How is Prostate Cancer Diagnosed

About 70 percent of men diagnosed with prostate cancer through PSA screening have low-risk, low-grade disease. Unfortunately, over 90 percent of these men are placed under aggressive treatment soon after diagnosis when in real sense up to 60 percent of them may not need treatment, even in the long-term. Why does this happen? The common screening tests are not able to distinguish between men with prostate cancer that requires treatment and those with clinically insignificant disease. In fact, the PSA test, which is the most frequently used screening test, gives up to 12.5 percent false positive results.

Tackling overdiagnosis and overtreatment

There have been growing concerns over the increased number of prostate cancer cases diagnosed and treated following PSA testing. For instance, overdiagnosis through PSA tests has resulted in more men undergoing biopsy, which comes with adverse effects such as pain, acute urinary retention and urosepsis. Likewise, for men placed immediately under aggressive treatment, there are concerns over psychological distress and adverse effects to treatment such as urinary incontinence, bowel dysfunction and erectile dysfunction, among others, which are typically longstanding and life-altering. So because of the quality-of-life issues and financial costs, attention is shifting to ways of minimizing the harm caused by PSA screening, particularly ways of mitigating the conversion of overdiagnosis to overtreatment.

Risk-based screening

At Advanced Urology Institute, we have designed our screening, diagnosis and treatment processes for prostate cancer to respond to these growing concerns and minimize both overdiagnosis and overtreatment. For instance, we have included a candid patient-urologist discussion of both the PSA and digital rectal exam to make sure our patients are properly informed of their pros and cons. We also perform these screening tests in an individualized manner, based on each patient’s risk factors. As a baseline, we allow men to take their first PSA screening only when in their 40s. This enables us to develop the right screening protocol for each patient.

If a man’s PSA is low during the first test, we generally consider him to have a low lifetime risk of the disease and may not recommend frequent PSA measurements for him. And if we find PSA < 2 for a man in his 60s, we consider him to have a negligible chance of dying from the cancer and recommend that he not undergo any further PSA screening. It’s only for men with higher risk, such as those who have had a first-degree relative with the cancer — which doubles their risk of developing prostate cancer — that we may recommend more frequent screening.

Taking advantage of newer diagnostic tools

Previously, any man with a PSA result that was worrisome, such as one showing a rise over time or has an absolute high value, would automatically be a candidate for biopsy. At Advanced Urology Institute, we have changed this and now may perform other tests before we can recommend a biopsy. For instance, we can use a second test called PCA3 to define a man’s risk level and assess whether or not a biopsy is necessary for him. The PCA3 is a more specific marker for prostate cancer than the PSA and it can be measured in urine, usually after a DRE. Similarly, we can assess the aggressiveness of a tumor through genomic testing and use the results to determine whether immediate treatment or active surveillance is appropriate. So we use such tests to reduce the harm that our patients may suffer from biopsies done due to PSA-based overdiagnosis.

Individualized approach to treatment

To further reduce the chances of treating indolent prostate cancer, we use a combination of PSA and biopsy to assess and classify patients according to degree of aggressiveness of their disease. At AUI, we are committed to minimizing unnecessary, worthless or even harmful treatment after cancer diagnosis. Our most preferred management strategy, particularly for men diagnosed with localized, low-risk prostate cancer, is active surveillance as opposed to immediate treatment. It involves following men with low-grade, low-risk cancer closely and only providing treatment for tumors that exhibit aggressive behavior or are spreading to other areas of the body. Through careful observation, we have realized that a majority of men do not need treatment and therefore are spared the unnecessary aggressive interventions.

During active surveillance, we usually recommend serial PSA testing and biopsy to help monitor the behavior of the tumor. Before we put patients on active surveillance, we inform them that there is a possibility that the cancer may spread to keep them psychologically prepared just in case we detect progress. We also make them aware of the cancer-specific mortality with and without treatment, which is usually less than 10 percent without treatment and reduced by about 50 percent with radiation or surgery. We also inform them of the pros and cons of active surveillance and provide them with all the information they need to make personal treatment decisions.

Our approach is quite different for patients with high-risk prostate cancer. For them, we usually begin curative treatment as soon as possible, using the tools available to deliver safe, timely and effective treatment. The most common treatments for high-grade, high-risk prostate cancer are radiotherapy, high-intensity frequency ultrasound and robotic prostatectomy. Want to know more about prostate cancer screening, diagnosis and treatment? Visit the “Advanced Urology Institute” site.

Cryotherapy An Alternative Treatment to Radiation Therapy for Prostate Cancer

Cryotherapy means using extremely cold temperatures to freeze and destroy cancer cells. Also called cryoablation or cryosurgery — though not actually a form of surgery — cryotherapy relies on the principle that cancer cells are typically more sensitive to freezing than normal cells. So when an area affected by cancer is exposed to the very low temperatures, cancer cells die while normal cells survive the treatment. While cryotherapy can be used to treat earlier-stage prostate cancer, it isn’t used as the first treatment. It is also a great option for treating prostate tumor that’s resistant or recurs after radiation therapy. However, like brachytherapy, this treatment is not ideal for men with enlarged prostate glands.

How is it performed?

During cryotherapy, the doctor uses a trans-rectal ultrasound (TRUS) to direct several hollow needles (probes) through an incision made on the skin between the scrotum and anus and into the prostate. A very cold (freezing) fluid, such as argon gas or nitrogen liquid, is infused into the prostate via the probes (needles) and used to freeze and kill cancerous prostate cells. To prevent damage to healthy, nearby tissues, the doctor uses the ultrasound to carefully monitor the process and target the tumor with more precision.

