Should You Be Screened for Prostate Cancer

Prostate cancer is a common cancer that affects the walnut-shaped male prostate gland. As with most cancers, early detection is an important part of any successful treatment. The most common way prostate cancer is detected is through prostate cancer screenings during a patient’s appointment with a urologist. According to Dr. Amar Raval, “Screenings are important, along with a digital rectal exam, because prostate cancer continues to be the number one cancer found in men.”

Should you be screened for prostate cancer? If you can answer yes to one or more of the following conditions, then you may need to be screened:

• If you are between the ages of 55 and 69.
• If there is a history of prostate cancer in your family.
• If you are African-American.
• If you have a pre-existing medical condition that makes treatment difficult.

Dr. Amar Raval of Palm Harbor, FLThese factors are known to increase the risk of developing prostate cancer, and it is recommended that someone who has one or more of these conditions is screened at least once a year.

There are two main types of prostate cancer screening tests that a patient may receive. The most common is a digital rectal examination (DRE). For this exam, the health care provider puts on a glove and inserts a finger into the patient’s rectum to feel for any abnormalities on the prostate that can be attributed to cancer. The other screening is a prostate specific antigen (PSA) blood test. This blood test checks the PSA level in the blood, as someone with prostate cancer will have an elevated PSA level.

If one of these tests leads to a prostate cancer diagnosis, the urologist will want to identify what kind of prostate cancer it is in order to develop the best treatment plan. Non-aggressive cancers may not necessarily need treatment and can be monitored with active surveillance, which means watching the cancer to make sure it doesn’t turn aggressive and spread. In cases where the cancer is of intermediate or high risk, early identification from a screening test can help make sure that the treatment used on the cancer has the best chance for success.

If you believe it is time for you to start being screened for prostate cancer, then you should have a conversation with your urologist. Early detection can be a life saver. For men who are concerned about prostate cancer, the Advance Urology Institute is an excellent place to begin screening.

What to know about Erectile Dysfunction

Erectile dysfunction, also commonly referred to as ED, is the inability for a man to maintain an erection for sexual activity. Although it can be an embarrassing subject to talk about, it is very common. Fifty percent of men over the age of 50 experience some degree of ED. It is important to know that there are plenty of treatment options available. As Luis Camacho, PA explains, “We have several patients with erectile dysfunction, and we can be very helpful with treatment and procedures.”

Luis Camacho, PA of Fort Myers, FLA man experiencing the symptoms of erectile dysfunction can make an appointment to discuss the issue with his urologist. A conversation about the patient’s medical history and symptoms can usually lead to an in-office diagnosis. Once diagnosed, and it is determined that the patient is healthy enough for sexual activity, the urologist and patient can discuss treatment options. Many patients find themselves surprised by the number of treatment options available to them.

The most common and familiar treatment for ED is medication. Pills are easy to take and highly effective in many cases. For this reason, most urologists start treating ED by prescribing one of the many pill options available. Another simple option is the vacuum erection device. For this treatment, a man inserts his penis into the cylindrical pump that works like a vacuum to draw blood to the penis resulting in an erection. A band then goes around the base of penis in order to maintain the erection. Yet another option is injection therapy. A patient using this therapy will give himself a small, nearly painless injection into the base of the penis. The injection stimulates an erection for a certain amount of time.

Some cases call for more invasive treatments. With a penile prothesis, an implant is surgically inserted into the penis. A pump in the scrotum that is attached to the prosthesis is used to create the erection.

When facing erectile dysfunction, it is important to know that you are not the only person dealing with this issue, and there are plenty of treatment options available that help men lead normal and satisfying sexual lives. All it takes is a conversation with a urologist at the Advanced Urology Institute to find the best ED treatment for you.

What happens when a man’s testosterone is low?

Testosterone is a male sex hormone that plays an important role in a man’s life. It is important to normal sex drive, energy and even mood. However, testosterone levels normally tend to decrease in men as they age. Although these decreases are generally normal and may even go unnoticed, they can also be severe and cause symptoms that are problematic.

Symptomatic low testosterone is a real problem that men can face when low levels of the hormone result in negative side effects. One of the most prominent symptoms is low energy and tiredness to the point of fatigue. A patient with low testosterone can also experience decreased libido or sex drive, or even erectile dysfunction. Personality can also be affected by low testosterone for those who experience moodiness, anxiety, and differing levels of stability.

