Magnetic Resonance Imaging (MRI) Instead of a Prostate Biopsy

May 24, 2017

For several decades I have ordered PSA testing as a screening test for prostate cancer, the most common cancer in middle aged men and the second most cause of death, following lung cancer, in men.  The PSA test is now controversial as a result of the U.S. Preventive Services Task Force recommended five years ago that men forgo the test because the blood test led to too many inaccurate prostate biopsies, which in turn resulted in diagnosis  of insignificant prostate cancer or cancers that were so slow growing that no treatment was required and also resulted in many men who received treatment and had side effects and complications that significantly impaired their quality of life.

Now, however, there is true progress in prostate cancer detection, bringing a new era of minimal intervention yet maximum accuracy of diagnosis and treatment. The single most important factor in this change is the addition of multiparametric MRI (mpMRI) before having a prostate biopsy. There is compelling research-based evidence, both in the U.S. and abroad, that mpMRI can help determine if a biopsy is not yet necessary. This means sparing men from conventional TRUS-guided biopsy that has a discouraging track record of inaccuracy. On the other hand, if mpMRI detects a suspicious area, a real-time MRI guided targeted biopsy facilitates pinpoint diagnosis and treatment matching.

According to a newly published article, “Prebiopsy MRI followed by targeted biopsy” appears to have the ability to overcome the limitations of the standard 12-core template [biopsy]. The authors of the review point out that both the American Urological Association and the Society of Abdominal Radiology have confirmed the utilization of MRI prior to biopsy.

I hope you have found this blog helpful.  If you have any questions about managing your elevated PSA, please let me hear from you.

Delayed Ejaculation-The Other Sexual Dysfunction

May 20, 2017

Unlike premature ejaculation—usually defined as ejaculating 3 minutes or less after penetration—there isn’t a set amount of time that constitutes delayed ejaculation.

Still, you may have it if you can’t orgasm within 20 minutes after penetration.

Statistically, that time frame is far enough away from the average guy’s norm of about 5 minutes.

Sound like you? Here’s everything you need to know about why it may be taking so long to finish in bed, and how to treat the condition.

What Causes Delayed Ejaculation?

Ejaculation is a complicated process that involves your brain, nerves, and muscles in your pelvic region. Your nerves send a signal from your brain to your pelvis muscles telling them to contract and release semen.

But when your nerves aren’t communicating properly—whether from a disease like diabetes or multiple sclerosis, or from aging—that “ejaculate now” message from your brain can get lost in translation.

Some drugs can also delay your ejaculation, especially those that affect your central nervous system.

Selective serotonin reuptake inhibitors (SSRIs) for depression, certain muscle relaxers, and anti-smoking meds may manipulate the neurotransmitters in your brain, which can postpone your ejaculatory response.

Then there are your hormone levels: Guys with low testosterone or low thyroid hormones may be more at risk for delayed ejaculation.

Psychological issues like anxiety, depression, performance anxiety, relationship conflict, or sexual shame, or even the fear of becoming a father can also hinder or delay an ejaculation.

Finally, if these problems pop up only when you’re with your partner, consider the way you masturbate. If you use an atypical technique—like rubbing your penis against a certain object, or sticking it into a vise-like device—your partner’s may not be able to replicate it.

Although endless sex sounds awesome, but many men with delayed ejaculation complain that the sustained effort makes them feel physically exhausted during the act. As a result a lot of men will actually have to stop sex before they orgasm.

Also, delayed ejaculation can be mentally draining. Men can start to feel depressed or anxious that they’re taking too long to finish.

The explanation is that if you stress about how long it’s taking orgasm, your body produces more of the hormone adrenaline and more adrenaline restricts the blood supply to penis resulting in difficulty holding or maintaining an erection thus contributing to a delay in ejaculation.

Treating delayed ejaculation begins with an appointment to see a urologist—preferably one who specializes in sexual medicine. The urologist will most likely order a full workup, including tests for testosterone, thyroid, and blood sugar levels.

