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Comments (16)Today we continue our discussion about Peyronie’s Disease as a subtopic of sexual dysfunction. The exact cause of Peyronie’s disease is not well understood. There are a few potential causes that most of the urological world believes may play a role in the condition. The first of these potential causes is trauma. If the penis bends in an awkward position or undergoes direct trauma the tunica albuginia which is the covering of the corpora cavernosum gets torn. This leads to the production of collagen during the process of wound healing. This excess of collagen reduces the normal elasticity of the penis and can cause painful erections, penile curvature and deformity. Mostly this is thought to happen on a microscopic level. Indirectly, it has been theorized that this repeated micro-trauma to the tissue of the penis may trigger an immune… read more
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Causes of Peyronie’s Disease
Posted by .(JavaScript must be enabled to view this email address) on 10/11/10 at 04:45 PM
Peyronie’s Disease
Todays blog is about a poorly understood problem called Peyronies Disease. The cause is unknown. The treatment options are only marginally successful. It is likely more prevalent than we in the medical community realize. And it can be the cause of erectile dysfunction which is our overall topic in the upcoming set of blogs. Peyronies disease (PD) was written about as early as 1678, but was first described by Francois Gigot de la Peyronie. in 1743. He was the personal surgeon to King Louis XIV of France. Peyronies is a benign disorder of wound healing. It is characterized by the presence of excess collagen laid down in the corpora cavernosum which are the erectile bodies of the penis. The penis when cut in cross section is a series of three tubular structures. The two on the top are the… read more
Posted by .(JavaScript must be enabled to view this email address) on 09/29/10 at 12:59 PM
Male Sexual Dysfunction
By discussing andropause earlier, we have ventured into the topic of male sexual dysfunction. This is a very broad topic which includes such issues as andropause, premature ejaculation, impotence (both psychogenic and organic) and Peyronies disease. Each one of these issues is in itself a part of the diagnosis of sexual dysfunction in men and deserves discussion. Sexual dysfunction can occur along the age spectrum from the beginning of sexual activity as a teenager all the way until the end of active sexual as an octogenarian or even later. Each of the various diagnoses tends to have an age group in which is more prevalent, but as always in medicine there are no hard and fast rules. We spent our last few blogs discussing andropause which is a hormonal issue. Over the next series of weeks, we will move… read more
Posted by .(JavaScript must be enabled to view this email address) on 09/14/10 at 06:38 PM
Heart Pain
Since the prostate is the only heart shaped organ in the body, I wanted to expand my blog to share a personal experience. Today, I took my only daughter, Cassidy J. Leventhal, to JFK International Airport. She is a 2010 graduate of Yeshiva of Greater Washington and has been accepted to Barnard College of Columbia University. Like many “frum” girls, she decided that spending a year of intensive learning in one of the many seminaries in Israel would be beneficial to her in the long run. (Certainly it was not beneficial to my wallet, but I was not going to argue with a kid who wanted to learn more about Judaism then I could possibly teach her.) On Friday morning, I awoke early before going to shul and went into her room. It was its typical mess and there… read more
Posted by .(JavaScript must be enabled to view this email address) on 08/15/10 at 10:10 PM
Andropause - Treatment in Today’s World
The newest generation of treatment for hypogonadism includes Testim and Androgel. These are gels/creams that can be applied to a muscular portion of the body and massaged in like a typical ointment. Sometimes they can leave a greasy type of feel, however the side effects are much improved over the patches. Androgel and Testim are very similar in approach and ability to address the problem of hypogonadism. I have had patients who prefer one over the other, but in my experience they are interchangeable and both work very well. Often the use of one versus the other is directed by the insurance company and is based on price which is unfortunate, wrong, and not the way to practice medicine, however it is reality and it isn’t going to get any better in the future. I usually don’t make too… read more
Posted by .(JavaScript must be enabled to view this email address) on 07/18/10 at 07:28 PM
Andropause - Treatment Options
Today we’ll continue our discussion of hypogonadism. This is also known as low testosterone in men and is associated with a whole series of symptoms which define what is now called andropause in middle to older aged men. To recap, low sexual desire (low libido), weaker and fewer erections, reduced sexual activity, low energy or fatigue, depressed mood or poor concentration, reduced muscle mass and even testicular discomfort are all common findings in men with hypogonadism. The evaluation typically is completed by blood work looking at the patients hormonal profile. Common causes or associated medical conditions include chronic opioid use, obesity, diabetes, AIDs, hypertension and hyperlipidemia. Once the diagnosis is made and a prolactin secreting tumor is excluded, treatment can be instituted. If we are dealing with straightforward hypogonadism, it is typically treated by the urologist or the primary… read more
Posted by .(JavaScript must be enabled to view this email address) on 07/13/10 at 04:53 PM
Andropause - Or What Happened To My Sex Drive?
