AAFP Geriatric Medicine July 18th-21st, 2018 in Charleston, SC

Featuring the latest evidence-based, in-depth information on family medicine topics, AAFP live courses make it convenient to learn and refresh your knowledge. Connect with your colleagues and experts, and improve patient care—all in just a few days.

Register for the AAFP’s Geriatric Medicine live course, July 18–21 in Charleston, SC. 

More than 10,000 baby boomers turn 65 every day. As this generation ages,

the geriatric patient population will surge, and the need for care will continue

to rise. Gain clinical knowledge related to geriatric medicine you can directly apply to your practice.

At the end of this course, you will be able to:

·         Improve adherence to evidence-based clinical guidelines in practice.

·         Construct evidence-based strategies to diagnose, treat and manage common

·clinical conditions seen among the geriatric population.

·         Demonstrate ability to communicate effectively with the patient to ensure

·that diagnosis and treatment recommendations are understood.

·         Recognize when to refer to, or consult with, other specialists to provide

optimal patient care.

Earn up to 25.5 AAFP Prescribed credits—19.5 credits for attending the course and another 6 for participating in optional workshops (additional fees apply).

AAFP members: $895/Nonmembers: $1,195

Save $100 when you register by June 18.  Register now or call (800) 274-2237.

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With OAB how long likely take to retrain? im on medication still have feel of going toilet constant like a trapped nerve. been 12 weeks for me

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Grandpa age90.prostate gland enlarge.no urine output.dr gave tablts n urine catheter for 2 weeks. will he recover in tblts?if not recover wht next

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Can I take cipro and saw palmetto at the same time?

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For 6 days I'm unable to pass urine. The little I can pass hurts my abdomen. Start tommorow I will be away until Thurs. Should I go to ER or wait?

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What is the reason for consistent urination at night and smelly stools.

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What are the symptoms of an enlarged prostate?

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I am using finasteride more than 10 years. Are there some problem to using this medicament for long time?

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I have enlarged prostate and erectile disfunction problem.Any solutions?

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I usually go to urinate 3times at my sleeping.Have i overactive bladder?At day , i usually go 8 times to urinate? What can be reason?

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What other treatment options are there for hypogonadism if Androgel causes me urinary problems?

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He takes a lot of time for doing toilet as the rate of flow is very slow. What could be the problem and how can it be checked?

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Fluke or Trend: 5ARIs vs Prostate Cancer

It's been a while since I looked closely at 5 alpha reductase inhibitors.  In March 2011, I discussed the potential side effects from taking a 5ARI.  In July 2011, I reviewed two studies aimed at using a 5ARI as chemoprophylaxis against prostate cancer.  Unfortunately, the results didn't turn out as hoped and the Food & Drug Administration refused to give either finasteride or dutasteride approval for marketing as preventing prostate cancer.

Well, in a case-control study published 10 days ago in the British Medical Journal, the authors concluded that use of 5ARIs to treat lower urinary tract symptoms also lowered Gleason score 2-7 prostate cancer.  This was an expected outcome.  What was unexpected was that 5ARI use did not increase risk of Gleason 8-10 prostate cancer in the ensuing 4yrs.  Recall that while both the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial demonstrated that regular use of 5ARIs can lower prostate cancer risk by up to 1 in 4, they also increased high grade prostate cancer risk.  

So how does a guy decide?  Well, for now, use the 5ARI for its intended purpose, assuming you still need it.    That means take it for your receding hair line or because you have symptoms of an enlarged prostate.  But don't take it in an attempt to prevent prostate cancer.  At least not until we have better research to support such an indication.

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I'm starting to drip urine even I don't have urinate,what could that mean?

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Is it possible for a prostate to be removed and well a penus still get stiff without it?

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USPSTF vs ACP vs AUA: Alphabet Soup re Prostate Cancer Screening w/PSA

Want to see a bunch of physicians get in a fight?  Ask them for their opinion regarding screening for prostate cancer, especially their views regarding use of prostate specific antigen.  Exactly a year ago, the US Preventive Services Task Force came out against PSA-based screening for prostate cancer in all men, regardless of age.  I led a discussion on this topic during the American Academy of Family Physicians' Geriatric Medicine conference last month in Santa Ana Pueblo, NM and boy did it get heated.