Also, to prevent urethral damage, a warm saline solution is circulated via a catheter in the urethra to stop it from freezing. The catheter may be left in place for many weeks afterward to enable the bladder to empty during recovery. Cryotherapy requires epidural (spinal) or general anesthesia. After the procedure, patients may remain in the hospital overnight, although many usually leave on the same day.

How cryotherapy works

Living cells — normal or abnormal — cannot endure extreme cold. That’s why when the prostate gland is infused with liquid nitrogen or argon gas it quickly loses heat, the ice balls or ice crystals swell instantaneously, and the cell membranes rupture, followed by tissue damage and then cell death. After cancer is destroyed, the dead cells and tissues are cleaned up from the body by white blood cells. Also, the body’s immune system is triggered to strike out, attack and destroy any remaining cancer cells.

Cryotherapy provides several advantages over radiation and surgery, particularly in early-stage prostate cancer. It’s a less invasive procedure that can be performed using spinal or epidural anesthesia instead of general anesthesia. This is especially important when treating prostate cancer in older men. It is also beneficial for men with prostate cancer occurring simultaneously with conditions such as lung disease, heart disease or diabetes. Cryotherapy causes less blood loss, pain and swelling, requires shorter hospital stay (1-2 nights) and involves a shorter recovery period. Also, when necessary, cryotherapy can be followed by surgery or radiation therapy.

Effective alternative to radiation therapy

Even with early intervention and prompt radiotherapy, about 30-40 percent of men still experience a return of prostate cancer. Hence, further treatment is almost always necessary after radiation therapy. Cryotherapy is a great option for preventing cancer recurrence or treating recurrent prostate cancer in cases where the initial radiation therapy fails to kill enough cells. The need to use cryotherapy is determined by conducting follow-up PSA tests after radiotherapy. High PSA levels after radiotherapy implies either radio-resistance or incomplete eradication of cancer cells and cryoprobes can then be used to prevent a recurrence, particularly when the tumor is still localized. When used this way, cryotherapy is very effective — freezing the area and killing cancer cells while sparing normal cells. For more information on safe, effective treatment of prostate cancer, visit the “Advanced Urology Institute” site.

Robotic Technology in Urology: Da Vinci Robotic Prostatectomy

Urology has always been one of the leading medical specialties in the adoption and application of the latest cutting-edge technologies. For many decades urology has been one of the areas of medicine that has often readily embraced new technologies and incorporated them into everyday practice for the benefit of patients. Urology was the first medical field to espouse and use scopes for various procedures. And then with the invention of robotic systems, urologists quickly adopted and integrated the da Vinci system in their practices, using it for prostate surgery and making the da Vinci prostatectomy one of the first mainstream
surgical procedures to be performed using robotic technology.

Influence of robotic surgical systems

The introduction of robotic systems in urology has quickly enabled urologists to overcome the limitations of open prostatectomy (traditional laparoscopy) such as limited instrument movement, difficult suturing, complex reconstruction and two-dimensional vision. Likewise, the introduction and quick assimilation of robotic technology has helped to solve the problem of surgeon fatigue in laparoscopic urology. Robotic systems have enabled urologists to perform complex reconstruction and dissection in less than 2 hours delivering excellent outcomes.

Overcoming limitations of open prostatectomy

Before the emergence of robotic surgical systems, men suffering from prostate cancer had very few treatment options. The principal surgical option available was open radical prostatectomy, a procedure that involved large incisions and serious post-operative side effects. For example, when using open prostatectomy, the removal of the entire cancerous prostate resulted in increased risk of post-operative infections, excessive blood loss, considerable pain and longer hospital stays. Open prostatectomy also may lead to loss of sexual function and bladder control due to cutting of the delicate nerve plexus around the prostate. The da Vinci robotic surgery is a minimally invasive procedure that uses smaller incisions, reduces blood loss and ensures a shorter hospital stay, making things better for the patient.

Utmost precision, great outcomes

The intuitive nature of the movement of robotic instruments results in highly precise, accurate, effective and safe prostatectomy. While laparoscopic surgery’s precision is reduced by the fulcrum effect (movement of the instrument tip in the direction opposite to the surgeon’s hands), the da Vinci robotic system has no fulcrum effect, offers three-dimensional visualization, boosts degrees of freedom, eliminates tremor, reduces fatigue and provides motion scaling and ergonomic positioning. Robotic surgery is a remote controlled process in which the surgeon’s movements are precisely translated through sensitive fibers to the instrument’s tip. When applied in prostatectomy, robotic systems have been found to offer several advantages over traditional laparoscopic surgery, including minimal scarring, diminished risk of complications, clinically superior results and quicker recovery.

State-of-the-art prostatectomy at Advanced Urology Institute

Want to be treated by a highly trained and experienced team of surgeons, technicians and nurses? At Advanced Urology Institute, we have urologists who are specialists in robot-assisted surgery for prostate cancer and other urological conditions. We perform dozens of surgical procedures every month using the da Vinci robotic system. This minimally invasive, high-precision robotic technology delivers great results with complex and delicate surgeries such as prostatectomies, where the target site is surrounded and confined by the nerves regulating erectile function and urinary flow. At AUI, we use the robotic system as an exacting tool to avoid damaging these nerves, shorten recovery time and ensure quick return to normal activities.

For more information on exceptional, world-class treatment using robotic technology, visit the “Advanced Urology Institute” site.

Treating Prostate Cancer

Prostate cancer is one of the most common cancers among American men. In fact, it is the most frequently diagnosed non-skin cancer in men, with over 2 million American men currently living with the cancer. Statistically, a new case arises every 3 minutes, one in six American men has prostate cancer, while an American man dies of it every 19 minutes.

