Testosterone Therapy May Lower Prostate Cancer Incidence

Testosterone replacement therapy (TRT) may help to reduce the risk of prostate cancer. According to a case-control study authored by Stacy Loeb, MD, MSc, of New York University, men who undergo testosterone replacement therapy (TRT) have lower risk of prostate cancer than those who do not undergo the therapy. Plus, the study found that testosterone therapy decreases the risk of aggressive prostate cancer, which is the form of the cancer that usually requires treatment.

Linking testosterone level to prostate cancer

The New York University study was based on the National Prostate Cancer Register of Sweden and included all the 38, 570 cases of prostate cancer diagnosed in Sweden from 2009 to 2012, together with 192,838 age-matched men without prostate cancer.

During the research, 284 prostate cancer patients (1%) and 1378 healthy men (1%) completed prescription forms for TRT. Then following a multivariable analysis, it was established that exposure to TRT did not produce increased prostate cancer risk.

On the contrary, TRT exposure resulted in reduced risk of the cancer within the first year and decreased the risk of the aggressive type of the disease after the first year of therapy.

Need for more studies

While the above study by New York University into the link between TRT and risk of prostate cancer was not conclusive, it demonstrated a reduced risk of the cancer after testosterone therapy. Besides, due to the increased administration of TRT in recent years, this study generated more issues that need further studies.

For instance, due to the more favorable-risk of prostate cancer in men who receive the therapy, the study pointed to the need for increased prostate cancer screening in men undergoing TRT. Also, it pointed to several possible biologic mechanisms involved in aggressive disease, including the role of testosterone in normal functioning of the prostate and epithelial cell differentiation.

Efficacy of testosterone therapy in several studies

Another study presented at the Sexual Medicine Society of North America 18th Annual Fall Scientific Meeting in San Antonio, Texas reported that hypogonadal men who receive TRT have reduced incidence of prostate cancer than those not receiving the therapy. The study also found that the form of prostate cancer diagnosed in recipients of testosterone therapy is less severe than the form diagnosed in men unexposed to the therapy.

The study was conducted in 400 hypogonadal men (those with testosterone level of 350 ng/dL or less) and who received testosterone undecanoate 1000 mg every 3 months for up to 10 years. It also involved a control group of 376 hypogonadal men who were not receiving TRT. A median follow-up of 8 years was done, where 9 men in the TRT group (2.3%) were diagnosed with prostate cancer compared to 26 men (6.9%) in the control group.

The diagnosed men in the TRT group underwent radical prostatectomy (RP). All of them except one patient had a Gleason score of 6 or less. In fact, most had a predominant Gleason score of 3 and all had tumor grade G2 and tumor stage T2.
On the contrary, in the control group, 18 required radical prostatectomy alone, 6 required both RP and radiation, while 2 required radiation. Plus, 26 patients in the control group had a Gleason score above 6, 2 had a score of 3, 20 had a score of 4, and 4 had a score of 5. The tumor grade was G2 in 6 patients and G3 in 20 patients; while in terms of tumor stage, 1 patient had stage T2 with 25 were at stage T3.

In the testosterone group, all the cancer cases were diagnosed within the first year. This suggested that the tumors had been present before the therapy was initiated. Since low testosterone is linked with low PSA, the cancer was probably not detected before testosterone therapy due to hypogonadism. The detection within one year of treatment was due to increasing levels of testosterone, which brought out occult cancer.

There are several other studies that have produced similar reports. For example, a population-based matched cohort study of men aged 66 years or older by the University of Toronto demonstrated that testosterone exposure reduces the risk of prostate cancer by up to 40-percent.

The research in Ontario, Canada by Christopher J.D. Wallis, MD, PhD, and colleagues was published in the Lancet Diabetes Endocrinology (2016;4:498-506) and involved exposure of the men to the highest tertile testosterone and comparing the results with controls. During the study 10,311 men received TRT while 28,029 men did not. Follow-up was made after 5.3 years in the TRT group and after 5.1 years in the control group.

Prompt prostate cancer diagnosis and treatment

Are you a man over the age of 50 years and would like to begin prostate cancer screening? Or are you having urinary issues and suspect you could be developing a prostate-related disorder?

At Advanced Urology Institute, we have assembled a skilled, experienced team of board-certified urologists to help diagnose and treat prostatic issues, including prostatitis, enlarged prostate and prostate cancer.

Our state-of-the art prostate cancer center is supplied with the latest equipment and technology to deliver prompt diagnosis and safe, effective treatment of prostatic problems. For more information on prostate cancer and other urologic disorders, visit the site AdvancedUrologyInstitute.com

When do you need a PSA test?

The prostate-specific antigen (PSA) test is a blood test performed to screen for prostate cancer. It measures the level of PSA in blood—a protein made only in the prostate gland. After production in the prostate, the PSA finds its way into blood. But the level of PSA in blood depends on age and on the health of the prostate.

What is the normal level of the PSA in blood?

The amount of PSA in blood is measured in nanograms per milliliter of blood (ng/ml).  For men aged 40 to 50 years, a PSA level above 2.5 nanograms per milliliter is considered abnormal. The normal range for men of this age is usually 0.6 to 0.7 nanograms per milliliter. 

And for men aged 50 to 70 years, a PSA score greater than 4.0 nanograms per milliliter is considered abnormal.  The normal PSA range for men in this age is 1.0 to 1.5 nanograms per milliliter.

Besides, any rapid increase or a continuous rise in PSA level over a period of time is considered abnormal. For instance, a rise of more 0.35 nanograms per milliliter of blood within one year is abnormal. 

