Latest news with #urologist
CNN
4 days ago
- General
- CNN
What a urologist wants you to know about prostate screening
When I learned that former President Joe Biden had not undergone prostate-specific antigen (PSA) screening since 2014—and was later diagnosed with metastatic prostate cancer—I knew there would be renewed interest and debate about prostate cancer screening guidelines. As a urologist, I regularly discuss the complexities surrounding PSA testing with my patients. The PSA test remains valuable for early detection, but it continues to generate controversy due to its limitations. Here's what you should know about PSA screening, why medical guidelines vary and why individualized approaches are essential. Prostate-specific antigen, or PSA, is a protein produced by the prostate. The PSA blood test measures this protein to help screen for prostate cancer. Typically, a PSA level above 4 on lab results is flagged as 'abnormal,' prompting further evaluation. However, even PSA numbers below 4 can be concerning if they're rapidly increasing. That's why PSA tests are done annually: to monitor trends over time. Elevated PSA levels don't always mean cancer. Noncancerous conditions like an enlarged prostate, prostatitis (inflammation), recent ejaculation, stress or even strenuous activity can temporarily raise PSA. Ultimately, the PSA level is just a starting point for a deeper investigation (or conversation). Additionally, not all prostate cancers cause elevated PSA levels. Some aggressive cancers may produce normal PSA results. Ultimately, the PSA level is a starting point for further evaluation and deeper conversations with your doctor. The controversy around PSA testing isn't really about the test itself, but about how its results are interpreted and acted upon. Before 2012, PSA screening was routinely recommended for all men over age 50. I completed my urology training that same year, witnessing firsthand how dramatically the screening landscape changed almost overnight. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screening due to concerns of 'overdiagnosis.' The worry was that screening could detect slow-growing cancers that may never cause harm but still result in unnecessary biopsies, anxiety, and treatments—some of which caused more harm than good. The recommendation led doctors to scale back, causing routine PSA testing to decline sharply. However, by 2018, new research and rising concerns about aggressive prostate cancers led the USPSTF to revise their recommendations again, advising men aged 55 to 69 to engage in shared decision-making with their providers. This current stance emphasizes personalized discussions between patients and doctors, acknowledging that there's no one-size-fits-all approach to PSA testing. According to their website, the USPSTF is now working on another update, so we can expect further adjustments in the near future. As someone who experienced this shift firsthand early in my career, I deeply appreciate how critical shared decision-making and patient involvement are in navigating these complex screening choices. These ongoing changes in recommendations have also reinforced the importance for me as a physician to stay informed, continuously adapting my practice as new research and technologies emerge. Several organizations provide prostate cancer screening guidelines, including the USPSTF, the American Cancer Society and the American Urological Association (AUA). Each offers slightly different recommendations for both patients and health care providers. The USPSTF generally focuses on minimizing potential harm from overtreatment, while the AUA provides detailed, individualized recommendations based on clinical factors and risk profiles. Even after practicing urology for more than a decade, I still sometimes find it challenging to navigate these subtle differences in guidelines. Although I primarily follow the AUA guidelines—my overarching professional body—I've established a balanced approach that feels comfortable for me and, I believe, best serves my patients' interests. I start PSA testing at age 40 for men at higher risk, such as African Americans or those with a first-degree family member who has prostate cancer. For most patients, I typically initiate annual PSA screening at age 50. It's important to know that primary care doctors perform most prostate cancer screenings. Depending on their training, clinical judgment and professional guidelines, their approach may differ slightly from my take as a urologist. This highlights the importance of clear communication among you the patient, your primary care provider and your specialists. Only through these conversations can we create personalized screening strategies that align with your health goals. President Biden's case raises a question: Could earlier PSA screening have detected his cancer sooner, at a more treatable stage? We will never know for certain. According to current guidelines, stopping screening in one's 70s is considered appropriate. Perhaps there was a shared decision to stop testing. From a guideline perspective, nothing was necessarily done incorrectly. Still, Biden's diagnosis highlights the potential consequences of discontinuing prostate screening for an otherwise healthy older adult. Men in the United States now have an average life expectancy of approximately 76 years, with many living healthy, active lives well into their 80s and beyond. Older guidelines based on shorter lifespans now need updating to reflect today's longer, healthier lives. I believe that decisions about prostate screening in older adults should thus focus more on individual health status rather than chronological age alone. Changing guidelines based on longer life expectancy will require thorough research and evidence-based data. Consequently, updates to recommendations will take time. What you can do in the meantime is be proactive in your conversations with your doctors about not just prostate cancer screenings but all cancer screenings. Prostate cancer isn't the only medical condition subject to evolving guidelines. Screening recommendations for colorectal and breast cancers have also changed recently. Colon cancer screening now generally starts at age 45 instead of 50 due to rising cases among younger adults. Breast cancer guidelines continue to vary among organizations, but the USPSTF updated its recommendation last year to say that most women should start getting mammograms earlier. These frequent shifts reflect ongoing research and the importance of personalized, informed conversations between patients and health care providers. Historically, an elevated PSA test led directly to a prostate biopsy, potentially causing unnecessary anxiety and sometimes overtreatment. Today, however, we have more advanced PSA-based tests that help better identify significant prostate cancers. Advanced imaging, like prostate MRI, allows us to pinpoint suspicious areas before performing a biopsy, increasing accuracy and decreasing unnecessary procedures. Biopsy techniques have also improved, some shifting from traditional transrectal biopsies to transperineal methods, reducing infection risks. Treatments have similarly evolved, emphasizing active surveillance of low-risk cancers and minimally invasive focal therapies. These advancements have significantly reduced side effects and improved quality of life, even among older patients. In my office, I frequently discuss PSA screening with patients who are over 70. If a patient remains active and healthy and we anticipate good life expectancy, I generally recommend that we continue regular PSA tests. However, the final decision always belongs to the patient, after we carefully weigh the pros and cons together. If your doctor hasn't initiated this conversation yet, it's important for you to bring it up. And remember, regardless of age, promptly inform your health care provider about any new urinary symptoms or health concerns. Staying proactive gives you the best chance to maintain good health this year and next.
