Prostate Cancer Recurrence: What Should You Know According to Dr. Jonathan Jay?

KEY TAKEAWAYS:

  • Prostate cancer recurrence can occur due to cancer cells left behind during treatment or because the cancer was initially diagnosed as less advanced than it actually was.
  • A rise in Prostate Specific Antigen (PSA) levels and the use of PET/CT imaging scans are effective ways to diagnose recurrent prostate cancer.
  • Treatment options for recurring prostate cancer depend on the initial treatment and may include radiation therapy, surgical removal of the prostate, cryotherapy, or hormone therapy.

Cancer of the prostate affects a small gland that is situated just in front of the rectum and around the base of the urethra in men. It is the most common type of cancer in men, with those over age 50 facing the greatest risk. The good news is that prostate cancer is treatable. Treatment options include surgical removal of the prostate gland, radiation therapy, hormone therapy and chemotherapy. A combination of various treatment methods may be applied for full effect. Sometimes, however, even after treatment has been administered successfully, the prostate cancer returns. This is called a recurrence and it occurs with other types of cancer too.

Causes of Prostate Cancer Recurrence

Prostate cancer can recur for two main reasons.

1. A small clump of cancer cells left behind during the earlier course of treatment can grow into a larger number.

2. The cancer initially was diagnosed as being less advanced than it actually was. For instance, a patient might be diagnosed with cancer that is limited only to the prostate while in fact, the cancer might have advanced to the surrounding lymph nodes.

Diagnosis of Recurrent Prostate Cancer

Dr. Jonathan Jay with patientA major indicator of recurring prostate cancer is a rise in Prostate Specific Antigen (PSA) levels. PSA is a protein produced by the prostate. A PSA test is always conducted as part of the preliminary work in the diagnosis of prostate cancer, whether initial or recurrent. Ideally, after successful treatment, PSA levels should go down and should stay consistently low. If the level starts to rise again, that is a red light that should be followed up with further testing.

Another test, which doctors agree is very effective in checking for recurrent prostate cancer, is the PET/CT imaging scan. Dr. Jonathan Jay, who has an office in Naples, FL, says the scan is effective because it has the ability to localize the cancer and map out its extent with great accuracy. Treatment of cancer usually depends on being able to tell exactly what part is affected. If this can be done, then it becomes easy to direct treatment at that specific area, which is what a PET/CT imaging scan does.

Treatment of Recurring Prostate Cancer

The form of treatment depends on what was initially administered. The following options are available:

1. If the prostate was surgically removed the first time, radiation therapy may be administered to treat the recurrent cancer;

2. If radiation therapy was administered the first time, a surgical removal of the prostate may be recommended. That decision depends on whether or not the cancer has spread outside of the prostate.

3. Cryotherapy. This treatment involves freezing the cancer cells to kill them.

4. Hormone Therapy. This may be used in combination with other methods. It is also used as a last option when the cancer has spread very far.

The management of recurrent prostate cancer depends on finding the cancer, which most likely would be detected in a post treatment screening. Men who have undergone successful prostate cancer treatment should attend regular screenings after the treatment is finished. Followup screening and checkups are important, and it is important to seek out a comfortable, patient centered treatment center, such as the Advanced Urology Institute. The staff at Advanced Urology Institute is very experienced in working with patients and helping with questions, diagnosis and treatment. They have the knowledge and technology to work with the patient through every step of the process. For more information, visit the Advanced Urology Institute website/

TRANSCRIPTION: 

Prostate cancer is one of the most common types of cancer in men, affecting about one in nine. While prostate cancer can be cured in some men, approximately one in three men will experience what is known as recurrent prostate cancer, which is prostate cancer that has come back after initial treatment. Now unfortunately, prostate cancer is the second leading cause of cancer death in men; about one in 41 will die from prostate cancer this year, and that’s according to the American Cancer Society.

The good news is that there are newer imaging techniques that can help locate recurrent prostate cancer. Being able to locate the disease in the body can really help doctors personalize care for patients living with recurrent prostate cancer. Here to help us understand more about this is Dr. Jonathan Jay and his patient Peter Irving. Welcome to both of you.