Nevertheless, not every increased PSA level is an indicator of prostate cancer. In fact, 3 in 4 men with elevated PSA do not have the cancer. Apart from prostate cancer, an elevated PSA level in your blood may be due to prostatitis, an enlarged prostate, and urinary tract infection.

So when should you get screened for prostate cancer?

The time to begin having PSA tests depends on a number of factors. According to new guidelines, men with no family history or known illness should undergo the PSA test starting from age 54 to 70 years. The reason for this is that it is at this age that they can benefit the most from screening. 

It is from the age of 54 to 70 when:

  1. You are more likely to develop prostate cancer.
  2. Treatment of diagnosed prostate cancer makes most sense—the benefits of treating the cancer outweigh any possible risks of treating side effects.

However, there are some men who may need screening earlier, between the ages of 40 and 54 years. Your doctor may recommend that you get screened this early if you:

  1. Have a positive family history of prostate cancer. That is if you have at least one first-degree relative, like a brother or father, who has had the cancer.
  2. Have at least two extended family members who have had prostate cancer.
  3. Are African-American; an ethnicity that has a higher risk of developing a more aggressive form of prostate cancer. 

But for men who are 70 years or older, taking the PSA test is not usually recommended. That’s because the benefits of treatment may not outweigh the adverse effects. Also, the cancer may not grow or spread to a life-threatening stage in the patient’s lifetime. Though, men above 70 years may undergo the PSA test if they have a life-expectancy greater than 10 years.

Choosing to get the PSA test

As you grow older, your risk of having prostate cancer increases. Hence, you will need to undergo screening to help you detect the cancer early should you have it. For most men, it is recommended that they undergo regular PSA tests after the age of 54 years.

However, you should ask your doctor for advice on when to start having screening tests and how frequently you should be screened. If you are 54 years or older, your doctor may advise that you have a PSA test every 2-3 years. The doctor will also explain to you the harms and benefits of screening for prostate cancer.

What next after an abnormal PSA test?

If your PSA level falls in the abnormal range, your doctor may make the following recommendations:

  1. Repeat the PSA test. If the level is still higher after the repeat, your doctor may recommend monitoring the PSA level over a period of time to see how it changes.
  2. A digital rectal examination to feel for the changes in your prostate gland that may help to detect prostate cancer.
  3. A biopsy, which involves taking small samples from the prostate and checking them for cancer cells.

If it is confirmed that you have prostate cancer, your doctor will want to know whether the cancer is indolent or aggressive. An indolent cancer is slow-growing and has only a minimal chance of spreading to other organs.  With such a cancer, you may not be treated, but may be placed under watchful waiting and active surveillance.

An aggressive cancer grows rapidly and has the potential to spread to other parts of the body. Your doctor will consider your age and other factors when weighing the risks and benefits of treatment.  Eventually, you’ll undergo a personalized treatment that may include radiotherapy and radical prostatectomy.

Do you have fears that you may be at risk for prostate cancer? Would you like to speak with a knowledgeable, experienced urologist to know your risk level and when to begin your prostate cancer screening? Contact Advanced Urology Institute today to book your consultation session with a urologist who will give you the best possible advice. For more information on prostate cancer screening, diagnosis and treatment, visit the site “Advanced Urology institute.”

BPH Enlarged Prostate Symptoms & Treatment

Benign prostatic hyperplasia (BPH) is a non-cancerous increase in the size of the prostate gland and surrounding tissue. As the gland enlarges, it squeezes the urethra and causes the bladder wall to become thicker. Over time, the bladder muscles weaken and the bladder loses the ability to empty fully, resulting in urinary symptoms.

The most common complaints in people with BPH include:

  1. Difficulty starting urination
  2. Having to strain or push in order to pass urine
  3. Weak stream due to a weak urine flow
  4. Dribbling at the end of urination
  5. Urgent or frequent need to urinate
  6. Nocturia—increased urinary frequency at night
  7. Intermittency—the need to stop and start many times when passing urine

In some men, rare symptoms may occur, including:

  1. Inability to urinate
  2. Blood in urine
  3. Urinary tract infections

The size of the enlarged prostate gland does not determine the severity of the symptoms. Actually, some men with only a slightly enlarged prostate have significant symptoms while others with a massive enlargement have only minor urinary symptoms. Plus, in some men, symptoms tend to stabilize and even improve with time.

Besides, an enlarged prostate shares urinary symptoms with a number of conditions, including:

  1. Inflammation of the prostate (prostatitis)
  2. Narrowing of the urethra (urethral stricture)
  3. Urinary tract infection
  4. Kidney or bladder stones
  5. Problems with nerves controlling the bladder
  6. Scarred bladder neck after surgery
  7. Bladder or prostate cancer

Therefore, it is advisable that you see a urologist as soon as possible if you are having persistent urinary symptoms. Regardless of whether the urinary symptoms are bothersome or not, seeing a doctor will help to identify or rule out any underlying causes. 

How is benign prostatic hyperplasia treated?

When your urologist is certain that you have benign prostatic hyperplasia, you’re typically started on an alpha blocker—a medication that relaxes your bladder neck muscles and the muscle fibers in the prostate, making urination easier.  

Commonly prescribed alpha blockers include alfuzosin (Uroxatral), tamsulosin (Flomax), doxazosin (Cardura), and silodosin (Rapaflo).  For men with only slightly enlarged prostates, alpha blockers work really quickly and relieve urinary symptoms effectively.

Another option is to prescribe medication that can shrink the prostate by preventing hormonal changes behind prostate enlargement. The medications, called 5-alpha reductase inhibitors, such as Finasteride (Proscar) and Dutasteride (Avodart), can shrink the prostate by as much as 50-percent over a period of six months. You can rely on these drugs to relieve urinary symptoms within a few weeks of usage.

