and you can usually return home the same day after the procedure and resume normal activities in 2-3 days. If the urologist inserts a stent after a procedure, it is removed 4-10 days later. During treatment, you also may be provided with a strainer that you can use to collect stone pieces that pass in urine for laboratory testing and to enable the urologist to recommend appropriate ways of preventing stone recurrence.

At Advanced Urology Institute, we offer shockwave lithotripsy, ureteroscopy and percutaneous nephrolithotomy routinely, and perform robotic and laparoscopic procedures for kidney stones when necessary. We perform blood tests and 24-hour urine analyses for every patient to identify the cause of kidney stones in order to provide the right treatment. We also design prevention strategies tailored to each patient, including personalized dietary recommendations based on results of 24-hour urine analysis. Our aim is to always ensure that our patients properly understand why they have kidney stones and make the necessary lifestyle changes to prevent a recurrence. For more information on kidney stones and how they are managed, visit the “Advanced Urology Institute” site.

Becoming a Urologist with Dr. Rishi Modh

Being a urologist is an opportunity to help people and make a difference in their lives. As a urologist, people come to you with sensitive and often awkward conditions of the genitourinary tract and you assess the problems and provide the most appropriate remedies. The goal of urologists is always to make interventions that ensure patients are able to live fuller lives. And that makes us proud of our work and of our unique place in the medical profession.

Urology — a big world of stuff

Many people think of urology as merely being about urine. But urology is a massive world that covers a wide range of stuff. It’s an amazing and exciting specialty, where you perform surgery, manage problems medically, develop enduring relationships with patients and go home every day feeling satisfied with your work. I like urology because I’m often able to see the results of my work. For example, when patients come with urological cancers — of the prostate or kidney — I am often able to make effective interventions and achieve great outcomes. Actually, almost all my operations usually result in improved quality of life.

Why urology?

Urology was a natural fit for me. I wanted to be involved in diagnosis, medical management and surgical procedures. With most of my cases I have found that wonderful balance of medicine and surgery in urology. I also like listening and talking to people, leading them to open up and share their problems, guiding them to see the bigger picture and helping them to make informed decisions. In urology, I’m able to do this and much more with my patients. Most crucially, I joined urology to have a chance to make a difference in people’s lives. And indeed, I have found the specialty well-rounded, fascinating and exciting, as well as a powerful instrument for improving people’s lives.

Path to urology

I was born and grew up in Tampa, Florida, where my passion for the health and well-being of the people around me and for public health and sanitation made me a volunteer in many causes right from a young age. I soon realized that pursuing medicine would help me to make a better contribution in health care and improve people’s lives. So I joined the University of Miami for my medical education, graduating with AOA honors. Then I went to Shands Hospital, University of Florida for my urology residency. Currently I am happy and proud to be back in Florida where I’m practicing and living the dream of my life — making a difference in people’s lives.

Areas of expertise

As a urologist, I routinely deal with a wide variety of issues, such as urinary tract infections, overactive bladder, urinary incontinence, low testosterone and prostate enlargement. I also offer procedures for kidney transplants, interstitial cystitis, prostatitis, overactive bladder, congenital abnormalities, urinary stones, correcting stress incontinence, operating on adrenal glands and treating bladder, prostate and kidney cancer. I provide vasectomies, vasectomy reversals and treat erectile dysfunction and infertility issues in men.

What makes urology even more interesting is the continuous integration of advanced technology. Today we can access the urethra via the bladder and get into the kidneys without making any incisions. Even operations to remove kidneys or prostates, which previously required open surgery, are now routinely performed robotically or laparoscopically — using tiny, image-guided instruments.

At Advanced Urology Institute where we use the da Vinci surgical system for several operations, a urologist can now just sit at a console, have fingers in sensors and remotely control a multi-armed robotic surgeon, which ensures access to more areas in the body and provides seamless movement during operation in ways that are impossible laparoscopically. Application of such technology guarantees less scarring, less blood loss and quicker recovery for our patients. And for the urologist, it’s always exciting in the operating room working with such technology.

Job satisfaction

It takes long and hard training to become a urologist. The residencies take 5-6 years and typically involve long hours of complex work and limited sleep. Then there are several hours per week spent in the operating room, which may test anyone’s tenacity and patience. However, it helps that urologists are generally professionals with a positive attitude, good bedside manners and vast empathy. So these challenges can hardly diminish our enthusiasm and commitment to urology.