Thank you. Doctor, let me start with you. This is Men’s Health Month, so let’s start with prostate cancer and what it is.

Well, we’ll take a step back and start with what the prostate is because most people don’t understand what the prostate is. The prostate is a male reproductive organ, and one-third of the fluid that a man sees in his ejaculation comes from the prostate. The purpose of this fluid is to nourish and protect sperm until conception.

It’s treatable?

Yes, prostate cancer is treatable. Prostate cancer in its treatable stages is asymptomatic, so it’s very important for men to understand that they need to have an evaluation on a yearly basis starting at age 50, which would entail a rectal examination and a blood test called PSA.

Alright, so let’s bring in Peter. When were you diagnosed? What happened?

In 2008, I was diagnosed with cancer following a needle biopsy in which 12 out of 13 were positive. So you were doing a routine exam, Peter?

Just routine, and the PSA started to spike over a period of months. From what to what?

My normal was 1.5, let’s say, and this kept creeping up, and I think my general practitioner sent me to a urologist when it got to like four or five. But at that time, they still did not believe I had prostate cancer; things just weren’t what they thought they should be. That’s why I went to the urologist, and then I had the needle biopsy.

Which confirmed it?

Which confirmed it, and then I went and had surgery, had it removed, and followed with the same urologist. To be checked?

Yeah.

Alright, doctor, let me bring you in. If you could define PSA for us, please, and inform us of the levels that happened.

PSA stands for prostate-specific antigen; it’s a protein that’s excreted solely by the prostate, so it’s a great way of monitoring whether a patient has prostate cancer, develops prostate cancer, or has a reoccurrence of prostate cancer. The significance of PSA is what the PSA is in an individual. In Peter’s case, his PSA was one and increasing over time; that was indicative that something was changing and something was wrong.

Understood. So, Peter, you have the surgery, you’re living your life, and then you have recurrent prostate cancer?

Well, my PSA started to spike again, you know, in theory, you shouldn’t have any PSA.

Exactly. And I believe it was somewhere again in the ones, and then it kept rebounding and going up and up, and we watched it for four years. In 2016, they decided to do radiation therapy and hormone therapy together, and they concentrated on the spot they found through the new imaging, and today I’m zero.

That’s fantastic. Doctor, since he mentioned the new imaging, it’s a PET CT imaging test. Tell me, what is different about this test as opposed to what is always used, I guess, in a bone scan and CT, right?

Yes. So, what are the differences between what was used then and what he used?

We had to define the location and extent of this disease, so conventionally, how do we do that? CT scan is a test that has the ability to survey the body without making an incision; we can survey the body for soft tissue changes, we can detect enlarged lymph nodes, we can detect masses within the abdominal cavity. Bone scan surveys the bone for reoccurring disease. Now, think of this: with these conventional tests, you have to have a mass—a mass would be hundreds of thousands or millions of cells in one place—to be detected by these conventional studies. This newer CT PET scan has the ability to define the location and extent of prostate cancer, reoccurring prostate cancer, at an earlier stage and at a lower PSA.

And how does that make a difference then for the treatment?

It’s very important because we want to treat the disease; we need to define the extent and location of the disease, as that dictates our treatment options. So, as opposed to, let’s say, affecting other organs in the body, you’re minimizing the effects?

Absolutely. In Peter’s case, we were able to do a CT PET scan, localize reoccurrence to one area within the pelvis, and we were able to treat that, but we treated that with radiation or hormonal therapy. We were able to treat that without affecting any of the other organs around it.

Peter, you’re doing fine now, right? Everything is controlled?

A negative PSA test for two-plus years.

So, for our viewers out there, and we have lots of males, what would you say, what would be your final thoughts, your words of wisdom?

Just have a routine, probably at the age of 45.

45, 50, yes. Start getting your PSAs on a yearly basis, and it’ll make you feel much better. Absolutely. So not worrying about that.

Doctor, any final takeaways?

One of the important things is that prostate cancer is prevalent in our community, yes, but if found early, it’s a treatable medical condition, and all you have to do is a simple rectal examination and a blood test called PSA with your primary care physician. If something were to happen again in the future, would you suggest again this new imaging test to him?

