Prostate cancer is the second leading cause of cancer death in men. If detected
and treated early, prostate cancer survival rates are high and associated with good functional outcomes. Brian Helfand, MD, PhD, Urologist
at Northshore, answers questions about prostate cancer risk, PSA values, early signs and symptoms, recommended screening, as well as current treatment options for prostate cancer and recovery after treatment.
What is a normal PSA? I always tell my patients that you should compare your PSA to what is "normal" for your age group. Most men age 50 and younger have a PSA below 0.7ng/ml. For simplicity, you could use a cutoff of 1.0ng/ml. It’s important to point out that having a
PSA value that is above your age group does not mean that you have prostate cancer. It does, however, mean that you are statistically at a slightly increased risk for being diagnosed with the disease. For that reason, you should continue to be screened with
PSA on an annual basis at least.
There are other factors that should go into the interpretation of PSA before deciding to perform a prostate biopsy and these include: PSA values that have been rising over time, family history of prostate cancer,
African-American heritage and history of benign prostatic hyperplasia (BPH). Remember, PSA is not a perfect test but it has saved many lives and it’s still the best test for prostate cancer screening.
Guidelines for median PSA levels by
If there is a family history of the disease,
does that increase your risk? When should someone with a family history of the disease begin screening? Prostate cancer is one of the most inheritable of all cancers. As such, risk factors that are most associated with prostate cancer are first-degree
family history (father, brother, uncle, etc.) and race (i.e. African-Americans). Based on statistics, a man with a first-degree connection to the disease is almost two times more likely to be diagnosed with prostate cancer than a man without a family history.
Although there is some debate regarding the routine use of PSA screening, I’m a firm believer that if there is a family history, one should start undergoing annual PSA screening by the age of 40.
After treatment, how often should a patient
return to their physician for further tests and screenings? After surgery, patients should have an initial post-operative PSA in about four to six weeks and then every three to four months (based upon their urologist's preference). After
two years of having an undetectable PSA, I suggest my patients get PSAs every six months.
Are there preventative measures that could potentially reduce one’s risk for developing the disease? It’s possible that
a heart-healthy diet low in fats and simple sugars may help reduce one’s risk of developing prostate cancer. There is emerging evidence that obesity is a driving factor for benign growth of the prostate (referred to as BPH or benign prostatic hyperplasia)
and that it could also contribute to one’s risk for prostate cancer. Extra weight may also make it harder to detect the disease until it is advanced. Obesity also is thought to contribute to prostate cancer recurrence. That’s why it’s important
for men to realize that a heart-healthy diet can help keep their prostates healthy too!
How likely is a patient’s sexual function to be affected after treatment? What surgical options result in the best possible outcome as far as recovering
sex life? I tell my patients that your post-operative sexual function is significantly related to your age and pre-operative function. In general, treatment for prostate cancer (radiation or surgery) has never improved a man's erectile
function. However, if a man is young, not diabetic or obese and had good erectile function prior to surgery, he has a very good chance of having normal erections post-op.
I believe that good, nerve-sparing surgery significantly helps with the recovery
of erectile function. This can be done by a urologic surgeon who is trained in the technique and frequently performs the operation. In addition, I believe that all men should start (at minimum) a rehabilitation program before and immediately after surgery
that helps to recover nerve function. This could involve taking drugs like Cialis before and after surgery.
If you do suffer from sexual dysfunction after prostate cancer treatment, what can you do to aid/improve recovery? Unfortunately,
there is no universal solution for every man but there are many different options that are available for treatment of sexual dysfunction after surgery. Prostate cancer patients should have an assessment of psychological function and desire for sexual activity
following surgery. Many men get nervous about intimacy following surgery and an evaluation by a trained professional can help relieve a lot of this anxiety.
If there are erectile issues after treatment, many men respond to simple medical therapies
like Viagra and Cialis. This is often a starting point. If you fail to respond to these therapies, other interventions such as a vacuum erection device or injection therapies can be used to obtain an erection. As always, regular exercise and a heart-healthy
diet help increases your chances of a successful recovery.
What are the differences between robotic laparoscopic surgery and conventional open prostatectomy in terms of recovery? I think the answer is surgeon experience. There
are many urologists who can perform open surgery with excellent outcomes (great cancer control, erectile function and continence). And there are many urologists who can perform robotic surgery with similar outcomes. It’s most important to be treated
by an urologist who is comfortable and experienced with a radical prostatectomy. Having said that, robotic surgery has recently become the most commonly used surgical intervention for prostate cancer. When compared to open surgery, robotic surgery offers significantly
less blood loss and a shorter hospital stay. Although not proven, it’s likely that the robotic surgery offers increased visualization of the area by the surgeon which provides an opportunity to spare more nerves and create a nice connection between the
bladder and urethra. These are both associated with increased erectile function and increased continence.