As a urologist, you are always conducting tests and procedures that may be quite uncomfortable for your patients, delivering news about diagnoses that your patients may not want to hear, and facing medical emergencies requiring you to think on your feet and solve issues to the best of your ability. But with skills to communicate well, eyes for detail and unquenchable desire to help people, you’ll always find yourself on top of things.

I really like urology because I’m a hands-on person who enjoys the hours it offers in the operating room. There are many potential conditions to treat, a wide range of procedures to perform and different tools to use —so no two days are the same. From a vasectomy to vasectomy reversal, circumcision to delivering antibiotics for urinary tract infections, laser surgery to robot-assisted procedures, there’s a lot to keep a urologist engaged and involved.

Urologists also are at the forefront of advanced technology, having pioneered laparoscopic approaches that have been adopted by other medical specialties and now leading the way in the use of cutting-edge robotics. The field is ever growing and changing, and we are constantly researching, learning and innovating to perform our duties better.

Most essentially, urology allows you to build lasting relationships and make a difference in people’s lives. I follow my patients over time, getting to know how they are doing and helping them make informed decisions. I enjoy what I do because I’m always involved in improving, prolonging and saving lives.

Why Advanced Urology Institute?

Advanced Urology Institute stands out for its commitment to excellent urological care. By bringing together a huge number of driven, hard-working, experienced and certified professionals, and having them adopt a collaborative, multidisciplinary patient-centered approach to care, AUI not only gives urologists an opportunity to grow, but also offers them a working environment that brings out the best of their knowledge, skills and experiences. I like the fact that all administrative duties have been centralized and we have all the time we need to work with our patients and give our best.

It’s also good that colleagues at AUI are quite laid back, funny and relaxed people. We are serious about our work but we also enjoy jokes with each other and maintain a positive, friendly practice. It’s a fantastic place full of people who love what they do and who handle diverse issues and patients with utmost diligence and thoroughness. And because we love our job, we work harder to get better at it and to achieve great outcomes for our patients. For more information on our urological services, visit the “Advanced Urology Institute” site.

Options for Treating Benign Prostatic Hyperplasia

The prostate is a tiny gland situated between the bladder and the penis. But as men get older, the gland grows larger, putting pressure on the urethra and bladder and causing urinary problems. An enlarged prostate is medically called benign prostatic hyperplasia (or BPH), a condition that’s quite common in older men. In the U.S. around 50 percent of men 51-60 years old have BPH while up to 90 percent of men over age 80 are affected by the condition.

The common symptoms of an enlarged prostate are:

  1. Inability to delay urination.
  2. Urge to urinate more than 8 times a day.
  3. Frequently waking up at night to pass urine.
  4. Dribbling after urinating.
  5. Urinary incontinence (urinating accidentally).
  6. Inability to completely empty the bladder (urinary retention).
  7. Having intermittent or weak urine stream.
  8. Straining to pass urine or difficulty starting urination.

So what are the options for treating BPH?

As urologists, the first thing we do when a patient has symptoms is to rule out other possible problems. We talk with our patients to learn the nature and severity of their symptoms, conduct exams, do ultrasound and relevant tests. Once it’s confirmed that it is BPH, we begin treatment starting with the least invasive procedures. Treatment options for BPH include medication, minimally invasive procedures and surgery, although various lifestyle changes also can improve or prevent symptoms.

1. Medications

The urologist may recommend medication to help control prostatic growth and reduce symptoms. For instance, alpha blockers such as alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura), tamsulosin (Flomax) and terazosin (Hytrin) may be used to relax prostate muscles and make it easier to urinate. They quickly increase urine flow and reduce the need to urinate frequently. Another type of medication that may be prescribed is 5-alpha-reductase inhibitors, such as finasteride (Proscar) and dutasteride (Avodart), which limit the growth of the prostate by blocking hormones that promote growth of the gland. It generally takes 3-6 months for 5-alpha reductase inhibitors to relieve symptoms.

Phosphodiesterase-5 (PDE5) inhibitors such as Sildenafil, (Viagra), Tadalfil (Cialis) and Vardenafil (Levitra) may be given to help relax urinary tract muscles and relieve BPH symptoms. However, in some cases, particularly when either a 5-alpha reductase inhibitor or an alpha blocker isn’t effective on its own, urologists may give a combination therapy. This typically involves a combination of a 5-alpha reductase inhibitor and an alpha blocker and usually results in greater symptom relief.

