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Do I Really Need a PSA Test?

The PSA test is helpful in detecting prostate cancer, but has its drawbacks.

Denver Urology Associates PSA testIf you’re a man who expects to live past 50, expect to hear a lot about prostate cancer detection, treatment and the prostate specific antigen (PSA). Commonly referred to as the PSA, this is a protein produced in the prostate glands that indicates prostate cancer (as well as other irregularities of the prostate, such as benign prostatic hyperplasia or BPH). The PSA marker has been one of the most revolutionary discoveries in men’s health.

The prostate consists of hundreds of proteins and a group of dedicated research physicians in the 1970s set out to discover the one that indicated prostate cancer. The Food and Drug Administration (FDA) approved the first diagnostic kit in 1986 and in 1994 the kit was approved as a screening aid for diagnosis.

Before early detection of prostate cancer with a PSA test was possible, a prostate cancer diagnosis was often made at a late stage with a 5 percent cure rate. The PSA exam now contributes to 80-90 percent cure rates in modern day prostate cancer diagnoses.

PSA testing is simple. A small blood sample is drawn and sent to a laboratory. Results are reported in a ratio of nanograms of PSA for every mL of blood. PSA levels below 4.0 ng/mL are generally considered normal. The higher the PSA level, the more likely a man has prostate cancer. If a PSA exam comes back high, a biopsy ultimately can confirm whether or not the patient has prostate cancer.

In 2011, the United States Preventive Service Task Force (USPSTF) recommended reducing PSA screenings for men. This task force was comprised of 16 volunteer clinicians including family physicians, general internal medicine physicians, nurses, obstetrician-gynecologists, occupational medicine physicians and pediatricians – there were no urologists directly involved in the recommendation. The task force went so far as to recommend PSA screening only when symptoms are present. The problem is that prostate cancer is slow growing and it is usually in its later stages when men start experiencing symptoms. Urology Associates believes that this recommendation is a disservice to all men.

If your PSA is high, consult a urologist

When changing the PSA screening guidelines, the USPSTF should have clarified and recommended that all men, no matter their risk of prostate cancer, be under the treatment of a urologist, not a primary care provider when it comes to prostate health. The American Urologic Association and Urology Associates recommend an annual prostate exam and PSA test in low-risk individuals every other year for men ages 55-69.

One in 6 men will at some time be diagnosed with prostate cancer, but only 1 in 35 will die from it, thanks to advancements like the PSA. Men with a family history of prostate cancer should consult with their primary care provider or urologist to decide when to start screening. Most men should get PSA screening once they turn 55 if they do not have a family history of prostate cancer.

For undetermined reasons, men of African and Caribbean descent are more prone to prostate cancer, while Asian men are not. Other risk factors of prostate cancer include being obese, aging and certain inherited genetic mutations. Diet may also play a role in susceptibility to prostate cancer. Men who eat higher levels of red meat or dairy products and fewer levels of vegetables have a slightly higher chance of prostate cancer.

The best step men can take toward proactive prostate health is to have an active and engaged relationship with their primary physician or urologist so they can understand all the implications of the PSA – and what to do with the results once they have them.

While the PSA is not perfect, it remains an important indicator for potential prostate issues. Men should talk to their primary care provider today to determine if they should get a PSA this year.

Urology Associates Welcomes Nina Casanova, MD, to Practice

Casanova will specialize in pediatric, female urology and pelvic reconstruction surgery

Dr. Nina Casanova| Urology Associates | Denver
Dr. Nina Casanova joins Urology Associates.

(DENVER)­­ — Urology Associates, a Denver-based general and surgical urology practice, is pleased to welcome Nina F. Casanova, M.D., as the newest member of its eight-physician practice.

“I’m thrilled to be practicing and living back in Colorado,” said Casanova. “As a Denver native, I’m grateful that Urology Associates is allowing me to focus on my passion of serving the urological needs of women and children.”

Casanova will join Dr. Galansky in the Center for Pediatric Urology and will also serve as the director of Urology Associates’ Center for Female Urology, Reconstruction and Incontinence. Although Casanova will focus on pediatric and adult female urology and pelvic reconstruction surgeries, she will also be available for general urological services.

“We couldn’t be happier to have such a distinguished, extremely well-trained and experienced urologist join our practice,” said Galansky, managing and founding partner of Urology Associates. “She will be a wonderful addition to our team.”

