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Urological Issues

Latest News

25

July 2016

Kidney Stone Season

By: Arkansas Urology

Summertime is sometimes known as “kidney stone season,” and for good reason. We often see a sharp rise in kidney stone patients during this time of year.

The main cause for kidney stones, and the reason there are so many in the summer, is dehydration. Sweating leads to water loss, and water loss leads to decreased urination. When the body is unable to eliminate excess minerals through urination, these minerals can settle and form stones. The simple solution? Drink more water!

Kidney stones have increased by as much as 30 percent in the past decade. Of the four main types of kidney stones, calcium-based stones make up 80 percent of all stones treated. Too much calcium in the diet, however, is very rarely the cause of stones. Rather, you should exercise caution when taking calcium supplements. It is best to only take calcium supplements with the approval of your doctor.

Watch out for those summertime barbecue foods! The second biggest cause for kidney stones, after dehydration, is a diet high in protein, salt and sugar. Make sure to monitor your intake of these, and keep your diet full of fresh vegetables and whole grains.

The good news is that treatment for most small stones can be as simple as drinking lots of fluids and taking pain relievers. The recommended fluid intake for stone treatment and prevention is two liters or around nine cups per day.

Remember that if you get one kidney stone you can be prone to get them again, that’s why it’s so important to know what causes them and how to prevent reoccurrence.

If you have more questions or need to talk to someone at our offices, call 1-877-321-8452.


 

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11

July 2016

7 Facts About Kidney Stones

By: Arkansas Urology

We all know that kidney stones are painful, and we all want to avoid them at all costs. Summertime is sometimes known as “kidney stone season,” and for good reason. Doctors see a sharp rise in kidney stone patients during the warmer months, notably August.

Kidney stones are hard clumps of minerals that sometimes form when your body doesn’t have enough natural chemicals in urine that prevent clumping. These clumps, or stones, can be very painful as they move from your kidneys and through your system.

Here are seven things you need to know to be ready for “kidney stone season” this year -

  • The main cause for kidney stones, and the reason there are so many in the summer, is dehydration. Sweating leads to water loss, and water loss leads to decreased urination. When the body is unable to eliminate excess minerals through urination, these minerals can settle and form stones. The simple solution? Drink more water!
  • Kidney stones have increased by as much as 30 percent in the past decade. Most people believe that it is because of dietary trend changes that have occurred in the past decade.
  • Of the four main types of kidney stones, calcium-based stones make up 80 percent of all stones treated. Too much calcium in the diet, however, is very rarely the cause of stones. Rather, you should exercise caution when taking calcium supplements. It is best to only take calcium supplements with the approval of your doctor.
  • Watch out for summertime barbecue foods! The second biggest cause for kidney stones, after dehydration, is a diet high in protein, salt and sugar. Make sure to monitor your intake of these, and keep your diet full of fresh vegetables and whole grains.
  • Across all demographics, white men have a higher risk for kidney stones with an increase in risk starting in their 40s. However, a woman’s risk rises beginning in her 50s.
  • Pregnant women also face an increased risk for developing stones due to their cardiovascular system’s increased output, their kidney’s increased filtration activity, and an increase in the amount of calcium absorbed by the intestines and released into the urine during pregnancy.
  • The good news is that treatment for most small stones can be as simple as drinking lots of fluids and taking pain relievers. The recommended fluid intake for stone treatment and prevention is two liters or around nine cups per day.

For more on kidney stones and treatment at Arkansas Urology, give us a call today at 1-877-321-8452.

 

 

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27

June 2016

What Steps Can You Take to Prevent Cancer?

By: Arkansas Urology

 

June is Men's Health Month. Unfortunately, there are many cancers and diseases that men are at greater risk for than women. Sometimes men assume Family gardeningbecause of genetics that cancer is inevitable. While family history does play a role, there are definitely steps you can take to be more proactive about preventing cancer. Making some specific healthy lifestyle choices can affect your risk.

Overall, having a healthy and balanced diet will lower your risk for most cancers. Avoid too many fatty foods. One of the easiest steps is to increase the amounts of fruits and vegetables you eat. They are full of vitamins and nutrients, which are shown to decrease your cancer risk. Actually, specifically eating tomatoes and other red foods may lower your risk. Tomatoes, watermelon and other red foods get their vibrant red color from lycopene. Research has shown that men who consume these have a lower risk for prostate cancer. Cooking tomatoes can also make it easier for your body to absorb lycopene.

Try eating more fish. Omega-3, which is a type of fatty acid found in salmon, tuna and herring, can lower your risk.

Many changes will not only help lower your risk for prostate cancer but help you live a healthier life. Quitting smoking is an obvious step if you are a smoker. Incorporating exercise into your routine several days a week can also help. This can be as simple as taking a walk around your neighborhood.

Obesity also affects your cancer risk. If your body mass index (BMI) is 30 or higher, you have a greater chance of developing prostate cancer. Many of these tips will also help you shed a few pounds in the process.