Dr. Paul Arnold of Palm Harbor, FLThere are many causes of low testosterone, with simply aging being the most common reason. Men can also experience low testosterone after an injury to the testicles, chemotherapy, certain types of infections, or autoimmune diseases. In addition, there are also medications that can lower testosterone levels.

Many men with low testosterone experience no symptoms at all and, for these men, a urologist would not recommend treatment. For men who do experience the negative symptoms, one option is testosterone replacement therapy.

With testosterone replacement therapy, the hormone is brought into the body through gels, patches, or injections. The supplemental hormone brings testosterone back to normal levels and, in most cases, the patient will notice the change quickly. Energy levels, mood, and libido see quick improvements. And when testosterone replacement therapy is closely monitored by a urologist, the risks are minimal.

According to Dr. Paul Arnold, for patients receiving testosterone replacement therapy, “It’s like a light switch from their symptoms prior to treatment to post treatment.” Symptomatic low testosterone can be a difficult and depressing condition for those who miss the active life they once had. Fortunately, the urologists at the Advance Urology Institute can help you feel better and live with energy and a positive outlook again. For more information about testosterone replacement therapy, visit the Advanced Urology Institute website.

Advancement in Prostate Cancer Biopsy

Prostate cancer is one of the most common forms of cancer found in men. The likelihood of it forming in the walnut-shaped prostate organ increases with age. Luckily, there have been many major advances in how prostate cancer is diagnosed and treated. When it comes to diagnosing, board-certified urologist Dr. Jonathan Jay says, “First we must define where it is, how much of it exists within your prostate, and then what its behavior is like.”

Answering the where, how, and what is key to determining the type of prostate cancer and how to watch or treat it. Urologists are using advanced technologies to answer these questions. Urologists want to know how aggressive a cancer is when determining how aggressively they need to treat it. They can use a molecular biopsy and a high-quality T3 MRI to pick up on aggressive cancers. If an aggressive cancer is found, urologists can perform a more focused biopsy.

Dr. Jonathan Jay - Naples, FLThis focused biopsy is called a GPS Guided Biopsy and it has some very important advantages over a regular biopsy. The cancer may exist in a very small portion of the prostate, especially early on. This small cancer can be missed during a biopsy just by a sampling error, leading to a diagnosis that may not give a completely accurate picture of the cancer. But with a high-quality MRI, a guided biopsy can pinpoint the growth and the urologist can detect and determine the type of cancer with greater accuracy.

When the cancer is detected with greater accuracy, the urologist can now follow it more closely and understand what type the doctor and patient are dealing with. The urologist can perform a biopsy on the cancer to look at and understand its genetics. If the genetics show that it is not very aggressive or growing, then the urologist may decide to watch the cancer, as treatment may not be necessary. MRI’s and patient follow up can be used to watch the growth to see if there are any changes that may require more aggressive treatment.

Along with MRI’s, the cancer can be monitored with rectal exams and prostate-specific androgens (PSA) tests. These tools offer insight into the patient’s specific prostate cancer and its progression. If it becomes aggressive, the urologist can recommend surgery or radiation therapy.

A diagnosis is the beginning of a patient’s cancer treatment. At the Advance Urology Institute, urologists like Dr. Jonathan Jay utilize recent advancements in prostate cancer biopsies to provide their patients with the most accurate diagnosis and best treatment options.

Erectile Dysfunction Overview

Erectile dysfunction (male impotence) is a man’s inability to achieve or maintain an erection with enough firmness to have satisfying sex. Occasional erectile dysfunction (ED) is common and many men experience it when undergoing some form of stress. But frequent ED can be a sign of serious health, emotional or relationship problems that require the attention of a professional.

How common is erectile dysfunction?

Roughly 30 million men in the United States have problems achieving or maintaining an erection. The frequency of ED increases with age, affecting only 5-40% of men in their 40’s and up to 50-80% of men over 70 years. However, while the risk of ED increases with age, the condition is not an inevitable consequence of aging. Good health is the key to a lifetime of good sexual function.

Who is at risk of erectile dysfunction?