Making treatment decisions

At Advanced Urology Institute, we make every effort to deliver world-class treatment and care for patients with prostate cancer. After a diagnosis, our physicians review various treatment options before picking any treatment for the patient. We also conduct further studies, such as biomarker testing and imaging studies, to ensure that we have correctly established the stage or extent of the disease. We use this information to make the right decisions and give prostate cancer patients the most effective treatments. We choose treatment options depending on the cancer itself (high-risk, intermediate risk or low-risk) and patient factors (personal preferences, age and other health issues).

Prostate cancer treatment options

Advanced Urology Institute offers a wide range of innovative and effective diagnostic and treatment procedures for patients with prostate cancer. At the institute, newly diagnosed patients get the opportunity to meet and discuss their condition with renowned and experienced specialists on the same day.

Our treatment options include:

  1. Active surveillance: For a low-risk prostate cancer that may not harm a patient over the course of his lifetime, urologists at AUI usually recommend close observation. It often comes with secondary chemoprevention.
  2. Prostatectomy: Prostatectomy is a surgical procedure to remove the prostate. For localized prostate cancer, radical prostatectomy may be employed. However, at Advanced Urology Institute, we commonly apply the robot-assisted technique, which is a minimally-invasive, laparoscopic procedure.
  3. Radiation: An external beam of radiation is directed at the prostate in order to kill cancerous cells.
  4. Cryotherapy: Probes are inserted into the prostate gland to allow for the introduction of liquid nitrogen into the gland. Once administered, liquid nitrogen produces an ice ball inside the prostate which destroys cancerous cells.
  5. Brachytherapy: A radioactive seed is implanted in the prostate. The procedure involves inserting and removing the needles that are used to place radioactive seeds inside the prostate.
  6. Hormone therapy: Various medications can be administered to reduce or inhibit the secretion of testosterone hormone. Diminished quantities of testosterone means reduced or no growth of the cancer.
  7. Chemotherapy: Certain drugs may be used to boost the effectiveness of the other treatments, both for metastatic and localized disease.

Multi-disciplinary treatment and care

At Advanced Urology Institute, our goal is to cure prostate cancer while also maximizing the quality of life of our patients. We carefully weigh the benefits of every treatment option against the side effects and develop the most practical individualized treatment programs for all patients. We also believe that effective management of prostate cancer needs extensive collaboration. We have implemented a multidisciplinary approach to treatment that allows our various specialists, such as urologists, radiation oncologists, medical oncologists, radiologists, pathologists and clinical trial nurses to deliberate and get diverse, specialized perspectives before making treatment decisions for any patient. During AUI conferences, detailed discussions among experts help to clarify the benefits and risks of various diagnostic tests and treatment options, resulting in better treatment outcomes for our patients.

Advanced Urology Institute uses image-guided targeting, MRI, ultrasound and fusing 3-D guidance to boost the accuracy and usefulness of prostate biopsies. We also apply minimally-invasive, outpatient procedures in most cases. So, with our comprehensive consultation service and multidisciplinary approach that incorporates the latest technologies, research developments and expertise, all our patients can be sure of the best possible prostate cancer treatment. Want help with prostate cancer? Get more information from our “Advanced Urology Institute” site.

Advanced Urology Institute Working Together For You

Advanced Urology Institute is a leading urology practice that excels in the diagnosis and treatment of disorders of the female and male urinary tracts and problems of the male reproductive system. Designed to be a world-class urology center, AUI brings together a huge group of doctors who are specialists in various areas to offer coordinated, effective and top-notch urology services to their patients. From restoring fertility to curing cancer, addressing incontinence to treating kidney stones, the urology services offered by AUI touch every sphere of life and bring back smiles to the faces of all who come to us for help.

Satisfying patient experience

By centralizing the administration of urology services, the doctors are able to concentrate on delivering the highest quality service to patients from initial consultation to follow-up care. The unique partnership and collaboration of many doctors and several care centers ensures that every physician or center in AUI can broaden the scope of expertise and services provided to patients, resulting in a positive experience to meet the unique needs of our patients wherever they are. At Advanced Urology Institute, we invest our time and effort, skills and experiences to make our services better. We are dedicated to delivering life-saving medical and surgical urology care in a prompt, safe and affordable manner. For us, it is not merely our job. The wellbeing and health of our patients is our number one priority.

Innovative and cutting-edge techniques

Advanced Urology Institute is a pool of urologists from multiple subspecialties. We pride ourselves on expertise and ensure that all members of our team continue to undertake training in the latest specialized surgical and medical techniques. Our experienced urologists work collaboratively to deliver highly complex treatment and care individualized to the needs of our patients. And with our exceptional range of specialist urologists, we are able to deliver more complex and innovative surgical services not available anywhere else. As a group, we are able to pool our resources, enabling all our members to have access to better equipment, instruments and tools for managing urologic disorders. Each member of the team has more experts to seek help from and we frequently send patients to other colleagues among us with more expertise and experience. As a result, we do as good a job and deliver as great results as any other premier urology centers in the country.

Unparalleled range of services

At Advanced Urology Institute, we offer a broad range of life-improving, life-extending and life-saving services to patients of all ages. Those who come to AUI have access to every possible treatment option available. In fact, most of the patients we see usually come with issues that other institutions are not able to diagnose or treat. As a team, we are committed to delivering the right care to every patient the first time they come, guaranteeing the highest rate of treatment success. We also endeavor to provide individualized, comprehensive care for all urologic conditions and diseases, giving every patient the opportunity to tap into our collaborative and team approach to have their issues resolved. At AUI, we ensure that all our hospitals, clinics, health care facilities and physicians serve with integrity and unwavering commitment to excellence. We listen to every concern, tailor every evaluation, apply the right treatment and do what is best for the patient. As a team, we deliver beyond the expectations of our clients.