CNN
4 days ago
- Health
- CNN
What a urologist wants men to know about vasectomies
As a urologist, I've performed countless vasectomies. They are my profession's bread and butter. When I'm not doing the procedure, I'm seeing men either alone or with their partners to discuss its safety, simplicity and effectiveness. Like many men, I've found myself contemplating whether it's time to get one, too. Maybe it's the recent US Supreme Court decisions on reproduction prompting more men to actively consider their role in birth control. Or perhaps it's part of a larger cultural shift toward shared family-planning responsibility. Then again, as a urologist who sees a growing number of men seeking vasectomy consultations, I'm more attuned to how common this conversation has become. An estimated 500,000 men in the US choose vasectomies as a form of contraception every year. And if you are like me and considering a vasectomy — or if you're just curious about this procedure as a form of birth control — here are the top things you should know. A vasectomy is typically a minor office-based procedure that requires minimal preparation. You can eat the day of the procedure, wear your T-shirt and shorts, and try to be relaxed. (If you choose to have the vasectomy done in an operating room, more preparation may be needed.) Once you're in the doctor's office, it takes 10 to 20 minutes to perform. After numbing the scrotal skin with a local anesthetic, the urologist makes a small opening in the skin, often so small that no stitches or scalpels are needed. From there, the doctor will find the vas deferens — the tube that carries sperm (made in the testicle) from a tightly coiled duct called the epididymis to the urethra prior to ejaculation. The vas deferens feels a bit like a piece of cooked spaghetti. The tube is brought out through the small opening, cut, sealed or blocked, preventing sperm from mixing with semen. The procedure is done on both sides, on both vas deferens, in a similar fashion. The cut ends are placed back into the scrotum, and the openings may be sealed with skin glue. Then you can go home and rest. Expect some soreness in the scrotum and surrounding areas. I advise patients to rest for one or two days, wear supportive underwear, and apply an ice pack to the scrotum for about 20 minutes every hour. For pain or discomfort, I suggest taking over-the-counter ibuprofen or acetaminophen if needed. Avoid heavy lifting or strenuous exercise for about one to two weeks, or however long your doctor recommends. Post-vasectomy complications are rare but possible and include minor bruising, swelling and temporary discomfort around the area where the procedure was done. Though uncommon, infections can occur and are typically resolved quickly with antibiotics if caught early. Around 1% to 2% of men can experience chronic post-vasectomy pain, which usually improves over time but in rare cases may persist and require further treatment. An important point to remember is that you won't be sterile immediately. It typically takes several weeks — and around 30 ejaculations — to clear out your remaining sperm. Your urologist will confirm your sterility with a semen analysis, which can be done at a lab or using new at-home testing kits. Until you're officially cleared, though, continue to use another form of contraception — it takes only one sperm to achieve pregnancy, so making sure you are sterile is vital. I've heard all the myths about vasectomies, so I want to share the answers to some of the most common questions men ask me during our consultations. Many men worry that after a vasectomy they will have lower testosterone levels, sex drive or sexual function. Not true. In fact, many couples report increased sexual activity and satisfaction after a vasectomy since they no longer have to worry about pregnancy. You will still have an ejaculate — almost the same volume and sensation — but now you'll be 'shooting blanks,' since your semen no longer contains sperm. Despite what you've heard, March Madness isn't the only good time for a vasectomy. Many men choose to recover while binge-watching football or even their favorite show. The truth is, you can safely book the procedure whenever it fits your schedule. Some men assume vasectomies are expensive or not covered by insurance, but most insurance plans fully or partially cover the procedure. Even if you're paying out-of-pocket, the cost is often less than $1,000, though prices can range from $500 to $3,000 depending on your location and whether you opt for anesthesia. It's worth shopping around, but always choose a qualified urologist who is board-certified and experienced in performing vasectomies — your safety is never worth compromising just to save a few dollars. But let's face it: Compared with the monthly cost of diapers alone (about $100 per month until your child is potty-trained), a vasectomy is a financial win. Though it's less common, I'm seeing more men without children choosing to get a vasectomy. Why? Often it's a firm lifestyle decision, because of concerns over passing certain genetic conditions, or simply being absolutely sure that fatherhood is not in their