Dr. James Renehan of Tallahassee, FLApart from occurring frequently among the elderly, ED is often a consequence of poor emotional and physical health. It is common in men with high cholesterol, diabetes, obesity, cardiovascular disease, hypertension, prostate disease, anxiety, damage from surgery or cancer, injuries, stress, depression, performance anxiety, relationship problems, alcohol use, smoking, and drug use. Typically, ED is caused by vascular disease (such as atherosclerosis) that prevents blood supply to the penis, a neurological disorder (like multiple sclerosis) that cuts transmission of nerve impulses to the penis, chronic medical disorders such as Peyronie’s disease, stroke and diabetes, trauma, and operations for bladder, colon and prostate cancer which may affect blood supply to the penis. These risk factors may work singly or in combination.

How is erectile dysfunction treated?

When you visit a urologist, the first step in the diagnosis of the problem is a thorough sexual, medical and psychosocial history. Physical examination with emphasis on the genitourinary, neurologic and vascular systems is performed. From the information gathered, the urologist may request hormone tests (testosterone, luteinizing hormone, and thyroid – stimulating hormone, prolactin and serum hormone-binding globulin), urinalysis, PSA (prostate-specific antigen), lipid profile, and serum chemistry. Functional tests such as prostaglandin E1 injection, formal neurologic testing, nocturnal penile tumescence testing and biothesiometry may be requested, together with imaging studies such as transrectal, testes and penile ultrasonography and angiography.

If erectile dysfunction is diagnosed, the doctor may recommend treatment depending on the cause and severity of the condition. For instance, the urologist may recommend sexual counseling when no organic causes can be established for the problem. Oral medications such as sildenafil, vardenafil, tadalafil or avanafil may be offered to relieve the problem. But for those not responding to oral medicines, the urologist may inject, implant or direct the topical application of drugs such as alprostadil, phentolamine or papaverine. In some cases, an external vacuum or constriction device may be recommended while for other patients hormone replacement therapy may be used to treat severe hypogonadism (lower-than-normal testosterone). Alternatively, the urologist may opt for surgery through procedures such as revascularization, placement of penile implant or surgical correction of venous outflow.

How is erectile dysfunction prevented?

  • Eat a healthy, balanced diet that avoids saturated fats and increases the intake of vegetables, fruits and whole grains.
  • Reduce cholesterol levels through exercise, medication and diet.
  • Maintain a healthy body weight.
  • Exercise regularly.
  • Seek prompt treatment or professional help for conditions such as stress, depression, hypertension, heart disease and diabetes.

At Advanced Urology Institute, we recognize that effective treatment of erectile dysfunction involves a proper determination of the underlying cause and a frank discussion of both medical and non-medical options. This is why we have assembled an accomplished team of physicians, state-of-the-art facilities and a patient-centered system that responds to the unique needs of each patient. If you are experiencing a urological problem, make an appointment today. For more information, visit the Advanced Urology Institute website.

Vasectomy: Easy Safe Effective Birth Control

As a permanent method of birth control, vasectomy has been around for decades with good results. Today it is performed as a routine procedure with over 500,000 operations done in the United States each year.

During the procedure, the vas deferens (the duct that carries sperm from the testicles to the urethra) is cut or blocked to prevent sperm from being released during ejaculation. Sperm must travel from a man’s testicles to the urethra for pregnancy to occur during sexual intercourse, and blocking this passage is what makes vasectomy an effective method of birth control.

How is a vasectomy performed?

Dr. James Renehan of Tallahassee. FLA vasectomy is an outpatient procedure that must be performed in a medical facility or in a doctor’s office. In one technique, the urologist makes two small incisions on either side of the scrotum in order to gain access to the vas deferens. In another technique, the urologist makes one small incision to access both tubes. After accessing the tubes, the doctor cuts and seals them and then adds stitches if necessary. Doctors perform vasectomy under local anesthesia, making it as painless as possible. The procedure takes 10-20 minutes and the patient is free to go home immediately.

Recovery from the operation is easy. Your doctor will give you clear instructions which, if followed, will allow you to get back to normal in a few days. To ensure a quick recovery, you will need to apply cold packs to the area for 12-48 hours and lie on your back as much as possible. Wearing comfortable underwear or a jockstrap will protect the area. It is common to have mild discomfort, bruising and swelling of the scrotum for a few days after a vasectomy. In case of persistent and considerable pain, contact your doctor for advice. Unless your job is strenuous, you can return to work in 1-2 days. However, you must avoid heavy lifting for at least a week to avoid aggravating the wound.