In some cases, your doctor may opt for a combined therapy using an alpha blocker together with a 5-alpha reductase inhibitor. This is done if either medication isn’t effective when used alone.

If your symptoms fail to respond to these medications, your doctor may recommend a minimally invasive surgical procedure. Such a procedure may also be necessary if your symptoms are severe or if you have a urinary obstruction, bladder stones or kidney problem.

Some procedures your doctor may consider include:

  1. Transurethral resection of the prostate (TURP)

This is a minimally invasive procedure that involves inserting a lighted scope into the urethra and using it to guide the removal of all but the outer part of the prostate.

  1. Transurethral incision of the prostate (TUIP)

Just like TURP, this procedure involves inserting a lighted scope into the prostate. The difference is that during TUIP, the surgeon makes 1-2 small incisions in the prostate gland, which enable urine to pass through the urethra.

  1. Transurethral microwave thermotherapy (TUMT)

As opposed to using a lighted scope, this procedure uses a special electrode inserted through the urethra into the prostate. The electrode provides microwave energy that is directed to the inner portion of the enlarged prostate. As a result, the prostate shrinks and urine flow improves.

  1. Transurethral needle ablation (TUNA)

This is another minimally invasive procedure that involves passing a scope into the urethra to allow the surgeon to place needles into the prostate gland. Radio waves are directed through the needles, which help to heat up and destroy excess prostate tissue.

  1. Laser therapy

During this procedure, high-energy laser is used to remove or destroy overgrown prostate tissue. It is preferred in men who are taking blood-thinning medications and who shouldn’t undergo the other minimally-invasive prostate procedures stated above.

  1. Prostate urethral lift (PUL)

This is a minimally invasive procedure that involves using special tags to compress the sides of the prostate in order to enhance urine flow. It is recommended in men who are wary about the impact of treatment on erectile and ejaculatory function. Prostate urethral lift causes minimal adverse effects on ejaculation and sexual function compared with TURP, TUIP, TUMT, and TUNA.

  1. Robot assisted prostatectomy

As a last resort or in cases where the prostate is too much enlarged, the bladder is damaged or there are other complicating factors, the surgeon may opt for da Vinci robot-assisted prostatectomy. The procedure involves making an incision in the lower abdomen to reach the prostate gland, which is then removed.

Reliable, unbeatable care

Are you 50 years or above and are having a frequent urge to urinate, a weak urine stream, leakage or dribbling of urine, or trouble beginning urination? You may be having benign prostatic hyperplasia.

At Advanced Urology Institute, we offer safe, timely and reliable diagnosis and treatment of BPH. Our urologists are skilled in doing physical examination, patient history, symptom evaluation, and ordering tests that form the basis for diagnosing the condition and ruling out other problems, including prostate cancer.

We also make sure that our patients understand the full range of treatment options available to them, and guide them on making an informed decision and on pursuing the treatment that is best for their individual medical situation. For more information on benign prostatic hyperplasia diagnosis and treatment, visit the site “Advanced Urology Institute.”

How long does radiation treatment take?

Key takeaways

  • Radiotherapy is a cancer treatment that uses high doses of radiation to destroy cancerous tumor cells. It can be administered externally or internally, and the length of treatment depends on the type, location, and characteristics of the tumor.
  • External radiotherapy is typically given daily, from Monday to Friday, for five to eight weeks, with breaks on the weekends to allow healthy cells to recover. The length of treatment may vary depending on the specific tumor and the location.
  • External radiotherapy is a painless process that typically takes 30-45 minutes, including set-up time, but the actual treatment only takes 2-5 minutes. The patient lies on a treatment table and is positioned under the radiation machine while special shields or blocks are used to protect healthy tissues.

Radiation therapy delivers controlled, safe and effective doses of radiation to cancerous tumors. The tumor cells are exposed to high doses of radiation that destroy their genetic material and eventually damage or kill them. Hence the cancer can no longer grow, multiply or spread after the treatment. Though the radiation affects all the cells, healthy ones are able to recover fully from the effects of the treatment.

Radiotherapy is generally administered either externally or internally. During external radiation therapy—the most common form of the treatment—a machine is used to direct high-energy rays at the cancer. In contrast, internal radiotherapy (also called brachytherapy) uses a radioactive source that is temporarily or permanently implanted directly into the cancerous area.

So how long does the radiation therapy take?

The exact duration of the treatment depends on the type, characteristics, and location of the tumor.  The length of treatment also depends on the dosage to be delivered, the number of fractions to be given, the treatment plan created by the radiation oncologist, and whether it is external or internal radiotherapy.

For example, if you have a deeper tumor, then you may require a more-focused beam delivered for a shorter period of time. But if you have a larger, shallow tumor, then you may need treatment for a longer period.

Equally, since the radiation must be given in a way that has minimal adverse effects on healthy cells, a shorter length of exposure is necessary if the tumor is located in more delicate organ (like the brain) or is in close proximity to very sensitive body tissues.

Your radiation oncologist will assess your tumor and make the necessary prescription. Then, by working with your radiation oncology team, the oncologist will determine how best to deliver the prescribed dosage, how many treatments are necessary, and how long it should take.

Next, your radiation oncologist will oversee the simulation of treatment to ensure that appropriate dose is given to the right location and that as little as possible reaches normal tissue. The simulation is followed by the testing of the delivery set-up to check the performance and positioning of the equipment to be used to give the treatment. After that, your treatment visits begin with the radiation therapist in charge of administering the daily fractions.

How long does external radiation therapy take?

