Greenlight Laser — An excellent treatment option for BPH

Author: Jeffrey Gevirtz, MD

Are you spending too much time in the men’s room? If you’re bothered by weak flow, frequency and urgency of urination, an inability to empty the bladder fully and sleep interrupted by the need to urinate frequently, you should be evaluated by a board- certified urologist, who can accurately diagnose the cause of your symptoms and discuss the different treatment options available.

The prostate is a walnut-sized gland that lies below the bladder and around the urethra in men. With age, the prostate grows in size and compresses the urethra, blocking the bladder outlet. Many men develop bothersome symptoms from this enlargement of the prostate.

There are many treatment options available to help improve the symptoms of prostate enlargement. Medications called alpha blockers can relax the prostate. Other medications can shrink the prostate. The gold-standard surgical treatment is transurethral resection of the prostate (TURP). During a TURP the obstructing prostate tissue is removed and the bladder outlet opened.
  
Many patients are unhappy with the cost, side effects and level of symptom relief that medications offer. On the other hand TURP offers excellent symptom relief but possible complications, recovery time and a few days in the hospital are a drawback.

The Greenlight Laser is a safe, effective treatment for the symptoms of prostatic obstruction. During this outpatient procedure the laser is used to vaporize the blocking prostate tissue. Symptom relief is the same as for a TURP with less risk of bleeding, no hospitalization and earlier return to normal activities. The procedure can even be done on men taking anticoagulants. The Greenlight Laser represents an excellent new option for treatment.

Experience Matters

Author: Dr. Joseph Trapasso

Is your urologist board certified? If you don’t know, you should ask.

The American Board of Urology awards certification … and recertification … to those individuals who meet specific qualifications to assure every patient that their physician has not only received appropriate training, but that he or she also has the level of urologic knowledge to practice safe and effective urology.

Board certification is a rigorous credentialing process that a urologist seeks, usually after completing a residency and training or fellowship … and then maintains. It confirms that the urologist satisfies the standards for high-quality practice. It includes a written and live exam. For patients, it adds an extra assurance of quality.

Board certification is not mandatory, but at USLV all of our physicians are board certified, and we take it very seriously. We want our patients to be confident that the doctor they are seeing has passed the urology boards and maintains certification as the years go by. They trust us with their health … so we do everything we possibly can to earn that trust.

Examining Prostate Cancer Radiation from all sides.

Author: Dr. Mark Alden

Radiotherapy is an excellent option for the treatment of prostate cancer. But before this option is chosen, it’s important to take a look at the advantages and disadvantages. 

Advantages of radiotherapy: 
• No part of your anatomy is removed. 
• It takes less than 15 minutes (daily). 
• It’s easy to do and one of the best tolerated treatments. 
• There is a significant body of literature documenting the 15-year-long term high success rate. 
• It’s designed to kill every last cancer cell, not just shrink the prostate. 
• It is exceedingly rare that radiation contributes to incontinence. (It is not on the list!) 
• No one loses potency initially from radiotherapy, but this does occur in some men over time, reaching a similar average by 5 years, as those who underwent surgical prostate removal. 

Disadvantages of radiotherapy: 
• Visiting the radiation center 5 days a week for 8 to 9 weeks is inconvenient. 
• There are some short-term side effects, such as urinary frequency, urgency, weak stream, burning, etc. and fatigue.  (These go away when the treatment is done). 
• There can be long-term side effects, such as smaller bladder capacity, loss of potency, occasional drop of blood in the stool. (Usually well tolerated, but may be permanent). 
• There is a very small incidence of radiotherapy causing cancer about 20 years later. 

Men with more advanced or “higher risk” prostate cancer (high PSA or high Gleason score) have a chance that their cancer has spread through the prostate capsule or into the lymph nodes near the prostate in the pelvis. For these patients, surgery or brachytherapy (“seed” implant) may not be sufficient. They may need a treatment that is able to be expanded to cover a wider area. In this case, radiotherapy is the best option. An Intensity Modulated Radiation plan can be generated to cover these at-risk sites in the pelvis, with relative sparing of the other organs.  Radiation therapy is the most commonly recommended approach for men with high-risk disease. 