Absolutely. If we saw increasing PSAs, the first thing that I would do is this new CT PET scan.

Alright, thank you so much, gentlemen, both of you for your time. Thank you, and I’m glad you’re doing fantastic.

REFERENCES: 

What Treatments Are Available For ED?

Erectile dysfunction is the inability to achieve or maintain an erection firm enough for sexual intercourse. It is not incidental to aging, though in reality it occurs mostly in men over the age of 40. The causes of erectile dysfunction are varied, and the first step is to establish whether it is caused by an underlying condition. Whatever the cause, however, there are various options when it comes to the treatment of erectile dysfunction.

1. Oral Medication (Pills)

Like many other medical conditions, erectile dysfunction can be treated effectively by taking medicine. Oral medicines for erectile dysfunction fall under a group called phosphodiesterase 5 (PDE 5) inhibitors. They work by preventing the functioning of the enzyme phosphodiesterase type 5 whose job is to control blood flow to the penile arteries. When the enzyme is not functioning, blood vessels relax, allowing blood to reach the penis, therefore causing an erection. The most common PDE 5 inhibitors are:

a. Sildenafil- commonly referred to as Viagra
b. Avanafil – also known as Stendra
c. Tadalafil – also known as Ciaris; and
d. Varednafil- also known as Levitra

Most of these medications are widely available. It is necessary, however, to consult with a urologist before taking any of them. A trained urologist should be able to assess a patient’s condition and advise whether oral medication is likely to work and if so, which of the available medicines is best suited to the patient’s case.

2. Penile implants

For some men, especially those with underlying conditions, oral medication does not work. They may have to resort to other treatment options and the most common of these is the penile implant. This involves a minor surgical procedure and the placing of an implant that causes an erection. There are two choices when it comes to the implant. There is the inflatable implant and the malleable/ semi-rigid implant. Both options have their advantages and disadvantages and the patient will decide based on his circumstances. Overall, however, both implant options report a success rate of over 90 percent.

3. Vascular reconstructive surgery.

Vascular reconstructive surgery involves reconstructing the arteries within the penis to increase blood flow. This last option is neither common nor popular. It is a very difficult, and therefore expensive, procedure. Additionally, it is not always successful and a patient might face the risk of relapse.

It is possible to treat erectile dysfunction. But the right treatment option must be sought for each individual case. It is recommended that anyone experiencing erectile dysfunction should see a urologist. The highly qualified and experienced urologists at Advanced Urology Institute can provide consultation, technology and treatment plans to help patients with erectile dysfunction. Want to find out more about erectile dysfunction? Visit the “Advanced Urology Institute” site.

How Did Dr. Jonathan Jay Become a Urologist?

KEY TAKEAWAYS:

  • Dr. Jonathan Jay’s path to urology began with a background in physiology, medicine, residency training, and fellowship training before becoming a board-certified urologist.
  • A proficient urologist requires not only a deep understanding of medicine but also emotional intelligence, honesty, empathy, and compassion to effectively treat and support patients with a variety of urological conditions.
  • Dr. Jay chose to practice at Advanced Urology Institute (AUI) due to its centralized administrative tasks, access to cutting-edge surgical and medical equipment, collaborative and multidisciplinary approach to patient care, and friendly working environment.

Urology is a fascinating, stimulating and satisfying field of medicine. As urologists, we treat conditions of the urinary tract in both men and women, together with disorders of the male reproductive system. Being a urologist is an opportunity to care for people with agonizing, embarrassing and life-threatening conditions, such as kidney stones, urinary incontinence, erectile dysfunction, and genitourinary cancers, restoring normalcy in their lives. For those like me who are passionate about saving and improving lives, urology is a worthwhile career. For me, every day spent with my patients is not only an opportunity to serve and help people, but also contribute to saving or extending lives. In turn, the positive outcomes from various interventions bring joy and satisfaction.

Why urology?

