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

A color-coded guide to urine

Normal urine has a yellow color, thanks to the pigment urochrome.  Urochrome is a yellow pigment formed when urobilinogen produced during the breakdown of hemoglobin is exposed to air. 

The pigment is specific to urine, but the intensity of its yellow color depends on the amount of water present in the urine. So generally normal urine can be straw-colored, yellow, or amber, depending on how dilute it is.

What color is abnormal?

Pale yellow to amber urine is normal. But the intensity of the color depends on whether it is dilute or concentrated.  Healthy urine may be clear or colorless if you drink a lot of water. But when you drink less, your urine becomes more concentrated and darker. That is why normal urine may appear honey or golden when you drink less water or are dehydrated.

Apart from fluid intake, several other factors determine the color of urine. For instance, urine color is affected by diet, vitamins, exercise, and medicines. A bright yellow pee color may be due to a high dose of vitamin B. 

When your pee color turns from the normal pale yellow to colors such as red, blue, brown, orange, or green, something may be wrong.  Of course, the usual causes of such changes may be diet, exercise, or medications, but these colors may also signal a serious health issue that requires urgent medical attention.

Here is a color-coded guide to urine appearance

  1. Clear urine

Clear urine indicates that you’re probably drinking more water than the daily recommended amount. Of course, being well-hydrated is good, but drinking too much can rob your body of some essential electrolytes.

If your urine is only occasionally clear, you shouldn’t be bothered. However, when it is always clear, then you should cut back on how much water you drink. 

Persistently clear urine even after reducing the volume of water you drink may indicate viral hepatitis or liver cirrhosis. Hence, if your urine is clear for a while and you’re not drinking large amounts of water, then you should see your doctor.

  1. Pink or red urine

Your urine can have a pink or red color after you eat foods with naturally deep pink or magenta colors, such as beets, rhubarb and blackberries. But certain medications may also give a red or pink color. For instance, medications like senna or senna-containing laxatives, phenazopyridine (Pyridium), and antibiotic Rifampin, can give a red or pink color to urine.

If you can rule out these foods and medications, then a red color indicates hematuria (blood in urine). Hematuria can be due to a range of health problems, such as kidney or bladder stones, urinary tract infections, an enlarged prostate, and tumors of the bladder and kidneys.

 Extreme exercise can also cause hematuria if it produces muscle damage, a condition called “runner’s bladder.”

  1. Light brown or orange urine

Urine can be orange when you are dehydrated. But your urine can also be light brown or orange when it has a high amount of blood due to urinary tract infection or bleeding from the bladder (especially in bladder cancer). 

Some medications, such as phenazopyridine (Pyridium), the anti-inflammatory drug sulfasalazine (Azulfidine), chemotherapy drugs, and some laxatives can equally cause urine to appear reddish-orange.

  1. Dark brown urine

If your urine looks like cola, it may be due to dehydration or to some foods, such as fava beans, aloe and rhubarb. Some medications, like laxatives, antibiotics, and muscle relaxants may also give urine a dark brown color.

When these are ruled out, then the dark brown color may be due to hepatitis, other liver disorder, or kidney malfunction, especially if you also have yellowing skin and eyes and pale stools.

  1. Blue or green urine

Food dyes can turn urine green or blue. For example, methylene blue dye found in many types of candy gives urine a bluish tinge. Also, some dyes used to test kidney or bladder function can turn urine blue. 

Besides, your urine may be blue or green due to medications, such as pain-relievers, anti-depressant drugs, urinary tract infections (green), or the rare inherited disorder called “blue diaper syndrome” that occurs in children.

When should you seek medical attention?

You should generally be proactive in seeking medical attention when your urine maintains an alarming color that gets your attention. Colors such as red or pink may be due to a serious health condition requiring urgent medical attention.

At Advanced Urology Institute, we work with our patients to ensure they appreciate the importance of a healthy urinary system on their overall health. For more information on the prevention, diagnosis and treatment of urologic disorders, visit our website “Advanced Urology Institute.”