Some men worry about backup. “What will I do if my first line of treatment fails?”  This is a worth considering.  What this question rests on, is “what is the chance that my treatment will fail?” This must be answered first. So, for low risk prostate cancer patients (whose PSA is under 10, whose Gleason score is 6 or less, and whose volume of disease is low) the cure rate is very high, better than 90%.  The chance that they will need backup is small.  So they should make their first choice of treatment the one that suits them the best. Backup is a secondary consideration. 

Fortunately, there is backup for radiotherapy failures. Cryosurgery is the standard backup option.  It is also fortunate that there is backup for surgical removal of the prostate.  Radiation is the backup after surgery.

 

Wouldn’t you rather know?

Author: Dr. Dan Silverberg

The PSA blood test has been accused of being a poor test for the detection of prostate cancer. In fact, the PSA blood test was never a test just for prostate cancer. It was a test of overall prostate health. An abnormal PSA occurs in a variety of prostate diseases. Prostate cancer is only one of them. An elevated PSA is like the “check engine light” for your prostate. If your PSA is elevated you should see a urologist to determine the underlying cause.

There have been several articles in various media lately citing statistics such as  “two thirds of men who have prostate biopsies for an elevated PSA do not have prostate cancer.” That means that one third of men who have prostate biopsies do have it. And wouldn’t you rather know?

When I tell my patients that they have prostate cancer, I tell them that we have some work to do over the next several months. I also tell them that they will live for many years and most likely live a normal life span. I want them to leave my office prepared to fight prostate cancer and understanding that they have an excellent chance of being cured.

The facts are that prostate cancer is the second-leading cause of cancer deaths in men, and is as prevalent as breast cancer is in women. Please, don’t end up as an unfortunate statistic. Have your prostate check-up every year.

I have a kidney stone. Now what?

Author: Dr. John Maggioncalda

The treatment of kidney and ureteral stones is dependent on a number of factors.  For most patients expulsive therapy will usually suffice. Expulsive therapy involves the use of analgesics, hydration and agents such as Tamsulosin to promote stone passage. If the pain from a stone can be controlled, most stones less than 6mm can be passed. For some patients with large stones or excessive pain or persistent nausea, expulsive therapy is not an option.

For larger stones, 6-7mm or greater, or for patients who fail expulsive therapy, extraction is usually preferred. Stone extraction requires ureteroscopic surgery. This procedure is often performed on an outpatient basis and requires about 45 minutes to complete. Pain post operatively is usually mild to moderate. Shock wave lithotripsy can also be performed as long as the stone is visible in the kidney or ureters. This technique is also performed on an outpatient basis with only heavy sedation.  Post operative pain is usually mild.

Larger kidney stones (>1cm) are more difficult to treat and often require multiple procedures. For patients suffering from large stones a percutaneous lithotripsy is the procedure of choice. This technique requires general anesthesia and is accomplished by dilating a tract into the kidney through the back. A large sheath is passed into the kidney near the stone and specialized instruments are used to fragment and extract the stone pieces. Post operative pain can be significant, and a hospital stay of 1 to 2 days is customary.

If you have a kidney or ureteral stone it important to seek therapy right away. Contact a urologist to make a treatment plan that is customized to you and your stone. It is also important to follow up on a regular basis to monitor the success of the treatment and to form a plan to help prevent more stones from forming.

Radiotherapy Treatment For Prostate Cancer

Author: Dr. Mark Alden

Prostate cancer is the most common cancer in men. It affects over 200,000 men in the United States every year, and over one million worldwide. Despite the popularized idea of its being less aggressive, it is a leading cause of cancer death in men. And many can suffer from it, while dying of other causes. A man’s lifetime risk of developing prostate cancer is approximately 8%.

Fortunately, it can be detected early and cured in a very high percentage of men in whom it is found. For men diagnosed with early stage prostate cancer, they have many excellent choices of treatment, all with high cure rates. The cure rates are generally at or above 90% for those in the most favorable categories.