Well, mine is a funny story. Growing up in Lansing, Mi., with both my parents having PHDs — my mother working at the Lansing School District and my father being a Michigan University professor — I learned to be inquisitive from a very early age. Being educators, my parents always encouraged me to be curious; to try to understand how various things worked. Eventually I became profoundly curious about how my body works and searched for answers wherever I could find them. As a result, I ended up studying physiology, then medicine, and ultimately specializing in urology.

Path to urology

Dr. Jonathan Jay - UrologistMy curiosity led me to study physiology — the study of how the body works — to learn more about the body. So I attended Michigan State University to pursue a Bachelor of Science degree in physiology. As I was studying physiology, I became interested in medicine. Upon graduation, I went to Ann Arbor, University of Michigan for my medical education. After that, I moved to Henry Ford Hospital for my residency training before going to and completing my fellowship training at the Beth Israel Deaconess Medical Center.

During clinical rotations in medical school I came across urology. I actually did not know anything about urology until my classmates at medical school told me about it. They really took me under their wings like a little brother. And because they liked me and I liked them, we were able to speak freely about our career aspirations and interests. So when they recommended that I study urology, telling me repeatedly that I had to try urology —”stay here and be a urologist’ — I gave it a shot and here I am, a board-certified urologist.

What does it take to be a urologist?

As urologists, we see the whole spectrum of age groups — from newborns to elderly patients. For instance, we can see children with congenital problems and care for geriatric patients with bladder control problems, sexual dysfunction or benign prostatic enlargement. So we delve into deeply emotional problems that require empathy, support and effective solutions.

That is why to be a good urologist, you need not only to understand medicine very well and be able to offer effective treatments, but you also must have emotional intelligence. That is, you need to know what to say, why to say it, when to say it and how to say it, and to treat patients as human beings, handling them in a warm, friendly and respectful manner. Actually, honesty, empathy and compassion are the marks of a proficient urologist.

Areas of expertise

I have practiced urology for several years now, seeing patients for a broad range of issues. Frequently I treat patients with enlarged prostate, urinary stones, urinary incontinence, prostatitis, testicular pain, recurrent urinary tract infections, urologic cancers and erectile dysfunction. But my areas of special interest include voiding dysfunction, pelvic floor reconstruction, urinary incontinence, female urology, urodynamics, and urogenital disorders triggered by neurologic disorders.

Over the years, I have performed pelvic floor reconstruction surgeries in both men and women, neuromodulation, surgery for bladder dysfunction, MonaLisa Touch laser procedure for post-menopausal sexual and urinary symptoms, Botox (botulinum toxin) injections, UroLift System procedure for BPH, and da Vinci robotic treatment for post-menopausal sexual and urinary symptoms. I also keep improving my knowledge and refining my skills through continuous medical education, training and research. I understand that I can only deliver the best to my patients when I have the right skills, tools and methods.

Job satisfaction

Urology is about providing relief to people with troubling and humiliating conditions. Patients come to us when they are at some of the lowest moments of their lives and we are able to address their issues and see them restored to normal lives again. Something unique about urology is that the problems we handle are often clearly defined, which means that almost every time a patient presents with a urological condition, we are able to pinpoint the exact etiology and extent of defect and then provide an effective solution.

Therefore, we are able to achieve great outcomes for almost all our patients. In fact, unlike other specialties such as neurology and oncology, the majority of our patients get better and do well after interacting with us. And with this understanding that we can solve many — if not most — of the urologic issues of our patients, we really feel satisfied with our work. And since we are able to achieve great results for our patients, they are always grateful and hold us in high esteem. So with urology, we are largely contented and happy about the work we do.

Why Advanced Urology Institute?

Urologists need a working environment that can bring out the best of their knowledge, skills and talents. For me, that dream place is Advanced Urology Institute. At AUI, all administrative tasks are centralized to ensure that physicians find enough time to deliver the best possible care. Urologists also have access to cutting-edge surgical and medical equipment and are able to apply the latest methods and techniques as soon as they are available.

Urologists at AUI work under a thriving culture of compassionate, collaborative and multidisciplinary approach to patient care, which enables frequent cooperation with other board-certified, skilled and experienced medical professionals. To crown it all, AUI clinics are always warm, friendly and buzzing with colleagues sharing stories, cracking jokes and interacting freely. It is always a wonderful experience being at AUI and I really feel privileged being part of the team.