For more information, visit the “Advanced Urology Institute” site.

Types of Prostate Cancer

Prostate cancer refers to an uncontrollable accumulation of cells in the prostate gland. When the cancer occurs it means the ability to control the multiplication, growth and death of prostate cells has been lost. The prostate cells form abnormal cells that join into masses known as tumors. Once formed, a tumor can remain at its original location and not spread to any location outside the prostate. Such a tumor is called a primary tumor. But some spread to other areas of the body outside the prostate and are called secondary tumors.

Prostate Cancer Is Generally Slow-Growing

Most prostate cancers are relatively slow-growing. This means that a prostate tumor typically takes many years to grow and reach a size that is detectable. Likewise, it usually takes even a longer time for prostate cancer to spread beyond the prostate. Nevertheless, in a small percentage of men, prostate cancer can grow rapidly and spread aggressively to other areas. Because of this, it is quite difficult to know with certainty which prostate cancers are likely to grow slowly and which ones are likely to grow aggressively. It can be quite difficult to make the right treatment decisions.

Aggressive Versus Indolent Prostate Cancer

While there are many types of prostate cancers, urologists usually break them down into aggressive and indolent categories to make it easier to determine the right treatment and to treat various types of cancers effectively. Aggressive cancer is a high-risk prostate tumor that if not treated remains highly active and very likely to spread to areas outside the prostate gland. The cancer grows quickly, spreads early, rapidly and widely, and causes increased damage in the body. Because aggressive cancer spreads as secondary deposits and can quickly result in widespread damage, it progresses rapidly to advanced stage cancer and can be very difficult to treat. So for aggressive prostate cancers to be treated successfully, they should be diagnosed early and treatment should be started when the tumors are still in their early stages.

On the other hand, indolent prostate cancer is a low-risk, slow-growing and low-volume tumor that can sit in the prostate gland for many years without causing any problems. An indolent cancer is not likely to spread outside the prostate even if not treated. But if it does, the spread will be local and slow. In fact, patients with indolent prostate cancers can live for 10-20 years without the cancer causing any serious effects on their lives.

Identifying Aggressive Prostate Cancer

When a patient is diagnosed with prostate cancer, the urologist will take a biopsy of the prostate gland to make sure the cells are checked under the microscope to determine whether the cancer is aggressive or indolent.

Various cancer cells are examined and their activity graded using the Gleason score. When the microscopic exam returns a Gleason score greater than 7 for cancer that has not spread beyond the prostate, the cancer is classified as aggressive and the patient is given the appropriate treatment. However, if the Gleason score is 7 or below, the prostate cancer may be classified as indolent, depending on other patient factors.

The Gleason score also helps the urologist to decide the appropriate treatment. For instance, if it is an early-stage, slow-growing cancer with a score of 6 or below, the urologist may recommend active surveillance, which means that treatment is postponed and the patient is closely monitored for progress, such as whether the tumor is spreading or worsening. But to determine whether active surveillance is ideal, the urologist also will have to consider factors such as the patient’s life expectancy, overall health and concomitant illnesses. For aggressive cancer, the urologist will work with other doctors to create a treatment plan.

At Advanced Urology Institute in Florida we have a knowledgeable and experienced team of urologists to help diagnose and treat all types of prostate cancers. Our multidisciplinary approach to treatment ensures that even the most aggressive forms of cancer are treated safely and effectively. For more information on the screening, diagnosis, treatment, care and support for prostate cancer, visit the “Advanced Urology Institute” site.

Prostate Cancer: Early Detection and Screening

Prostate cancer screening means conducting tests to find the cancer in people with no symptoms. Screening helps in early detection of the cancer when it is still easier to treat. To detect prostate cancer before symptoms appear, urologists recommend either measuring the amount of prostate-specific antigen (PSA) in blood or doing a digital rectal exam (DRE), when the urologist inserts a gloved, lubricated finger into the rectum. If the results of a PSA or DRE are abnormal, the urologist will request further tests. Finding prostate cancer via a PSA or DRE screening means the disease is probably still at an early stage and will respond well to treatment.

PSA Screening

Prostate Cancer: Early Detection and ScreeningThe prostate-specific antigen (PSA) test measures the amount of the protein (PSA) released in blood by prostate cells. Even though both normal and cancerous (abnormal) prostate cells produce the protein, higher blood levels of PSA indicate the possibility of cancer. The PSA test is one of the best indicators of prostate cancer and is recommended by urologists because it is widely available, relatively inexpensive and is a low-risk blood test for patients.

Digital Rectal Exam (DRE)

To perform a digital rectal exam, the urologist inserts a gloved and lubricated finger into the rectum in order to feel the state of the prostate gland. Since prostate cancer often begins in the back of the prostate, DRE helps to assess the texture of this area and checks for hard areas and bumps (nodules) which might indicate cancer. DRE is also effective in detecting whether the cancer has spread to nearby tissues or has reoccurred after treatment.

Confirming Prostate Cancer

After a digital rectal exam (DRE) or PSA blood test, the urologist may request a biopsy to confirm the cancer. But before the doctor can decide whether biopsy is necessary, a number of supplementary tests and considerations must be made, including family history, ethnicity, prior biopsy findings and different forms of PSA. A biopsy means the doctor takes out a small portion of the prostate tissue to be examined under a microscope for cancerous cells. Since cancerous cells appear different from normal prostate cells, a close exam of biopsy cells will help to confirm the cancer.

