Magnetic Resonance Imaging (MRI) Instead of a Prostate Biopsy

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

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)

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

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

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

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.