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.
Screening tests are those that are done at regular
intervals to detect a disease such as prostate cancer at an early stage. If the
result of a screening test is normal, the disease is presumed not to be
present. If a screening test is abnormal, the disease is then suspected to be
present, and further tests usually are needed to confirm the suspicion (that
is, to make the diagnosis definitively). Prostate cancer usually is suspected
initially because of an abnormality of one or both of the two screening tests
that are used to detect prostate cancer. These screening tests are a digital
rectal examination and a blood test called the prostate specific antigen (PSA).
In the digital rectal examination, the doctor feels (palpates) the prostate
gland with his gloved index finger in the rectum to detect abnormalities of the
gland. Thus, a lump, irregularity, or hardness felt on the surface of the gland
is a finding that is suspicious for prostate cancer. Accordingly, doctors
usually recommend doing a digital rectal examination in men age 40 and over.
The PSA test is a simple, reproducible, and relatively accurate blood test. It is used to detect a protein (the prostate specific antigen) that is released from the prostate gland into the blood. The PSA level is usually higher than 4ng/mL in people with prostate cancer than in people without the cancer. Situations of large prostate size, infection and inflammation are other reasons why the PSA may be elevated. The PSA, therefore, is valuable as a screening test for prostate cancer. Accordingly, doctors usually recommend doing a PSA in men age 40 and over. Subsequent screening is recommended based on individual preference and assessment of risk for developing prostate cancer. For example, patients with a high risk of developing prostate cancer due to a family history or a high initial PSA should have more frequent evaluation (usually annually).
Although, still considered controversial, most urologists recommend regular screening for prostate cancer in men who are likely to live for more than 10 years (for
example, life expectancy > 10 years). The American Urological Association (AUA) issued their latest guidelines for prostate cancer in 2009. According to these, men at the age of 40 should be offered a baseline PSA test and a prostate exam (digital rectal exam or DRE) to ascertain the risk of prostate cancer. Subsequent screening and tests may be performed according to the findings on this initial evaluation and an individual's risk of getting the disease on the basis of other factors such as race, ethnicity, and family history of prostate cancer. As mentioned, most urologists currently would advise some form of screening in men with
a life expectancy greater than 10 years. Most frequently, it would be performed on an annual basis. Although, there is no definite cutoff age to stop prostate cancer screening, most physicians would rarely screen men more than 75 years of age for this disease.
Results of the PSA test under 4 nanograms per milliliter of blood are generally considered normal. (See the next two sections on false-positive elevations of the PSA and on refinements in the PSA test.) There is a recent trend, however, to perform prostate biopsy in all patients with a PSA more than 2.5 ng/ml in order to detect prostate cancer at an earlier (and hopefully, completely curable) stage. The American Urological Association guidelines (2009) do not define a definite cutoff point but advise that all the other risk factors for prostate cancer should be taken into account while making a decision on whether to proceed for a biopsy. One of the important factors that need to be considered is the rate at which the PSA value has increased over time on repeated measurements (PSA velocity). Results between 4 and 10 are considered borderline. These borderline values are interpreted in the context of the patient's age, symptoms, signs, family history, and changes in the PSA levels over time. Results higher than 10 are considered abnormal, suggesting the possibility of prostate cancer. It has been shown that the higher the PSA value, the more likely the diagnosis of prostate cancer. Moreover, the level of PSA tends to increase when the cancer has progressed from organ-confined prostate cancer to local spread to distant (metastatic) spread. Very high values, such as 30 or 40 and over, are usually caused by prostate 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.
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