What does active surveillance involve? Why would someone choose to do that instead of actively treat their cancer? We have
come to a "new era" of understanding prostate cancer and realized that many men have prostate tumors that may not harm them during their lifetime (benign-type prostate cancer). This is because many prostate tumors grow very slowly and other medical problems
may ultimately harm a man before the prostate cancer spreads
Unfortunately, there is currently no diagnostic test that can tell whether one has a lethal prostate cancer or more benign-type tumor; therefore, we have developed a program of surveillance
in which we avoid treating patients with prostate cancer until there is evidence that it has an aggressive component. This involves actively and regularly monitoring men through the use of PSA tests and prostate biopsies. While this does increase the number
of times that a man is evaluated by an urologist, it avoids overtreatment, like unnecessary surgery or radiation that could cause erectile problems and/or incontinence. Currently, NorthShore University HealthSystem has the largest program in the Midwest.
Personalized Medicine is the next frontier in medicine, and NorthShore University HealthSystem is at the forefront of this new field. Personalized Medicine (sometimes referred to as Precision Medicine) is all about custom care—tailoring a patient's
treatment based on his or her genetic makeup and individual health history. Thanks to genetic testing, doctors can now identify changes in our genome that influence disease risk and develop customized treatment plans accordingly.Pharmacogenomics,
a key area of Personalized Medicine, lets us study how genes influence a person's reaction to medication. Having this genetic information helps doctors the right drug in the right dose the first time. Learn more about Personalized Medicine from the experts
at NorthShore University HealthSystem in the infographic below. Click the image to view the full infographic.
The kids are back in school and already busy with homework, classes and practice. Don't let hectic schedules put your children’s health in detention. Parents can do plenty to help their children stay healthy and succeed in school—from
ensuring they get adequate sleep and regular exercise to serving up balanced meals and more. After all, children’s health has been shown to be directly linked to success in school.
infographic explores the connection between children’s health and academic performance with health information and tips from the experts at NorthShore University HealthSystem. Click on the image below to see the full infographic.
Join NorthShore's new online community, The Parent 'Hood, to connect with other new and expecting parents, as well as our expert physicians. Find support, ask questions and share your stories. Click The Parent 'Hood to start now!
Summer is reaching its end, and many parents are still finding themselves with questions
about the upcoming school year. Lindsay Uzunlar, MD, Pediatrician at NorthShore, answers five common questions to help prepare
parents for what's ahead:
My child gets stressed out pretty easily, and now that she’s entering middle school, I’m nervous that she’ll have a tough time. Are there any tips I can give her in case she panics?This can be a very stressful time for kids and transitioning to a new school is even harder. There are a couple of things that you can do to help:
I’ve been struggling to get my 7 year
old up and moving in the mornings. Is there any way I can make this easier for him?The first way to help is to make sure that he goes to bed early the night before. Children between 6 and 13 should be getting between 9-11 hours of sleep a night.
Secondly, trying to let the sunlight in early will help a lot as it stimulates the body to wake up. Lastly, try to get everything together and done the night before. This includes bathing and setting out clothes for the next day.Can you
give me some tips to tell my children about walking to school? We’re in a good neighborhood, but I still want to be cautious.Living in the city, there are a couple of things that you want to focus on:
Do you have any recommendations when it comes to packing a lunch? I have a little one starting elementary
school, and I’m feeling a little lost when it comes to how much to give her. I've seen some cute boxes and containers online, and am wondering if these will help.First of all, make sure that you include fruits/veggies AND a protein
(preferably a meat but if she is a vegetarian then cheese/yogurt). Giving her some some carbs such as bread in a sandwich or baked chips is great as well but try to limit it to one portion. Too many carbs could make her sleepy in the afternoons. As for portions,
it really depends on how much she normally eats and/or what your pediatrician has recommended. There are definitely some great boxes etc that you can find to help guide you with this.What are some good mid-day snack options? I want to make
sure I’m not giving my child junk food to take to class.The best snacks include fruit and veggies. If your child isn't milk allergic or lactose intolerant, string cheese is delicious and fun!You can learn more about
health and nutrition for kids through NorthShore’s Pediatrics department. Find more back to school tips from Dr. Uzunlar in our Back to School Basics chat.
Going through treatment, trying to cope with a
social disorder or building the courage to start exercising again all come with their own physical and emotional stresses. When facing a unique struggle, many patients have found an equally unique solution in the form of pet therapy. This treatment method
pairs patients with animals such as a dog, cat or another creature to provide comfort and support that’s shown to have a number of benefits.Pet therapy animals can provide individual comfort to a patient working towards a specific goal through
structured activities. This could include:
Therapy animals and their handlers both go through a certification process, but it’s important to note that therapy dogs don’t receive the
same training as service dogs.Not only are domestic animals like dogs and cats able to become therapy animals, but there are also ways to work with smaller animals (rabbits, fish, birds), as well as even bigger animals like horses or dolphins.
Leon Benson, MD, Orthopaedic Surgeon at NorthShore and owner of two certified therapy dogs (pictured right with Chelsea) details
the process of animal therapy and some of the positive effects it can have on patients. Studies have shown that pet therapy can help improve:
is happy to be offering a pet therapy program for its patients through Evanston Hospital. Learn more through our Physical
Medicine & Rehabilitations Services.
What do you think would be a great new way to use pet therapy?
