I didn't know what ‘metachromatic leukodystrophy’ meant. I asked for an explanation and when they told us it was something to do with his brain I just kind of panicked and freaked out… His mental abilities are going to be changing and I think having the mental aspect going in his life is going to be a big situation in our lives… When he's not going…
Matthew was a red-haired little boy suffering from congenital microvillus inclusion disease, an autosomal recessive disorder that is characterized by intestinal failure and often treated with multivisceral organ transplantation. This patient and his family experienced a great deal of suffering. When he was 5 years old, after a year-long hospitalization and careful consideration of prognosis and establishment of realistic goals of care, his family decided to…
Life is so strange. Sometimes you feel it's like a book with chapters to fill, never ending. Sometimes it's like a chess game where you have to make each move so carefully. Other times it's like a mystery where each hidden chamber reveals its secrets. It is even a war where to live it is to win it. ( p. 131 ) —Karen Beth Josephson, age…
The medical art consists in three things — The disease, the patient, and the healer. —Hippocratic Epidemics , Book 1, Section 2 Epidemiology involves the science and art of comparison. While historically the ideas and tools of epidemiology were developed to study the distribution of health and disease in human populations and environmental factors associated with illnesses, modern epidemiologic concepts and methods can and are applied…
Words are deeds. The words we hear May revolutionize or rear A mighty state. The words we read May be a spiritual deed Excelling any fleshly one, As much as the celestial sun Transcends a bonfire, made to throw A light upon some raree-show. A simple proverb tagged with rhyme May colour half the course of time; The pregnant saying of a sage May influence every…
Background Prostate Cancer as a Contraindication for Testosterone Therapy Numerous cross-sectional and longitudinal studies demonstrate that serum testosterone levels decrease with advancing age while the incidence of symptomatic male hypogonadism increases and may be as high as 500,000 new cases annually in men aged 40–69 years in the United States. Similar data have been shown for men in Australia and Europe. The implications and consequences of…
Introduction Prostate cancer (PCa) is the most commonly diagnosed solid tumor among men in the United States and Europe. Even without treatment, PCa-specific mortality rates at 5 and 10 years remain low. Improvements in optimizing screening, diagnosis, and treatment have resulted in decreasing PCa mortality. Nevertheless, certain challenges still remain for men facing important disease state decisions and there is a need for biomarkers that can…
Introduction The legal implications of prostate cancer screening flow from the formalization of expert opinion and scientific data into clinical practice guidelines (CPGs). These guidelines are a nexus between the daily clinical practice of prostate cancer care and the broader legal framework that permeates all medical practice. As public statements of appropriate care, they provide the lens through which clinical decisions between patients and their physicians…
PSA testing: an ongoing dialogue Prostate-specific antigen (PSA)-based screening for early detection of prostate cancer was approved in two stages by the US Food and Drug Administration (FDA). In 1986, the blood test was approved mainly to monitor disease status in men already diagnosed with prostate cancer. In 1992, it was approved for prostate cancer diagnosis. Following its approval, the test was subsequently used to detect…
Introduction Today, cancer of the prostate has become an everyday problem in most urological practices. In this chapter we will review the coding and billing of the various services provided by urologists for this clinical problem. The correct use of diagnostic and procedural codes will be presented so that entitled reimbursements may be collected for diagnostic and therapeutic services. The International Classification of Disease, 9th and…
Erectile dysfunction (ED) is the most reported sexual dysfunction after prostate cancer treatments. However, there are other sexual dysfunctions that receive less attention and adversely impact quality of life after treatment, including absence of ejaculation, changes in orgasm or libido, sexual incontinence, and loss of penile length. Our understanding of the pathophysiological basis of ED and other sexual dysfunctions has evolved over the past decade. In…
Introduction Prostate cancer is the leading solid organ malignancy diagnosed in men in USA, with an estimated 238,590 cases in 2013. The diagnosis of prostate cancer brings about a significant change in the health-related quality of life (HRQOL) of the patient, his sexual partner, and his family. Treatment effects and side effects present a significant socioeconomic burden, given the prevalence and incidence of prostate cancer. Options…
Introduction In contemporary clinical practice, multiple modalities of cancer treatment allow therapy to be tailored according to the continuum of disease severity. As trends in prostate cancer (PCa) presentation change, existing treatment options must be adapted to adjust risk and efficacy accordingly, or in some cases, new treatment modalities must be developed. In recent years, PCa presentation and diagnosis has changed significantly with the identification of…
Introduction Increases in prostate cancer (PCa) screening due to the widespread use of prostate-specific antigen (PSA) has resulted in the diagnosis of more focal and clinically insignificant prostate adenocarcinomas. Active surveillance is often offered as an option for managing carefully selected patients with low-volume disease; however, guidelines for selecting which men should qualify have not been widely accepted or implemented. Studies have suggested that there can…
Introduction According to data from the Surveillance, Epidemiology, and End Results (SEER) Program, 233,000 estimated new cases of prostate cancer (PCa) will have been diagnosed in the United States in 2014, and approximately 29,480 men will die of this disease. Common treatment options for localized PCa include radical prostatectomy (RP), radiation therapy (RT), or active surveillance. External beam radiation therapy (EBRT) and brachytherapy (BT) have become…
Introduction Androgen deprivation therapy (ADT) using the luteinizing hormone-releasing hormone (LHRH) agonist or antagonist has been the mainstay treatment of systemic hormone-sensitive prostate cancer. Following an initial decline in PSA levels and a clinically significant response rate of 80–90%, majority of patients on ADT develop progressive disease after an average of 18–24 months despite castrate levels of testosterone. Following further treatment with chemotherapy, median overall survival…
Introduction Among five new therapies for patients with metastatic castration-resistant prostate cancer, sipuleucel-T (Provenge ® ) stands out as the first immunotherapy approved by the FDA for asymptomatic or minimally symptomatic castrate metastatic prostate cancer with the added benefit of improvement in overall survival. Its approval was determined by the results of a placebo-controlled, randomized trial (the IMPACT trial), conducted in 512 asymptomatic or minimally symptomatic…
Introduction The development and subsequent normal physiologic function of the adult prostate gland is heavily dependent upon the presence of androgens. Although between 70% and 90% of testosterone is produced by the testicles, under certain circumstances the contribution by the adrenal glands can also be of importance. For the last 80 years, it has been known that removal of male hormones by surgical or medical castration,…
Introduction Prostate cancer is the second most common cancer (after skin cancer) and one of the major causes of cancer mortality in the United States with an expected 29,720 deaths in 2013. About 40% of prostate cancer patients will fail surgical or radiation therapy and will develop metastatic disease. Testosterone suppression is an effective frontline treatment in newly diagnosed metastatic disease; however, cancer will ultimately progress…
Introduction The maintenance of bone health is important throughout the entire prostate cancer disease spectrum. The majority of prostate cancer patients are already at increased risk for fragility fractures secondary to age-related bone loss. This is further compounded by the threat of treatment-associated osteoporosis and fractures. In more advanced stages, additional risk arises from disease-associated skeleton-related events (SREs) secondary to bone metastasis. Further complicating the prevention…