Radiotherapy is one of the excellent options. In the 21st century, it is both very simple and very complex. It is simple in that patients come in to the center, usually wait five to 10 minutes, walk into the treatment room, lie on the treatment table, FEEL NOTHING for the 10-to-12 minutes the beam is on, walk out, drive home or to work or to their favorite hobby. The process is repeated daily, Monday to Friday for a number of weeks. There are no restrictions on activities or favorite pursuits.

Radiotherapy is complex technologically. In its state-of-the-art form we use IMRT or Intensity Modulated Radiation Therapy. This means that multiple beams are used, and each beam is made up of lots of little beams—like “pixels” — to create a highly 3D-shaped dose “cloud” around the targeted area. Each little “pixel” beam can be regulated from zero dose to full dose depending on what other organs it may pass through. In this way dose to sensitive organs can be minimized, and dose to the target maximized. This ability to get high doses into the cancer and keep the normal organs relatively lightly dosed has resulted in the high cure rates and low side effects of modern radiotherapy.

Why I Screen For Prostate Cancer

Author: Dr. Dan Silverberg

I want to tell you about a man I saw in my office recently. To protect his identity and privacy, I will call him Ted and change a few of the details of his story.

Many of you know Ted. He runs a local restaurant. He greets you when you walk in, asks how you enjoyed your meal and bids you goodbye at the cash register as you leave. If you do not know Ted, you know someone very much like him. Ted is under 60, the father of three children, two in high school and one in college. He has worked long days all of his life to provide for his family. He is a pillar in his community.

Ted is not one to go to the doctor, particularly if he is not sick. Recently, Ted had his prostate checked. He had no symptoms at all, but his prostate exam was abnormal and his PSA level was about 90. It should be less than 4.0. Prostate biopsies confirmed the diagnosis of prostate cancer. Additional testing showed that the tumor had already spread throughout his body. Ted is under treatment now, and responding well, but his prostate cancer has a huge head start. His cancer is not curable, but we hope to be able to control it for a number of years.

As Ted and his wife left my office, shell-shocked after I broke the news to them, I asked myself, where was Ted five years ago? Where was Ted three years ago or even two years ago when we could have done so much more to help him? Where was Ted when we still had a chance to cure him?

Because prostate cancer has no early signs or symptoms, the only way to find the disease while it is still curable is to screen every man over the age of 50 annually. The screening includes a PSA blood test and a digital rectal exam.  If Ted had been screened starting at age 50, his life would be much different now.

Is that a kidney stone?

Author: Dr. John Maggioncalda

Uh-oh, that feeling of pressure giving way to pain, that wave of nausea — yep, it’s a stone. To many, these very unwelcome sensations herald the passing of a kidney stone. The pain may be short-lived or long, the passing brief or not.

Kidney stones affect millions of Americans every year. About one in 10 people will form kidney stones at some point in their lives. The majority of people who get stones are between the ages of 20-50. Men are afflicted more than women (three to one). The most common risk factor for forming stones is a history of stone formation. Those who form more than one stone are at risk of multiple episodes throughout their lives.

Kidney stones can be made up of different compounds. The most common type of stone is a calcium stone. Over 80% of kidney stones are calcium mixed with other agents such as oxalate or phosphate. Uric acid makes up about 15% of stones while cysteine accounts for about 1-2%.

The cause of kidney stones is multifactorial. Dehydration from poor fluid intake is a prominent cause. As urine becomes concentrated, calcium salts can precipitate out, clump together, and form stone material. Residents of hot, dry regions are particularly prone to stones. Other factors include chronic urinary tract infections, metabolic diseases (gout, excessive calcium absorption), inflammatory bowel disease and gastric bypass, hormone imbalances (hyperparathyroidism), renal disease and poor dietary choices. 

If you have a kidney or ureteral stone, it is important to seek therapy right away. Contact a urologist to make a treatment plan that is customized to you and your stone. It is also important to follow up on a regular basis to monitor the success of the treatment and to form a plan to help prevent more stones from forming.