Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
What about hormonal treatment for prostate cancer?
The male (androgenic) hormone is called testosterone. It
stimulates the growth of cancerous prostatic cells and, therefore, is the
primary fuel for the growth of prostate cancer. The idea of all of the hormonal
treatments (medical and surgical), in short, is to decrease the stimulation by
testosterone of the cancerous prostatic cells. Testosterone normally is
produced by the testes in response to stimulation from a hormonal signal called
LH-RH. The LH-RH stands for luteinizing hormone-releasing hormone and is also
called gonadotropin-releasing hormone. This hormone comes from a control
station in the brain and travels in the bloodstream to the testes. Once there,
the LH-RH stimulates the testes to produce and release testosterone.
Hormonal treatment, also referred to as androgen
deprivation (depriving the prostate of testosterone), can be accomplished
surgically or medically. The surgical hormonal treatment is removal of the
testes in an operation called an orchiectomy or a castration. This surgery thus
removes the body's source of testosterone. The medical hormonal treatment
involves taking one or two types of medication. One type is referred to as the
LH-RH agonists. They work by competing with the body's own LH-RH. These drugs
thereby inhibit (block) the release of LH-RH from the brain. The other type of
drug is referred to as anti-androgenic, meaning that these drugs work against
the male hormone. That is, they work by blocking the effect of testosterone
itself on the prostate.
Today, most men electing hormonal treatment choose
medication over surgery, probably because they view surgical castration as more
devastating cosmetically or psychologically. Actually, however, the
effectiveness and side effects of medical hormonal treatment as compared to
surgical hormonal treatment are very much the same. Both types of hormonal
treatment usually effectively eliminate stimulation of the cancer cells by
testosterone. Some tumors of the prostate, however, do not respond to this form
of treatment. They are referred to as androgen-independent prostate cancers.
The principal side effects of all of these hormonal treatments (that is, the
side effects of androgenic deprivation) are enlarged breasts (gynecomastia)
that often are tender, flushing (like hot flashes), and impotence.
The LH-RH agonists, leuprolide (Lupron) or goserelin
(Zoladex), are given as monthly injections in the doctor's office. The
anti-androgenic drugs, flutamide (Eulexin) or bicalutamide (Casodex), are oral
capsules that are used usually in combination with the LH-RH agonists. The LH-RH agonists are often effective alone. The anti-androgenic drugs are added, however, if the cancer progresses despite the use of the LH-RH agonists. The hormonal treatments may have value, as well, when combined with radiation therapy. Current evidence suggests that hormonal therapy enhances the therapeutic effect of radiation.
Generally, hormonal treatment is reserved for individuals
who have advanced prostate cancer with local spread or metastases.
Occasionally, an individual with organ-confined (localized) prostate cancer
will receive hormonal treatment because he has severe associated medical
problems or simply because he refuses to undergo surgery or radiation. Hormonal
treatment is used in less than 10% of men with organ-confined
(localized) prostate cancer. Remember that the intent of hormonal therapy
usually is palliative. This means that the goal is to control the cancer rather
than cure it because a cure is not possible.
Prostate Cancer - Symptoms At Onset Of DiseaseQuestion: The symptoms of prostate cancer can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Prostatitis is a painful condition of the prostate gland. There are four types of prostatitis, acute bacterial, chronic bacterial, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis. Diagnosis is made with a digital rectal exam, urinalysis, ultrasound, MRI, biopsy, or blood test. Treatment depends upon the type of prostatitis.
Impotence, also known as erectile dysfunction, is a common
problem among men characterized by the consistent inability to sustain an
erection sufficient for sexual intercourse or the inability to achieve
ejaculation, or both. Impotence can have emotional causes but most often it is
due to a physical problem.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Hydronephrosis is a condition in which the kidney swells, due to a backup of urine. Hydronephrosis generally occurs with another disease.Symptoms of hydronephrosis include nausea, vomiting, urinary tract infection, fever, painful urination, increased urinary frequency and urgency, flank pain, and swelling of the abdomen. Treatment of hydronephrosis depends on the cause.
Benign prostatic hyperplasia (BPH or enlarged prostate) is very common in men over 50 years of age. This noncancerous enlargement of the prostate can impede urine flow, slow the flow of urine, create the urge to urinate frequently and cause other symptoms like complete blockage of urine and urinary tract infections. Treatment may involve watchful waiting, medication, or surgery.
There are many types of urinary incontinence (UI), which is the accidental leakage of urine. These types include stress incontinence, urge incontinence, and overflow incontinence. Urinary incontinence in men may be caused by prostate or nerve problems. Treatment depends upon the type and severity of the UI and the patient's lifestyle.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Men's health is an important component to a happy lifestyle and healthy relationships. Eating healthy, exercise, managing stress, and knowing when to have medical tests for a particular age is key to disease prevention in men.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
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