How effective is vasectomy?

Vasectomy boasts of a better success rate than even the most effective forms of female contraception. The chance that a vasectomy fails (and a man impregnates his partner after the operation) is anywhere from 0.3% to 9% in the first six months after surgery. This is usually because it will take a few months for semen to be fully without sperm. Doctors suggest using another method of birth control such as condoms until follow-up analysis of semen shows zero sperm. But after this initial period, the failure risk of vasectomy drops to between 0.04% and 0.08% (about 1 in 2000). In comparison, the failure rate of intra-uterine device (IUD) is 0.2% to 0.8% while that of tubal ligation is nearly 1% during the first year after the procedure. Therefore, vasectomy is not only the best birth control method for men, but also one of the best overall.

Easy, safe and effective birth control

Vasectomy is a safe and low-risk way a man can take on the medical responsibilities of family planning. Whether you want to commit to a child-free life or do not want any more children, vasectomy is a long-term, discreet, 10-20 minute procedure with no danger to your hormonal balance and sex life. It is safer than common forms of contraception for women and recovery is quick and easy. Although this procedure should always be considered a permanent change, the success rate for vasectomy reversals is between 40% to 90% depending on how the original procedure was performed. If you decide that you do not want any more children, this procedure is worth discussing with your doctor. For more information, visit the Advanced Urology Institute website.

Symptoms and Treatment of Low Testosterone

The level of testosterone hormone in the body naturally declines as a man grows older. In fact, up to 40% of all men aged 45 years and older experience the effects of low testosterone. The symptoms of low testosterone may appear even earlier in some men.

Also called hypogonadism or low-T, low testosterone is characterized by a variety of symptoms such as:

  • Low libido (decreased sex drive)
  • Fatigue and lethargy
  • Erectile dysfunction (impotence)
  • Reduced testicle size
  • Breast growth in men (gynecomastia)
  • Loss of body and facial hair
  • Muscle weakness
  • Thinning of bones (osteoporosis)
  • Moodiness, irritability and depression
  • Decreased sense of well-being
  • Increased body fat or reduced muscle mass
  • Difficulties in concentration
  • Memory loss and sleep disturbances
  • Decreased hemoglobin level and mild anemia
  • Skin changes such as fine wrinkles
  • Diagnosis of low testosterone

Dr. Amar Raval of Palm Harbor, FLLow-T is diagnosed by measuring the quantity of testosterone in the blood. To clearly assess the level of testosterone, a urologist will request blood tests for both total testosterone and free testosterone. Often, it takes several measurements to confirm that a man has low-T because the levels tend to change throughout the day, with the highest levels occurring in the morning. Testosterone levels are also affected by body mass index (BMI), alcohol consumption, nutrition, age, illness and certain medications. Additional tests for sex hormones such as follicle stimulating hormone (FSH) and luteinizing hormone (LH) may also be requested by the urologist for a better picture.

Treatment of Low Testosterone

If low-T is diagnosed, the missing hormones may be replaced through hormone replacement therapy, restoring the body’s testosterone levels to normal. In some cases, however, particularly when low-T is diagnosed but no troublesome symptoms are noted, the urologist may not administer any treatment.

For men with bothersome symptoms, the therapy is administered to remove the symptoms and associated sexual problems. Testosterone replacement therapy can be given in different forms and the urologist will discuss options with the patient before deciding on the most appropriate method. After the treatment begins, testosterone levels are monitored to ensure the most effective dose is given.

The different ways of administering testosterone include:

  1. Injections – The urologist gives regular injections deep into a muscle (intramuscular injection) every 2-3 weeks to 3 months depending on the type of injection chosen. When appropriate, the urologist may delegate the task of injecting testosterone to a nurse or teach the patient how to self-inject. When done correctly, the injections are not painful.
  2. Testosterone Implants – Cylindrical pellets are inserted into the abdomen, thigh or buttock by the urologist under local anesthetic, once every 3-6 months.
  3. Testosterone Patches – Used every day and applied on different areas of the body, including arms, back, buttocks and abdomen, the patches work similarly to nicotine patches used by people trying to quit smoking. They deliver testosterone hormone gradually through the skin.
  4. Testosterone Gel – These gels are applied to clean dry skin, usually on the arm, shoulder, back or abdomen. They should be applied after showering to prevent the gel from washing off too quickly.

