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Recent posts

Testosterone Therapy. New Concerns about Safety.

February 5th, 2014

Testosterone therapy has grown immensely since the introduction of easy to use gels and implant. Drug companies have been quick to hype the benefits of Testosterone therapy but much of the testosterone use today is outside of standard guidelines.

Several recent studies have suggested that use of testosterone replacement therapy in men over 65 may increase risk of heart attack or other vascular events such as stroke. The FDA is now investigating the safety of these approved drugs and has yet to make a statement about conclusions and recommendations.

In my assessment, testosterone replacement therapy is not an erectile dysfunction therapy unless levels of testosterone are low. If levels are normal (over 300) I do not advise it under most circumstances. The range of normal values is large so sometimes its difficult to know what’s normal for a given individual. In my experience the people that respond best are those with truly low testosterone.

For those that do take it, its important to monitor the testosterone blood levels regularly until a steady state is reached , monitor PSA to be sure it doesn’t spike and monitor the blood count as too much testosterone can thicken the blood. Until the cardiac risk is worked out and the FDA has a final recommendation, someone with vascular disease who is over 65 may want to consult their cardiologist about the risks vs the benefits of testosterone therapy.

Eugene Dula, M.D., FACS
February 4, 2013



The PSA Supertanker that turned on a dime

July 15th, 2013

Recently the AUA has announced a change in its position on PSA screening in the general population. They can be read here:  http://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm .

This indeed is a radical departure from previous positions as recent as 2009 but going back almost 20 years. Can a Supertanker  turn on a dime and if so why?

In retrospect, there is no doubt in my mind that the medical community has been over aggressive in screening for prostate cancer and treatment of prostate cancer. Patients have been exposed to potential harm, have suffered painful tests and experienced emotional agony.

There is also no doubt in my mind that lives have been saved and lives have been improved as a result of prostate screening and use of PSA.

The controversy leaves us naked.  If we shouldn’t rely on PSA and early detection, then what should we do?  These guidelines tell us what not to do but it doesn’t tell us what we should do. The fact remains that prostate cancer is the second leading cause of cancer deaths in men.  So we can’t just walk away from this and say “PSA is useless” or “there is no use or prostate cancer screening or detection”.  There must be a reconciling of prostate cancer lethality and a means of detecting and treating it before it kills.  So I suggest that this has not been played out yet and is an act in motion.

More needs to be learned about the natural history of prostate cancer to determine which are lethal cancers and which are indolent.  We need better tools to detect the lethal cancers while they are still treatable.  In the mean time we need to rely on what we have, take into account recent studies (flaws and all) , meta-analysis and guidelines and uphold the dictum of “first do no harm”.

-E. Dula, M.D., FACS

 

 

 



LOS ANGELES CHARITY MEDICAL EVENT FOR THE NEEDY

October 1st, 2012

This last weekend I had the opportunity to volunteer my Urologic services at a charity medical event at the Los Angeles Sport Arena. The event called Care Harbor is a four day event whereby thousands of people who are unable to get medical care elsewhere came for free health care. I must admit that it was an overwhelming display of unity and cooperation of the city coming together to help its own. Hundreds of volunteers and scores of doctors and nurses and other health care professionals were in attendance to serve the needs of many greatly appreciative and needy Angelinos.

I was able to help people with everything ranging from Kidney Cancer to infertility. Everyone I came in contact with was most gracious and grateful. I met one woman who was previously diagnosed with Kidney Cancer out of State and had no idea how to continue her care. She had met with roadblocks due to her limited insurance coverage and didn’t know where to turn. I was able to council her on where she can go to get evaluation and treatment and she was most grateful. Imagine someone with a life threatening cancer unable to get it treated.

The atmosphere was one of community and compassion. It was well organized and the large groups of people seemed to be cared for in a most expeditious fashion. I look forward to doing this again in future years.

Eugene Dula, M.D., FACS
October 1, 2012



THROWING THE PSA OUT WITH THE BATH WATER

January 9th, 2012

Patients often ask me about my feelings about the news reports regarding PSA. Some patients are reluctant to have PSA drawn and many are confused. I can start by telling you that I agree with the impetus behind the controversy as PSA has been used incorrectly, has been misinterpreted and even abused. My response is that PSA is like an artist’s paint brush in that it’s just a tool. In the right hands it can help create beauty and art, but in the unskilled hands it is useless. Similarly, PSA is a tool and its usefulness and interpretation is highly nuanced. If not used properly it is not only ineffective but can lead to incorrect interpretations and unnecessary procedures.
Here is some information about PSA
• PSA is the most valuable cancer marker of all cancers. While PSA is only useful for prostate cancer, there are no other cancers for which there is a marker anywhere near as reliable, easy to use and specific as PSA is to prostate cancer.
• We would all like to have a prostate screening test that works like a pregnancy test. If it turns black you have cancer and if it turns white you don’t. Such a test does not exist for prostate or any other cancer. In fact, PSA as a screening test is now less focused on absolute cut-off of 4.0 as normal or abnormal. We are now looking more at PSA trends over the course of years, PSA corrected for prostate volume and fractionated PSA (free and complexed PSA). Also there are other tools such as PCA3 a urinary tumor marker that we are using in combination. Thus, PSA is only one tool of many that we have available to determine ones risk of prostate cancer.
• PSA came into popular use as a tool for prostate cancer around 1990. Starting around 1994 the death rate due to prostate cancer has dropped dramatically. Nonetheless, prostate cancer is the second leading cause of cancer deaths in men.
• The controversy about PSA is solely limited to its use as a screening tool. Its usefulness as a tool to monitor existent prostate cancer is well established. So for someone who has or had prostate cancer, PSA is a very valuable indicator for knowing its current status or if it is growing back.
In summary, PSA is a very valuable tool in screening and monitoring of prostate cancer. But like a painters brush, it needs the right person behind it who knows how to use it and how to interpret it in context of other screening tools.

Eugene Dula, M.D., FACS



Welcome!

January 3rd, 2012

Welcome to my blog! Within this regularly updated feature of my website, I will provide visitors with practice news and specials, as well as information regarding the most recent technological advances and new treatments in Urology.

I believe that patient education and open communication with your doctor are the keys to achieving healthy, fully functional results and patient satisfaction, which is why I strive to provide the highest quality of Urology care for patients of all ages. This is done by combining technical skill and broad experience with cutting-edge technology for impeccable medical results.

I sincerely appreciate you taking the time to visit my new blog. Please check back often to learn about the latest news, updates and additions to the practice and within the field of Urology, and feel free to post comments and/or suggestions on any posts that you find of interest.