Last week we discussed the symptom complex that is often seen with the diagnosis of hypogonadism or low testosterone levels. We discussed a small portion of the hormonal axis that keeps men in hormone balance, that being the a couple of portions within the brain and the testes. We touched on the medical conditions that were commonly associated with hypogonadism. And finally, I tried to emphasize that change in testosterone over time is a normal function of aging. But that does not mean that you as the patient need to resign yourself to the side effects that hypogonadism brings to your life. If you have a few of the complaints associated with hypogonadism, and you find them limiting to your lifestyle, you need to approach your family doctor or urologist and let them know. It is important to note… read more
Posted by .(JavaScript must be enabled to view this email address) on 06/27/10 at 08:13 PM
Hypogonadism - Low Testosterone and Its Effects on Men
How many men over the age of 45 could answer yes to one or more of these questions? Is your libido (sexual desire) lacking? Do you feel like you are losing muscle mass? Is your overall energy level just not where it used to be? Is your sleep pattern disturbed? Are your erections not quite what they used to be? Have you been sad or grumpy lately? Have you noticed a recent deterioration of your ability to play sports? Are you falling asleep after dinner? Has there been a recent deterioration in your work performance? Have you lost height? A positive answer to three or more of these questions could indicate low testosterone levels. Obviously these are general questions and there are a number of diagnoses which also are supported by these symptoms, however, hypogonadism (low testosterone levels) is… read more
Posted by .(JavaScript must be enabled to view this email address) on 06/20/10 at 05:07 PM
Completing Our Discussion with Dr. Redwood
This week’s blog is the completion of the discussion with Dr. Mark Redwood who is the new Chief of Urology at Sinai Hospital. Starting on July 1, 2010 will head the urologists who are working directly with Sinai Hospital in a physician/hospital relationship that is becoming very common in the medical world as pressure from insurers and the government make it difficult for many physicians to remain viable in solo, small and even larger group practice. As noted before, Dr. Redwood is a graduate of Pikesville Sr. High School. He is well known in both the Jewish and African-American communities and has been at the forefront cutting edge technology in urology since finishing his residency. Last time we discussed his history and reasoning for making the move to a hospital doctor relationship. Today I wanted to more to the… read more
Posted by .(JavaScript must be enabled to view this email address) on 06/05/10 at 10:57 PM
The Last Prostate Cancer Blog
Ok. We are about to finish prostate cancer. It has taken over a year, but we have covered every base I could possibly think of. And while I did not intensively discuss things like IMRT or Proton Beam therapy, I believe that I alluded to about every treatment that is available to attack local and distant disease. Today is the final topic. What do we do with the man presenting with metastatic disease? This is, in today’s world of medicine, a very unusual presentation. Back when I was a medical student and even very early in my residency many men presented to their doctors with voiding symptoms, back pain, hematuria and came away with a diagnosis of advanced prostate cancer. The use of PSA as a screening tool to identify early disease has made a profound impact in saving… read more
Posted by .(JavaScript must be enabled to view this email address) on 05/26/10 at 05:02 PM
An Interview with the Chief of Urology at Sinai Hospital.