External radiotherapy is typically delivered daily, from Monday through Friday, for five to eight weeks. Weekend breaks are factored into the treatment schedule to allow healthy cells to recover. Each treatment is offered on an outpatient basis.

But there are exceptions to this schedule.  Some tumors may require treatment for less than five days per week and only need treatment for one to two weeks. Specifically, shorter durations of two or three weeks in length are commonly used in palliative care—the use of radiation to relieve cancer symptoms. Still other tumors, such as certain brain cancers, may require just a single treatment.

External radiation therapy is a painless process and is almost like having a regular x-ray. You’ll be in a room for 30-45 minutes because of the time it takes to set up equipment and place you in the correct position, but the actual treatment takes 2-5 minutes.

Once in the room, you’ll lie on the treatment table. You’ll then be positioned under the radiation machine. Your radiation therapist will place special shields or blocks between the machine and other parts of your body to protect normal tissues. Thereafter, you’re expected to remain still, though you don’t have to hold your breath.

After you’re in the correct position, your radiation therapist will move into a separate, nearby room to turn on the machine and begin the actual treatment. The therapist will watch you on a monitor and you’ll be able to communicate with the therapist through an intercom.

How long does internal radiation therapy take?

Brachytherapy uses radiation implanted inside the body to treat cancer. The radiation implant is placed as close as possible to the tumor in order to concentrate the radiation on the cancer cells and minimize radiation damage on normal tissue around the tumor.  The radioactive material is sealed in a thin wire or hollow tube (catheter) and implanted directly into the cancer affected area on a temporary or permanent basis.

Internal radiation therapy is used when the oncologist decides that the best way to treat the tumor is to expose it to a higher radiation dose. The radioactive implant is closer to the cancerous cells and delivers a higher dose over a shorter period of time. The treatment is ideal for several types of cancers, including breast cancer, brain tumor, gynecological cancer (like ovarian and cervical cancer), lung cancer, and head and neck cancer.

The time taken for brachytherapy and whether it is done on an inpatient or outpatient basis depends on the type of therapy used and the nature of the cancer. In some cases, internal radiotherapy can be completed within three to five outpatient treatments of a few minutes each. But in other cases, the radioactive implant may be left in place for up to a week and there is need for a hospital stay during that period.

Finishing your radiation therapy sessions

It is important to finish all sessions of radiotherapy. And never to miss or delay treatments because this may reduce the effectiveness of the radiation in killing the tumor cells.

You should remember that your doctors are not just bothering you with making several hospital visits. There is need for different sessions because radiation is destructive and should not be delivered all at ago. In fact, if the recommended dosage was to be given once, it would pose a greater risk to healthy tissues and produce more adverse effects.

At Advanced Urology Institute, we spend the necessary time, effort and expertise to design a detailed treatment plan for radiation therapy. We offer the treatment in conjunction with other therapies and with the help of experienced oncologists and a multidisciplinary cancer care team.

We are also committed to reducing the time our patients take in treatment and often implement maximized aggressive treatments when necessary. Contact us today to learn whether radiotherapy is right for you and the various options available for you. For more information, visit the site “Advanced Urology Institute.”

References

What can cause an elevated PSA?

Key takeaways

  • The PSA test measures the quantity of a protein produced by cells of the prostate gland in a blood sample. It is typically used to screen for and monitor prostate cancer in men.
  • Elevated PSA levels can also be caused by non-cancerous conditions such as age, prostatitis, benign prostatic hyperplasia (BPH), and urinary tract infections.
  • To use an elevated PSA as the basis for ordering a prostate biopsy, it is now recommended that the level of PSA is monitored over time and any changes are monitored regularly, with a suspicious lump detected during a DRE being a more accurate basis for suspecting prostate cancer.

Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. It is synthesized by both normal and malignant cells and released in blood. The PSA test measures the quantity of this protein in a blood sample, which is then reported in nanograms of PSA per milliliter (ng/mL) of blood. A PSA level of 4.0 ng/mL and below is often considered normal.

What causes an elevated PSA level?

The blood PSA level is typically elevated in men with prostate cancer. Therefore, the test is usually ordered in conjunction with the digital rectal exam (DRE) to screen men that are asymptomatic for prostate cancer. It is also recommended for monitoring the progression of prostate cancer in men already diagnosed with the disease, and to test men with prostate symptoms to find out the nature of their problem.

Apart from prostate cancer, there are a number of conditions that may increase the PSA level. For instance, PSA is elevated with age, usually due to enlargement of prostate tissue over the years. Prostatitis (inflammation of the prostate), which is a condition common in men under 50 years due to bacterial infection, tends to result in increased PSA level. Other conditions that lead to increased PSA level include benign prostatic hyperplasia (BPH), urinary tract infections, prostate injury, recent ejaculation, high parathyroid hormone, and surgical procedures.

Normal versus abnormal PSA level

Although a PSA level of 4.0 ng/mL or below is often considered normal, the level of the protein can vary over time in the blood of the same man, making what is usually taken as the normal range less accurate. In fact, studies have indicated that some men with PSA level below 4.0 ng/mL have prostate cancer while many men with levels above 4.0 ng/mL have been found free of the cancer.

Besides, due to the various factors that may cause a fluctuation of PSA level, such as age, prostatitis, BPH, and urinary tract infections, having a fixed normal range for all men is unreliable in some cases. Equally, since PSA test results vary from one laboratory to another and because drugs like Dutasteride (Avodart) and Finasteride (Proscar) that are used to treat BPH tend to lower PSA level, a single elevated PSA may not be very helpful.