Want to know more about AUI and the services we offer? Find out more by visiting the “Advanced Urology Institute” site.

TRANSCRIPTION: 

I’m Jonathan Jay, I’m a board-certified urologist with Advanced Urology Institute. 

Funny story, I just had a curiosity about how my body worked, so that led me into physiology because that was a study of how your body really works and then with time that just led into medicine.

Lansing Michigan, my family and my parents were educators, both PhDs, my mother working in Lansing School District, my father worked for Michigan State University as a professor.

Interesting enough, education was important in my family. I always had a curiosity about learning and understanding things, so that’s what they gave me, they gave me a curiosity of trying to understand things.

It’s funny, urology came about by a rotation through medical school, all the medical school students said, hey you got to try urology, they let the medical school, medical students close the wounds, that’s a pretty rare thing.

So all the guys were very nice, these guys took me under their wing like a little brother and so with that they said, hey why don’t you, they liked me, I liked them, they said why don’t you stay here and be a urologist.

Now urology was something that I never even knew existed, in fact they gave a lecture in the second year of medical school, I said who would want to do that, that is the grossest thing I’ve ever seen, but here I am being a urologist all because of a great experience that people provided me, took me under their wing like a little brother. So for me, I always felt like being a doctor you had to have four qualities. The first quality you had to have is you had to understand medicine. You don’t have to be the valedictorian of the class, but you got to understand medicine fairly well.

The next thing you have to have is stellar social intelligence. You got to be able to talk to a human being like a human being, be able to read social cues, know what to say, when to say and how to say it. Then above all you have to care and have empathy for another human being. You have to have all four of those qualities.

REFERENCES:

Advantages of da Vinci Surgical System

The da Vinci Surgical System is a minimally invasive procedure where the operation is performed with the help of robotic instruments inserted through minor incisions. The surgeon sits at a console that offers a three dimensional view of the patient’s anatomy and full control over the surgical instruments.

The da Vinci system provides a suitable alternative to the more traditional open surgery where a surgeon has to make large incisions through skin and muscle to reach the affected organ. It also is an improvement to other minimally invasive procedures, such as laparoscopy. Now a patient has the opportunity to choose robot assisted laparoscopy over conventional laparoscopy.

Advantages of the da Vinci Surgical System

1. Increased precision

The precision with which miniaturized robotic instruments move through the body is comparable to that of a scalpel in a surgeon’s hand. Robotic instruments can access parts of the anatomy that are delicate or hard to reach with no risk of accidental puncture or laceration. The margin of error is very low because precision increases accuracy.

2. Reduced blood loss, pain and scarring

Blood loss, pain and scarring are incidental to any surgical procedure. Blood loss is especially critical and it is a significant contributor to mortality rates in procedures such as hepatic and thoracic surgery. The da Vinci Surgical System requires very little cutting and the incisions made are very small. Advantages of the smaller incisions include less pain, smaller amount of blood loss and a shorter healing period after the surgery. The high definition cameras and the 3D view in the da Vinci Surgical System also offer increased visibility, which reduces the chances of puncturing blood vessels or any other part during the surgery.

3. Faster recovery

Patients who undergo surgery using the da Vinci system report faster recovery. They require less after care and the risk of post surgery complications is remarkably reduced. This is especially the case with post surgery infections, which are a concern in cases of open surgery because of the larger wounds. Patients undergoing this kind of surgery realize the objectives of their treatment quickly and they can return to their normal activities with no problems.

Conclusion

The da Vinci Surgery System is available for almost all forms of surgery, including gynecological, kidney and colorectal. Areas such as urology are known to have been at the forefront of adopting this system to urological surgeries and to date, most urologists, including the members of the Advanced Urology Institute, champion the use of the da Vinci Surgery System.

For more information about the da Vinci Surgery System, visit the “Advanced Urology Institute” website.

Radical Prostatectomy vs Radiation Therapy


Introduction

Radical prostatectomy and radiation therapy are both cancer treatment methods. Radical prostatectomy is specific to prostate cancer and involves the surgical removal of the prostate, either alone or with other surrounding tissues such as the seminal vesicles and some lymph nodes. There are currently various ways in which a radical prostatectomy can be carried out, including robot assisted laparoscopic prostatectomy, open prostatectomy and laparoscopic prostatectomy.