At the present time there is no medication to treat delayed ejaculation. However, there are drugs that have been shown in small studies but without FDA approval to treat delayed ejaculation. These include cabergoline or oxytocin, which act on certain chemicals in your brain whose levels have been disrupted.  However, the most successful treatment includes both medical intervention and sexual counseling with a certified sex therapist.

Bottom Line: Delayed ejaculation is a common problem especially in middle aged and older men. Although no medical treatment is available, you can be helped and can solve the problem with a discussion with your doctor and perhaps a referral to a counselor or sex therapist.

Xiaflex for Peyroine’s Disease, Caveat Imperator (or let the buyer beware)

May 20, 2017

Peyroine’s disease is a common malady of penile curvature that impedes normal sexual intimacy and affects millions of American men. One of the treatment options for Peyroine’s disease is Xiaflex. Xiaflex can cause serious side effects, including penile fracture, which is a medical emergency often requiring surgery to repair the fracture. After treatment with Xiaflex, the erection tissue in the penis may break during an erection. This is called a penile fracture.

After treatment with Xiaflex, blood vessels in your penis may also break, causing blood to collect under the skin which is referred to as a hematoma. This could also require a procedure to drain the blood from under the skin

Other serious injury to your penis may include a popping sound or sensation that may occur with an erection, sudden loss of the ability to maintain an erection, pain in your penis, purple bruising and swelling of your penis or even difficulty urinating or blood in the urine.

I suggest that you call your urologist if you have any of the symptoms of penis fracture or serious injury to the penis.

The manufacturer of Xiaflex recommend that you not have sex or any other sexual activity between the first and second injections of Xiaflex.
The manufactures also recommend that you not have sex or have any other sexual activity for at least 2 weeks after the second injection of a treatment.

Xiaflex is a prescription medicine used to treat adult men with Peyronie’s disease who have a curve in their penis greater than 30 degrees when treatment is started.

Bottom Line: Peyroine’s disease is a plaque formation in the penis that results in bending or curvature of the penis that can impair the ability to engage in sexual intimacy with your partner. One option is Xiaflex injections into the plaque. However, these injections are not without risks ad complications include penile fracture, which is a medical emergency. For more information speak to your doctor.

 

 

Wipe Away Premature Ejaculation

May 20, 2017

Premature ejaculation (PE) is one of the most common sexual problems affecting men, especially younger men. Nothing is more embarrassing to a man than a problem of rapid ejaculation.  Men are interested in satisfying their partners and when they ejaculate\cum too soon, it is a source of embarrassment and anxiety for every man and a source of frustration and lack of fulfillment for every partner.

Premature ejaculation (PE) is a problem that plagues 36,000,000 men and is defined as ejaculation in less than 5 minutes of penetration. It is important to point out that premature ejaculation depends on the satisfaction of the partners.

The exact cause of PE isn’t clear, but it is felt to be a lack of control of the receptors to the nerves from the spinal nerve to the prostate gland and the seminal vesicles, the two organs behind the prostate gland that store the sperm prior to ejaculation.

A list of treatments that have been shown NOT to be beneficial includes:

  1. Long-term psychoanalysis.
  2. Getting drunk.
  3. Use of one or more condoms.
  4. Concentrating on something other than sex while having intercourse. (i.e. Baseball line-ups, or state capitals)
  5. Biting one’s cheek.
  6. Frequent masturbation.
  7. Testosterone injections.
  8. Tranquillizers.
  9. PD5 inhibitors such as Viagra, Levitra, or Cialis

Now a new treatment option is available containing benzocaine wipes may help men with premature ejaculation.

In one study, men with premature ejaculation (PE)—those who lasted two minutes or less during sex, were unable to delay their orgasm, and were distressed about it—used a benzocaine topical wipe, a local anesthetic, compared to men with PE used wipes without benzocaine before sex.

After two months of using the benzocaine wipes, the men lasted on average of four minutes longer during sexual intimacy

They also reported a greater improvement in distress and control over their ejaculation, as well as greater satisfaction with sex.