Casanova completed her medical degree, urology residence and fellowship in pediatric and reconstructive urology at the University of Michigan.

About Urology Associates

Urology Associates has provided general and surgical urology services for children, women and men in the Denver metro area for nearly four decades. Doctors and staff at the Lone Tree, Englewood and Littleton locations work as a team to provide personal, family-centered care, with providers devoted to getting patients back to health and their lifestyles. For more information, visit the Urology Associates.

Can Supplements Legitimately Improve Fertility or Are They Just a Farce?

Nutritional supplements not a Holy Grail solution for male infertility, but worth considering

fertility Supplements| Fact or Farce | Urology Associates | Denver

A variety of nutritional supplements are available on the market touted to reverse male infertility by improving sperm count, health and morphology. But do they really?

Physicians and patients alike want to use therapies proven both effective and safe to use. Many studies have been conducted on several supplements to evaluate whether they are, in fact, safe and effective.

The problem with some of these studies is that there is no standard dose for many of the supplements, and few of the studies attempted to assess whether there was any deficiency in patients before initiating therapy. Also, keep in mind that a well-balanced diet will already include many of these supplements.

So how do we interpret such mixed results? When there are contrary results from different, well–designed, randomized studies, it raises questions such as:

  • Was there a different patient population being studied?
  • How long was the population studied?
  • Was there a deficiency in this substance prior to enrolling in the study?
  • Are there are other variables that are not being adequately controlled?

When in doubt, ask the expert urologist

Urologists specializing in male infertility can help the male and his partner achieve a pregnancy in many ways. Most studies on nutritional supplements include patients with idiopathic issues (i.e. without any identifiable cause). It is therefore imperative to work closely with a physician with this expertise to look for and correct any other underlying issues before self-treating with a supplement.

Regardless of what supplement you choose to take, it is important to limit the amount ingested. Even if the supplement is beneficial, consuming excessive amounts of over-the-counter supplements may be detrimental to sperm production and can have serious adverse effects, ranging from gastrointestinal upset to effects on the central nervous system (fatigue, irritability, headache, vision changes). It is important to work closely with your infertility specialist to identify which supplements are appropriate at what dosages.

Physicians Ko and Sanbanegh and Zini and Al-Hathal recently reviewed the medical literature to see if supplements are helpful or not. The following represents a partial list of supplements that have been purported to be helpful.

Supplements: some work, some don’t

Selenium supplementation has been studied mostly in combination with other vitamins. The results in these studies have largely been positive, once again suggesting that selenium supplementation may be beneficial, particularly in those who had low selenium levels.

Carnitine is an energy source for cells in general, and in particular for sperm. Some studies have shown it to be effective in improving sperm count, motility (ability to properly move through the female reproductive tract) and pregnancy rates. While in other studies, no significant benefit was observed. Given the demonstrated benefit in at least some of the studies, it is possible that carnitine supplements will be beneficial with those patients who have an abnormal semen analysis.

Coenzyme Q-10 protects cells from oxidative stress, so in theory it would seem beneficial for damaged sperm. Unfortunately, the data supporting its use are contradictory, with some studies showing improvement in sperm quality and other studies showing no improvement whatsoever. Given this fact, the conclusion that can best be drawn is that coenzyme Q-10 may be beneficial.

Vitamins A, C and E, generally regarded as the main antioxidant vitamins, have been studied largely in combination to assess for any benefit in male fertility. Once again, the data are confusing, with some studies showing some benefit and others showing no benefit at all.

N-acetylcysteine decreases free radical levels, and thus may decrease oxidative injury to cells. Several studies have demonstrated improvement in semen analysis parameters. However, due to high risk of significant side effects and the difficulty of absorbing adequate amounts into the bloodstream from oral supplementation, this supplement is seldom used.

Zinc supplements, taken in the presence of zinc deficiency, have shown to be beneficial. However, with a well-balanced diet, zinc deficiency is quite rare. Given the low incidence of zinc deficiency and the potential side effects of zinc supplementation, it is seldom recommended.

Arginine has an important role in preventing oxidative injury in cells. So in theory, this would be a useful supplement to improve sperm quality. No randomized clinical trials have demonstrated efficacy, so the use of arginine cannot be recommended.

Remember, there is no magic bottle or potion that will ensure a pregnancy. But taking steps, such as working with a urologist to identify possibly beneficial fertility supplements, will put you in the best possible position to conceive.

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