On the other hand, radiation therapy, also known as radiotherapy, is used in the treatment of almost all cancers, including prostate cancer. It involves the use of high doses of radiation to kill cancer cells or to slow their development by destroying their DNA. For radiation therapy to work effectively, it needs to be applied consistently over a period of time.

Choosing between Radical Prostatectomy and Radiation Therapy

The main advantage of radical prostatectomy is that it is arguably a one time procedure. It takes just a few hours to completely remove the affected prostate and the patient is likely to recover fully, albeit gradually and with the monitoring of a urologist. The main disadvantage is that it is appropriate only where the cancer has not spread to other organs outside the prostate. If it has spread, then removing the prostate and leaving behind other affected organs will have no effect at all. In cases where the cancer has spread, radiation therapy may be the more reasonable choice.

Other factors that urologists and surgeons consider before suggesting either procedure include:

1. Age of the patient — Radical prostatectomy is offered mostly to men under 70 years of age because they are more likely to live longer and be able to survive any long term effects of the disease.

2. The natural progression of the disease — Slow progression of a non-aggressive tumor does not lend itself to surgery. This is a case that can be managed by what is called watchful waiting where the disease is monitored constantly but treatment is deferred for a while.

3. The possibility of cure — The goal of radical prostatectomy is to cure the patient of prostate cancer. If for whatever reason it appears that it is unlikely that this objective will be achieved, then radiation therapy or other forms of treatment should be preferred.

Conclusion

It is important to choose the treatment option that works for your body. In order to make the right choice, make a point of consulting a qualified urologist. Reading material on the subject should also be helpful, and sites such as the one operated by the Advanced Urology Institute should be a good place to start.
For more information, visit the Advanced Urology Institute website.

Treating Erectile Dysfunction


Like every other medical condition, the treatment of erectile dysfunction is safer and more effective when done by a doctor with expertise in treating it — the urologist. Seeing a urologist as soon as you have ED symptoms not only ensures quick relief, but also saves a lot of money. But with so many phony cures being promoted and ED products being advertised, men with ED are often tempted to pursue such options rather than seeing a urologist.

The rush for seemingly convenient cures

Actually a lot of men often rush to vascular clinics to get tests done and undergo procedures, some they do not even need. For many, it is a question of seeking the most convenient or popular remedy rather than the safest and most effective treatment. Likewise, with Viagra now generic and cheaper — available for as low as 30 cents per pill in several outlets — it has become quite easy for ED patients to just buy the drug and try it without seeing a urologist.

Dangers of non-prescribed treatments for ED

While it is safe to say that millions of men find these non-prescribed treatments a convenient way of improving their sex lives, it is never prudent to use a prescription drug such as Viagra when it has not been prescribed by a doctor. These medications come with side effects and risks, and if you have certain medical conditions taking such a drug can lead to severe consequences. For example, if you have heart disease and are taking nitrates, a dangerously low blood pressure may develop if you take Viagra. But when the drug is prescribed by a urologist, the doctor will ensure that you are healthy enough to start using the medication.

So why should you still see a urologist?

Most of the treatments advertised are not only bogus and a waste of money, but also may be harmful. Actually you may try several solutions without relief and eventually find yourself in a worse situation than before you started. So it is wise to just forget about every ED treatment that does not require a prescription. It won’t cure your condition! And when you find products advertised as a “breakthrough” or endorsed by medical organizations, you still need to check them out with your urologists. It is the doctor who should confirm whether or not the product is legitimate, a medical breakthrough or has been endorsed by a reputable medical organization.

Not everyone may take ED medications

ED medications are not for everyone with the condition. The drugs will work for some men, but they may be unsafe or inappropriate for others. You should see a urologist to learn whether your condition requires treatment with ED drugs. A urologist will take your medical history, do a physical exam and order various tests to determine whether you need treatment and which drugs are best for you.