The average guy lasts just over 7 minutes during sex, a study in the Journal of Sexual Medicine found. But a man with premature ejaculation? They tend to last about 1.8 minutes on average.

That’s because benzocaine can make sex less pleasant for her—using benzocaine on your penis and then having sex without a condom can numb your partner’s vagina, making sex feel uncomfortable for her.

Bottom Line: Premature ejaculation is one of the most common sexual problems impacting millions of American men. Now there is a topical wipe containing benzocaine which has demonstrated significant improvement in delaying orgasm in men who are suffering from PE.

GERD Medication and Kidney Disease

May 6, 2017

Millions of Americans take proton pump inhibitors (Prevacid, Prilosec, Nexium, and Protonix) for heartburn or gastroesophageal reflux disease or GERD.  Data show that more than 15 million Americans suffering from heartburn, and acid reflux have prescriptions for PPIs, which bring relief by reducing gastric acid. Many millions more purchase the drugs over-the-counter and take them without being under a doctor’s care.

A recent report in a medical journal has shown that taking popular proton pump inhibitors (PPIs) for heartburn for prolonged periods has been linked to serious kidney problems, including kidney failure resulting in the need for dialysis or kidney transplantation.

Many patients who use PPIs may not be aware of a decline in kidney function as kidney function can deteriorate very slowly without any symptoms or warning of decline in kidney function.

Since many of the PPIs are over the counter and don’t require a doctor’s prescription, patients should tell their doctors if they’re taking PPIs and only use the drugs when necessary.

Bottom Line:  Your doctors should pay attention to your kidney function if you are using PPIs, even when there are no signs of problems.

5 ways to boost your libido

May 3, 2017

The bad news: men’s sex drive is based on the serum testosterone level which starts to decrease about 1% a year in second decade of a man’s life.  The good news is that low testosterone can easily be replaced.  Here are a few steps or suggestions that you can easily do to restore your libido without testosterone replacement therapy.

Re-connect: Now that the children have left and it’s just you and your partner again, it’s time to re-connect. Raising a family might have kept you very busy, oftentimes taking you away from each other. Spend some time re-connecting and getting to know one another again in order to reignite that flame.  I suggest having a date night with your significant other.  And one other piece of advice: turn off your cell phone and focus on each other! 

Exercise: Health conditions and poor circulation can impede on your libido, while being as healthy as you can is a great way to support your sex drive. Exercise can help reduce your risk of illness and boost your circulation to ensure all your parts are working as they should.  I suggest 20 minutes of cardiovascular exercise at least three times a week.

Be mindful: Stress is a big mood killer, so practicing mindfulness and reducing stress can help boost your libido.  There’s an app for that.  I suggest Headspace.  It’s free and a nice way to learn the art of meditation.

Seek therapy: Maybe you need to see a therapist and work through any underlying issues that could be preventing you and your partner from connecting on a sexual level. Addressing these concerns can help you get past the wall you or your partner may have built between each other.  I suggest that you seek out a therapist that has expertise in dealing with sexual problems.  You can find a therapist near you at: https://www.aasect.org/referral-directory

Check your medications: Some medications cite low libido as a side effect. Antidepressants and pain medications are most known for this. Check with your doctor if you are on any meds.

Bottom Line:  A decrease in libido doesn’t mean you have to live a life devoid of sex. Speak to your doctor.  Get a blood test to check your testosterone level and consider replacement therapy using testosterone injections, topical gels, or tiny pellets inserted under the skin all of which can successfully restore the testosterone level and more importantly your ability to engage in intimacy with your partner.

Nourishment for Your Nature

April 28, 2017

Since the late 1990s there has been a great advancement in the treatment of erectile dysfunction.  We know pills, pumps, and surgeries work for erectile dysfunction, but what about food and nutrition? Are there things you can eat that can help with ED? This article will discuss several options that may be an alternative to medications, injections and surgery for ED.

Watermelon

This sweet, refreshing fruit has a compound that can have effects similar to ED meds on your blood vessels. It may even rev up your libido. Most of watermelon is water, however the rest is loaded with lycopene, an antioxidant that’s good for your heart, prostate, and skin and even your erections .