Can Dr. Samuel Lawindy provide treatment for large kidney stones?

KEY TAKEAWAYS:

  • Percutaneous nephrolithotomy or nephrolithotripsy (PCNL) is a specialized procedure designed to remove larger kidney stones (2 cm or bigger) or complex stones, where minimally invasive procedures such as ureteroscopy and shock wave lithotripsy are not effective.
  • PCNL is performed under general anesthesia with a tiny incision made in the back of the kidney, using ultrasound or fluoroscopy guidance, and involves breaking the stone into smaller fragments with a laser or ultrasound, which are then safely flushed out of the kidney.
  • While PCNL carries some risks, such as injury to nearby organs, infection, and bleeding, it is generally a safe and effective minimally invasive procedure that provides immediate relief from symptoms and fast recovery times.

 A kidney stone that is 2 cm or larger in size causes more severe symptoms. Unfortunately, for such a large stone, the usual minimally invasive procedures such as ureteroscopy and shock wave lithotripsy do not work.

So you’ll need a more specialized procedure called percutaneous nephrolithotomy or nephrolithotripsy (PNCL).

PCNL is a surgical technique designed to remove kidney stones located in the kidney or upper ureter, where shock wave lithotripsy or ureteroscopy are not effective. Also, it is the ideal procedure for stones that are too large.

How is PCNL performed?

With percutaneous nephrolithotomy or nephrolithotripsy, a tiny incision is made through the back of the kidney directly to where the stone is.  To gain access to the exact location of the stone in the kidney or upper ureter, the surgeon relies on the guidance of ultrasound or fluoroscopy.

Once the stone is reached, the surgeon uses a power source, such as laser or ultrasound, to break the stone into smaller fragments. The resulting smaller pieces are safely flushed out of the kidney through an external tube or an internal stent.

Typically, your surgeon passes a nephroscope—a miniature fiber-optic camera—together with other small instruments through the incision and into the kidney area where the stone is located. These instruments allow the surgeon to see the stone and to then use high frequency sound waves to break it.

If the resulting pieces of the stone are removed via the tube, the procedure is called percutaneous nephrolithotomy (PCNL). But if the stone is broken up and removed by other means, the procedure is called percutaneous nephrolithotripsy (PCNL).

Depending on the position of the stone in the kidney, the surgeon will take 20 to 45 minutes to complete the procedure. The goal of the procedure is to remove all of the stone, so that no pieces are left to pass through your urinary tract.

When is PCNL recommended?

Percutaneous nephrolithotripsy or nephrolithotomy is used for:

  1. Larger stones, 2 cm in diameter or bigger
  2. Complex stones
  3. Lower pole renal stones, larger than 1 cm
  4. Irregularly shaped stones
  5. Removing kidney stones in people with infections
  6. Stones that have not broken up enough by SWL (extracorporeal shock wave lithotripsy)
  7. Kidney stones in individuals who are not candidates for ureteroscopy

Is the procedure safe?

Percutaneous nephrolithotomy does have risks but is generally a safe, effective minimally invasive procedure. Most often, it successfully removes larger kidney stones and results in immediate relief of symptoms.

During PCNL, a hole is created in the kidney that should eventually heal without other forms of treatment. However, since the procedure is done around the back or abdomen, it comes with a small risk of injury to other nearby organs, like the ureter, bladder, liver, or bowel. 

Also, like other surgical operations, PCNL comes with some risk of infection and bleeding. And because all surgeries on the kidney have a relatively rare long-term risk of high blood pressure or reduced kidney function later in life, the procedure carries these risks and should be conducted by an experienced, specially trained urologist.

What is the recovery like after PCNL?

Percutaneous nephrolithotomy is done under general anesthesia. So after the procedure, you will need a short stay in hospital to be monitored before you can go home. 

Often, an overnight stay in the hospital after the surgery is enough and you can go home the very next day. Recovery is fast and generally smooth. You should be off work for just a week. 

