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 are the differences between hormonal treatment and chemotherapy?
Hormonal therapy is the mainstay of treatment for symptomatic, advanced-staged prostate cancer. A vast majority of prostate cancers, particularly initially, are dependent on testosterone (the male hormone produced by the testes) for their growth and spread. The objective of hormonal treatment is to withdraw this source of sustenance for prostate cancer cells in an attempt to slow down or control this disease. The
following are treatments available for hormonal therapy:
Orchiectomy is the surgical removal of the testicles.
Luteinizing hormone-releasing hormone (LHRH) agonists, such as leuprolide (Lupron, Viadur, Eligard), goserelin (Zoladex), or buserelin (Suprefact), stop the production of testosterone from the testes and induce a state of "medical castration" (castration without surgery). Many men prefer this over surgical castration.
Antiandrogens, such as flutamide (Eulexin) or bicalutamide (Casodex), block the action of testosterone on the prostate cancer cells and other parts of the body. Each of the above
two classes of medicines produce symptomatic relief in about 80% of patients. Improvement is often dramatic.
Side effects of these medications vary. Orchiectomy and LHRH agonists may cause impotence, hot flashes, and loss of sexual desire. Antiandrogens may cause nausea, vomiting, diarrhea, and breast enlargement or tenderness. Any of these therapies can weaken bones and lead to osteoporosis and bone fracture.
Other agents that are helpful include the following: progestins such as
megestrol acetate given daily orally and other drugs that inhibit androgen production such as aminoglutethimide (Cytadren) or ketoconazole (Nizoral, Extina, Xolegel, Kuric). These agents are effective but are sometimes difficult to tolerate. Corticosteroids are often given simultaneously.
As opposed to hormonal therapy, chemotherapy provides relief in only 20%-25%
of symptomatic patients with prostate cancer. Various regimens are being used.
Estramustine, cisplatin, 5-FU, vinorelbine, and mitoxantrone are the most
popular agents. However, recently docetaxel (Taxotere) has become the drug of choice used by oncologists in treating castrate-resistant prostate cancer (prostate cancer which has become unresponsive to hormonal therapy).
When to use hormonal therapy and chemotherapy depends on the nature of the prostate cancer itself. If the prostate cancer is hormone-sensitive, then hormonal therapy is the therapy of choice. When the cancer becomes hormone-resistant (for example, manipulation of the hormone levels has no effect on the prostate cancer), then the only potential therapy available to the patient is chemotherapy. Chemotherapy, then, is used generally when advanced prostate cancer is hormone-resistant. Unfortunately, chemotherapy after hormone therapy is nowhere near as effective as hormonal therapy because the cancer itself has often evolved to become more aggressive so that the prognosis is significantly worse. When prostate cancer transforms from being hormone-sensitive to hormone-resistant, the prognosis has taken a significant turn for the worse and the chemotherapy option at that particular time is usually the only treatment option available.
Other factors considered in choosing treatment include the age, general health, and preference of the individual and the Gleason score and stage of the cancer. The results of the PSA test sometimes also can help to decide on the treatment. For example, a borderline elevation of the PSA (4-10), if shown to be due to a prostate cancer, suggests that the cancer is confined to the gland. If other tests also point to an organ-confined tumor, surgery or possibly radiation can be considered to attempt a cure. In contrast, a very high PSA (for example, over 30 or 40) raises the possibility of metastases. If the metastases are then confirmed by other tests, the treatment options would be limited to hormonal therapy or chemotherapy.
PSA tests also should be done periodically after treatment to help assess the results of treatment. For example, an increasing PSA suggests growth or spread of the cancer, despite the treatment. In contrast, a decreasing PSA indicates improvement. As a matter of fact, a post-treatment undetectable PSA (PSA less than 0.05 or 0.1 ng/ml) may indicate complete control or cure of the cancer.
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.
Cancer RSS
Healthy Living Tips
This site complies with the