Today’s blog is again a departure from prostate cancer. One can only blog about prostate cancer for so long you know. What I wanted to do today was to introduce to our Jewish Times community a personal friend and colleague who has taken over as the Chief of Urology at Sinai Hospital. He is just about to leave Chesapeake Urology, a large single specialty group in Baltimore, and is transitioning to being part of the Sinai community of employed physicians and the senior urologist in The Center for Urologic Specialties. Mark Redwood is an outstanding surgeon who is well known throughout the community at large, but more importantly from my perspective he is an outstanding person. Frankly, that to me is just as important as his surgical skill. And while I would not want to be seen by a… read more
Posted by .(JavaScript must be enabled to view this email address) on 05/24/10 at 06:58 PM
PSA Recurrence after Radiation Therapy
PSA recurrence is demoralizing whether or not it is after surgical therapy or radiation therapy. Finding out that the primary treatment you chose to attack your prostate cancer did not work is a difficult pill to swallow. In any case the evaluations are similar. The treatment options differ to some degree but not greatly. Again, the first discussion with the patient is about the point in time that he wants a further evaluation. The older the patient, the less likely he is to succumb to prostate cancer. Therefore, most urologists tend to be less aggressive in their evaluation and treatment options for the patient over 70 as opposed to the patient under 60. As with surgical failure, typically I’d have the patient pick an arbitrary number at which he is no longer comfortable with watchful waiting and if his… read more
Posted by .(JavaScript must be enabled to view this email address) on 05/08/10 at 10:13 PM
PSA Recurrence After Radical Prostatectomy
For the man who underwent a radical prostatectomy and had an undetectable PSA, finding out that your PSA is now detectable and rising can be devastating. The evaluation of most PSA recurrent disease starts out in a similar fashion. The first discussion with the patient is about the point in time that he wants a further evaluation. For a man who had his prostate removed at age 64 and then ten years later at 74 his PSA starts to very slowly increase, I would typically recommend watchful waiting. I’d have the patient pick an arbitrary number at which he is no longer comfortable with watchful waiting and if his PSA hits that number we would embark upon the evaluation. Obviously at age 74 the likelihood of the patient succumbing to prostate cancer that is slowly advancing is small. However,… read more
Posted by .(JavaScript must be enabled to view this email address) on 05/02/10 at 09:00 PM
Liberalism, Hollyweird and PNS
In today’s blog we are straying away from Urology in order to discuss PNS. No, not PMS but PNS - that is Persistent Nausea Syndrome. If you are not the type of person that likes sarcasm, I would suggest you stop reading this weeks blog and wait for the next iteration in which we will again be discussing prostate cancer. But political correctness be damned and hopefully my bosses at the Jewish Times won’t mind. After watching Avatar on DVD the other night, my blood was boiling and I was nauseous for hours. Being an ardent science fiction and fantasy fan I went past disappointment into utter disgust. And now I’m going to take a few minutes to tell you why. I realize that Hollywood is a bastion of liberalism. I understand that they truly believe they are smarter… read more
Posted by .(JavaScript must be enabled to view this email address) on 04/26/10 at 06:42 PM
Biochemical Recurrence of Prostate Cancer After Initial Treatment of Localized Disease
Perhaps one of the most confusing problems for patients and urologists is the treatment of biochemical recurrence of prostate cancer. Essentially this means that PSA after definitive therapy starts to rise. For someone who has had surgical extirpation this means that their PSA which had been zero starts to creep up slowly over time. For the men who have had primary treatment with some form of radiation, this means that they have had three successive rises in their PSA after a PSA nadir (their lowest PSA value.) There are no great studies or “book” answers for how to treat biochemical recurrence of prostate cancer. Just as in the initial phases of decision making, patient preference and expectation are intrinsically involved in the decision making process. Typically, a metastatic evaluation would be performed. This would often include a whole body… read more
Posted by .(JavaScript must be enabled to view this email address) on 04/19/10 at 05:49 PM
“Advanced” Prostate Cancer
Over the next couple of blogs we are going to be discussing advanced prostate cancer. If we define localized prostate cancer as that which can be treated with the hope and expectation of cure, advanced prostate cancer by definition is that prostate cancer which has escaped the confines of the prostate and can no longer be “cured.” I place quotes around the word cured, because I want our readers to understand that many men live with advanced prostate cancer for many years. Often times their cause of death is totally unrelated to their prostate cancer. So even though prostate cancer can be outside of the confines of cure, it does not necessarily mean that it will be the ultimate cause of any specific patients demise. One of the problems with dealing with the subject is in its definition. Advanced… read more
