April 29, 2010 —  This drug is for patients with metastatic or prostate cancer that has spread outside the prostate ( this is uncommon condition )  There are no great treatments for these patients but this therapy may help!

 click on drug name to see full article from new york times today…

In a widely anticipated announcement, the US Food and Drug Administration (FDA) has approved an immunotherapy, sipuleucel-T (Provenge, Dendreon), for the treatment of asymptomatic or minimally symptomatic metastatic, castration-resistant prostate cancer (mCRPC).

This well written review by times columist places the issue into perspective.  When patients get screened we find more cancers male infertility and testicular cancer is also linked due to increased detection.

This is a trick situation.  A urologist is the best person to evaluate male infertility, sexual health and screen for prostate cancer.

Dr. Grotas is a board certified urologist practicing in NYC and the five towns.  He authored a chapter in the latest edition of Infertility in the Male

click on request an appointment to contact the doctors staff!

Health
Well: Male Infertility Linked With Prostate Cancer
By By TARA PARKER-POPE
Published: March 23, 2010
New research linking male infertility with aggressive prostate cancer joins a growing body of evidence that male infertility is an important risk factor for long-term health problems.

I recommend robot prostatectomy as the surgical option for most patients with prostate cancer.

 At Beth Israel Dr. Caner Dinlenc leads our robot prostate program. Drs. Tareen and Grotas also perform this surgery. We are here to help!
Have you already had a robot? need follow up have erectile dysfunction? positive margin? rising PSA? incontinence?we can help click to on request an appointment if you have questions or need an opinion!

no medical advice will be given over email all urologic consultations are done in person.
NYTIMES 2-14-2010 Health
Results Unproven, Robotic Surgery Wins Converts
By GINA KOLATA
Published: February 14, 2010
Robot-assisted prostate cancer surgery makes sense on some levels but it costs more, and it is not clear whether its outcomes are better.

This article in the journal of urology highlights the need to repeat ruine test

when a dipstick urine test shows blood.

Formal urinalysis with a microscope and a urine cytology can be done before any

invasive tests need to be done.

If you have microscopic hematuria a Ct-scan ( xray tests) or ultrasound

and cystoscopy ( camera test ) fiber optic scope is placed into the penis or female urethra to inspect the bladder.

This study showed that dip stick tests caused invasive workups when urine tests should have been send for microscopic analysis first. 

dipstick analysis is very good at determining urinary tract infection but may have a trace of blood without a urologic hematuria problem

Dr. Grotas offers state of the art diagnostic testing without unnecesary tests.

call today to make an appointment if you have hematuria!!

Volume 183, Issue 2, Pages 560-565 (February 2010)

Dipstick Pseudohematuria: Unnecessary Consultation and Evaluation

Pravin K. Rao, Tianming Gao, Marc Pohl, J. Stephen Jones‡

Received 29 June 2009 published online 16 December 2009.

Purpose
While many primary care providers advocate routine screening urinalyses, a heme positive dipstick test often leads to a false-positive diagnosis of hematuria, or pseudohematuria. Thus, American Urological Association guidelines recommend urological evaluation for asymptomatic patients only for at least 3 red blood cells per high power field in 2 of 3 microscopic urinalyses. We determined the percentage of patients referred for asymptomatic hematuria undergoing unnecessary consultation and studies.

Materials and Methods
Patients were retrospectively identified if seen for initial consultation associated with CPT 599.7X, hematuria. Among these patients those referred for evaluation of asymptomatic nonmacroscopic hematuria were identified, and referral patterns, ancillary tests, procedures and findings were examined.

Results
Of 320 new patient visits with diagnosis code 599.7X, 91 were referred for asymptomatic, nonmacroscopic hematuria. Of these patients only 37 (41%) had microscopic urinalyses before referral and only 22 (24%) had microscopic urinalyses showing 3 or more red blood cells per high power field. Of the 69 patients referred without confirmed microhematuria approximately 25% had true microhematuria and 15 with no true hematuria had undergone imaging before referral. The Medicare reimbursement value for the evaluation of these 69 patients was $44,901. Of these patients 35 underwent cystoscopy and only 1 (with true microhematuria) had a malignancy.