When to Start Screening

The age of beginning or stopping prostate cancer screening depends on individual risk. Men with a higher risk of having prostate cancer should start screening at age 40. This includes African American men and all men with first and second degree relatives with a history of prostate cancer. Men with average risk should start screening at 50, but only after discussing it with their doctors to reduce the rate of unnecessary biopsies. Men age 75 and older or those with limited life expectancy (less than 10 years) should be discouraged from early detection testing for prostate cancer because they may not benefit much from screening. Nevertheless, a decision to go for prostate cancer screening must be made with the help of a urologist or GP and should depend on a man’s lifestyle, family history, overall health and life expectancy. For more information on screening, diagnosis and treatment of prostate cancer, visit the site, Advanced Urology Institute.

What is Prostate and Prostate Cancer?

The prostate gland is a chestnut-shaped male reproductive organ located below the urinary bladder and surrounding the upper portion of the urethra, the duct that allows passage of semen and urine. It is a conglomerate of secretory ducts that emit fluids into the urethra and ejaculatory ducts. The prostate produces a thick, white fluid which mixes with sperm from the testicles to create semen, contributing 15-30 percent of the semen secreted by a man. The gland also produces a protein known as prostate-specific antigen (PSA), which turns semen into liquid. While the prostate matures into a small, walnut-sized gland at puberty, usually between 10-14 years old, it will still grow slowly with age. However, prostate enlargement after age 50 may lead to urinary problems, often occurring as a result of inflammation or malignancy.

Prostate Cancer: What is it?

Prostate cancer is a disease that occurs when changes in prostate cells make them grow uncontrollably or abnormally. The abnormal or cancerous cells then may continue to multiply non-stop and even spread outside the prostate into nearby or distant areas of the body. Prostate cancer is rare before age 50, but is common among older men and is the second most frequent cause of all cancer-related deaths in American men. The disease is typically slow growing, often showing no symptoms until it reaches advanced stage. Hence, most men with the cancer will never know it and will just die of other causes. Nevertheless, when prostate cancer starts to grow and spread quickly, it can be very lethal and requires prompt treatment.

Causes of Prostate Cancer

Prostate cancer occurs mainly in older men, with more than 80 percent of cases seen in men older than 65 and less than 1 percent observed in men younger than 50. Men who eat lots of high-fat diets such as red meat have a higher risk of getting the disease. Studies have shown that the disease is more common among men who consume meat and dairy products regularly than in those who eat vegetables, rice and soybean products. Fats increase the amount of testosterone in the body and in turn speed up the growth and spread of prostate cancer. Men from families with a history of the cancer are at a higher risk, as are welders, rubber workers, battery manufacturers and men frequently exposed to metal cadmium. Failure to exercise regularly also may make the cancer more likely.

Symptoms of Prostate Cancer

Prostate cancer tends to show no symptoms in the early stages, but will show some symptoms in the later stages. Common symptoms include sudden or frequent urge to urinate, trouble starting a urine stream or knowing when to urinate, pain or discomfort when urinating, blood in urine or semen, and pain in the upper thighs, lower back or hips. While these symptoms may not necessarily mean you have prostate cancer, you should see a urologist or GP when you have any of them.

Diagnosis and Treatment

When you visit a urologist, a medical history and physical examination will be performed followed by a digital rectal exam (DRE) and PSA test. If the doctor detects that you are at risk of prostate cancer, a biopsy will be requested to confirm it. There are several treatment options for prostate cancer including active surveillance (watchful waiting), surgery, radiation therapy, cryotherapy, hormone therapy, chemotherapy and bone-directed treatment. Remember that early diagnosis and treatment of prostate cancer improves your chances of survival. For more information on treatment of prostate diseases, visit the site, Advanced Urology Institute.

Most Common Forms of Prostate Diseases

Located just beneath the bladder and in front of the rectum, the prostate is a tiny gland in men that helps to make semen. It is a walnut-sized gland in young men which is wrapped around the tube carrying urine away from the bladder. The prostate grows larger with age, but when it becomes too large medical problems may arise. For men older than 50, the risk of having prostate related problems is quite high.

The most common prostate diseases are:

  • Prostatitis: Inflammation of the prostate, often caused by bacteria.
  • Enlarged prostate (BPH): Benign prostatic hyperplasia is a frequent problem in older men and is characterized by the frequent urge to urinate (especially at night) and dribbling after urination.
  • Prostate cancer: A common cancer in men which responds well to early treatment.

Benign prostatic hyperplasia (BPH)

This is the most common prostate disease found in men older than 50. BPH occurs when the prostate gland has enlarged to the extent of squeezing the urethra and obstructing the flow of urine from the bladder. Benign prostatic enlargement only means the prostate has enlarged, but there is no cancer. It is treated using active surveillance or watchful waiting when symptoms are not severe, but medications or surgery may be needed in severe cases. Other treatments such as microwaves, radio waves and lasers also may be used.

Prostatitis

Inflammation of the prostate (prostatitis) is frequent in men older than 50. There are three forms of prostatitis: acute bacterial prostatitis, chronic bacterial prostatitis and chronic prostatitis. Acute bacterial prostatitis has sudden onset after a bacterial infection and is characterized by chills, fever and pain in addition to other prostate symptoms. A combination of antibiotics and pain medication may relieve the problem.

Chronic bacterial prostatitis is a recurrent bacterial infection of the prostate. It can be relieved by taking certain medications for a long time, but you contact your doctor immediately when symptoms occur. Chronic prostatitis (also known as chronic pelvic pain syndrome) is a common problem which causes pain in the groin, lower back and tip of the penis. It may be treated by a combination of medication, surgery and lifestyle changes.