Oysters

These shellfish may boost your testosterone levels, and that can help with sex drive. They’re also chock-full of zinc, a nutrient your body needs. One caveat is to be sure they are they’re cooked properly.

Coffee

Your morning cup of joe is more than a satisfying pick-me-up. It may give your love life a boost, too. Men who drank two or three cups’ worth of caffeine a day were less likely to have erectile dysfunction. That’s because caffeine helps increase the blood flow to the penis.

Dark Chocolate

This treat may have perks in your private parts. An ounce of chocolate a few times a week can help your Johnson. Chocolate is rich in flavanols, plant nutrients that can increase blood flow and lower blood pressure.

Nuts

Walnuts have lots of arginine, an amino acid your body uses to make nitric oxide. They’re also good sources of vitamin E, folic acid and fiber.

Juice

Maybe you enjoy an adult beverage made from grapes, but here’s a reason to drink the stuff kids like. Nutrients in grape juice also increase the amount of nitric oxide in your body. If you’re not wild about drinking grape juice, try pomegranate juice.

Garlic

The strong-smelling bulb may raise the dead. If plaque forms on the walls of the arteries, blood flow could be decreased. Garlic in your diet may help keep your arteries healthy, open and clear as you age.

Fish

Salmon and other fatty fish are great sources of heart-healthy omega-3 fatty acids, which may boost nitric oxide in your body. These omega-3 fatty acids also lower your blood pressure and your risks for heart attack and blood clots.

Greens

Kale is also a nitric-oxide booster. They’re packed with vitamins, minerals and omega-3s.

Peppers

You might spice up your love life by adding some chili peppers to your diet. Chilies can also help lower blood pressure and cholesterol and prevent blood clots.

Olive Oil

Olive oil may help your body make more testosterone. It’s also full of u monounsaturated fat, which can help get rid of the bad cholesterol in your body, the LDLs.

Bottom Line:  Let the truth be told there is no magic bullet or food that can restore your nature.  But there are foods that can help you “keep ‘em up!”

Pain Pills Won’t Put Potency In Your Penis

April 25, 2017

There’s a opioid epidemic in the United States as the number of prescriptions written for opioids has skyrocketed over the years. From 1991 to 2013, the total number of prescriptions written for opioid painkillers skyrocketed by 172%. It is estimated to cause nearly 40,000 deaths in the United States which is more than those people who died in car accidents each year.  Besides the risk of death and havoc on the user and his\her family, opioids cause a deficiency in testosterone which significantly impacts a man’s sexuality.

Testosterone deficiency is an underappreciated consequence of using opioids.

Understanding the risks and the potential treatment options available may help minimize the impact of opioids on testosterone levels. This blog will discuss the relationship between opioid use and testosterone deficiency.

Yes, it is true that opioids are well-known to be highly effective at managing pain. Also well-known is their negative impact on testosterone levels in men taking these potent pain killers.   Interestingly, even with the recognition of this phenomenon, this side effect of reducing testosterone remains an underappreciated consequence of treatment.

Testosterone deficiency can lead to serious health consequences. Symptoms include reduced libido, erectile dysfunction, osteoporosis and decreased bone density, fatigue, depressed mood, reduced muscle mass, poor concentration, and sleep disturbances. As such, testosterone deficiency also impacts quality of life and may even be involved in the development of heart disease.

New Findings

In a large study a higher risk of low testosterone was found with opioids. Data revealed that men on long-acting opioids were significantly more likely to be testosterone deficient.

Treatment Options

The management of low testosterone levels in men taking opioids begins with the checking the symptoms of low T such as decreased sex drive, loss of energy, loss of bone and muscle mass and the confirmation with testosterone testing. However, monitoring of hypogonadism can be a challenge as patients may not necessarily report their symptoms.

Additionally, when possible, baseline serum testosterone levels should be obtained prior to initiating therapy with potent pain medications. Testosterone levels could then be recorded at regular intervals to monitor changes.

