Low Testosterone Symptoms with Dr. Brian Hale

My name is Brian Hale. I’m a board certified urologist working with Advanced Urology Institute. Men with low testosterone usually have fatigue or loss of sex drive. That’s the thing that would prompt me to check a testosterone level. Lot of times they come in with erectile dysfunction and then I have to kind of bring that out of them [and ask] “Are you also having symptoms of low testosterone?”. If they do, we try to address that first before we treat erectile dysfunction.

The Advantages of Laparoscopic and Robotic Surgery with Dr. Amar Raval

My name is Amar J. Raval and I’m with Advanced Urology Institute.Laparoscopic and robotic surgery is unique because it minimizes your pain, it [does] small incisions, and less hospital stay. So those three things are a big deal and patients recover faster and can go home with minimal pain and discomfort.

Let alone with robotic and laparoscopic techniques, the visualizations are significantly improved. You’re able to small anatomy in great detail, in 3D and also make fine movements to have a nice outcome and surgery.

Advances in Prostate Cancer Research

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.

Kidney Stones Symptoms with Dr. Brian Hale

My name is Brian Hale. I’m a board certified urologist working with Advanced Urology Institute.

So patients who have kidney stones usually complain of flank pain, which is where the pain would be behind the lower ribs and sometimes it wraps around towards the front [and] down towards the groin area. Those are the most common symptoms, [sometimes] they’ll also have blood in the urine on our testing in the office.

Usually we’ll get an ultrasound or CT scan that diagnoses the stone, it’ll tell us the size and location. If the stones are smaller [about] less than 4 millimeters in size, ninety (90) percent of those times it will pass on their own. So on those patients, I give them a chance to try to pass the stone before we operate on them. When they’re bigger, they’ll be more than 6 millimeters in size, the less of a change of passing [the stone], less than ten (10) percent. For those patients, we look at the scheduling surgery for.

How effective is a vasectomy reversal?

My name is Yaser Bassel. I’m a board certified urologist with Advanced Urology Institute.

When we counsel patients before they get a vasectomy, we do tell them that this is considered a permanent form of sterilization. However vasectomies can be reversed. The vasectomy reversal process is typically one that is not covered by insurance so it can be expensive but it is possible and typically with seventy-five to eighty percent (75-80%) success rates. [While], I do not personally perform the vasectomy reversals themselves, I do have a partner that specializes in that area. So if that is something men are interested in, that is something that is offered by our practice.

Common Prostate Health Issues – Dr. Yaser Bassel

My name is Yaser Bassel. I’m a board certified urologist with Advanced Urology Institute.

Most patients that come to us with regards to prostate health issues, the majority of them are dealing with benign disease, in particular something called Benign Prostatic Hyperplasia or BPH. Oftentimes those types of diseases and those types of symptoms can be addressed with medication and then beyond that, there are treatments for BPH that include in-office procedures and then beyond that, surgical procedures as well. 

The other spectrum is malignant prostate disease which is prostate cancer. Typically that is found with prostate cancer screening. We use the Prostate-specific Antigen (PSA) blood test for that and also digital rectal exam (DGA) to detect prostate cancer oftentimes in asymptomatic men. Typically treatments range from robotic prostatectomy, radiation therapy and now there are some newer technologies such as high intensity frequency ultrasound at our disposal. Beyond that, there are also new advanced prostate cancer therapies for prostate cancer that have gone out of the prostate as well.

Advances in ED treatment

My name is Brian Hale, I’m a board certified urologist working with Advanced Urology Institute.

When I first started urology we had injection therapy and surgery, so we did a lot of surgery for erectile dysfunction. When Viagra came out in the late 90s that obviously changed everything, and now we have a lot of options besides Viagra, medically. So the treatment of erectile dysfunction transitioned from a surgical problem to a medical problem. We still do treat men with surgery if they fail the medical options but the numbers now are very low for patients who undergo surgery for erectile dysfunction.

Surgery or Radiation for Prostate Cancer – Dr. Amar Raval


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

Surgery is surgery at the end of the day and it does have its own complications [such as] when making incisions. With radiation, I like to give it to patients who are older, who want treatment and also have medical comorbidities or different things that may limit them from being successful from a surgical outcome. It’s a big conversation to have and ultimately I give my thoughts but I leave it up to patients to decide what they want to do.

What Is Screening for Prostate Cancer?

My name is Brian Hale, I’m a board certified urologist working with Advanced Urology Institute.

Certainly any man over the age of 50 should be screened for prostate cancer, it is the #2 cause of cancer death in men. There’s a lot of controversy about the PSA because of its lack of specificity: a lot of men who have elevated PSA do not have prostate cancer, but unfortunately we don’t have a better task. We have a rectal exam but that misses more cancer than the PSA, so to stop screening for prostate cancer was a mistake and they actually only reversed that recommendation on screening for prostate cancer based on what was happening. We were seeing a lot of men with Metastatic disease.

Dr Brian Hale: Urologist in Tampa, FLI started private practice in 1995, and from 1995 until the last five (5) years or so, I didn’t have any metastatic prostate cancer patients in my practice, and now I have a lot, and a lot of it was from a lack of screening. I have patients that were trying to do everything right: watching their weight, exercising and they stopped screening for prostate cancer because of the recommendations. They would have symptoms like blockage from their prostate or blood in their urine. We would check a PSA and we would find it to be extremely high and later find they have metastatic disease because of lack of screening. I have several patients I know on the top of my head that have had that problem, unfortunately. So I would definitely recommend that they continue screening for prostate cancer. [While] it is true, we need a better test than PSA, but just because we don’t have a better test doesn’t mean we should stop screening and I think the government is coming back around to that because the treatment of metastatic prostate cancer is a lot more expensive than the treatment of early prostate cancer.

Why Nursing Is Still a Great Career Choice for Women – Donna Irving ARNP

Donna Irving, APRN of Naples, FLHi, My name is Donna Irving and I’m a Nurse Practitioner with Advanced Urology Institute.

I would say nursing, in general, [is] for women that get bored easily or they want some opportunity that will expand through a lifetime. You could still work into your sixties (60s) and still be able to do something in nursing and if you become a Nurse Practitioner you can have several specialties. You don’t have to rely on one specialty, you can go to another if you so choose so it gives you a wide variety of jobs within a job.