I think the best way to describe the interaction was an agreement to disagree between those who had an experience with prostate cancer, either personal or family, vs those who had not.  The former tended to come out in favor of doing some sort of screening, even using the imperfect PSA, while the latter felt just as strongly about the USPSTF guidelines, especially given all the possible complications once screening is started for a disease that most men will die with, not from.

Of note, USPSTF comes out rather strongly, almost heavy handily against screening, not even making any suggestion to discuss risks, benefits & alternatives with one's patients.  Just prior to the conference (but after the presentation deadline had passed), the American College of Physicians published early online in Annals of Internal Medicine their clinical guidelines suggesting that physicians inform 50-69yo men of the risks, benefits & alternatives to screening for prostate cancer.  The ACP did not recommend screening average-risk men younger than 50yo or older than 69yo.  Furthermore, the ACP also did not recommend screening those with life expectancy less than 10-15yrs.

Most recently, the American Urological Association tossed their hat into the guideline arena but in a very nuanced fashion.  The AUA recommends against screening w/PSA in men younger than 40yo but "does not recommend routine screening" in those 40-54yo.  And for men 55-69yo, the AUA "strongly recommends shared decision making".  In those who still desired screening, the AUA also came out in favor of testing every 2 years rather than annually.  

So what are we supposed to do?  Make no mention or offer at any age?  Set aside even more precious time to discuss the above in detail?  And if the latter, at which age group would you start?  There's no single right answer for every provider so read the guidelines for yourself and come to your own decision.

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Tamsulosin makes my husband anxiuos, depressed and almsot paranoid. Can we stop for a few days and try saw palmetto during the stop period. Alternate?

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If i have chronic prostatitis would i feel pain?

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Exercise vs Prostate Cancer: Impact of Skin Color

Last month, someone wrote in and asked if exercise was good for an enlarged prostate.  At that time, I was not aware of a direct link although some studies have suggested that men are more likely to die from heart disease than from prostate cancer.  So I found it interesting that a prospective study was published earlier this week in Cancer, the American Cancer Society's journal, in which the authors noted that more exercise was associated with lower risk of prostate cancer in white men but not black.

Prior to their prostate biopsies, the authors asked 307 men (164 white & 143 black) how much they exercised using a validated survey.  Among white men, those who exercised more than 9 metabolic equivalent (MET) hours/week were 53% less likely to have a biopsy turn up positive for prostate cancer.  However, no relationship was noted in black men between exercise & prostate cancer.

So in the process of recommending exercise as a means to affect prostate health, we've just opened Pandora's box because we can't explain the ethnic difference.  Regardless, we should still be exercising for heart health, stroke prevention & weight maintenance (if not fat loss).  So don't just sit there, do something!

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Q: I had prostrate cancer,can i still take Andropause.

Someone asked the above question on my Facebook Andropause page.  Well, the simple answer is "No" but only because the semantics aren't correct.  Andropause is the laymen's term for clinical hypogonadism or low testosterone.  So in that sense, you can't take a diagnosis.

However, men with localized prostate cancer who are also hypogonadal may be candidates for testosterone supplementation if they're closely monitored by their urologist, oncologist, and family physician.  As I've noted previously, this is definitely not a do-it-yourself project with online medications shipped from off-shore.

Just know that most physicians lump all prostate cancers together and declare testosterone a contraindication.  But there are those who view low grade localized prostate as a separate entity from the more deadly high grade metastatic lesion.

With that in mind, and because I don't want to re-invent the wheel, let me point you towards a few posts where I've addressed this issue already:

Testosterone vs Prostate Cancer: Malpractice or Act of God?

Prostate Cancer Patients Can Still Take Their Testosterone Therapy!

Can a person who had prostate cancer and was treated with radiation take testosterone injections 41 treatments

But what if you're referring to erectile dysfunction after your treatment for prostate cancer?  In that case, you have many options for treatment, unrelated to testosterone, for which there should be no contraindication related to prostate cancer.

Again, I direct you to a previous post where I addressed this question:

In 2010 I had prostrate surgery, 8 on gleason scale, cancer found by an insurance exam no erections, what can be done?? viagra hasn't worked

Finally, if loss of libido is the issue, let me direct your attention to the appropriate topic heading on this blog.

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