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 treatment
options for prostate cancer?
Deciding on treatment can be difficult, partly because the
options for treatment today are far better than they were 10 years ago but
also because not enough reliable data are available on which to base the
decisions. Accordingly, scientifically controlled, long-term studies are still
needed to compare the benefits and risks of the various treatments.
To decide on treatment for an individual patient, doctors
categorize prostate cancers as organ-confined (localized to the gland), locally
advanced (a large prostate tumor or one that has spread only locally), or
metastatic (spread distantly or widely). The treatment options for
organ-confined prostate cancer or locally advanced prostate cancer usually
include surgery, radiation therapy, hormonal therapy, cryotherapy, combinations
of some of these treatments, and watchful waiting. A cure for metastatic
prostate cancer is, unfortunately, unattainable at the present time. The
treatments for metastatic prostate cancer, which include hormonal therapy and
chemotherapy, therefore, are considered palliative. By definition, the aims of
palliative treatments are, at best, to slow the growth of the tumor and relieve
the symptoms of the patient.
What about prostate cancer surgery?
The surgical treatment for prostate cancer is commonly referred to as a
radical prostatectomy, which is the removal of the entire prostate gland. The
entire prostate, seminal vesicles, and ampulla of the vas deferens are removed,
and the bladder is connected to the membranous urethra to allow free urination.
The radical prostatectomy is the most common treatment for organ confined or
localized prostate cancer in the United States. This operation is currently
performed in about 36% of patients with organ-confined (localized) prostate
cancer. The American Cancer Society estimates a 90% cure rate nationwide when
the disease is confined to the prostate and the entire gland is removed. The
potential complications of a radical prostatectomy include the risks of
anesthesia, local bleeding, impotence (loss of sexual function) in 30%-70% of
patients, and incontinence (loss of control of urination) in 3%-10% of patients.
Great strides have been made in lowering the frequency of the complications of
radical prostatectomy. These advances have been accomplished largely through
improved anesthesia and surgical techniques. The improved surgical techniques,
in turn, stem from a better understanding of the key anatomy and physiology of
sexual potency and urinary continence. Specifically, the recent introduction of
nerve-sparing techniques for the prostatectomy has helped to reduce the
frequency of impotence and incontinence. Of men who undergo these newer
techniques, 98% are continent, and 60% are able to have an erection.
Radical
prostatectomy can be performed by open surgery, laparoscopic surgery, or by
robotic surgery (robotic assisted radical prostatectomy). Currently, almost 70%
of radical prostatectomy surgeries in the U.S. are performed using the of the Da
Vinci robotic system. For robot-assisted surgery, five small incisions are
made in the abdomen through which the surgeon inserts tube-like instruments,
including a small camera. This creates a magnified three-dimensional view of the
surgical area. The instruments are attached to a mechanical device, and the
surgeon sits at a console and guides the instruments through a viewing device to
perform the surgery. The instrument tips can be moved in a variety of ways under
the control of the surgeon to achieve greater precision in surgery. So far,
studies show that traditional open prostatectomy and robotic prostatectomy have
had similar outcomes related to cancer-free survival rates, urinary continence,
and sexual function. However, in terms of blood loss during surgery and pain and
recovery after the procedure, robotic surgery has been shown to have a
significant advantage.
If post-treatment impotence does occur, it can be
treated by sildenafil (Viagra) tablets, injections of such medications as
alprostadil (Caverject) into the penis, various devices to pump up or stiffen
the penis, or a penile prosthesis (an artificial penis). Incontinence after
treatment often improves with time, special exercises, and medications to
improve the control of urination. Occasionally, however, incontinence requires
implanting an artificial sphincter around the urethra. The artificial sphincter
is made up of muscle or other material and is designed to control the flow of
urine through the urethra.
Transurethral resection of the prostate (TURP) involves the removal of a part
of the prostate by an instrument inserted through the urethra. It is used as an
alternative to prostatectomy in patients with extensive disease or those who
are not fit enough to undergo radical prostatectomy to remove tissue that is
blocking urine flow. This is often referred to as a channel TURP.
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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