Therefore, to use an elevated PSA as the basis for ordering a prostate biopsy to ascertain whether prostate cancer is present, it is now recommended that the level of PSA is monitored over time. A continuous trend of increasing PSA in blood over a prolonged period of time, together with a suspicious lump detected via the DRE, is a more accurate basis for suspecting prostate cancer and ordering for a prostate biopsy.

Elevated PSA in prostate cancer screening

For men without symptoms of prostate cancer, an elevated PSA level may be followed by a repeat PSA test to confirm the original finding. And if the PSA level is still high, the urologist may recommend that more PSA tests and digital rectal exams be done at regular intervals so that any changes can be monitored over time. If the PSA level continues to rise or if a suspicious lump is found during a digital rectal exam, the doctor may now order for confirmatory tests.

For example, a urine test may be requested to establish if the rising PSA level is due to a urinary tract infection. Likewise, imaging tests like cystoscopy, x-rays or transrectal ultrasound may help to show the size and nature of any lump.

And if the tests show there could be prostate cancer, the urologist will recommend a prostate biopsy.  Multiple samples of prostate tissue are collected by inserting hollow needles into the prostate through the wall of the rectum. The samples are examined by a pathologist to confirm whether the cells are cancerous or not.

Elevated PSA in monitoring prostate cancer treatment

After treatment for prostate cancer, the urologist will want to continue to monitor the PSA level to establish whether the disease is recurring or not. An elevated PSA level after treatment is usually the first sign that the cancer is recurring. In fact, an elevated PSA after treatment often happens many months or years before the signs and symptoms of prostate cancer recurrence show.

A single elevated PSA test isn’t enough to conclude that the cancer has recurred. So the urologist will recommend that the test be repeated a number of times, and be done together with other tests, to check for evidence of prostate cancer recurrence. Repeated PSA tests help the doctor to establish a trend over time instead of relying on a single elevated PSA level.

At Advanced Urology Institute, we are committed to the highest standards of urologic care. We make sure to use the right diagnostic and treatment tests, techniques and procedures to deliver the best possible outcomes for our patients. That is why when it comes to the PSA test, we do not rely on a single elevated result to draw conclusions about your prostate health.

It is our practice to monitor elevated PSA for a prolonged period of time and to use the test alongside risks factors (age and family history) and other tests like the digital rectal exam, before we can make conclusions regarding your prostate health. We believe that an elevated PSA level is a valuable tool for early detection of prostate cancer and for successful treatment of the condition if the test is used properly. For more information on prostate cancer diagnosis and treatment, visit the site “Advanced Urology Institute.”

References

What to Expect When Having Radiation Therapy

Key takeaways

  • Radiotherapy is a treatment for cancer that uses high doses of radiation to kill cancer cells. It may be used before, during, or after surgery, and can also be used in conjunction with chemotherapy.
  • A radiation oncology team typically includes a radiation oncologist, radiation oncology nurse, medical radiation physicist, dosimetrist, and radiation therapy technologist, who work together to design and administer the treatment plan.
  • Before radiotherapy treatment begins, a patient will typically be referred to a radiation oncologist, have their medical records reviewed, undergo a physical exam, and have imaging scans to locate the tumor. The patient will then be asked to sign a consent form and a treatment plan will be developed before the first session.

Scheduling your initial radiotherapy session can create concern and anxiety. And of course many are worried and feel overwhelmed. 

At Advanced Urology Institute, we encourage our patients to be partners in the process and to educate themselves about the procedures. We believe that the more you know about radiotherapy before your treatment, the more confident you’ll be to face the treatment and the more likely you’ll play an active role in your recovery.

So what is radiation therapy?

Radiation therapy is the treatment of cancer using focused high doses of radiation to kill cancer cells. During treatment, specific amounts of the radiation are aimed at tumors or parts of the body affected by the cancer.  Once administered, the radiation kills, stops, or slows down the growth of cancer cells.

Radiotherapy may be used before surgery to shrink a tumor to a smaller size. But it may also be used during surgery to target certain cancer cells. In some cases, radiation therapy is used after surgery to destroy the remaining cancer cells.

When paired with chemotherapy, it can help to improve treatment outcomes. And in cancer cases where a cure is not possible, radiation therapy can be used for palliative purposes—to reduce pain, pressure or other side effects of treatment.

While the radiation affects all cells, healthy ones are able to repair themselves and recover their normal cell function after treatment. Alternatively, unhealthy cells, such as cancer cells, aren’t able to repair after radiation.  Hence, the treatment helps to destroy and eliminate unhealthy cells with minimal adverse effects on healthy cells.

What is a radiation oncology team?

Typically, radiotherapy is designed and administered by a team of highly trained medical professionals. The team usually includes a radiation oncologist, radiation oncology nurse, medical radiation physicist, dosimetrist, and radiation therapy technologist.

The radiation oncologist is the doctor who specializes in delivering radiotherapy for treating cancer and who oversees the overall treatment protocols. The doctor works closely with other team members to develop the treatment plan.

The radiation oncology nurse is skilled and experienced in caring for patients receiving radiation therapy. The nurse answers patient questions about the treatment, monitors the patient’s health during the treatment, and helps to manage the side effects.

The medical radiation physicist designs the treatment plan and is an expert in using radiation equipment. To ensure the right doses are administered with accuracy and precision, the radiation physicist is a key member of the team.

And finally, the radiation therapy technologist (radiation therapist) will directly operate the treatment machines such as a linear accelerator during therapy sessions and give the scheduled treatments. Other professionals might include social workers, nutritionists (dietitians), dentists, and rehabilitation therapists, such as physical therapists or speech therapists.

What happens before your treatment?