future. During our consultation, we openly discuss the motivations for making this decision, and I review the pros and cons. One big con is the permanent nature of the procedure. Yes, vasectomy reversals exist — and I do them myself for patients — but I don't advise undergoing a vasectomy assuming it's temporary. Reversal procedures are expensive and not always successful. If you're not sure whether you want children, pause and seriously reconsider the decision. Ultimately, it remains your personal choice. Men who need birth control can use condoms or avoid sex altogether. There is also research on male birth-control pills, injections and 'switches,' which could be a long time away from being offered to men. For women, there are birth-control pills, intrauterine devices (IUDs), implants, injections, patches, vaginal rings and tubal ligation. Each of these methods has its own pros, cons and effectiveness rates, so a detailed discussion with your health care provider and partner can help you make the best choice. Deciding on a vasectomy isn't easy. I should know, because I'm right there with you. My advice is don't rush it. Talk with your partner, ask your doctor all the questions you have during your consultation and think through what this means for your future. Whatever decision you make, though, make sure it feels right for you. Get inspired by a weekly roundup on living well, made simple. Sign up for CNN's Life, But Better newsletter for information and tools designed to improve your well-being.
Daily Mail
23-05-2025
- Health
- Daily Mail
Man who drank up to three litres of Coca Cola every day has to have 35 stones removed from his bladder
A doctor has warned of the dangers of drinking too many fizzy drinks, after he was forced to remove 35 stones from the bladder of a man who had a habit of drinking three litres of Coca-Cola every day. In an Instagram video that's so far attracted more than 8.5 million views, Brazil-based urologist Dr Thales Andrade said 'excessive' consumption of sugary, fizzy drinks can cause kidney stones. Speaking in portuguese, he showed viewers a dish of several large yellow stones that he had removed, as the patient lay on the table following the procedure. Kidney stones are calcium deposits that build in the urinary tract and move to the bladder to be urinated out, causing sharp pain, nausea, vomiting, pinching or stinging and potentially blood in the urine. If left untreated, they can migrate to the bladder and lead to life threatening complications like kidney failure or sepsis—when the body attacks its own tissues and organs. The caption below the video explained how the stones developed. Drinking too much Coca-Cola, which contains high amounts of sugar, can increase the amount of calcium in the body, raising the risk of stones forming. What's more, carbonated beverages are filled with chemicals like phosphoric acid, which creates an acidic environment in the kidneys that is further encouraging of the formation of hard stone-like lumps. Dr Andrade added: 'Maintaining adequate hydration and avoiding excessive consumption of soda are essential measures for prevention. Kidney health begins with the daily choices of what we drink.' According to the National Kidney Foundation, the larger the stone, the more noticeable the symptoms. A severe pain on either side of the lower back is a common complaint. These periods of intense pain may last for minutes or hours. Blood in the urine, a urinary tract infection and feeling sick or vomiting are also other common warning signs of the ailment. Kidney stones affect more than one in ten people, mostly aged between 30 and 60, and are caused by waste products in the blood forming crystals. Over time, crystals build up to form a hard stone-like lump. Once a kidney stone has formed, the body will tries to pass it through urine. Most are small enough to do so and can be managed at home. When they get too big, however, surgery is usually needed to remove them.
Forbes
20-05-2025
- Health
- Forbes
Greg Murphy Says 'Hard To Believe' White House Doc Didn't Conduct Cancer Test For Biden
Congressman Greg Murphy (R-NC), a board certified urologist, joined "Forbes Newsroom" to discuss President Joe Biden's prostate cancer diagnosis. Watch the full interview above.
Medscape
20-05-2025
- Health
- Medscape
AUA 2025: Practice Impact of New mPC Data
Mohammad Mahmoud, MD, recalls how the AUA 2025 meeting in Las Vegas was an exciting and informative experience, especially regarding the management of metastatic prostate cancer. As a practicing urologist, Dr Mahmoud found the metastatic prostate cancer course particularly valuable for its practical updates on therapeutics like apalutamide and the importance of dose adjustments to reduce toxicity. He notes that the emphasis on genetic testing for patients with de novo metastatic disease and the emerging role of PARP inhibitors reinforced the need for personalized treatment approaches. Additionally, discussions around triplet therapy and the growing role of prostate-specific membrane antigen in both diagnostics and treatment are set to impact clinical decisions and tumor board discussions in meaningful ways.
