When is PSA OK? New Prostate Guidelines (2004) - Anthony Kim, M.D.
Can TUNA Put Your Prostate on a Diet? (2004) - Stephen Siegel, M.D.
Overactive Bladder (2004) - Joseph P. Antoci, M.D.
The above articles are excerpts from our newsletter,
Healthy U - Sept. 2004 [PDF].
See also Archived Articles.
When is PSA OK? New Prostate Guidelines (2004)
Anthony Kim, M.D.
Prostate cancer is the number one cancer affecting men over the age of 50 years old. The American Cancer Society currently recommends prostate cancer screening for all men over the age of
50. Screening includes a yearly prostate exam and blood test for PSA (prostate specific antigen). PSA is a blood test which urologists use to stratify patients as high or low risk for prostate
cancer. The normal range for PSA has historically been a level less than 4.0 ng/ml. Anything over the normal range is an indication for prostate biopsy to determine if a patient has prostate cancer.
Recent data published by the New England Journal of Medicine which has also been quoted in the New York Times, Wall Street Journal, and National Public Radio, has determined that 15% of men with "normal" PSA levels have prostate cancer. Some of these patients with "normal" PSA have an aggressive type of prostate cancer. Recently, there has been a push to decrease the normal
threshold for PSA.
The National Comprehensive Cancer Network has revised its guidelines towards PSA screening. The revised guidelines state that prostate cancer screening, with a prostate exam and PSA, should
begin at the age of 40. If the PSA in a man over the age of 40 is greater than 0.6, he should
be followed annually with PSA and prostate exam. If the PSA is lower than 0.6, then a repeat
PSA test should be obtained at age 45. If the PSA remains less than 0.6, follow-up PSA should
be tested at age 50, and then continued yearly. However, in African American men, annual
screening should begin at age 45. If PSA level increases over a level of 2.5, a prostate biopsy
should be performed. The goal of this is to further increase our ability to identify patients with
prostate cancer and diagnose it at an earlier stage. Prostate cancer is much more likely to be cured if caught early. PSA screening has been helpful in identifying patients with early disease.
With all of these changes it is important to consult your urologist to help
you understand how these changes affect you. If you have any questions, or are due for a
new PSA, please contact our office.
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Can TUNA Put Your Prostate on a Diet? (2004)
Stephen B. Siegel, M.D.
Fifteen million men over the age of 50 have benign prostatic hyperplasia (BPH). This is a
disease in which the prostate gland grows and blocks the release of urine from the bladder. Symptoms include a slow urinary stream, frequency, urgency, difficulty starting the stream, and getting up at night to urinate. Even though this is a benign disease, it can cause serious long term effects. If untreated, BPH can lead to chronic need for a drainage catheter and, even, kidney
The treatment options include medication, surgery in the hospital and minimally invasive
therapy in the office. The traditional surgery is called the transurethral resection of the
prostate (TURP). This procedure requires general or spinal anesthesia and 1-2 nights in the hospital. Risks include need for blood transfusion, urinary leakage and erectile dysfunction.
The current medications cause a relaxation of the prostate to allow for some symptom relief.
Most men describe their urination as being "like I was 20!" These medications will need to be taken for the rest of a man's life and cost about $1000 per year.
Transuretheral needle ablation (TUNA) is a minimally invasive procedure that is done
in the office. It causes the prostate to shrink in a more permanent way without the
need for long term medication. It can be done with simple local anesthesia and takes only 20-30
minutes to perform. TUNA is done by passing a telescope into the urethra and into the middle of the prostate. Two small probes are then extended into the prostate tissue. Using radio frequency, the probes heat up to a very high temperature causing destruction of the interior part of the prostate. This procedure has been available for five years and has shown to be effective over the
long term. You deserve relief!
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Overactive Bladder (2004)
Joseph P. Antoci, M.D.
Overactive bladder (OAB) is a condition that affects at least 33 million Americans. The
syndrome is characterized by frequent voiding with a strong urge. It is associated with loss
of bladder control in 17 million people. As a result, this disorder interferes with the
lives of those afflicted on occupational, social and psychological levels. Medicare
spends up to $26 billion per year in treating incontinence.
Some people have identifiable causes for OAB. These include neurological problems such as Parkinsons, strokes or spinal cord injury. Non-neurologic causes include infections, stones or tumors. Enlarged prostates in men can also cause OAB. Many people have no obvious cause for the
Initially, most patients try to cope with the problem. These strategies include knowledge of bathroom locations, use of absorbent pads, wearing dark clothing and decreasing their
fluid intake. It is also important to realize that many individuals employ these coping strategies in lieu of seeking professional treatment. The reasons for this often include embarrassment, the fear that surgery may be necessary, the mistaken belief that this is a part of "normal aging," or that there is no treatment available.
Once OAB is diagnosed, there are a variety of treatment options available. While these
include behavioral modification techniques, biofeedback, and pelvic floor exercises, most
patients are managed with medication. The major class of drugs is called anticholinergics. They stop the bladder from contracting inappropriately, thus improving the bladder's storage capacity,
as well as reducing the urgency and frequency of urination. There are newer drugs on the
market that have reduced the side effects of dry mouth and constipation. These drugs,
Ditropan XL, Detrol and Sanctura, can be taken less often and have proven effective.
There is also a patch, Oxytrol, that can deliver the medication. There is no "right" or standard
dose for every patient with OAB. Treatment is individualized to each patient. There is a mistaken belief that this is a normal part of aging or that there is no treatment available.
Many patients can see further improvement when they combine medical therapy with
behavioral therapy as well.
Finally, it is important to have realistic expectations as to what
treatment can achieve. Total dryness is not always possible. The goal of therapy is
improvement in symptoms so that patients can once again become active in their community and family. We strive to improve the patients' social and psychological well being. Virtually all patients can be helped, but only if they make the first step which is discussing the issue with their doctor.
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