You’re usually referred to a radiation oncologist when your doctor believes radiotherapy might be an option worth considering. The radiation oncologist will then review your medical records, conduct a physical exam, and order various tests. The doctor then explains your options, speaks with you about the potential benefits and risks of the treatment and answers questions.

If you decide to proceed with radiotherapy, you’ll be asked to grant permission by signing the consent form. Your treatment team will then design the treatment plan before your first session.

Your treatment team will use imaging scans, such as computed tomography (CT), X-ray, and magnetic resonance imaging (MRI) to identify the tumor location. You’ll then receive small marks on your skin to assist the team in targeting the radiation beam at the tumor.

In addition, you may be fitted with immobilization devices such as tapes, foam sponges, headrests, simply molds or plaster casts. These items will help you stay secure and in the same position throughout treatment. If the radiation is targeting your head or neck, you may receive a thermoplastic mask, which is a mesh mask molded to your face and secured to the table. 

Though it is crucial for your body to remain in the same position for each treatment, your oncology treatment team cares about your comfort and would like to hear your suggestions. So speak up about how you’re feeling. Communicate with the team so you can find a comfortable position every time.

What happens during treatment?

Radiotherapy is generally scheduled for five days a week over a six to seven week period although the treatment can last for as little as two to three weeks if the goal is merely palliative. Over the course of treatment, you’ll receive small doses (fractions) of daily radiation instead of large doses. This helps to best target cancer cells and protect healthy cells in the treatment area. Compliance and consistency is key. It is advisable that you complete all your sessions as scheduled and not miss or delay any treatments. 

Before treatment is administered, your radiation therapy technologist will ask you to change into a gown and lie on the movable bed. The marks on your skin are used to position the machine and table—though you may be positioned using molds, boards or special holders. If necessary, special blocks or shields are used to protect your normal organs. You’ll then have to remain still in that position during your treatments breathing normally.

For each treatment session, you’ll be in the room for 10-30 minutes with the radiation administered for 1-2 minutes of that time. As soon as the treatment begins, the radiation therapy technologist will leave you alone in the room with a closed circuit TV and an intercom. The technologist will see and hear you at all times. So if you think you need to move, just notify the therapist and the machine will be turned off and adjusted.

The technologist controls the machine from outside as treatment progresses and monitors the machine at all times.  The treatment is painless and you’ll not see, smell or hear the radiation. In between your treatment sessions, you’ll need to undergo various tests and checks to confirm that the treatment is going on as earlier planned.

For instance, port films will be taken to ensure the positioning remains as it should be. Weekly blood tests may also be run to check your blood cell counts. Plus, your radiation oncologist will meet with you once a week to assess how your body is responding to treatment. Be sure to tell the doctor of any changes or concerns.

Top-notch radiotherapy services

At Advanced Urology Institute we provide cutting-edge treatments for cancer. Our radiotherapy service is tailored to deliver specifically targeted radiation to precisely target and kill cancer cells.

For more information on radiotherapy and other forms of cancer treatment, visit the site “Advanced Urology Institute”.

References:

What are the Conditions We Treat at Advanced Urology Institute?

Are you looking for comprehensive, effective, and safe urology services in Florida?

Advanced Urology Institute is here for you. 

With a healthcare institure designed to provide excellent, compassionate, patient-centered urologic care, Advanced Urology Institute offers top-notch, life-changing, and life-saving urology services. 

Through our experienced board-certified physicians, we’ve become a one-stop center for evaluation, diagnosis, treatment, and care for all types of urological conditions. 

We have well-equipped, thoroughly-resourced urology centers throughout the state of Florida, ensuring you can enjoy and access the highest level of care from a facility near you.

What conditions do we treat?

At Advanced Urology Institute, we use a multidisciplinary approach to help our patients diagnose, treat manage and recover from all urologic conditions. 

This includes prostate enlargement, urinary incontinence, overactive bladder, urinary tract infections, painful urination, kidney and bladder stones, erectile dysfunction, and cancers of the bladder and kidney, ureter, and testicles.

For the men, we offer diagnosis and treatment of:

  1. Enlarged prostate (BPH)
  2. Bladder problems
  3. Erectile dysfunction and male infertility
  4. Penis and testicle problems
  5. Low testosterone (low T)
  6. Peyronie’s disease
  7. Urinary incontinence
  8. Overactive bladder
  9. Vasectomy and vasectomy reversal
  10. Urinary tract infection
  11. Prostatitis
  12. Kidney stone removal

For the women, we diagnose and treat:

  1. Chronic pelvic pain
  2. Vaginal dryness
  3. Vaginal pain
  4. Pelvic organ prolapse
  5. Urinary tract infections (UTIs)
  6. Urinary incontinence
  7. Overactive bladder
  8. Interstitial cystitis
  9. Pyuria
  10. Kidney and bladder stone removal

Life-saving cancer care

We offer safe and effective state-of-the-art treatments, minimally-invasive surgical procedures, and palliative care for cancer patients who desire the highest level of cancer care. 

Our medical and surgical teams take a collaborative approach to treatment. Integrating expert knowledge from recent research and various innovations and specialties, we can ensure every patient receives the utmost care for the best possible outcomes.

We diagnose and treat:

  1. Prostate cancer
  2. Testicular cancer
  3. Bladder cancer
  4. Kidney cancer
  5. Urethra cancer
  6. Retroperitoneal tumors
  7. Soft tissue tumors

Wide range of revolutionary technology

Advanced Urology Institute boasts a friendly and supportive environment where providers offer urology services that integrate the latest technology in diagnosing and treating various conditions. 

As a result, AUI has an exceptional track record in diagnosing and treating urological problems and a reputation for outstanding outcomes for patients.