Prostate cancer

It is the most frequent cancer diagnosed in American men, affecting almost 50 percent of men older than 70. An estimated 200,000 men are diagnosed with the cancer in the U.S. every year, but many men can live with it without problems as it causes few symptoms unless it has spread to other areas of the body. The risk of getting prostate cancer depends on age (men older than 50 are at higher risk), race (African-American men are at higher risk than Native-American), family history (you are at higher risk if your father or brother had it) and diet (more common in men who eat high-fat diets). It is highly curable when detected early. Prostate cancer is diagnosed using a digital rectal exam or prostate-specific antigen (PSA) test. Treatment options include watchful waiting, surgery, radiation therapy and hormone therapy.

Symptoms of prostate disease

You should visit your doctor if you have any of these symptoms:

  • Frequent urge to urinate
  • Painful or burning urination
  • Need to urinate several times at night
  • Painful ejaculation
  • Dribbling of urine
  • Blood in urine/semen
  • Frequent stiffness or pain in lower back, pelvic area, hips, upper thighs or rectal area

At Advanced Urology Institute, we have experienced physicians and state-of-the-art facilities for diagnosis and treatment of prostate diseases. If you have any of the symptoms above, visit us for help. For more information, visit the site Advanced Urology Institute.

Vasectomy Poses Minimal Risk of Prostate Cancer

For men who are done having children, vasectomy is an effective method for birth control. As a surgical procedure that involves the cutting, blocking or sealing off tubes that transport sperm out of the testicles, vasectomy prevents the release of sperm during sex and is therefore a long-term form of birth control. About 1 in 7 men undergoes vasectomy after the age of 35 years. However, while the procedure is fairly simple and generally safe, it has sparked controversy about various long-term risks, particularly its link to prostate cancer (PCa). The prostate gland is located just behind the tubes and adds essential fluids to semen, so there has been a longstanding fear that vasectomy may cause prostate cancer.

Does vasectomy increase the risk of prostate cancer?

A 2014 Harvard research generated panic when it associated vasectomy with a 10 percent increase in the risk of prostate cancer and a 20 percent increased risk of the aggressive form of the cancer. But according to a recent report published online in the JAMA Internal Medicine, those numbers were probably overblown. Based on a comprehensive review and meta-analysis drawing on more than three decades of epidemiologic literature, the researchers in this study demonstrated that any risk posed by vasectomy, if at all existent, is too small to be of clinical importance.

The researchers reviewed and analyzed 53 studies, including 33 case-control studies involving 44,536 men, 4 cross-sectional studies involving 12,098,221 men, and 16 cohort studies involving 2,563,519 men. The analysis revealed no significant link between vasectomy and aggressive prostate cancer, whether high-grade cancer (Gleason score of 8 or more), advanced (normally T3-4, positive nodes or metastasis), or fatal prostate cancer (PCa). And when data from 6 case-control studies and 7 cohort studies considered to be of low risk according to the Newcastle-Ottawa Scale were analyzed, a non-significant 6 percent increased risk of prostate cancer was noted in the 6 case-control studies while the 7 cohort studies gave a weak but noteworthy 5 percent increased risk of prostate cancer.
From the data, the researchers calculated the absolute increase in lifetime risk of prostate cancer for those who have undergone vasectomy. It was found that vasectomy has an absolute lifetime risk of prostate cancer of just 0.6 percent and may only be responsible for 0.5 percent of prostate cancer cases in the population. This led to the conclusion that the association between vasectomy and prostate cancer is at most trivial, clinically insignificant and should not stop the use of the procedure for long-term contraception.

Vasectomy is Safe

This study affirms that vasectomy is unlikely to substantially increase the risk of having any type of prostate cancer. It also affirms that there is no difference in development of prostate cancer between those who undergo vasectomy and those who do not. In fact, the small risk of low-intermediate tumors reported is attributed to the fact that men who get vasectomies also tend to take PSA tests for prostate cancer, which can detect early-stage disease.

If you are looking for a safe and effective form of birth control, do not let fears of prostate cancer discourage you. Vasectomy does not increase your risk of the cancer. And while more research on the causes of prostate cancer is still ongoing, you can lower your risk by maintaining a healthy weight, regular exercise, eating a low-fat diet, increasing vegetable intake, decreasing dairy intake, and quitting smoking. Talk to your urologist about what is right for you depending on your medical history.

Symptoms of Enlarged Prostate

An enlarged prostate, also called benign prostatic hyperplasia (BPH), is an increase in the size of the prostate. While most men have prostate growth throughout their life, not all men get bothersome symptoms. As the prostate grows it presses on the outside of the urethra and can slow down or even stop the flow of urine. BPH is common in men in their 50’s, with about 1 in 3 men above 50 years of age having urinary symptoms.

It is not clear what causes prostate enlargement. However, the following risk factors are involved:

Age – While prostate gland enlargement hardly causes symptoms in men below age 40, about a third of men in their 60’s and about half of men in their 80’s have BPH symptoms.

Hormone Levels – The balance of hormones in the body changes as men grows older, causing the prostate to grow.

Family History – Those with a blood relative, especially a father or brother, with prostate problems are more
likely to have BPH.

Ethnic Background – BPH symptoms are more common in white and black men than Asian men. Black men tend to experience BPH symptoms at a younger age than white men.

Lifestyle – Regular exercise lowers the risk of BPH while obesity increases the risk.

Diabetes and Heart Disease – The risk of BPH increases in men with diabetes, heart disease and those on beta blockers.

What are the symptoms of an enlarged prostate?

