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 false-positive
elevations in the PSA test?
False-positive elevations in the PSA are increases in the
PSA that are caused by conditions other than prostate cancer. For example,
benign prostatic hyperplasia (BPH) and infection or inflammation of the
prostate (prostatitis) from whatever cause can elevate the PSA. Note also that
even a rectal examination or an ejaculation within the prior 48 hours can sometimes
elevate the PSA. False-positive elevations are usually in the 4 to10 range,
but they can go as high as 25 or 30. At these higher levels, however, caution
in the interpretation of the test is warranted because a prostate cancer may
well be present. Non-prostatic diseases or infections, medications, foods,
smoking, and alcohol do not cause false-positive elevations of the PSA.
The ability of the PSA test to detect prostate cancer
(called the sensitivity of the test) is high. The reason for this is that most
patients, although not all, with prostate cancer have a borderline or an
abnormally elevated PSA. The ability of the test to exclude other diagnoses
(called the specificity of the test), however, is lower because of the other
conditions that can cause false-positive elevations of the PSA.
What refinements have
been made in the PSA test?
Recently, several refinements have been made in the PSA
blood test. The purpose of these refinements is to help doctors to better
assess a borderline or an elevated PSA. The goal is to determine more
accurately who has prostate cancer and who has a false-positive elevation of
the PSA from another condition. In other words, the purpose of the improvements
is to improve the sensitivity and the specificity of the test.
One refinement is called the PSA ratio. This ratio is
determined by dividing the amount of PSA that circulates freely in the bloodstream by the amount of PSA that is bound to proteins in the bloodstream.
Research has shown the PSA that circulates freely in the blood tends to be
associated with benign prostatic hyperplasia (BPH) whereas the PSA that is
bound to protein tends to be linked with prostate cancer. Thus, a high PSA
ratio suggests a false-positive elevation of the PSA and weighs against the
diagnosis of prostate cancer. In contrast, a high PSA with a low PSA ratio
favors the diagnosis of prostate cancer.
Another recent modification of the PSA test is based on
the observation that as men age the amount of PSA in the blood can normally
rise without the presence of a prostate cancer. Thus, doctors can use what is
referred to as an age-specific PSA, especially to evaluate borderline values.
In the age-specific PSA, the normal values are adjusted for the age of the
patient. Accordingly, the age-specific normal ranges are 0 to 2.5 for men in
their 40s, 0 to 3.5 in their 50s, 0 to 4.5 in their 60s, and 0 to 6.5 for men
70 years of age and over. Therefore, as an example, a PSA of 4 would be considered
borderline for men in their 30s and 40s but could be normal for men in their
50s, 60s, and 70s.
Furthermore, another improvement of the PSA test is called the PSA
velocity or slope. The velocity is calculated as the rate at which the PSA
changes with repeated testing over time. The more rapid the rise in the PSA,
the more likely is the presence of a prostate cancer. The less rapid the rise
in the PSA, the less likelihood there is that a prostate cancer is present.
Prostate cancer gene 3 (PCA3) is a new gene-based test carried out on a urine sample. PCA3 is highly specific for the diagnosis of prostate cancer. Therefore, in contrast to PSA, the PCA3 is not increased by conditions such as benign enlargement or inflammation of the prostate.
The PCA3 urine test can provide additional information over a PSA test that may help in deciding whether a prostate biopsy is really needed.
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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