Types of Prostate Cancer: What You Need to Know

Prostate cancer is a complex disease. It is not easy to predict how any particular prostate tumor will grow, or how rapidly it will spread to areas outside the prostate. After a prostate cancer diagnosis, your urologist will assess various factors to determine the level of risk associated with the disease. Understanding the risk level—low, intermediate or high—will help you and your doctor make decisions to achieve the best survival rate and quality of life.

Types of prostate cancer

While there are many types of prostate cancers, urologists first divide them into two categories—aggressive and indolent—to begin determining the best treatment.

1. Aggressive prostate cancer

Dr. Scott Sellinger of Tallahassee, FLAggressive prostate cancer is the type that grows rapidly, spreads fairly early, quickly and widely, and causes massive body damage. Since it spreads swiftly via secondary deposits, it quickly becomes advanced stage cancer and is very difficult to treat, particularly during the later stages.

For aggressive high-risk prostate cancer, treatment is most effective when it begins while the tumor is still in its early stages. Without early treatment, the cells of the tumor remain highly active, multiplying rapidly. The tumor grows swiftly, spreads rapidly and causes widespread damage.

2. Indolent prostate cancer

Indolent prostate cancer is the type that grows very slowly and is unlikely to spread to areas outside the prostate. Therefore, it is a low-risk, low-volume tumor that can exist in the prostate for several years without causing significant problems. Even if left untreated, it is unlikely to spread outside the prostate; and if it spreads, it only does so slowly and locally.

How are high-risk and low-risk prostate tumors identified?

If you are diagnosed with prostate cancer, your doctor will monitor the disease periodically to see if it is growing and spreading. The primary way for monitoring the growth and spread of the tumor is the prostate-specific antigen (PSA) level in blood. PSA is produced by the prostate and reaches the bloodstream; but larger amounts of PSA in the bloodstream are usually a signal that the prostate is enlarged, infected or malignant.

For instance, the PSA doubling time—the time it takes for a patient’s PSA level to double—predicts how aggressive the cancer is. The faster the PSA level doubles, the more aggressive is the cancer. Likewise, the PSA velocity helps to predict the aggressiveness of a tumor. If the PSA level increases sharply, then the cancer is likely aggressive.

Urologists also use the Gleason score to detect how fast the cancer is growing and spreading. This score is obtained by grading cells in the tumor on the basis of how abnormal or normal the cells look under the microscope. The two most abnormal areas of the tumor are evaluated, each given a score from 1-5, and then the two numbers are added. The higher the score (typically 6 or more), the more aggressive the tumor.

While immediate treatment is called for with aggressive, high-risk tumors, a patient can live with an indolent, low-risk tumor for 20-30 years without the cancer causing any serious effects. For the slow growing tumor, we may recommend observation or a watchful waiting called active surveillance, where we monitor the growth and spread of the tumor without medical intervention.

At Advanced Urology Institute, we offer a wide range of treatment options for prostate cancer, including chemotherapy, hormone therapy, radiotherapy, and surgery. But before we can recommend any treatment, we try to determine the risk of advanced disease. For more information on the diagnosis and treatment of prostate cancer, visit the Advanced Urology Institute website.

Women have many treatment options for urinary incontinence

Female Urinary Incontinence: Lauren Masters, ARNPMy name is Lauren Masters with Advanced Urology Institute. When we’re looking at urinary incontinence, for example, most women are having some degree of incontinence; whether it be soaking through one (1) pad a day or wearing depends all day long.

Usually we can get someone at a minimum to a 50% improvement. It varies based on your history, your basic demographic and whatever else is going on in your body, but a lot of times we can get you to a good 50% and there are many women we can get to 80-90 [percent] and even a complete resolution of their issues.

Are Medications Effective in Treating Erectile Dysfunction – Dr. Yaser Bassel

My name is Yaser Bassel, I am a board-certified urologist with Advanced Urology Institute.

I would say the vast majority of them, especially if they have not tried medications prior to them being seen in our office, probably 70-80 percent of those men will at least have a response to the medication oftentimes enough to basically be satisfactory to the patient or make them pleased with the way the medication is working. So most of them would actually get a good response to the medication.

Are there other treatment options for ED?