The severity of symptoms in people with BPH varies, but tends to worsen over time. Common symptoms include:

  • urgent or frequent need to urinate
  • nocturia (increased frequency to urinate at night)
  • difficulty starting urination
  • inability to completely empty the bladder
  • weak urine stream or a urine stream that stops and starts
  • straining while urinating
  • dribbling at the end of urination

The less common symptoms of BPH are:

  • inability to urinate
  • urinary tract infection
  • blood in the urine

You may never get all of these symptoms. In fact, some men with an enlarged prostate do not get any symptoms at all. In some men, the symptoms eventually stabilize and may even improve over time, while in others they may get worse. Some of these symptoms may be caused by other conditions, like anxiety, cold weather, lifestyle factors, certain medicines and other health problems. Therefore, if you have any of the above symptoms, visit your physician to find out what could be causing them.

How can a urologist help?

A urologist will take your medical history and conduct a physical exam. Depending on the severity of the symptoms, the urologist will order tests such as digital rectal exam, urine test, blood test for kidney problems, prostate-specific antigen (PSA) blood test or a neurological exam. The doctor may also request additional tests such as urinary flow test, post-void residual volume test, and 24-hour voiding diary. If the problem is more complex, the urologist may recommend a transrectal ultrasound, prostate biopsy, cystoscopy, urodynamic and pressure flow studies, intravenous pyelogram or CT urogram. If an enlarged prostate is diagnosed, the urologist has various treatment options to offer including lifestyle modifications and medicines. In severe cases, the urologist will opt for surgery. For more information and help with BPH, visit Advanced Urology Institute.

4 Common Symptoms of Enlarged Prostate

Prostate gland enlargement occurs in men as they age and is quite common in men above the age of 50. Medically referred to as benign prostatic hyperplasia (BPH), the condition can be completely benign or have serious complications such as bladder blockage, urinary retention, bladder infections, kidney stones or kidney damage. Since the prostate gland is located underneath the bladder, its increased size can block the flow of urine through the urethra, a tube that carries urine from the bladder out of the body via the penis. This in turn results in problems with urination and other complications.

Benign prostate enlargement (BPH) is not prostate cancer.

Even though the complications of an enlarged prostate may be serious, BPH is not prostate cancer. Neither does it imply you have a greater risk of getting prostate cancer. Usually, the growth of prostate tissue associated with BPH starts around the inner prostate (a ring of tissue around the urethra) and progresses inward. In contrast to this, prostate cancer often grows from the outer part of the prostate and continues outward. Therefore, having an enlarged prostate does not increase your risk of prostate cancer because the two conditions typically begin in different areas of the prostate. Nevertheless, men can have prostate cancer and enlarged prostate at the same time, so you should speak with your urologist or GP if you have any concerns about prostate cancer. Keep in mind that BPH does not cause erection problems and does not affect a man’s capacity to father children.

What causes BPH?

Generally, an enlarged prostate is considered a normal part of the aging process in men, believed to result from changes in hormone levels and cell growth. And while the actual cause of benign prostate enlargement is still unknown, studies have shown that changes in the cells of the testicles play a role in the growth of the gland. This is confirmed by the fact that men whose testicles are removed at a young age never develop the condition while those whose testicles are removed after developing BPH experience shrinkage in the size of the prostate. Some studies have also revealed that men with obesity or diabetes, as well as men with a father or brother with the condition, are more likely to develop BPH.

What are the 4 common symptoms of an enlarged prostate?

One of the more common symptoms of BPH is a frequent or urgent need to urinate. Men with BPH will have the urge to urinate more often and particularly at night, a condition known as nocturia. By frequent urination, we mean having to pass urine eight or more times a day. The need to urinate will be urgent because the increased pressure placed on the bladder and urethra by the enlarged prostate make holding urine more difficult.

On the other hand, urinating can be made more difficult by BPH because the increased pressure on the urethra may block urine flow from the bladder out through the penis. You may find it hard to start a urine stream or experience an interrupted or weak urine stream. Depending on the severity of your BPH, you may find it difficult to pass urine, a condition resulting in urine retention. When this happens, you must see your doctor immediately so that a catheter can be inserted into your bladder to drain the urine. Your doctor may recommend you see a urologist for surgery to remove a portion of the enlarged prostate tissue or make cuts on the prostate in order to widen the urethra.

Another symptom is pain during urination or ejaculation caused by pressure on the urinary tract or reproductive system due to BPH. In fact, some men even feel the need to push out urine, which may also cause pain. Remember, pain during ejaculation or urination may also be due to infection.

Other problems associated with an enlarged prostate include urinary tract infections, unusual urine color or smell, blood in urine, bladder stones, and bladder or kidney damage. But not all men with BPH show these symptoms. In fact, some men with enlarged prostate do not get any symptoms at all. If you do have symptoms, you should definitely see your doctor.

How is an enlarged prostate treated?

Your urologist will ask you questions about your symptoms and about your past health. A physical exam, a urine test (urinalysis) and a digital rectal examination will also be performed to aid diagnosis. In some cases, your doctor will request the prostate-specific antigen (PSA) test in order to rule out prostate cancer.

If you only have mild to moderate symptoms, your doctor can recommend “watchful waiting” for lifestyle changes and regular check-ups to monitor symptoms. Your doctor may also prescribe medications such as alpha-blockers or 5-alpha-reductase inhibitors to alleviate the symptoms.

If your condition does not improve after trying recommended lifestyle changes and medications, your doctor may opt for surgery. The type of surgery chosen by the urologist will depend on the size of your prostate, any other medical problems you have and the potential risks and benefits of the operation. For more information about treatments for enlarged prostate, visit an Advanced Urology Institute clinic near you.