Safe, successful PCNL

At Advanced Urology Institute, we consider percutaneous nephrolithotomy one of the most effective techniques for stones larger than 2 cm in diameter. From our experience, patients leave the hospital stone-free after the procedure and are usually completely freed from any stone-related symptoms.

At Advanced Urologist Institute, we have a talented and skilled pool of urologists that perform the procedure frequently. For more information on the diagnosis and treatment of kidney stones, visit the site “Advanced Urology Institute.”

TRANSCRIPTION:

So my name is Samuel Lawindy, I’m a board certified urologist at Advanced Urology Institute.

So if you have a large stone in the kidney, usually two centimeters or larger, minimally invasive procedures such as a ureteroscopy or shockwave will not work.

So a PCNL or long term is percutaneous nephrolithotripsy would work very well for that.

That is where the procedure goes through the back of the kidney, directly to where the stone is and we can break it up and pull those pieces out safely and it’s a one night overnight stay at the hospital and you go home the very next day and usually patients tolerate it very well.

It’s a good option for patients who have that stone, it’s important to recognize that it is done here and does not require a tertiary care center, we do take care of it here at this facility.

 REFERENCES:

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.”

Can you still have an orgasm after vasectomy?

Rest assured, in virtually every case, you will have normal orgasms after a vasectomy. And you’ll also continue to ejaculate during those orgasms. 

A vasectomy is specifically surgically elected to stop sperm from being part of the ejaculate in order to prevent pregnancy. But in all other respects, it doesn’t change anything about sexual function.  It doesn’t stop you from ejaculating during sexual intercourse or masturbation. Neither does it stop you from achieving orgasms.

How does a vasectomy work?

The vasectomy procedure involves either cutting or blocking off two sperm-carrying tubes called the vas deferens that lead directly from the testicles. This procedure disrupts the flow of sperm to the penis during sexual activity preventing sperm cells from leaving the body. 

But having a vasectomy doesn’t stop your body from working normally. Your testicles will continue to produce sperm as usual. And your prostate gland and seminal vesicles will continue to produce semen. The only difference is that the sperm will no longer mix with the semen.

After a vasectomy, the sperm produced by the testicles doesn’t leave the body. Neither are the cells stored in your body. Instead, the sperm cells are broken down and reabsorbed by your body with no adverse effect on your sexual desire, erections, and performance.

Even without a vasectomy, sperm is usually produced and reabsorbed if they don’t leave the body during sexual intercourse or masturbation. So the process is normal and natural and has no effect on your sexual drive or performance.

No noticeable change in the ejaculate

Since your prostate gland and seminal vesicles will continue to produce the fluid that is predominant in your ejaculate, you’ll still have unaltered orgasms and unchanged ejaculations. The reason for this is that a typical ejaculate before a vasectomy is 95-99 percent semen and only 1-5 percent sperm. 

So when sperm is stopped from being part of the ejaculate, there is no significant reduction in the volume, quality or other characteristics of the ejaculate other than the absence of sperm.  You’ll still produce more or less the same quantity of fluid during orgasm with the same amount and texture of semen.

No effect on testosterone

A vasectomy has no effect on your ability to produce the male sex hormone testosterone. Once testosterone is produced in your testicles the hormone is transported through your body via the bloodstream. Since a vasectomy doesn’t change the flow of blood from your testicles to the rest of the body it won’t affect your testosterone levels.

So the good news is that a vasectomy will not affect your sexual performance. Sex will be the same as before but without the risk of making your partner pregnant. 

After a vasectomy, your sex drive and ability remains intact and there is no change in your erections or on the feeling and sensation you have during ejaculation. In fact, neither you nor your partner will notice a change in the ejaculate and in the orgasms.

No effect on muscle contractions

Orgasms are usually associated with a series of intense muscle contractions. Since a vasectomy does not interfere with the pelvic and sphincter muscles that contract during orgasm, you’ll still reach powerful and pleasurable orgasms. Plus, the procedure doesn’t interfere with the nerve impulses received from the penis.

