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.
The staging of a cancer refers to determining the extent of the disease
(where in the body have the prostate cancer cells spread). Once a prostate
cancer is diagnosed on a biopsy, additional tests are done to assess whether the
cancer has spread beyond the gland.
Radionuclide bone scans can determine if there is a spread of the tumor to
the bones. The radioactive substance highlights areas where the cancer has
affected the bones. This test is usually reserved for men with prostate cancer
who have deep bone pain or a fracture or who have biopsy findings and high PSA
values (>10-20 ng/ml) suggestive of advanced or aggressive disease.
Chest X-ray can be used to detect whether or not cancer has spread to the
lungs. Ultrasound tests can be used to look for the effects of a urinary
blockage on the kidneys. This study can also be used to assess the bladder for
any sign of urinary obstruction due to prostate enlargement by looking at the
thickness of the bladder wall as well as the amount of urine remaining within
the bladder after an attempt at passing urine.
Additionally, CT scans (coaxial tomography) and MRIs (magnetic resonance
imaging) can determine if the cancer has spread to adjacent tissues or organs
such as the bladder or rectum or to other parts of the body such as the liver or
lungs. Newer scanning using a method called PET scan can sometimes help to
detect hidden locations of cancer that has spread to various areas of the body.
Cystoscopy is usually performed in selected situations. A thin, flexible,
lighted tube with a tiny camera on the end is inserted through the urethra to
the bladder. The camera transmits images to a video monitor. This may show
whether the cancer has spread to the urethra or bladder and may be utilized to
take a biopsy from these organs.
To summarize, doctors do the staging of prostate cancer based primarily on
the results of the prostate biopsy, possibly other biopsies, and imaging tests.
In staging a cancer, doctors assign various letters and numbers to the cancer,
depending on which of the classifications for staging they use. The numbers and
letters in the different classifications define the volume or amount of the
tumor and the spread of the cancer. The stage of the prostate cancer, therefore,
helps to predict the expected course of the disease and determine the choice of
treatment.
The stages of prostate cancer are categorized as follows:
Stage I (or A): The cancer cannot be felt on a digital rectal exam, and there
is no evidence that it has spread outside the prostate. These are often found
incidentally after surgery for an enlarged prostate.
Stage II (or B): The
tumor is larger than a stage I and can be felt on a digital rectal exam. There is
no evidence that the cancer has spread outside the prostate. These are usually
found on a biopsy when a man has an elevated PSA level.
Stage III (or C): The
cancer has invaded other tissues neighboring the prostate.
Stage IV (or D):
The cancer has spread to lymph nodes or to other organs.
Most doctors currently use the 2002 TNM (Tumor, Node, Metastases) staging
system for prostate cancer. This is based on a combination of three criteria: extent
of the primary tumor (T stage), involvement of lymph nodes by the cancer (N
stage), and the presence or absence of spread to distant areas of the body in the
form of metastasis (M stage). The TNM 2002 staging system is as follows:
Evaluation of the (primary) tumor ("T")
TX: The primary tumor cannot be evaluated.
T0: There is no evidence of tumor.
T1:
Tumor is present but not detectable clinically or with imaging.
T1a: Tumor was
incidentally found in less than 5% of prostate tissue resected (for other
reasons).
T1b: Tumor was incidentally found in greater than 5% of prostate
tissue resected.
T1c: Tumor was found in a needle biopsy performed due to an
elevated serum PSA.
T2: The tumor can be felt (palpated) on examination but
has not spread outside the prostate.
T2a: The tumor is in half or less than
half of one of the prostate gland's two lobes.
T2b: The tumor is in more than
half of one lobe, but not both.
T2c: The tumor is in both lobes.
T3: The tumor
has spread through the prostatic capsule (if it is only partway through, it is
still T2).
T3a: The tumor has spread through the capsule on one or both sides.
T3b: The tumor has invaded one or both seminal vesicles.
T4: The tumor has
invaded other nearby structures.
It should be stressed that the designation "T2c" implies a tumor which is
palpable in both lobes of the prostate. Tumors which are found to be bilateral
on biopsy only but which are not palpable bilaterally should not be staged as
T2c.
Evaluation of the regional lymph nodes ("N")
NX: The regional lymph nodes cannot be evaluated.
N0: There has been no spread
to the regional lymph nodes.
N1: There has been spread to the regional lymph
nodes.
Evaluation of distant metastasis ("M")
MX: Distant metastasis cannot be evaluated.
M0: There is no distant metastasis.
M1: There is distant metastasis.
M1a: The cancer has spread to lymph nodes
beyond the regional ones.
M1b: The cancer has spread to bone.
M1c: The cancer
has spread to other sites (regardless of bone involvement).
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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