Hypogonadism (low testosterone)
Male hypogonadism is a condition in which the testes do not produce enough testosterone, a hormone that plays an important role in sperm production and in male sexual development. Sometimes males are born with the condition, but it can also develop in adulthood as a result of other medical problems. Often hypogonadism can be treated with testosterone replacement therapy.
If hypogonadism occurs during fetal development, a male will have ambiguous or undeveloped male genitals. If it occurs during puberty or in adulthood, it may alter male physical characteristics and can impair normal erectile function and sperm production, decreasing a man’s fertility. The condition can cause other physical problems, such as a decrease in muscle and bone mass, and may sometimes affect cognitive and emotional functioning.
Certain genetic conditions put males at risk for hypogonadism, including Klinefelter syndrome and Kallmann syndrome. The condition can result from illnesses such as HIV/AIDS, tumors, and some cancer treatments. A drop in testosterone is also a normal part of the aging process, and in such cases, does not necessarily require treatment.
Hypogonadism is diagnosed on the basis of symptoms and on blood tests that measure testosterone. If your testosterone level is low, your doctor will order additional tests to make sure you do not have an underlying condition such as a pituitary abnormality that requires treatment.
Adult men with hypogonadism may be treated with testosterone replacement therapy to improve sexual function and restore muscle and bone strength. Testosterone can be delivered in several ways, including through injection, patch and gel. If a pituitary problem is the underlying cause of hypogonadism, surgery or replacement pituitary hormones may be indicated. Testosterone therapy may also be used in boys with underlying genetic conditions to encourage normal pubertal growth.
Testosterone therapy is NOT a treatment for infertility. In fact, treatment with testosterone is very likely to make fertility worse. However, several other treatments are possible for men who have both low testosterone and infertility.
Hematuria (blood in urine)
Hematuria refers to the presence of blood in the urine. If the blood is visible (appearing pink, red or cola-colored) it is called gross hematuria. Blood that can be detected only when urine is examined under a microscope, is called microhematuria. Most men with hematuria do not have symptoms. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate, or urethra. It increases in frequency with . It.. It age and lifestyle factors such as smoking.
Hematuria has many causes, including vigorous exercise, sexual activity, viral illness, trauma/injury, or infection such as a urinary tract infection (UTI). More serious causes include kidney or bladder stones, cancer in the urinary tract, and medical conditions such as blood disorders, inflammatory conditions, polycystic kidney disease, or sickle cell disease.
Overall, the chance of cancer among people with hematuria is only 3-4%, but is higher in in those men with risk factors, such as smoking, older age, history of pelvic radiation, and exposure to certain medications and chemicals. Hematuria can also occur after recent urologic procedures or if you are taking anticoagulant medications (blood-thinners such as aspirin).
When microscopic hematuria is identified, the next step is to diagnose the cause. Your physician will take a complete medical history and retest your urine at 48-hour intervals. If two of three urine samples reveal blood, it is important to conduct further tests to make sure that the microhematuria is not related to a serious underlying condition, such as cancer. Likewise, all cases of gross hematuria merit further testing. Hematuria evaluation may include use of cystoscopy—looking inside the bladder with a thin, flexible telescope—to visualize the bladder, and imaging with CT or MRI to visualize the kidneys and ureters. Urine tests include cytology to look for cancer cells in urine and urine culture to rule out infection.
As previously discussed, many prostate cancers do not pose an immediate risk to health and may not require treatment. Active surveillance is a way to monitor low risk prostate cancer (cancer that is not an immediate risk to your health or well-being) with a plan of timely intervention should the tumor progress.
A radical prostatectomy is surgery to remove the entire prostate gland and seminal vesicles after a diagnosis of prostate cancer is made. Sometimes, this also entails removal of the regional lymph nodes, depending on a number of factors.
Radiation therapy is done with the intent of curing the disease by killing cancer cells.. Radiation can be given as external beam radiation therapy (EBRT) and/or as brachytherapy (temporary or permanent radiation seed implants). This treatment is sometimes coupled with hormone therapy because most prostate cancers are driven by testosterone. Hormone therapy attempts to establish very low levels of testosterone in an effort to control the cancer progression.
Brachytherapy (Seed Implants)
With brachytherapy, radiation is given from inside the body, with radioactive seeds placed permanently in the prostate or with narrow, seed-filled tubes that are placed temporarily for one or two days.
This procedure, used to treat localized prostate cancer, kills the cancer cells in the prostate by freezing them.
What If Initial Treatment Is Not Sufficient or Your Cancer Recurs?
While the diagnosis and treatment of prostate cancer has improved significantly in recent years, the cancer can still recur. Not surprisingly, clinical studies show the likelihood is higher the more advanced the disease was at initial diagnosis, and the more time that passes since diagnosis and treatment. While differences emerge between different types of treatment, many other factors also come into play such as the original staging, Gleason score, extent of the cancer, and age of the patient. Various statistical tools called nomograms help assess this risk.
There are usually a number of treatment options that men in such situations can consider to successfully treat or control the cancer. Choosing among them will require a new decision-making process. It is still essential that you and your physician continue to monitor your PSA on a quarterly basis for some period of time, no matter how successful your treatment has seemed to be.
The kidneys are paired bean-like organs located in the back of the abdominal cavity in the retroperitoneum. The kidneys play a large role in the regulation of wastes, electrolytes, water, blood pressure and acid-base balance throughout the body. Although it is normal to have two kidneys, it is quite possible to live with just one.
The most common type of kidney cancer is called renal cell carcinoma (RCC). Risk factors include smoking, regular use of non-steroidal anti-inflammatories such as ibuprofen and naproxen, a family history of kidney cancer, and renal disease requiring dialysis.
Most commonly, kidney cancer is detected incidentally on imaging for some other purpose and has no signs or symptoms. In cases where the cancer has formed a larger tumor, a patient may experience flank pain, a mass in the abdomen, or blood in the urine that is either visable or apparent on a dipstick test. Other tests to help stage the extent of kidney cancer may include a CT scan of the abdomen and pelvis to help characterize the size of the tumor and parts of the kidney that are involved as well as to exclude any metastatic disease in the abdomen or pelvis. Additional tests may include a chest xray or chest CT scan to rule out any spread of cancer to the lungs. A bone scan to exclude spread to the bones may be done if there is a high suspicion that these structures may be involved. A biopsy may also be performed in certain cases to confirm a diagnosis of kidney cancer.
Kidney cancer is most often treated with surgery. This can involve removal of the entire kidney or removal of the mass and part of the kidney, to spare as much normal tissue as possible. Treatment can also involve heating the tumor with radiofrequency ablation or freezing the tumor with cryoablation. If the tumor mass is small of if the patient has significant comorbidities, the mass can be monitored with active surveillance. This involves periodically imaging the mass to see if it has grown and intervening if any progression is detected. Finally, there are medications that may help to shrink mass size and tumor burden, but these have side effects, so are reserved for more advanced or metastatic disease.