2. Minimally invasive procedures

When medications fail to relieve BPH symptoms, the next step in treatment usually involves minimally invasive interventions. During the procedure, a urologist inserts an instrument into the rectum or urethra to either widen the urethra or destroy excess prostate tissue. For instance, TUMT (Transurethral Microwave Thermotherapy) uses microwaves to heat and destroy excess prostate tissue. TUMT does not cure BPH but makes it easier to pass urine, cuts down urinary frequency and reduces weak flow. Another treatment, TUNA (Transurethral Needle Ablation), uses high-frequency radio waves that are delivered via twin needles to burn a specific area of the prostate. TUNA is an outpatient procedure that relieves BPH symptoms and improves urine flow.

A third minimally invasive option for BPH is water-induced thermotherapy. During the treatment, hot water delivered through a catheter and into a treatment balloon located at the center of the prostate is used to heat up a definite area of the prostate and destroy problematic tissue. Once destroyed, the excess tissue is either reabsorbed in the body or excreted through urine. Another minimally invasive treatment option is the Urolift procedure, which involves inserting small implants into the prostate to retract, hold and lift the enlarged prostate tissue, opening up the passage for urine and relieving bladder blockage. While the Urolift procedure does not involve heating, cutting or removing the excess prostate tissue, it is effective in restoring normal flow of urine and relieving symptoms, and patients usually return home the same day without a catheter.

A revolutionary minimally invasive procedure for treating BPH is the Rezum system. During the treatment, sterile water vapor is injected into the prostate to help destroy overgrown tissue. It takes roughly three months for the body’s healing mechanisms to remove dead prostate cells and shrink the prostate, opening the passage for urine to flow. The Rezum procedure improves urine flow and relieves symptoms without the adverse effect of erectile dysfunction. It’s an ideal option for men who are medically unfit for the other procedures or for those already catheterized.

For prostates that have grown larger than 100 grams, a procedure called aquablation is a good option. It uses a high velocity saline jet to remove the overgrown prostate tissue. After the treatment is planned, the procedure is robotically driven, so its duration and side effects do not depend on prostate size. It does not use heat and postoperative bleeding is prevented by inserting a large catheter and applying a bladder washout (irrigation). The results achieved through aquablation are similar to TURP, except it comes with less dysuria and minimal irritation symptoms because no heat is used.

3. Surgical procedures for treating BPH

If both medication and minimally invasive procedures fail to improve BPH symptoms sufficiently, the urologist may recommend surgery. Surgical interventions also may be necessary if complications develop or symptoms become severe. The most common type of invasive surgery for BPH is TURP (Transurethral Resection of Prostate). In fact, it’s the first surgical option for treating BPH and involves the removal of excess prostate tissue by inserting a resectoscope through the urethra and into the prostate. Or the urologist can opt for TUIP (Transurethral Incision of Prostate) that involves making incisions in the bladder’s neck and into the prostate. The operation is done to widen the urethra and boost urine flow.

In other cases, the urologist may choose to perform laser surgery. This surgical procedure involves inserting a scope into the urethra and using the scope to deliver laser to the prostate tissue. The laser treats enlarged prostate through either enucleation (cutting) or ablation (melting). Both the GreenLight Laser PVP and Holmium laser ablation of prostate (HoLAP) procedures remove the excess prostate tissue by photoselective vaporization while holmium laser enucleation of prostate (HoLEP) uses two instruments, a laser for cutting and removing excess tissue and a morcellator for slicing extra tissue into tiny fragments for removal.

In complicated cases of BPH, such as men with much enlarged prostates or those with bladder damage, urologists may opt for open surgery. During an open simple prostatectomy, the urologist makes an incision just below the navel or numerous small incisions in the abdominal area via laparoscopy. The surgeon then removes the portion of the prostate that’s blocking urine flow.

At Advanced Urology Institute, our choice of treatment usually comes down to patient preferences and their ability to cope with BPH symptoms. We often prefer the least invasive options and give medication in many cases, but other treatment options are considered for patients who aren’t responding well to drugs or who can’t tolerate the adverse effects. As an alternative to TURP and open surgery, we prefer to treat BPH that’s characterized by acute urinary retention, high post-residual volume, recurrent urinary tract infections or bladder stones through the GreenLight Laser PVP or the newer heat treatments like TUNA and microwave. For more information on treatment options for BPH, visit the “Advanced Urology Institute” site.