There are several benefits that can be derived from testosterone replacement therapy. They include:

  • Improved sexual function
  • Enhanced mental sharpness
  • Increased bone density and protection against osteoporosis
  • Increased muscle mass and loss of body fat
  • Greater strength and improved physical performance
  • Enhanced mood and better sense of well-being

Are you experiencing any bothersome symptoms and suspect you could be having low testosterone? Speak with your doctor as soon as possible about the problem. You do not have to live with these symptoms when effective treatment is available. For more information about testosterone replacement therapy, visit the Advanced Urology Institute website.

Female Urology Conditions & Treatment—Dr. Jonathan Jay

I am Dr. Jonathan Jay, a board certified urologist with Advanced Urology Institute. While I am board certified in general urology, I also did fellowship in female urology, voiding dysfunction and pelvic floor dysfunction.

Dr. Jonathan Jay of Naples, FLOne of the inevitable consequences of aging in women is urinary problems. With increasing age, the pelvic floor muscles—a group of muscles that support the bladder, vagina and rectum—face the risk of damage. Since these muscles need to relax in order to pass urine well or have smooth bowel movement, their disruption may result in urinary problems, such as incontinence, overactive bladder, pelvic organ prolapse or pelvic floor dysfunction. Tension in these muscles may also lead to pain during sexual intercourse, painful or frequent urination and lower back pain.

Aging and urinary problems

As women age, they may develop and overactive bladder, which means they urinate at all hours and with little warning. Many women suffer from incontinence after childbirth, a condition characterized by unintentional leakage of urine when coughing, sneezing, laughing or jumping. Childbirth may also cause injury to the pelvic floor muscles leading to weak spots in the walls and muscles of the vagina when adjacent organs move from their normal positions resulting in pelvic organ prolapse.

Informed decision-making

Unlike other specialties, such as neurology and oncology, urology offers a range of treatments that deliver great results for these conditions. Actually, most patients do get better after intervention by a urologist.

In fact, one of the reasons I chose this profession is that there are so many ways to help rectify problems and restore normalcy to people’s lives. As a urologist, I get the opportunity to care for patients in their declining years when urologic problems are so common. I care about both their medical and emotional challenges.

As urologists, we have the ability to find your problem when you present with symptoms. Once the problem is identified, we educate you on what you need to do and talk with you about the different treatment options available. I like counseling patients; talking to them about the bigger picture and helping them make informed decisions.

And as we define these problems, educate patients and talk about the different treatment options available, especially the positives and negatives, we help our patients to make choices that they are comfortable with. Still, because we understand that these choices have risks, we ensure that we provide enough information to minimize the risks.

Most urinary problems are not life-threatening, but are quality of life issues. That means that by resolving them, we restore confidence, meaning and hope into our patients’ lives.

What does the treatment involve?

When we make choices for treating urinary problems, we prioritize the least invasive procedures in order to minimize the risks. Typical treatment begins with a physical examination and evaluation followed by a discussion of options such as physical and behavioral therapies–including exercises to build strength in pelvic floor muscles–and reducing water, alcohol and caffeine intake.

As an option for treating overactive bladder, we may recommend nerve therapy, a procedure which involves placing a needle in the ankle to transmit electric stimulation to the nerves that control bladder function. We may also recommend more invasive options for overactive bladder such as Botox injections and an implantable bladder pacemaker.

Depending on the symptoms, we may choose to manage pelvic organ prolapse using silicon or rubber diaphragm called a pessary, which is inserted into the vagina to support the pelvic floor. We may also recommend vaginal medications or muscle injections to help with pelvic floor dysfunction. But if the problem persists or worsens even with these interventions, we may explore surgery as a last resort.

Remarkable outcomes

In urology, we are fortunate that most of the problems are clearly defined, the treatment path is clear, and the results are usually good. At Advanced Urology Institute, we offer everything, from observation, pessaries and medications to surgery. Fortunately, most of our patients do well and get better after we apply minimally invasive procedures.