If a patient presents with opioid-induced low T, there are several possible treatment options that can be pursued. Strategies that allow for opioid reduction could be considered, such as the concomitant use of non-opioid pain medications. The good news is that discontinuing opioid therapy can result in the normalization of testosterone, with data suggesting recovery of symptoms may occur as fast as a few days to up to 1 month after stopping treatment. Unfortunately, this is an unlikely option for men suffering from chronic pain.

Lastly, testosterone replacement therapy is a viable option for some patients. Testosterone can be given via injections, topical gels, or pellets inserted beneath the skin to restore the normal level of testosterone that will improve the symptoms of low T.  Close monitoring by your doctor will help identify the development of low T levels. Men who are educated on this potential side effect of low T can also be active participants in helping to identify this complication. While several treatment options are available, the best course of action for treating hypogonadism will ultimately depend on symptoms and the blood level of testosterone.

Bottom Line:  Opioids can help with the control of pain but with the price of decreasing the testosterone level in men.  Men who use opioids should speak to their doctor about their symptoms of decrease in sex drive, loss of energy or loss of muscle mass are candidates for hormone replacement therapy.

Take Two (Miles) and Call Me In the Morning

April 17, 2017

Take Two (MileI am often asked what’s the best way to stay healthy and avoid medications and even avoid visiting  the doctor.  I am of the opinion that running may be the single most effective exercise to increase life expectancy. The new study found that, compared to non-runners, runners tended to live about three additional years, even if they run slowly.

The findings from the Cooper Clinic in Dallas, TX found that as little as five minutes of daily running  was associated with prolonged life spans.

Cumulatively, the data indicated that running, whatever someone’s pace or mileage, dropped a person’s risk of premature death by almost 40 percent, a benefit that held true even when the researchers controlled for smoking, drinking and a history of health problems such as hypertension or obesity.

Scientists then determined that if every non-runner who had been part of the reviewed studies took up the sport, there would have been 16 percent fewer deaths over all, and 25 percent fewer fatal heart attacks.

Perhaps most interesting, the researchers calculated that, hour for hour, running statistically returns more time to people’s lives. Figuring two hours per week of training, since that was the average reported by runners in the Cooper Institute study, the researchers estimated that a typical runner would spend less than six months actually running over the course of almost 40 years, but could expect an increase in life expectancy of 3.2 years, for a net gain of about 2.8 years.

Bottom Line:  an hour of running statistically lengthens life expectancy by seven hours for each hour on the track.  So a combination of diet and regular exercise is better than an apple to keep the doctor away!

Pain in Your Private Parts-When You Hurt Below Your Belt

April 12, 2017

Pain below the belt should never be ignored.  This blog will discuss a few causes which may cause “pain in your pouch” and should be reported to your doctor.

Pelvic pain

If you have difficulty with urination, pain in the pelvic area or between your scrotum and your rectum, accompanied by fever and flu-like symptoms, then you may have an infection in your prostate gland.  This requires an appointment with your doctor as this requires an examination of your urine and possibly receiving a prescription for a course of antibiotics.

Painful urination

If you have a burning sensation with urination and the frequent urge to urinate, you may have a urinary tract infection (UTI), an enlarged prostate gland or an early sign of bladder cancer.  This requires an appointment with your doctor as if an infection is identified, then you will need antibiotics since UTIs are the most common cause of these symptoms.  If you do not have an infection, you may be advised to have other tests to determine if something else is causing your symptoms.

Sudden testicular pain

If pain comes on quickly as a sharp quick to the groin and feels like a dull ache and make walking difficult.  The sudden onset of pain may be accompanied by swelling of the scrotum.  This condition may be a testicular torsion.  This condition occurs when the flow of blood to a testicle gets cut off.  This is a medical emergency as this condition requires surgical relief of the torsion in order to save the testicle.

Bottom Line: Don’t take lightly any pain or discomfort in your private parts.  Your sex life might just depend on obtaining prompt medical care.