Becoming a Urologist with Dr. Sean Heron

If I had to do it again, I would still happily choose urology. I really love urology and I’m always excited about the opportunity it offers to listen to people talk about distressing conditions, detect life-threatening conditions and make interventions that improve their lives. For me, the honor of being relied upon to offer advice, the awe of discovering problems in the genitourinary tract, the chance to provide life-improving and life-saving treatments, and the gratitude that comes with helping people through difficult illness — these things just never cease to motivate me. So even in my most stressful work days — when crushed by unbearable time constraints or enormous pressure — I have never felt anything like a drop in my passion for urology.

Why urology?

Ever since I was a child, I wanted to be a doctor. My mother, who was a teacher, realized this early and encouraged me to work hard in school to fulfill my dream. I went to Denison University for my undergraduate studies, then to Ohio State University for my medical degree, graduating in 1989. In medical school, I wasn’t really sure which field of medicine I wanted to specialize. In those days, the first two years of medical school were dedicated to intensive classwork and then in the third year we would go for clinical rotation.

When I went for my rotations, my first area was nephrology, medical care for kidneys. It was quite depressing working with patients with kidney problems and those under dialysis. I couldn’t figure out why patients who were not doing well were discharged to go home only to be back in the hospital the next day. This early experience shaped my attitude toward urology and at this stage, I felt strongly that I would never be a urologist.

We had eight choices as electives, including urology, but I didn’t want to work with kidneys and tried to avoid urology. However, as things turned out, I ended up picking urology. My eureka moment came when I watched from a side view as the prostate was being cut by a urologist. As the procedure went on before my eyes, I immediately changed my mind about urology.

That was my first real experience with urological surgery and it inspired my career choice and my lifelong commitment to the field. I completed a six-year urology and surgery residency at Emory University, Atlanta, Ga., and soon became a certified urologist by American Board of Urology. And even though I heard people say that urology was boring, I have found it fun and fascinating.

Areas of expertise

As a urologist, I offer diagnosis, treatment and follow-up care for a broad range of urological ailments and associated emotional issues. I routinely provide medical and surgical treatments for conditions such as kidney stones, urinary incontinence, erectile dysfunction, male infertility, pelvic pain, urologic cancers and genitourinary tract injuries. But I also perform specialized laparoscopic, laser and robotic procedures for various conditions, such as laser enucleation and laser vaporization for prostatic problems, steam ablation (Rezum) of the prostate, da Vinci robot-assisted surgery for prostate and kidney issues and high-intensity focused ultrasound for prostate cancer. Most importantly, I believe that every patient has unique needs that must be fully understood by the urologist before treatment can commence. So I always make sure to take into account all the needs, concerns and presenting factors of every patient and to provide tailored treatments that meet the specific needs of individual patients.

Job satisfaction

Urologists manage genitourinary tract disorders medically and surgically, taking care of their patients from start to finish. The ability to fix urologic disorders, see the lives of your patients improve, have them enjoy life much better and establish enduring relationships with them is quite satisfying. Likewise, the chance to use some of the latest and most innovative technology, including scopes, lasers and robots for complex urology procedures makes the field continually interesting. Even though urology is a surgical subspecialty, we have far better working hours than in general surgery. There are much fewer urological emergencies and rarely are there painful trauma situations to handle, so urologists have more control over their work schedule and better control over their lives. While urology residency is quite grueling, it isn’t nearly as bad as general surgery residency. With urology you get a good mix of surgery and medicine and enjoy better working conditions and great outcomes, all of which makes it quite fulfilling.

Why Advanced Urology Institute?

When I was choosing urology, there were people around me who thought it was a boring field of medicine. So for me, the inspiration to join the specialty was not enough. I also wanted a practice that would make urology exciting and fun. Luckily I found that in Advanced Urology Institute. I joined AUI’s Pinellas Urology in 1995 and quickly found its collaborative, multidisciplinary and patient-centered approach to care useful in bringing out the best of my skills, knowledge and experiences. And with all administrative work centralized at AUI, there are no bothersome phone calls, electronic documentation, paperwork, quality assurance measures and insurance forms for me to deal with. That makes it easier for me to concentrate on providing the best possible care to my patients. So even if I can’t always guarantee that I’ll make my patients better, I have all the time to work out the best possible remedies for their conditions. For more information on urology and urological services offered by AUI, visit the “Advanced Urology Institute” site.