Conclusions
Positive dipstick heme tests should always be confirmed by microscopic urinalysis before urological referral or evaluation. Education of referring physicians regarding the American Urological Association guidelines could possibly help limit costly and potentially harmful, unnecessary evaluation of patients without true microhematuria.

Male health is important In 2010 don’t let these problems get ahead of you!

Dr. Grotas provides some insights! Make an appointment today!

1. prostate check up: PSA and digital exam for prostate

1. Do you have a family history of prostate cancer? Did you have I high PSA and not do anything about it?  All your friends have prostate issues?

2. lower urinary track symptoms: getting up at night, weak urinary stream, frequent trips to urinate

2. stop pushing to urinate, stop being sleep deprived because your bladder/prostate wake you at night, Do you DVR everything due to frequent bathroom breaks?

3. Male sexual perfomance:

3. inadequate erections for intercourse or unreliable erections may have bothered you in 2009 but in 201o you can get help

4. Birth control Blues:

Had enough kids?  Vasectomy may be the right choice for you.  Come in for a fair and balanced discussion of the risks, benefits and alternatives

prior blog entries go over these in detail

watch this video to learn more about ed

click here

erectile dysfunction is common it can be caused by several things check out this video to see an animation and learn more about causes of ed.

A UCSF University of Califorina San Francisco Study published online in Cancer incidentally found a link between heavy drinking and prostate cancer. 

Men who consumed 4 or more drinks of alcohol a day and took finasteride were at much higher risk for prostate cancer than men who didn’t drink.  It appears that finasteride’s chemopreventative effect is negated by heavy drinking.

Make an appointment to talk to the doctor about prostate cancer, finasteride or other urinary complaints.  Request an appointment today!

In 2005 I assisted Dr. Caner Dinlenc, Physician in charge of Minimally Invasive urology, with this robotic radical prostatectomy for prostate cancer.  This is an informative video about how to treat prostate cancer and the tools we use in the operating room.

I currently perform these procedures at Beth Israel Medical Center, New York using the Da-Vinci system.

http://www.or-live.com/bethisrael/1421/

Medscape(6/1, Foster) reported, “Moderate to vigorous physical activity during young adulthood may help offset the increased risk for prostate cancer in black men,” according to a study that included 160,000 white men and 3,671 black men. After analyzing questionnaire responses, investigators found that while “physical activity was not significantly associated with prostate cancer risk in the white men,” black men “who reported at least four hours of physical activity per week between the ages of 19 and 29 years were 35 percent less likely to develop prostate cancer.” An earlier study revealed that the “apparent protective effect of physical activity may be related to race-specific differences in tumor immunobiology.” Similarly, the lead investigator of the current study, Steven C. Moore, PhD, of the National Cancer Institute, also pointed out that “tumors seem to be different in black men,” adding that “physical activity influences both immune function and inflammation, which play a larger role in the tumors of black men.”

This research report is consistent with dietary and physical wellness recommendations that most doctors recommend to patients.  Eat healthy and exercise are typical things we say.  This study is interesting because it found that good health at a young age prevents prostate cancer later on in life.  Black men are at a higher risk so this is a useful thing to counsel young men who usually come in for circumcision, testicle pain, vasectomy or kidney stones. 

I guess a treadmill a day keeps the doctor away!

There has always been speculation that burnt meat or grilled meat may contribute to cancer or contain carcinogens.  The data is not very convincing.  This NYT blog entry is very interesting.  Men should always eat a balanced diet do reduce risks of colon and prostate cancer BUT you don’t have to sell your BBQ on craigslist!  Diets high in read meat also can cause kidney stones.  To mix it up you can try grilling fish too!