Author: Akash Kapadia, MD

Do All PSA Rises Spell Cancer?

Posted on April 24, 2024April 24, 2024 by Akash Kapadia, MD in Prostate-Specific Antigen (PSA)

When men reach middle age, they are often struck by the number of tests needed to prevent disease and keep them healthy. One such test that used to be controversial simply because it was misinterpreted but is now very useful is the prostate-specific antigen or PSA test. Let’s briefly touch on the idea of this incredible comeback – PSA was widely used in the 80s and 90s as a measure of prostate and guidance for a biopsy. At the time, we didn’t know much, certainly not as much as we do now, about prostate cancer. Often, these PSA readings were misinterpreted, and the following occurred:

PSA levels found to be above four, immediately biopsy
If the biopsy shows any cancer, go straight to the prostatectomy
Manage post-prostatectomy side effects, including incontinence and erectile dysfunction

As you might imagine, this treat-everything approach led to over-treatment of a cancer that can be alternately slow-growing or very aggressive. When it was recognized that many patients were over-treated, PSA screening became controversial

We now use PSA as a screening test in conjunction with many additional tests including urine and blood genomic markers for prostate cancer as well as a multiparametric prostate MRI to determine which patients need a biopsy. Furthermore, we are also more selective about which patients need treatment if prostate cancer is diagnosed after a biopsy.

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How Long After a Vasectomy Reversal Can You Expect to Get Pregnant?

Posted on April 10, 2024April 18, 2024 by Akash Kapadia, MD in Vasectomy

Embarking on a vasectomy reversal journey is no small decision. For one, vasectomy reversals are costly and typically not covered by insurance (unlike the original vasectomy); second, the microsurgical surgical process is intricate and takes quite some time – three to four hours. Lastly, there are no guarantees that a vasectomy reversal will work, though over 90% of vasectomy reversals within ten years of the original vasectomy produce sperm in the ejaculate. This, of course, doesn’t guarantee pregnancy. With all that said, when a man decides to have the vasectomy reversal, he is typically very motivated. One of the top-of-mind questions is “When can we start to try for a pregnancy,” and “How long will it take to get pregnant?”

Of course, these two questions are quite different in that the former relies on the recovery time from surgery while the latter is based on good timing, a bit of luck, and the couple’s fertility status. Let’s dive in.

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Can More Than One Enlarged Prostate Procedure Be Performed?

Posted on March 25, 2024May 3, 2024 by Akash Kapadia, MD in BPH, News, Treatments

In middle age, most men begin to battle lower urinary tract symptoms or LUTS, most of which are precipitated by a very usual and benign issue known as benign prostatic hyperplasia or BPH. This is what we call the proliferation of cells within the prostate that cause it to enlarge and, ultimately, restrict the outflow of urine. This happens because as the prostate grows, it clamps down on the urethra and narrows its diameter. It is estimated that about 50% of men over the age of 50 and 80% of men over the age of 80 experience BPH. Hence, the likelihood of frequent or incomplete urination, dribbling, or waking up to pee at night is a genuine possibility starting when we hit our 40s.

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Are Viagra (Sildenafil) and Cialis (Tadalafil) Interchangeable?

Posted on March 11, 2024May 3, 2024 by Akash Kapadia, MD in Cialis (Tadalafil), Viagra (Sildenafil)

With all the novel medical and surgical therapies developed over the past few decades to address Erectile Dysfunction or ED, two remain stalwarts in the front-line fight to improve erectile function. These, of course, are Viagra and Cialis, generically known as Sildenafil and Tadalafil, respectively. Both drugs are PDE 5 inhibitors, which essentially relax the muscles in the lining of the arteries, allowing them to expand and delivering more blood as a result. Being that ED is a primarily vascular concern, this increased blood flow is exceptionally important for continued erectile function and sexual health.

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Comparing Viagra/Sildenafil to Cialis/Tadalafil

Posted on December 27, 2023April 18, 2024 by Akash Kapadia, MD in Erectile Dysfunction, Penile Implants

When patients find that they need erectile dysfunction/ED medication, their mind often goes straight to which medication is best. This decision can be challenging with all of the marketing swirling around ED treatment. Ultimately, however, the two most commonly known medications on the market are Sildenafil, the generic version of Viagra, and Tadalafil, the generic version of Cialis. Other than the dosages – 100 mg maximum for sildenafil and 20 mg maximum for Tadalafil, the two drugs have similarities and differences that every patient should know and understand.