Some of the techniques we use include:

  1. Minimally-invasive incontinence procedures
  2. Da Vinci robotic-assisted surgery for prostate, bladder, and kidney cancer, female pelvic prolapse, and pediatric and adult urologic conditions
  3. Minimally-invasive prostate surgery
  4. Reconstructive bladder and kidney surgery
  5. Partial and total nephrectomy
  6. Endoscopic stone surgery, including percutaneous techniques
  7. Minimally-invasive endoscopic, percutaneous, and shockwave nephrolithotomy for renal calculi
  8. Urodynamics
  9. Penile implant surgery
  10. Testosterone replacement therapy
  11. Vasectomy and vasectomy reversal
  12. Sacral nerve stimulator (interstim)
  13. Botox injections
  14. Pediatric surgery, including circumcisions, hypospadias, and orchidopexy
  15. Cryoablation and cryotherapy for prostate cancer
  16. MRI fusion biopsies of the prostate
  17. Radiotherapy including brachytherapy, oncology services, and clinical trials

Safe, reliable, and effective urology care

At Advanced Urology Institute, we are committed to treating others as we would like to be treated. We value and prioritize the wellbeing of our patients and want to see them overcome their condition and live fulfilling lives. 

We offer urology services tailored to our patient’s needs and give safe, effective therapies that will deliver the best outcomes.

When you visit AUI, you will feel at ease and encouraged by the support you will receive.

We are committed to answering all your questions and providing you with the best information to help you make the best decisions about your health.

Call us today to schedule your consultation and find relief from your urological problem.

What Are the Side Effects of Prostate Cancer Treatment?

My name is Rishi Modh, I’m a board certified urologist with Advanced Urology Institute. 

So quality of life after prostate cancer can be a big problem for guys. We do a great job of treating the cancer but sometimes we’re left with side effects. Those side effects often include urinary incontinence for guys or erectile dysfunction. Thankfully now we have great solutions for those problems too. One of the best options we have for guys is penile implants. A penile implant is a device that is an hour long surgery with a small incision done as an outpatient where you go home the same day. This provides lasting great erectile function for men, it really restores your quality of life. 

Genetic Testing for Cancer Risk

My name is Amar J. Raval and I’m with Advanced Urology Institute.[For] men with prostate cancer or kidney cancer or upper tract urothelial carcinoma of the kidney, all of these can be predisposed to genetic risk factors. So [for example] if there’s family members with colon cancer or family history of prostate cancer or even females with breast or ovarian cancer. There are certain genes that are expressed that can be identified in these family members and so they can be screened earlier and be able to be detected earlier. This is huge in the realm of cancer and oncologic treatment because to be able to identify these patients earlier allows you to avoid bigger surgeries or avoid metastatic disease later in life and treat them so that you can extend years, joyous years in your life.

What Treatment Options Are Available for Prostate Cancer – Dr. Amar Raval

My name is Amar J. Raval and I’m with Advanced Urology Institute.

The first is watchful waiting, that’s knowing that you have prostate cancer but you don’t want to really do anything about it.

Active surveillance is when you’re diagnosed with either low risk or low volume intermediate risk prostate cancer, you follow up with PSAs and digital rectal exams every three to six (3-6) months and then biopsies subsequently. If it advances or it’s a higher stage, then you treat it.

There’s also radiation therapy with hormones, brachytherapy, and of course surgery which is a radical prostatectomy that can be done open or laparoscopically/robotically.

So there’s plenty of options out there. It can be a very confusing type of cancer to have and I think it warrants us long conversations with the patients so they know all the options that are available.

What’s New in Prostate Cancer Research with Dr. Jonathan Jay?

KEY TAKEAWAYS:

  • Proper use of the prostate-specific antigen (PSA) test is a recent advance in prostate cancer research, allowing doctors to better identify and categorize high risk or low risk, aggressive or indolent cancers and develop targeted treatment plans.
  • Advances in molecular biology, such as studying abnormal prostate cancer genes, help identify high-risk cancers and better understand the likelihood of cancer growth and spread.
  • Advanced Urology Institute offers comprehensive prostate cancer care, utilizing the latest research knowledge and techniques to minimize overtreatment and unnecessary biopsies and develop targeted treatment plans for patients.
Prostate cancer is one of the most common types of cancer in men. However, it might not show any symptoms until it reaches an advanced stage. A considerable number of men only realize they have the disease when it is already adversely affecting their lives.“This cancer is a big thing, with huge effects on the lives of patients,” says Dr. Jonathan Jay, a board certified urologist at Advanced Urology Institute in Naples, Florida. “The condition can cause urinary incontinence, reduced sexual desire, erectile dysfunction, changes in orgasm, and infertility, among other problems,” he adds.
Treatable Condition

The good news is that there are various treatments and management options for prostate cancer, even if it is found at a later stage. When detected early, the cancer is highly treatable, and most men with the disease survive.

“Prostate cancer is quite complex, which makes it difficult to predict how fast or slow it will grow and the risk associated with it,” says Dr. Jonathan Jay. “That is why, during diagnosis, we evaluate several factors to determine the aggressiveness of the tumor. After we determine the risk associated with the cancer, we are better placed to recommend the right treatment for our patients, which can yield great results,” he affirms.

The cancer is categorized as low risk, intermediate risk, or high risk depending on its ability to grow and spread to other areas of the body. Low risk prostate cancer is slow-growing and unlikely to spread quickly. In contrast, a high risk cancer is likely to spread rapidly outside the prostate.