It’s hard to avoid screens these days. Between television, computers, tablets and cell
phones, kids have easy access to hours of entertainment. According to the American Academy of Pediatrics, children under the age of two should not have any screen time, while children older than two should only be in front of a screen for one to two hours
a day at most. In reality, the averages are much higher; kids are spending 7 or more hours watching programs/videos, texting and playing games. This can be troubling, especially in younger children, as too much screen time can increase the risks of childhood
obesity, poor language development and unhealthy sleep patterns.
Finding a balance between screen time and other activities can seem like a big task. Amanda Britt, MD, a pediatrician at NorthShore provides some tips for how to make the most out of your child’s digital time so that it is both productive and educational.
NorthShore is a proud sponsor of Moochie
Kalala Detectives Club, an educational children’s show on PBS that teaches kids about arts and sciences while featuring some of Chicago’s best museums, zoos and educational resources.
best tip for managing screen time in your home?
If you have young children and watch the news, you’re probably aware that there is a strand of lice that is resistant to over-the-counter treatments.
While an annoyance, head lice, including this strand, can be effectively treated at home. Lice are a very common problem for preschool, kindergarten and elementary students. In fact, the Centers for Disease Control and Prevention estimate 6-12 million infestations
occur a year among children ages 3-11.
While typically not known for spreading disease, these parasites can be a nuisance to identify, treat and exterminate. As the school year begins, Felissa Kreindler, MD, shares her insight on warning signs for detecting and treating head lice:
Have you or your kids ever had lice? What did you do to get rid of them?
Summer is winding down, and many of us are looking for ways to
use our fresh produce before it gets chilly out. Our latest healthy recipe has a Mediterranean twist that will be a saucy addition to soups, meat dishes, and more. Emmaline Rasmussen, MS, RD, LDN, Dietitian at NorthShore, recommends this
sofrito recipe that’s rich in antioxidants:
Serving Size: 3/4 cupRecommendation of at least 2 servings per week for the best health benefitsIngredients4
tomatoes, diced1/2 large onion, diced2 cloves garlic, minced1-2 tablespoons extra virgin olive oil
To prepare the base:
Note: You can also make this recipe during the fall. Our favorite way is to serve it over baked spaghetti squash instead of traditional pasta to cut carbs and add more veggies to your diet.
Discover more appetizing
and healthy recipes that are part of the Mediterannean Diet on our new Pinterest board.
Jorge Saucedo, MD, has had a love for medicine since he was a student, which has led to his success as the Division Chief of Interventional Cardiology at NorthShore. He now shares his experience and some helpful tips on heart
health, as well as some of his most interesting personal passions.
When did you know you wanted to go into medicine? Was there a particular moment of realization? Where did it all start?For me, it was when I was finishing high
school. Outside of the U.S., you begin medical school right after high school (there is no college, and medical school is longer). For me at the age of 17-18, it was more like “I guess I will go into medicine”. I truly fell in love with medicine
at the end of my second year of medical school. My love for the profession has increased with every year that goes by.
When did your attention turn to cardiology? What led you to this specialty?The second hardest decision was
to choose between surgery and internal medicine when finishing medical school. The decision was made the night before the interviews. In regards to cardiology, this was easy. As soon as I started my internal medicine training, I knew I wanted to become a cardiologist.
What do you enjoy most about your job?Spending quality time with patients. I also enjoy doing complex interventions, particularly in patients with heart attacks.
What do you
find most challenging about cardiology? Treatment of patients?Keeping up with how tremendously fast the field evolves.
What do you think is the most important thing everyone should know about their heart/the
care of their heart?Prevention is crucial. Watch your blood pressure, know your cholesterol levels, exercise and don't use tobacco products.
What can/should people do themselves to improve their heart
health?Maintain healthy eating and sleeping patterns, and do not abuse alcoholic drinks.
One of your other passions is opera and classical music? Where did this passion start?When I was around 15 years old. Both,
music and voce have been a fascination to me.
Is there any particular performer or performance that inspires you?I have had the privilege of hearing the best opera singers on the best world stages. I love Mozart and Verdi operas.
Obviously, Spanish tenors like Placido Domingo are on the top of my list. Hearing Joyce DiDonato was also truly inspirational.
If you could perform anywhere or for anyone, where or who would it be?If I had any talent, I would
love to perform at Teatro alla Scala in Milano or the Lyric in downtown Chicago. Maybe the roles of Manrico in Il Trovatore or Mario Cavaradossi in Tosca.
In honor of National Relaxation Day, we’re getting serious about stress
relief. When people talk about relaxation, it often seems like something that we aren’t always able to fit into our busy schedules. In reality, relaxation can be one of the healthiest things to incorporate into your everyday life.Daily stress
can take a toll on both physical and mental health. Studies show that various forms of relaxation can help reduce many chronic health concerns as well as restore energy and encourage a more positive sense of self. Some popular relaxation techniques include:
Dr. Mina Lee Ryu, MD, FACP, Internist in Internal Medicine at NorthShore working in internal medicine, lists some of the many benefits of making relaxation a part of your daily routine:
How do you incorporate relaxation into your daily routine?