Posted by .(JavaScript must be enabled to view this email address) on 04/10/10 at 08:42 PM
The PSA Controversy
As you may have been reading over the last year or so, there is a continuing controversy about the utility of PSA when used as a screening tool for prostate cancer. Almost exactly one year ago, we discussed PSA in this blog. Given the continuing questions and arguments, I thought it would be prudent to revisit the issue. The following is a letter sent to all of the members of the American Urologic Association. I thought that our followers of the Men’s Health Blog would be interested in reading what our association is saying about PSA. “Dear AUA Member, As you know, the American Urological Association (AUA) has been monitoring the recent debate about prostate-specific antigen (PSA) testing and actively inserting our position on the topic as needed. On Tuesday, March 9, an op-ed in The New York Times,… read more
Posted by .(JavaScript must be enabled to view this email address) on 03/20/10 at 09:15 PM
Cyberknife for Prostate Cancer - Our Experience
We (Sinai Hospital Radiation Oncology in conjunction with Advanced Urology Associates) have now been performing Cyberknife Stereotactic Radiosurgery (CK SRS) for prostate cancer for just over 18 months. There have been over 50 men in that time that have had their prostate cancer treated by CK SRS. And while it is too early to make any judgements about the long term efficacy of the treatment, there are a number of observances that can be made. The first is that overall, there are less side effects with CK SRS than the other options for radiation therapy. It appears that the percentage of men having profound symptoms from radiation are far fewer in number than with seed implantation or even IMRT. Most men have transient frequency and urgency of urination that is well controlled with medications such as flomax or uroxatrol.… read more
Posted by .(JavaScript must be enabled to view this email address) on 03/11/10 at 03:35 PM
Cyberknife Stereotactic Radiosurgery in Treating Localized Prostate Cancer
Todays blog is going to start the discussion about the use of Cyberknife to treat prostate cancer. Because this is such a new and interesting modality to treat prostate cancer, I am going to break up the discussion into at least two sessions. The first will introduce the method of treatment and the particulars of the treatment itself. Further discussion will take place about my experience with Cyberknife in terms of its side effects, complications and results. Cyberknife Stereotactic Radiosurgery (CKSRS) is one of the newest and fastest growing radiation treatment options for localized prostate cancer. While Cyberknife is being offered at a small handful of hospitals in Maryland, there is no question that Sinai Hospital of Baltimore has the largest experience with this exciting technology. There are multiple uses for Cyberknife, but given my specialty and this forum,… read more
Posted by .(JavaScript must be enabled to view this email address) on 01/11/10 at 08:15 PM
There is no good time to lose your mother.
I realize that it has been awhile since my last post but now that the new year has started, my goal is to post a couple of times a month. Today the health discussion is more on a spiritual level than physical level. On the 10th of November my mother Sylvia “Mickey” Leventhal Weinberg suffered a massive cerebellar stroke. Three weeks later she was buried to rest alongside my father who died when I was a young man of 18. My mother was a few months shy of 90 when she died. She was your typical old Jewish lady. She was as parsimonious as they came, but was generous with her time. She volunteered at the Weinberg center where she lived for years before she lived there. She was a member of the Golden Rule Guild and used to… read more
Posted by .(JavaScript must be enabled to view this email address) on 01/03/10 at 09:09 PM
Prosate Seed Implantation For Treating Prostate Cancer
Prostate seed implantation is a highly successful treatment option for localized prostate cancer. Over the last twelve years, it has become one of my preferred methods of treating prostate cancer. During that time I have personally performed almost three hundred seed implantations in conjunction with a radiation oncologist. Seed implantation (also call prostate brachytherapy) is typically performed as an outpatient. It can be easily managed in a hospital or even in an outpatient ambulatory surgery center. Typically the patient will go home with an indwelling catheter to drain their bladder. All of my patients remove their own catheter the morning after the procedure. There are two main techniques used and they are both successful. Each urologist or radiation oncologist will have his or her bias as to which is best. What is most important is their long term results.… read more
Posted by .(JavaScript must be enabled to view this email address) on 11/15/09 at 08:38 PM
Prostate Cancer Treatment Complications