If you would like to schedule a cancer screening or talk to a physician, call us today at 1-877-321-8452.

 

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14

June 2016

From WSJ: New Prostate Cancer Tests

By: Arkansas Urology

 

 

A Better Prostate-Cancer Test?

 

By Melinda Beck

 

When Al Piazza learned he had prostate cancer, his first thought was, “Let’s get this out and be done with it,” he says. But his urologist, Jeremy Lieb, said the side effects of treatment could be more harmful than the cancer itself.

Dr. Lieb ran a genetic test on the patient’s biopsy sample, which calculated that Mr. Piazza, then 70 years old, had only a 3% chance of dying from prostate cancer over the next 10 years if he left the tumor untreated.

Four years later, the retired AT&T manager from Discovery Bay, Calif., has been monitoring his cancer with regular blood tests and imaging scans and says he is comfortable leaving it alone. “My feeling is—it’s there, but it’s not going to kill me,” Mr. Piazza says.

Al Piazza learned he doesn’t require treatment for prostate cancer after a genetic test performed on his biopsy sample revealed small odds of harm if the tumor was left untreated. 

The procedure done on Mr. Piazza’s tumor sample, called Prolaris by Myriad Genetics, is one of several new prostate-cancer tests that aim to reduce detection and treatment of tumors that are likely to be harmless while still spotting those that are lethal.

That has been a daunting challenge in recent years. Routine screenings for prostate cancer, using blood tests for prostate-specific antigen, or PSA, have dramatically increased early detection of the disease. More than 99% of cases are curable today. Most of the cancers that prostate screenings find are so slow-growing they are effectively harmless, experts say. Still, because some cancers are aggressive and deadly, most men have opted for treatment with surgery or radiation despite a significant risk of incontinence or impotence.

The ratio of potential benefit to harm is so small that the U.S. Preventive Services Task Force recommended in 2012 that men not be screened for prostate cancer at all.

 

Should I Get a PSA Test?

Many experts recommend against routine PSA blood screening for prostate cancer, leaving many men to wonder whether they should get one.

The new tests, using blood, urine and tissue samples, go well beyond PSA tests and aim to tell men, in advance, not simply if they have prostate cancer, but also if it is aggressive enough to warrant locating and treating or if it can be safely monitored instead. (Gleason scores, which pathologists use to grade prostate cancers found on biopsies, help classify them as low, intermediate or high risk but don’t always reflect the cancer’s true aggressiveness.)

“The solution isn’t to stop screening. The better idea is to use more specific tests,” says Stacy Loeb, an assistant professor of urology and population health at New York University School of Medicine, who led a session on the new tests at the American Urological Association’s annual meeting, May 6 to May 10.

Dr. Stacy Loeb, a New York University urologist, led a session on new prostate-cancer tests at the American Urological annual meeting this month.

The new tests, however, don’t provide useful information for every patient and add significantly to the cost, Dr. Loeb and other urologists caution. Few of them have been vetted by the Food and Drug Administration. And while most have been validated in retrospective studies, there’s little data on how they compare with each other or whether they will improve prostate-cancer care long term.

“It’s very exciting to have these tests available, but it’s sort of the wild west now,” says Scott Eggener, a University of Chicago urologist and a spokesman for the American Urological Association.

 

Do you need a biopsy?

Several of the new tests aim to reduce the number of needless prostate biopsies. More than 1 million U.S. men undergo the painful, intrusive procedure each year mainly because of an elevated PSA level. Overall, fewer than 20% of biopsies find prostate cancer.

The 4Kscore, developed at Memorial Sloan Kettering Cancer Center in New York, analyzes four different types of PSA-related proteins in blood samples and calculates the likelihood, from 1% to 100%, that a biopsy would find an aggressive cancer, defined as a Gleason score of 7 or above.

“It’s frightening for a patient to be diagnosed with cancer that doesn’t need to be treated. If it’s not going to bother him, then why find it?” says Peter Scardino, chairman of surgery at Memorial Sloan Kettering who advises the test’s maker, OPKO Health Inc., and is eligible for stock options. The 4Kscore became available in 2014 and costs about $1,000.

Another PSA-based test, Prostate Health Index, or PHI, from Beckman Coulter Inc., costs only about $100. It calculates the likelihood that a biopsy will find cancer but not how aggressive the cancer might be.

Other new tests check urine samples for gene fragments of prostate cancer to assess whether it is likely to be high-risk. SelectMDx, available from MDxHealth in the U.S. since April, requires a digital rectal exam first.

A new test from Exosome Diagnostics, expected to be available in June, checks for the presence of exosomes, the chemical messengers that can pave the way for cancer’s spread. A study in JAMA Oncology in March found the Exosome test correctly identified 97% of cancers that were later found to be aggressive in biopsies.