As far as what we have available to us now and what’s on the forefront, [for] those patients that do not want medication there are some newer technologies that are available that utilize shockwave energy to try and create newer vascularity in order to get a better response for that medication and that is something that’s basically come out over the past couple of years that we are starting to utilize in our practice. For those that do not respond to medication and still want to have treatment, the next step oftentimes [is] performing a test called a Penile Doppler where we will inject the penis with a vasoactive medication which will then initiate an erection so that we can measure blood flow and also measure for a venous leak which are two reasons why patients can have issues with erectile dysfunction.

What Urology Procedures Are Performed in Our Naples Office?

I’m Rolando Rivera, I am board-certified in urology and female public medicine and reconstructive surgery with Advanced Urology Institute.

So the surgery center is designed for primary outpatient interventions that are fairly uncomplicated, so we do do a fair amount of things at the surgery center. We do our prostate procedures…Urolift, we do a fair amount of those. Simple reconstructive procedures [such as] public reconstructive surgeries, stone disease, those kinds of things [and] the more complex reconstructive surgeries that require specific equipment like I do robotic surgery for prolapse, that is a hospital procedure.

Spanish Speaking Urologists at Fort Myers, FL

Luis Camacho, PA of Fort Myers, FLMy name is Luis Camacho. I am with Advanced Urology Institute. Dr Harris and I serve patients who speak Spanish. Spanish is my mother tongue and we want patients to feel comfortable in their own language. Sometimes, there are communication issues and when we speak our main language, we communicate better. Patients feel more comfortable. Our goal is to reach a bigger Hispanic audience so we can offer them a proper service for any urological condition they might have. Regardless if there are prostate problems, erection problems, [or] kidney stones, there are a lot of treatments we can provide in this field.

UroLift Procedure for BPH

Benign Prostatic Hyperplasia (BPH) can be described as the blockage of urine as it tries to flow from the bladder, through the urethra, and out of the body. It occurs when an enlarged prostate begins to pinch the urethra, which is the tube that urine flows through as it leaves the bladder. The result is difficulty urinating, weak urine streams, and frequent urgent needs to urinate. BPH is the most common prostate problem faced by men over 50.

Dr. David Harris of Fort Myers, FLFortunately for men who suffer from BPH, medical progress is on their side. According to Dr. David S. Harris, “We now have new tools and less invasive ways of treating guys with blockage.” One of the tools he is referring to is called UroLift. This clever cutting-edge procedure is changing the way the condition is treated and how men live post-BPH.

Before UroLift, in order to open the channel in the urethra a scope would be inserted through the penis to cut and remove tissue from the blocked channel. In other instances, urologists would use a heat method to destroy prostate tissue. Although this procedure would decrease the size of the prostate to relieve pressure on the channel, it required general anesthesia and resulted in a great deal of irritation and inflammation, as well a long recovery time.

UroLift has replaced these invasive procedures. UroLift is a small implant that is placed in the urethra and compresses the tissue that is causing the blockage, opening the channel for the flow of urine. This new implant dramatically improves the strength of urine flow. It also helps create normal patterns of urination, thereby stopping the frequent, strong urges to urinate. It brings men back to normal.

The UroLift procedure is minimally invasive and is well tolerated by patients. Another huge benefit is that UroLift has far fewer side effects than previous BPH procedures. One of the main negative side effects of previous BPH treatments was that they caused sexual problems by affecting a man’s ability to get and maintain an erection for intercourse. Thanks to UroLift, sexually active men do not have to choose between their sex lives and treating their BPH.

UroLift may be the best option for men who wish to take back their lives from the symptoms of BPH without resorting to an invasive procedure. Make an appointment for a consultation with Dr. David Harris or one of the many board certified urology specialists at Advanced Urology Insitute to find out if Urolift will work for you. For more information, visit the Advanced Urology Insitute website.

BPH Causes, Symptoms, Diagnosis, and Treatment

Benign Prostatic Hyperplasia (BPH) is a condition in which the male prostate gland interferes with the outflow of urine from the bladder. It is the most common prostate problem for men 50 and older. BPH is caused by an enlarged prostate that blocks the flow of urine. The enlarged prostate pinches the urethra, which is the tube that carries urine out of the body.

The symptoms of BPH are similar to what happens when you step on a running hose. The hose becomes pinched, blocking the flow of water and weakening the stream coming out. People dealing with BPH will have trouble starting to urinate and a weak urine stream. They will strain to urinate, with the flow stopping and starting several times. Another major symptom is frequent urination. Frequent, strong urges to urinate often disrupt sleep and everyday life. This is the symptom that brings men to their urologist.