We have discussed radical prostatectomy and are now in the midst of discussing radiation therapy as definitive treatment for prostate cancer. I’d like to take a break from discussing specific treatments today in order to discuss complications and side effects of prostate cancer treatment in general. In our next discussion we will address specific types of radiation therapy treatments. With radical prostatectomy (removal of the prostate gland and its associated structures such as the seminal vesicals and ampulae of the vas) there are a number of common complications that are frequently encountered. In our discussion about the procedure a few weeks ago, we specifically mentioned the big “I’s,” of impotence and incontinence. Impotence is common after radical prostatectomy. A man with excellent erectile function prior to surgery will have some degree of impotence anywhere from 30% to 70% of… read more
Posted by .(JavaScript must be enabled to view this email address) on 10/28/09 at 07:01 PM
Radiation Therapy To Treat Prostate Cancer
Today’s discussion will open the topic of radiation therapy as definitive treatment for prostate cancer. Just as there are multiple ways to perform extirpative surgery, there are also multiple ways of treating prostate cancer with radiation. What differs between them is that extirpative surgery removes the prostate irrespective of the approach, whereas the multiple methods of radiation therapy differ in their theoretic rationale for how to treat the disease. There are multiple methods of dispensing radiation into the prostate gland and while I do not plan to go in-depth with each method, I will take at least a couple of the treatment options and discuss them specifically. This may not be a fully inclusive list but at the present the following are currently the most utilized methods of dispensing radiation to the prostate: Prostate Brachytherapy - also call prostate… read more
Posted by .(JavaScript must be enabled to view this email address) on 10/08/09 at 07:36 PM
Treating Prostate Cancer - Radical Prostatectomy
Today’s discussion regarding prostate cancer will address surgical removal of the prostate. Other treatment options will be addressed at a later date. Radical prostatectomy implies removal of the prostate and seminal vesicles with reattachment of the bladder to the urethra. It can be performed in multiple fashions including open retropubic (abdominal incision), perineal (subscrotal incision), laparoscopic and robotic fashion. The procedure in one form or another has been present in urology for decades. It would be unfitting to speak of radical prostatectomy without mentioning Dr. Patrick Walsh of Johns Hopkins Medical Center who was one of the pioneers in the advancement of the procedure. He, along with some other notable urologists, turned the procedure from what was a bloody surgery with a very high complication rate into a technically sound procedure with good to excellent results in terms of… read more
Posted by .(JavaScript must be enabled to view this email address) on 09/22/09 at 07:19 PM
Treatment Options for Prostate Cancer Thanks to all the wonderful comments on the last blog. We obvi
Thanks to all the wonderful comments on the last blog. We obviously disagree on the Presidents version of good medicine. Looks like the majority of America disagrees with the President as well. As far as access is concerned the 44 million number bandied about by the left includes millions of illegal immigrants, those who refuse to buy healthcare, and those already eligible for medical assistance but for one reason or another are not assigned. I like how M. Hyman opines on the proper role for government. Where by the way does the Constitution create an entitlement for healthcare? That is debatable to say the least, and if Canada is such a wonderful provider of healthcare, why are they now re-instituting some level of private insurance and why do the wealthy of Canada come to the United States for they… read more
Posted by .(JavaScript must be enabled to view this email address) on 09/18/09 at 10:52 AM
I have prostate cancer, now what do I do?
Today we start the process of evaluating your prostate cancer and making a decision on how best to treat it. For now at least you have options. For those unfortunate men in Canada, the UK and anywhere else where socialized medicine is the norm, you get what they tell you they will pay for. Think about that closely when you read about how President Obama and the Democratic Congress want to change health care. They will swear on a stack of bibles that it won’t happen, but rationing of care and restriction of choice is the backbone of a socialized medicine system. I know, as I worked in the US military for a decade. If you care about your ability to chose you doctor and your treatments, then make your voice heard. Otherwise you will find yourself with a… read more
Posted by .(JavaScript must be enabled to view this email address) on 06/28/09 at 08:44 PM
Today, I have some not so great news….
What a fascinating past couple of weeks. The Orioles bring up Matt Wieters and Jason Berkin. It looks like Brad Bergesen can pitch. A-roid is back with the Yankees and playing at a high level until it comes to the playoffs. And finally we have the rebirth of the “Open the JCC on Shabbat,” argument. So much to talk about, its hard to concentrate on prostate cancer. I hope that I do not offend anyone, but I will throw in my two cents. For millennia, it has been said that the Jews kept the Shabbos. Actually, the reverse is true. It is Shabbos that kept the Jews. All one has to do is look at assimilation rates amongst people who are Shabbos observant versus non-observant and you will see the truth. And while I would never tell someone how… read more
Posted by .(JavaScript must be enabled to view this email address) on 05/26/09 at 08:29 PM
My biopsy results are….
