Each year, about half of men over age 50 receive a PSA (prostate specific antigen) screening, according to the Centers for Disease Control. PSA is a protein produced in the prostate, and high levels of PSA may indicate cancer. About 10 percent of men tested receive results that indicate elevated levels of PSA. Often, when elevated PSA levels are detected, your physician will recommend a biopsy. The good news is, nearly three quarters of those biopsies will show no cancer.
The National Institutes of Health estimates that as many as 30 million men in the U.S. experience erectile dysfunction, and prostate cancer is a contributor. Before you choose a treatment course, it’s important to understand this serious side effect and learn more about how it might be avoided or minimized.
Getting your questions and concerns out in the open will help ensure that you have the real story. Let’s start with the basics.
A high PSA level. A positive biopsy. A treatment recommendation that includes the word “radical.” Once a prostate cancer diagnosis sinks in, many men just want to remove it. Now. And that’s a completely valid response. But surgery may not be the only answer. It may not even be the best option for you.
Contradicting government recommendations four years ago that men should not get routine PSA testing, a new study says this simple blood test used to detect prostate cancer can reduce the number of deadly cases.
For Foothills Urology prostate surgeon Derek Zukosky, DO, the new findings reinforce his longtime position. “I strongly believe every man with a life expectancy greater than 10 years should be offered the option of prostate screening including a rectal exam and PSA test. The issue isn’t the screening—it’s what’s we do with the information that it produces and the interventions we do or do not employ,” Zukosky says.
Prostate specific antigen, or PSA, testing measures antigens in the blood that are linked to the presence of prostate cancer. Since PSA testing was introduced in the early 1990s, the United States has seen about a 50 percent reduction in the death rate from prostate cancer, but questions remain about the role testing played. Prostate cancer remains the second leading cause of cancer death among American men and the second most common cancer in men after skin cancer.
In 2012, the U.S. Preventive Services Task Force recommended against routine PSA testing, saying the benefit was offset by the risk of exposing men to potentially unnecessary treatment. The 2012 recommendation cited the possibility that PSA screenings could identify cancers that would never spread and never pose a risk. Detecting such non-threatening cancers would, overall, provide little benefit, but could needlessly expose men to treatment that carries potential side effects, including erectile dysfunction, urinary incontinence, and bowel dysfunction, according to the recommendation.
Foothills Urology’s Derek K. Zukosky, DO, is one of the metro Denver area’s first physicians to employ UroLift® System implants for permanent treatment of urinary symptoms caused by benign prostatic hyperplasia (BPH). The UroLift, approved by the U.S. Food and Drug Administration in 2013, is the first permanent implant to treat the urinary symptoms of BPH, or enlarged prostate, in men 50 or older while preserving sexual function.
“The UroLift System provides men suffering from an enlarged prostate an alternative to drug therapy or more invasive surgery. The UroLift System provides fast and meaningful relief from BPH symptoms,” Dr. Zukosky said.
Seeing blood in your urine can mean many things, but it always means you should call your doctor right away.
Common causes of leakage of blood cells into urine — or hematuria — include:
- Urinary tract infections - Bacteria have entered your body through the urethra and multiplied in your bladder. Symptoms include painful, burning, urgent, or frequent urination, and very strong-smelling urine.
- Kidney infections - Bacteria can enter your kidneys from the bloodstream or from the ducts that pass urine from the kidneys to the bladder. Signs are similar to bladder infections, but more likely to cause fever, back pain, nausea and even confusion.
- Bladder or kidney stone - Minerals in concentrated urine can leak out to form crystals on the walls of your kidney or bladder that can turn into small, hard stones over time. These stones can cause excruciating pain and bleeding. Urinary stones should be treated by a urologist to relieve immediate emergency pain and develop a treatment plan to prevent recurrence. (Foothills Urology treats all urinary stones within 24 hours, seven days a week.)
Gleason scores are the most common and useful measure of the severity of prostate cancer. But, to a patient, the score can - at first- seem as confusing as it is scary.
Gleason grades range from 1 (low) to 5 (high). When a pathologist looks at your prostate tissue biopsy, he will give a primary grade to the area where the cancer is most prominent, and a secondary grade to the next most prominent site. Those grades are added to come up with a Gleason score of 1 to 10.
Foothills Urology’s Dr. David J. Cahn is a leader in the implantation of the InterStim System, which uses mild electrical stimulation -- much like that of a pacemaker – to treat symptoms of overactive bladder. Foothills Urology is one of a handful of practices in the Denver and Boulder areas to offer the InterStim System; since 2002, Dr. Cahn has implanted hundreds of the devices.
More than 37 million adults in the United States – one in six—suffer from overactive bladder, which includes urinary urge incontinence (leaking), frequent urges to urinate, and bladder emptying problems. Women are twice as likely as men to experience urinary incontinence, and it is more common among older women. Although many of those with overactive bladder symptoms struggle with everyday activities, the condition may go undiagnosed for years because patients fear humiliation when discussing it. In fact, only one in eight Americans who have loss of bladder control has been diagnosed.
The good news is that when diagnosed, the symptoms of overactive bladder are highly treatable. However, for some people medications for overactive bladder don’t work, or produce unwanted side effects. For those patients, the InterStim System may be the answer.
As many as 1 in 10 women may develop pelvic organ prolapse. Of those, about 10 percent will need surgery, called sacrocolpopexy or sacral colpopexy, to repair pelvic organ prolapse. One of the questions women often ask me is what is the best approach to these repairs and what is the difference between robotic sacrocolpopexy and laparoscopic sacrocolpopexy
I find this question refreshing and sophisticated because it shows that women are doing their homework and becoming active in making decisions over their own health rather than just following doctor’s orders. Here are the three main things you should know about the difference in these two types of prolapse surgery:
- These are two similar approaches to the same surgery.
- Both are minimally invasive, which means surgery is performed through several small incisions rather than one large abdominal incision.
- While most urology and gynecology surgeons now perform laparoscopic sacrocolpopexy, only a few are trained and offer robotic sacrocolpopexy. It’s important that if you choose this option that you find a surgeon who has completed a fair number of these surgeries and does this surgery routinely.
Minimally invasive robotic surgery restores life to normal
For 47-year-old Patrizia Sicuranza, the expectation she had just another kidney stone was quickly replaced by a diagnosis of a rare disease: transitional cell cancer in the renal pelvis.
Now she counts six small scars among her blessings. They are the fading marks of a minimally invasive robotic surgery called a radical nephroureterectomy last November to remove her right kidney, the renal pelvis and ureter. The largest souvenir is a 2-inch scar below her belly button.
“They are disappearing. And I feel good, just the same as ever,” the Napoli-born Sicuranza said after her work shift. She’s a server in her sister’s Italian restaurant in Lakewood.