We understand that many women with urological problems might not know how common and treatable these problems are—a fact that keeps them from seeking proper care. So at AUI, we try to provide information to the public so that people are aware that there are solutions for even the most awkward and uncomfortable urinary problems. For more information on female urology conditions and their treatment, visit the Advanced Urology Institute website.

Ways to Pass Kidney Stones

Kidney stones can be a painful and difficult experience for the many men and women who get them. These stones are hard deposits of minerals that build up in the body and cause blockages in the urinary tract. The blockages can make it very painful and difficult to urinate. In addition to difficulty urinating, the stones can cause nausea as well as pain in the groin and abdomen. Luckily, there are many ways that urologists can help speed up the process.

Quynh-Dao Tonnu, PA-C: Physician Assistant in DeLand, FLFinding the best way to help a patient to pass a kidney stone depends on several factors. Not all patients are the same, and the size and difficulty of their kidney stones vary as well. If the stones are smaller than 5 millimeters, the urologist will want the patient to try and pass them naturally. This is the least invasive way to pass kidney stones, although it may not always be possible. Drinking lots of liquids for frequent urination is the key for this method. Urologists may also recommend movement like bicycling and jumping jacks to help dislodge the stones naturally.

If passing naturally is not an option, then medication may be the next step. Urologists will use some of the same medications that are used to treat an enlarged prostate. Medication like Flomax helps relieve pressure on the urinary tract by relaxing the muscles in the prostate. This allows for easier urine flow and can help the patient pass the stones.

Another treatment option that makes passing stones easier is called shock wave lithotripsy. This treatment uses a machine pressed up against the patient’s body that targets water waves directly at the kidney stones. With as many as 2,500 waves per treatment, these waves break the kidney stones into small, sand-like particles. The sandy remnant is then easily passed during urination.

In some cases, a more invasive treatment may be needed to remove the stones from the body. A surgeon may use a scope fitted with a medical laser to enter the patient’s urinary tract through the penis. They can then use the laser to break the stones up into smaller fragments for easier passing. This method is sure to help pass the stones, but a urologist may prefer to try more natural methods first.

There is no single method to passing kidney stones. What matters most is making the process as fast, safe and pain-free as possible. For more information about kidney stones, visit the Advance Urology Institute website.

Surgical Options for Overactive Bladder

If you feel frequent, sudden urges to urinate that you cannot control, you might be suffering from overactive bladder. This condition can lead to feelings of embarrassment or shame, but it’s a common problem and can be treated in a variety of ways. For many people, overactive bladder can be treated with lifestyle changes such as special diet, weight loss, regularly timed trips to the bathroom, and exercises to strengthen the pelvic floor. Dealing with symptoms by using absorbent pads is also an option.

However, for some people, these methods are not enough to ensure they can live a healthy, fulfilling life. In these situations, surgical intervention is an option to correct overactive bladder problems.

Augmentation Cytoplasty

One of the options for treating overactive bladder is called augmentation cytoplasty. This procedure increases the size of the bladder. The surgeon accomplishes this by removing a small part of the intestine and using it to replace parts of the bladder in order to increase its capacity. For some people, this procedure allows them to resume normal bladder function. For others, the use of a catheter may be necessary for the rest of their life.

Urinary Diversion Surgery

Another surgical treatment option for overactive bladder is urinary diversion surgery. This procedure involves diverting urine from the bladder. One option for bypassing the bladder involves linking the ureters, which normally connect the kidneys to the bladder, to an ostomy bag outside of the body. Another option involves the creation of a new bladder inside of the patient’s body, which means they will be able to continue normal urinary function.

Bladder Removal

Bladder removal surgery, or a cystectomy, is the last resort option for patients with overactive bladder for whom no other treatment has been successful. For men, bladder removal surgery also involves the removal of part of the prostate; for women, it involves removal of the uterus, ovaries and part of the vagina. Because this is a risky procedure that involves multiple organs, it is usually only used for more serious urological conditions such as bladder cancer or birth defects. Removal of the bladder necessitates the use of a urinary diversion such as an ostomy bag or a stoma.

An overactive bladder can be a debilitating condition, but there are many options for treatment. If you are dealing with this issue, the physicians at Advanced Urology Institute are here to help you reach a diagnosis and find a treatment to restore your quality of life.