You may have ED due to untreated diabetes, hypertension (high blood pressure), your current medications or another issue. Your ED also may have gotten worse because of stress, depression or anxiety. So it is crucial that you are evaluated by a urologist to determine the underlying cause and provide the right treatment. Remember also that erectile dysfunction may be a sign of another more serious health problem and will not be resolved if the underlying issue is not addressed. So you need to see a urologist to get a comprehensive, effective and safe treatment for your condition.

As urologists, we talk with our patients openly, get to know their medical history, conduct physical exams, and recommend treatment tailored to the individual. In many cases, we recommend erectile medications. But when the drugs fail, we have several alternatives to offer, ranging from penile injections and vacuum devices to penile implants. When you work with a urologist, your condition will be evaluated and the solution offered will not only improve your sexual health, but also boost your long-term health. For more information on the treatment of erectile dysfunction, visit the “Advanced Urology Institute” site.

Prostate Problem Warning Signs


At Advanced Urology Institute, we frequently see first-time visitors with symptoms of advanced stage prostate problems. For us, that is quite heartbreaking because it means the patients come too late, when only limited treatment options are available for their conditions.

As urologists, we always want the best for our patients. We want to see them leave when they can pee better and are free from the embarrassment of accidental urine leaks. And because early detection and treatment of prostate problems — whether prostate cancer or non-cancerous condition — improve the chances of cure and of long-term survival, we always encourage men to be more mindful of their bodies, especially when it comes to their urinary function and habits. By doing that, they are able to detect warning signs of prostate issues early and can seek treatment.

Warnings signs of prostate problems include:

  1. Frequent urination or frequent urge to pass urine.
  2. Passing urine more often than usual, particularly at night.
  3. Pain, discomfort or burning sensation when passing urine.
  4. Dribbling urine
  5. Weak or interrupted urine streams.
  6. Accidental urine leakage.
  7. Blood in urine or semen
  8. Frequent stiffness or pain in your lower back, rectal area, hips, upper thighs or pelvic area.
  9. Difficulty or inability to urinate
  10. Trouble with starting or stopping your urine stream.
  11. Painful ejaculation
  12. A feeling that you aren’t able to empty your bladder completely.
  13. Swelling of lower extremities.
  14. Paralysis or weakness in lower limbs.
  15. Inability to pass urine while standing up.
  16. Loss of appetite and weight, fatigue, nausea and vomiting.

It is important to see a urologist immediately if:

  1. You find urination difficult, abnormal or painful. The doctor will examine your prostate gland to find out if it is inflamed, enlarged or has a cancer.
  2. You have frequent urination, urinary retention, blood in urine, dribbling or slow flow of urine, problems starting a urine stream, or repeatedly urinate urgently.
  3. You have a chronic pain in your pelvic, lower back, upper thigh or other areas of your lower extremities. While any unexplained ongoing pain in these areas may have various causes and always merits medical attention, seeing a urologist may help detect whether or not you have prostate cancer.
  4. You have swollen legs, weakness in your legs or trouble walking.
  5. You have unexplained weight loss.

As urologists, we have several options for tackling prostate problems, but our interventions normally depend on the severity of the symptoms, type of condition and how it is impacting your overall quality of life. For example, if the prostate condition is not severely affecting your quality of life and you have no complications (such as bleeding, bladder stones or urinary infections), the decision to treat the problem is often optional and left for you to make.

That means if you aren’t bothered enough to undergo a procedure or take medicine for the condition, then you’ll only need frequent follow-up with your urologist to check whether your symptoms remain stable over time and your bladder continues to empty well. But if you already have complications or your bladder is holding increased quantities of residual urine after urination, then we often begin treatment immediately.

To help you pass urine better, we may offer medications such as alpha blockers, 5-alpha reductase inhibitors or a combination of drugs. But minimally invasive surgical procedures such as TUMT (transurethral microwave thermotherapy) and TUNA (transurethral needle ablation), water-induced thermotherapy, PVP (photoselective vaporization of prostate), and HoLAP (holmium laser ablation of prostate) also may be considered. For more information on diagnosis and treatment of prostate problems, visit the “Advanced Urology Institute” site.

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.

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.

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.