Dr. David Harris of Fort Myers, FLOnce an appointment is made with the urologist, doctor and patient can begin discussing symptoms and the diagnostic process. If the patient’s complaints are consistent with BPH, the urologist will proceed with a prostate exam. There are also other simple, non-invasive tests that can be completed at the urologist’s office that will indicate the patient’s urine flow and ability to empty his bladder. More sophisticated testing is available if additional data on the patient’s BPH issue is needed. For example, fiber optic scope evaluations give the urologist the most detailed picture of the patient’s BPH, which can then be used to devise the best treatment plan.

Treatment for BPH depends on many factors. For some men, mild symptoms can be managed with slight lifestyle changes and without medical intervention. For men with more severe symptoms, there are a variety of treatment options available. Oral medications can help relax the muscles around the prostate to allow easier urine flow. In serious cases, when medication is not enough, there are surgeries that can treat BPH. One cutting-edge option, that is less invasive than surgery and carries fewer side effects than medication, is Urolift. This minimally invasive procedure implants a stint in the urethra that opens the flow of urine and minimizes the symptoms of BPH.

BPH is a common medical issue that affects men and impacts their lives. As Dr. David S. Harris explains, “In general, many of our guys can tell you every bathroom from Lowe’s to Publix.” Living with BPH means having to plan their lives around the frequent and urgent need to urinate. The urologists at the Advanced Urology Institute work closely with patients to find the best way to solve their BPH-related issues.

Becoming a Urologist – Dr. Howard Epstein MD

To become a urologist, one must really be committed to both people and study! First, students have to be top high school students. Then they go to a college or university to study the subjects needed before attending a graduate-level medical school.

Medical School

After completing the required subject courses, students take the Medical College Admission Test (MCAT) and complete medical school applications. Applicants then must pass face-to-face interviews with professors who are medical doctors and have just one question: “Would I want this person to be my doctor?”

Once admitted to medical school, the future urologist can look forward to a program that will last at least four years, including grueling residency requirements and more exams. Upon completing exams, the student is a doctor, but merely graduating from medical school does not make a urologist!

Urology Studies

Howard Epstein, MD of St Augustine, FLThere is yet another exam called the American Board of Urology (ABU) Qualifying Examination, Part 1. Then the future urologist must complete five more years of schooling and residency practice. During this time, the new doctor must learn general surgery, surgical critical care, trauma, colorectal surgery, transplantation and plastic/reconstructive surgery. Also during this time, at least four years of clinical urology training are required. After all of that has been completed, the doctor must pass the ABU Certifying Exam (Part II) to become an ABU certified urologist.

There are a few medical programs that can shorten this process of nine years of graduate school, but they are not accepted in every state.

Re-certification as a urologist must occur every ten years. To continue as a licensed medical doctor, one must do a certain amount of continuing education credits each year. The learning never ends.

Urologists must learn how to examine and treat a large number of different disorders. They work with all kinds of diseases and injuries related to the urinary tract. The urinary tract includes the kidneys, ureters, the adrenal glands, the related arteries and veins, the bladder and the urethra. Urology also includes the male reproductive system, which means urologists also treat issues concerning erectile dysfunction.

The urinary tract is one of the most important parts of the body. It regulates which chemicals, vitamins, minerals and gasses go to every part of the body. While the urinary tract does not regulate what goes into the body, it does regulate what comes out, at least as urine, and ensures that blood composition is just right.

Dr. Howard Epstein

Dr. Howard Epstein did not have a traditional course of undergraduate studies for medical school. His first university degrees were a dual-major in electrical engineering and business administration. From friends who were in medical school, he discovered that he was more interested in their work than in the fields for which he had degrees, so he went back to school.

Dr. Epstein has been practicing medicine since 1984. He is a board certified urologist with the American Board of Urology, a fellow of the American College of Surgeons and a member of the American Urological Association. He is also with the Florida Urologic Association. Serving as the chief of urology at the Gainesville Veteran Administration Medical Center increased his awareness of the unique needs of American veterans. He currently practices medicine at the Advanced Urology Institute’s two offices in St Augustine, Florida at the Southpark and Tuscan locations. To contact Dr. Epstein or for more information, visit the Advanced Urology Institute website.

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.

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.