Improved PSA Screening

One recent advance in prostate cancer research is the proper use of the prostate-specific antigen (PSA) test. Although the PSA test has had its limitations, it is still valuable for identifying and categorizing cancer as high risk or low risk, aggressive or indolent. When correctly used, it shows with accuracy those patients who have the aggressive type of cancer. This finding effectively guides the doctor to develop a more targeted treatment plan.

“The PSA got a bad reputation because it was used wrongly,” says Dr. Jonathan Jay. “But today, urologists understand that the PSA is still a very valuable tool in prostate cancer diagnosis and treatment. And it is now known that the significance of the PSA is not in whether it is elevated relative to the average, but in how it changes over time,” he asserts.

Studies have shown that the PSA is not abnormal just because it is elevated compared to the average. If the PSA of a man is stable over time, it doesn’t show prostate cancer, let alone an aggressive type of the disease. But if the PSA of a man has been stable for a prolonged period and then changes suddenly, it shows that something is wrong.

“If your PSA is one over the years, but changes to 3, then something is wrong, regardless of the fact that 3 is still within the normal range,” explains Dr. Jonathan Jay. “And if you’ve had a PSA of 6 over the past many years, then it’s not abnormal since it remains stable, regardless of the fact that it’s not within the normal range,” he adds.

Enhanced Precision with Molecular Biology

Significant progress has been made in prostate cancer research in the area of biopsies. Traditionally, prostate cancer has been confirmed and graded through a biopsy. To confirm a diagnosis, a urologist takes 8-12 needle biopsies along the prostate in a random sample and examines the cells under a microscope. However, while a biopsy tends to provide more accuracy than a typical PSA, it doesn’t give a perfect picture of the cancer.

“It is difficult to detect an aggressive cancer through the way cells look or behave,” says Dr. Jonathan Jay. “Besides, a biopsy may miss the specific areas of the prostate that would help to distinguish an aggressive from an indolent cancer,” he adds.

Advances in this area have ensured more accuracy and reduced the risk of misdiagnosis. For instance, abnormal prostate cancer genes can now be used to identify high risk cancer. The look of genes, occurrence of virulence factors, behavior, and other features are studied to better understand how likely it is that a cancer will grow and spread.

“Nowadays, we look at genes to determine the aggressiveness of prostate cancer,” says Dr. Jonathan Jay. “For example, genes of cancer cells may contain virulence factors or show how fast the cells will multiply and spread to other areas. This helps determine which cancer should be treated faster, and which categories of patients may benefit from therapeutic interventions,” he adds.

Apart from genomics, urologists can now use magnetic resonance imaging (MRI) technology before a biopsy to look for areas in the prostate that are suspicious of the cancer. This is possible thanks to new technology that fuses MRI images with real-time ultrasound to guide prostate needle biopsies to areas of specific concern.

Why Seek Prostate Cancer Treatment At Advanced Urology Institute?

At Advanced Urology Institute, we understand that prostate cancer is highly treatable when detected early and accurately.

We offer comprehensive prostate cancer care that includes the use of the latest research knowledge and techniques. With the advances in prostate cancer research, we can know who has aggressive or indolent cancer with greater accuracy, minimizing the chances of overtreatment and unnecessary biopsies.

Moreover, our urologists are acquainted with up-to-date prostate cancer knowledge, tools, and techniques. All of this helps guide treatment and enables us to develop more targeted treatment plans for our patients.

When you come to see us at our Naples, Florida office for diagnosis or treatment, we will consider your unique situation from a point of knowledge and recommend the best possible treatment for you.

For more information on prostate cancer treatment and diagnosis, visit the Advanced Urology Institute website.

TRANSCRIPTION: 

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

Listen, I’m excited about all facets of urology. You know, cancer is a big thing. Remember, prostate cancer didn’t have a chance when we died of our heart attack at 60 and 70, but it lived to be 90 and 100. Prostate cancer has got a big chance. We’re going to see a lot of patients, actually, their lives being affected by this disease.

So, one of the things that I like is that our ability to define the disease is improving. For instance, not only do we have PSA, PSA stands for prostate-specific antigen. This is a protein excreted by the prostate that can be detected at certain numbers, and there should be a certain number within the serum at a certain age. And if it’s elevated, or if it’s different than it used to be, then we know something’s wrong. And that’s important to understand. PSA got a bad reputation. Why was that? Because we used it wrong, not because it was a bad test.

The significance of PSA is not what it is in you relative to average, but what it is in you over time. For instance, my PSA for the past 10 years has been one. If my PSA is 3, which is considered normal, something’s wrong. Mr. Jones has a PSA of 6 for the past 10 years. This is above average. But he doesn’t have prostate cancer because his PSA is stable. So, again, we use this PSA in a wrong manner. That’s been one of the great evolutions of understanding this. And understanding, too, there’s some molecular biology. Again, we used to grade prostate cancers by looking at a prostate cancer under a microscope to understand the pattern and what it looked like.

You can’t really tell the aggressiveness of a prostate cancer by looking at it in its morphology. For instance, you’ve got two people walking down the street. You’ve got a young kid with a hoodie on. You’ve got a well-dressed man with a trench coat. Who’s your bank robber? Well, the guy with the trench coat has a machine gun under his trench coat. You can’t tell the behavior of something by the way it looks. So what we’ve done with prostate cancer is we have the ability to take that cancer and look at the genetics and define if it can multiply fast, can it move to other places. We can look at the virulence factors of these cancers to tell which cancer should be treated and which cannot. This is early in the process of looking at molecular biology and making decisions on how to treat and who to treat for prostate cancer. But it’s the light that we need as we hone this in and become more, be better at defining it. We’re going to make better decisions on who to treat and not to treat.

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