Sorry I have been inactive for so long but Passover and business issues kept me from working on the blog. I realize it’s a bad excuse, but it is the only one I have and hopefully one you will accept. First lets cover the Ravens draft. While I was hoping for a receiver to show up on draft day, I was very satisfied with the work done by The Wizard of Oz, Eric DeCosta and the rest of the gang at 1 Winning Drive. We needed a long term solution at right tackle and got it in Michael Oher who not only can play, but is a great human interest story. Paul Kruger, our second round pick, reminds me of a young Michael McCrary. Hopefully he will do so on the field. The rest of the draft filled needs… read more
Posted by .(JavaScript must be enabled to view this email address) on 05/03/09 at 08:57 AM
I need a what? Yes, a prostate biopsy!
So your primary care doctor told you that your PSA was elevated. Your wife convinced you that you needed to see the urologist. The appointment wasn’t that bad and he didn’t have fingers the size of Andre the Giant. But you just got the wonderful news that you need a prostate biopsy. What!!!!!! Are you sure????? Actually with modern ultrasound and advances in the use of local anesthesia, a prostate biopsy should not be as horrific as you would expect. Lets talk a little about the indications and the procedure. If your PSA is elevated for your age and/or if you have an abnormal digital rectal examination of the prostate, you need a prostate biopsy. That is assuming that there are no other reasons for the abnormality such as an active urinary infection or recent ejaculation within 48 hours… read more
Posted by .(JavaScript must be enabled to view this email address) on 03/22/09 at 11:37 AM
So you just found out that your PSA is elevated….
What is PSA and why do you even care? PSA stands for Prostate Specific Antigen. It is a protein that is responsible for the liquefaction of semen. More importantly, it has become one of the most sensitive markers for cancer we have in medicine. PSA is made in both health and disease states. There is a range of normal values and depending upon the lab and your age, your PSA may be anywhere from almost zero to upwards of 6.5 ng/ml. PSA can be elevated because of prostate infection or enlargement. It can be elevated by ejaculation within 24 - 48 hours of having your blood drawn. It can be elevated by chronic inflammation. It can also be elevated because you may be outside of the range of normal yet still be totally normal. But we are most concerned… read more
Posted by .(JavaScript must be enabled to view this email address) on 03/16/09 at 08:08 AM
Welcome to the Baltimore Jewish Times Men’s Health Blog.
Ok, I’ll bite, What in the world is a men’s health blog and better yet, why is there a men’s health blog.? Before we get to the question above, I think an introduction is in order. My name is Ed Leventhal. Many in the Jewish Community know me as Dr. Leventhal. I am a Baltimore native, graduated Milford Mill Sr. High School far too long ago and after college and medical school found myself serving in the United States Army. Nine years later, I ended up back in Baltimore and have been a private practice urologist with Advanced Urology Associates, living back in my hometown since 1997. In the interest of fairness, I admit to loving the Ravens, bemoaning the ownership of my Orioles and hating the Pittsburgh Squealers, the Cleveland Clowns and the DC Deadskins, but not necessarily… read more
Posted by .(JavaScript must be enabled to view this email address) on 02/24/09 at 05:29 PM
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Most recent entries
Causes of Peyronie’s DiseasePeyronie’s Disease
Male Sexual Dysfunction
Heart Pain
Andropause - Treatment in Today’s World
Andropause - Treatment Options
Andropause - Or What Happened To My Sex Drive?
Hypogonadism - Low Testosterone and Its Effects on Men
Completing Our Discussion with Dr. Redwood
The Last Prostate Cancer Blog
An Interview with the Chief of Urology at Sinai Hospital.
PSA Recurrence after Radiation Therapy
PSA Recurrence After Radical Prostatectomy
Liberalism, Hollyweird and PNS
Biochemical Recurrence of Prostate Cancer After Initial Treatment of Localized Disease
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