Safe and secure vasectomy

Are you looking for a safe and permanent form of contraception? At Advanced Urology Institute, we offer vasectomies for men interested in the highest and most reliable form of birth control. 

All vasectomies are completed on an outpatient basis with the procedure taking 20-30 minutes. Afterward, expect to go home and rest for about 48 hours, then engage in lighter activities for the next 7 days followed by going back to your routine after a week.

We are proud that our vasectomy procedure:

  1. Is 99.99 percent effective in helping you prevent pregnancy
  2. Has no long-term effects on your health
  3. Does not affect your hormone levels, sex drive, erections, ejaculations, and orgasms
  4. Does not interfere with sex or the spontaneity of sex
  5. Gives you a simpler, safer and more reliable alternative to female sterilization

We also provide vasectomy reversals. 

For more information on vasectomy and vasectomy reversals, visit the site “Advanced Urology Institute.”

What is the primary symptom of bladder cancer?

Blood in the urine is the primary symptom of bladder cancer.  In fact, 8 in 10 people with bladder cancer will have blood in their urine, a condition doctors call hematuria. 

Generally, if you have visible blood in the urine there is an elevated chance that bladder cancer might be a concern. 

Non-specific sign of bladder cancer

Blood in the urine is the most common but not a very specific sign of bladder cancer. Blood in your urine could suggest common conditions such as urinary tract infection, benign (non-cancerous) tumors, kidney stones, or other benign kidney diseases.

So it’s important you tell your doctor if there is blood in your urine so that other conditions can be ruled out. 

What is the color of urine when there is bladder cancer?

Due to the presence of blood, urine can be rusty or deep red in color. In some cases, the urine may be dark brown. 

However, when the blood in urine is microscopic, it may not be detectable to the naked eyes so a urine test will be essential as a first order diagnostic tool. 

Bladder cancer and its symptoms can be subtle and oftentimes there’s little to no pain initially. 

As your bladder cancer progresses, you may experience the following:

  1. Urinate more often than usual (urinary frequency)
  2. Pain or burning sensation during urination
  3. Uncontrollable urge to urinate (urinary urgency)
  4. Pain in your pelvis or lower back
  5. Difficulty beginning urination (urinary hesitancy)
  6. Getting up several times at night to urinate
  7. Weak urine stream or trouble urinating

These symptoms may also be caused by other conditions, such as bladder stones, urinary tract infection (UTI), an overactive bladder, or an enlarged prostate (in men). You’ll need to have the symptoms checked by your doctor so that the cause can be found and treated.

What are the signs of advanced bladder cancer?

When bladder cancer has grown larger or has spread to other parts of the body, it can cause other more severe symptoms.  

Some of the symptoms include:

  1. Pain in the side or lower back
  2. Being unable to pass urine
  3. Feeling weak or tired
  4. Swelling in the feet
  5. Bone pain
  6. Weight loss
  7. Loss of appetite

Again, many of these symptoms can be caused by other conditions. So it is important that you get checked by your doctor.  If your doctor suspects that you have bladder cancer, the physician will order more specific tests and exams to confirm the cancer. 

At Advanced Urology Institute, we offer diagnostic and treatment services for bladder cancer. 

For more information on the diagnosis and treatment of bladder cancer, visit our website AdvancedUrologyInstitute.com

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 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. 

Technological Advancements in Urology

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

I love urology. I am privileged to be part of this community of urologists in the United States, and especially with Advanced Urology Institute. I think there are tremendous technological platforms that are available and we’re certainly unique in that field of surgery. From open [surgery] to robotics to laparoscopic to even prosthesis: whether it’s penile prosthesis or Interstim devices in the back to help control urinary incontinence, [and] urethral slings, there’s so much technology available in urology. It’s just a pleasure to be able to treat those patients.