For one, both are PDE5 inhibitors, which relax and widen blood vessels to allow for increased blood flow. This is the primary mechanism of their effectiveness, and it’s why they are so good for mild to moderate ED.

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Choosing Between In-Office and Surgical BPH Treatment

Posted on December 13, 2023April 18, 2024 by Akash Kapadia, MD in BPH

Benign prostatic hyperplasia, or BPH, is a common concern as men age and represents a significant cause of lower urinary tract symptoms ranging from mild to severe. Due to the prevalence of this condition, there are plenty of treatment options, from medication to office therapies and surgery. With all the available options, it can be confusing for patients to make the best choice for their circumstances. This article will discuss office versus surgical treatment options and when they make the most sense for your circumstances.

When patients first begin to experience lower urinary tract symptoms, many believe that they may have prostate cancer. However, prostate cancer rarely presents with urinary symptoms in its earlier stages. Most patients are relieved to find out that their symptoms are caused by benign prostatic enlargement, and they often, at this point, may or may not pursue therapy. Unfortunately, BPH is a progressive condition and tends to get worse. The gradual worsening, however, is often managed through lifestyle changes, including not going out to events or dinner or limiting fluid intake. These slowly creep up on a man, and their life can be severely limited before they know it. Many patients do not understand the breadth of minimally invasive options, including in-office ones, and consequently wait too long for treatment.

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Bent Penis? How Peyronie’s Disease Affects Your Physical and Mental Health

Posted on November 29, 2023 by Akash Kapadia, MD in Peyronie’s Disease

Peyronie’s Disease, or PD, is an abnormal deformity of the penis that often presents as a bend or curve of the penis, but it may also present as narrowing, indentation, flopping, or ‘hourglassing’ of the penis. Peyronie’s disease or PD is common and affects up to 10% of men over the age of 40. It is often caused by micro-trauma or ‘wear and tear’ of the penis, but it can also be genetic. While not every bent penis needs treatment, it is important to recognize the physical and psychological impact of PD and learn whether your condition needs treatment. Determining whether treatment is needed can often be as much of a psychological question as a physical one. Why? Not all cases of Peyronie’s are painful, and not all instances inhibit a regular and enjoyable sex life.

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Eroxon Topical Erectile Gel

Posted on November 15, 2023November 21, 2023 by Akash Kapadia, MD in Erectile Dysfunction

You may have heard of a new erectile dysfunction therapy known as Eroxon (MED 3000) that the FDA recently approved for over-the-counter use. It is a topical gel marketed in Europe and the UK as a faster way to gain an erection versus Viagra or Cialis, and their generic forms sildenafil and tadalafil, respectively. However, while this sounds like a fantastic erectile dysfunction therapy, does it work?

Before determining whether this particular gel works, we should discuss the history of topical erectile dysfunction gels and formulations. This very short discussion centers around the fact that we have tried to create topical versions of several medical therapies, including, for example, trimix, which is otherwise used as an injection into the penis, without any success – the simple fact is that, to date, we do not have a reliable therapy that functions topically.

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P-Shots for Erectile Health. Legit?

Posted on October 25, 2023April 18, 2024 by Akash Kapadia, MD in Erectile Dysfunction

You may have heard of the term biohacking. It’s a colloquialism now used for a practice that is centuries, if not millennia, old – fine-tuning the body to extract the highest and best performance. A favorite therapy of Biohackers is known as platelet-rich plasma therapy, posited as a rejuvenation therapy, and is used in several applications. Orthopedic surgeons use it to help rejuvenate joints. Hair loss specialists claim it may assist with regrowth, especially in those with androgenic alopecia or male pattern baldness. Plastic surgeons use it for facial skin rejuvenation – the list goes on.
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The Stages of Incontinence After Prostatectomy

Posted on October 11, 2023April 18, 2024 by Akash Kapadia, MD in Incontinence, Prostatectomy

Before we get into the details about incontinence after prostatectomy, we must discuss Prostate Specific Antigen (PSA) and how we have modified our diagnostic process and, ultimately, treatment of prostate cancer over the years. You may have read elsewhere on our website that we once used to aggressively treat prostate cancer at the first signs of PSA rising above 4. As we have learned over the years, prostate cancer is often very slow-growing, and a single high PSA reading does not necessarily warrant a biopsy or treatment. Similarly, the presence of prostate cancer with a biopsy does not necessarily mean an immediate prostatectomy. The restraint we have shown with this newer knowledge of prostate cancer has reduced the number of prostatectomies we’ve had to perform and ultimately helped some patients avoid the consequences of such surgery, including incontinence and erectile dysfunction.

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