Another urine-based test, the University of Michigan’s Michigan Prostate Score, has been available since 2013 and has been shown to reduce the number of negative biopsies by 50% while delaying the finding of just 1% of high-risk cancers.

 

What if the biopsy is negative?

The typical 12-core prostate biopsy, which samples only about 1% of the prostate gland, can miss about 25% of cancers. In the past, men with a negative biopsy who still have other signs of prostate cancer, such as a rising PSA, have undergone second, third or fourth biopsies to search for tumors.

A new test called ConfirmMDx, also from MDxHealth, searches biopsied tissue for precancerous changes known as the “field” or “halo,” suggesting a tumor may be lurking nearby. In a 2013 study in the Journal of Urology, ConfirmMDx identified two-thirds of prostate cancers missed on first biopsy, and correctly identified two-thirds of patients who could correctly forgo a repeat biopsy.

 

What about imaging?

Some urologists are using advanced imaging studies known as multiparametric MRIs, or mpMRIs, to guide initial and repeat biopsies. Several recent studies show a technique called fusion biopsy, combining MRI and ultrasound images, results in much higher accuracy for biopsies.

Dr. Mark Scholz at Prostate Oncology Specialists in Marina del Rey, Calif., says an mpMRI can yield much of the same information as a biopsy and far less invasively.

Some urologists are using mpMRI instead of biopsies for patients who opt for active surveillance of low-risk prostate cancers.

Mark Scholz, a prostate oncology specialist in Marina del Rey, Calif., maintains that an mpMRI can yield much of the same information as a biopsy and far less invasively. Low-risk prostate cancers barely register, he says, adding, “When patients find out they have a choice between 12 harpoon sticks to the prostate through the rectum or an MRI, they are on board big time.”

Joel Copeland, 62 years old, has been monitoring his PSA closely for a decade; his two brothers were diagnosed with prostate cancer. He opted for an MRI instead of a biopsy when his PSA bounced up in 2013. “I don’t like needles, but that’s not the point,” Mr. Copeland says. “The point is, biopsies can cause infection and miss cancers.”

Other urologists cite studies showing mpMRIs can miss an many as 16% of significant cancers and suggest patients also get a traditional biopsy. “Just because you have a negative MRI doesn’t mean you don’t have cancer,” Dr. Eggener says.

The biopsy is positive - now what?

Traditionally, urologists have urged men whose biopsies show prostate cancer with a Gleason score of 7 or higher to proceed immediately with surgery or radiation. Increasingly, doctors are counseling those with a Gleason 6 score, the lowest possible, to opt for “active surveillance” of the cancer.

Now, though, even some Gleason 7s are thought to be indolent, while about 20% of Gleason 6s are found to have been aggressive if the prostate was removed.

Dr. Jeremy Lieb, of Pacific Urology, says the new tests are useful in part because they reassure patients with low-risk cancers that it’s OK to watch and wait. 

The new tests aim to provide better predictive information by analyzing the genetic makeup of tissue sampled in a biopsy. Even for patients with low-risk cancers, “it helps to have some validation to tell them, ‘you can just wait and watch it’,” says Jeremy Lieb, Mr. Piazza’s urologist in Walnut Creek, Calif., who has participated in some Prolaris test studies.

Prolaris examines the RNA expression of 46 genes involved in tumor-cell growth and predicts a patient’s likelihood of dying from prostate cancer in the next 10 years. OncotypeDx, by Genomic Health, studies a different set of 17 genes and predicts the patient’s chance of having a “favorable pathology,” or a cancer that won’t metastasize.

The two tests each cost from $3,000 to $4,000. They are covered by Medicare and most insurers for patients with low or very low risk cancers.

ProMark, by MetaMark Genetics, measures protein levels of eight biomarkers in tumor tissue to predict aggressiveness. GenomeDx Biosciences announced in March that its Decipher test, which predicts the risk of cancer recurrence after a prostatectomy, can be used to evaluate cancers in newly diagnosed patients as well.

Dr. Loeb of NYU says the tests are most useful when a patient’s cancer pathology is borderline. “If the patient already has aggressive disease, we don’t need a test to tell us,” she says. “And if it’s very low risk, only a tiny amount of Gleason 6, there’s already good data that shows we can use active surveillance.”

Prostate cancer experts say more tests are needed to spot and derail aggressive prostate cancers that kill about 26,000 Americans a year. “The goal should be that we can see a man’s prostate cancer coming from so far away that it never harms him,” says Jonathan Simons, president of the nonprofit Prostate Cancer Foundation, which helps fund research.

Write to Melinda Beck at HealthJournal@wsj.com

 



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Swings for Screens

Teach. Test. Treat. The Swings for Screens Foundation provides free patient education and health screenings men. We want to be at your next event.

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Kickoff to Men's Health

Arkansas Urology and Epoch Men’s Health observe National Prostate Cancer Awareness Month each September by offering men a free and complete health screening.

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