Effective Ways To Detect Prostate Cancer

If you are a man, there is a 1-in-6 chance that you will develop prostate cancer at some point in your life. Prostate cancer is basically a tumor of the prostate, the gland located in front of the rectum and just below the bladder. The prostate helps in making the milky fluid called semen, which carries sperm out of the body during ejaculation. Prostate cancer is most common among men over 65 years of age and fairly prevalent in men aged 50-64 years. Still, the cancer can occur in younger men below 50 and screening for it should begin between 40 and 45 years of age.

Risk factors of the cancer include:

  • (Age
  • Obesity
  • Family history
  • Race
  • History of STDs (sexually transmitted diseases)
  • Diets high in fats from red meat

While prostate cancer is a highly treatable condition, many men suffer needlessly because they did not know the symptoms in order to catch it before the advanced stages. And though the cancer typically shows few signs until it has reached advanced stages, knowing the symptoms can be the difference between having to face surgery and just making a few lifestyle changes. The symptoms of prostate cancer include:

In some instances of early prostate cancer, no symptoms occur and the cancer can only be detected through routine screenings.

Effective Ways to Detect Prostate Cancer

Your urologist will start by asking you about your medical history, symptoms and risk factors. A physical examination will also be performed. The doctor will then request a prostate-specific antigen (PSA) test to analyze your blood sample for higher-than-normal levels of the prostate-specific antigen, which is a protein secreted by the prostate gland. Higher PSA levels may indicate presence of cancer. In some cases, your doctor will opt to use the PSA3 test to check for levels of antigen 3 in your urine. When PSA levels are abnormal, the urologist will usually suggest that you return in 6 months for a second PSA test to confirm the presence of the cancer. Other test options that may be used to confirm a diagnosis of prostate cancer are:

(a) Digital rectal exam: The doctor will insert a gloved finger into your lower rectum and prostate gland to check for any abnormalities in size, texture or shape of the prostate.

(b) Targeted biopsy: The doctor removes tissue samples from the prostate by using either MRI fusion-targeted 3D imaging method or the ultrasound high-yield saturation method. Samples taken are analyzed to detect the cancer and determine its severity.

(c) Prostate imaging: Also called perfusion dynamic MRI, prostate imaging uses a special contrast agent inserted into the prostate to precisely identify patients with the risk of prostate carcinoma.
Once prostate cancer is confirmed, the next step is determining its aggressiveness. The aggressiveness of a cancer helps the urologist to choose the best treatment option for the condition. So, after knowing how aggressive the cancer is, the urologist can recommend:

(a) Active surveillance: You are not offered any treatment but kept under careful observation and medical monitoring.

(b) External beam therapy (EBT): The urologist refers you to a radiation oncologist to deliver a beam of high-energy proton beams or x-ray to the tumor location. The oncologist may also use other radiation techniques such as conformal external beam radiation therapy, stereotactic body radiation therapy, proton beam therapy, or image-guided radiation therapy.

(c) Brachytherapy: In this case, radiation is delivered to your prostate by placing radioactive materials inside the prostate. The two forms used are low-dose rate (LDR) and the high-dose rate (HDR) Brachytherapy.

(d) Cryotherapy: This method uses extremely low temperatures (as low as -190 degrees Celsius) to freeze and destroy cancer cells.

(e) Surgery: The urologist makes an incision through the perineum or in the lower abdomen to remove the prostate. A skilled and experienced urologist will perform the surgery without interfering with your sexual function.
At Advanced Urology Institute, we have the best pool of urologists and state-of-the art equipment to help detect and treat prostate cancer. If you want to be screened for the condition, even without symptoms, never hesitate to see a urologist. Remember, early detection is the key to successful prostate cancer treatment. To learn more about prostate cancer screening, prevention and treatment, visit Advanced Urology Institute.

Life Changing Treatment At Advanced Urology Institute

What I Do as a Physician Assistant – Lisa Cunningham

 

 

Driven by an unwavering commitment to excellence in urology, Advanced Urology Institute offers a complete range of innovative, specialized and high quality medical services for male and female urological conditions. We have assembled a multidisciplinary team of specialists who work together for you, including preoperative nurses, urologists, pathologists, radiation oncologists, dedicated robotic surgeons, postoperative recovery specialists and nurse navigators who coordinate urologic cancer care. Our board certified experts will work with you to identify the most effective treatment that meets your individual needs, ensuring a minimal disruption of your lifestyle.

Better Outcomes

At Advanced Urology Institute, we recognize that the most effective treatment for urologic conditions requires close collaboration between urologists, oncologists and other medical specialists. We have therefore created an environment in which the interactions between different specialists result in better patient care and improved outcomes. Our specialists work together managing each case jointly right from the start because we have removed all artificial boundaries between specialties, thus ensuring that transitions are seamless. In fact, we can deliver comprehensive treatment from one location by combining surgical expertise, on-site pathology and clinical laboratories, imaging services such as radiation therapy and CT scan, leading-edge robotic technology and synchronized care, resulting in unmatched personalized patient experience.

Comfort and Convenience

As experts on the conditions of the female and male urinary tract and the male reproductive system, we endeavor to help patients navigate sensitive health issues with a focus on their comfort and convenience. Every urologist at our center is open, friendly and willing to listen to the unique story of each patient in order to correctly recognize the symptoms and provide proper diagnosis. This extends to the use of the most recent diagnostic tools and the development of personalized treatment programs for conditions such as kidney cancer, bladder cancer, prostate cancer, male erectile dysfunction, renal pelvic obstructions, adrenal disease and female urologic disorders.

Are you looking for the highest quality urology services? Visit our site ‘Advanced Urology Institute‘ for more information.