Prostate cancer is the second leading cause of cancer death for men. Recently, questions have emerged about the potential overuse of PSA as a screening tool by the U.S. Preventative Task Force.
Providence Business News asked Dr. Kathleen Hwang, a urologist who recently joined the team at The Men’s Health Center at Miriam Hospital in August 2011, to explain the controversy – and to offer her insights into future research into men’s health.
PBN: There is currently some disagreement in the medical world regarding testing for prostate cancer and what the results mean. Can you please clarify the issues?
HWANG: In 2011, the American Cancer Society reported that prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. Prostate cancer is a potentially devastating disease that is best managed when caught early.
Current screening involves a physical exam and a yearly blood test to measure levels of prostate-specific antigen (PSA), a protein produced by cells of the prostate gland. While it’s normal for men to have a low level of PSA in their blood, prostate cancer or non-cancerous conditions can increase a man’s PSA level.
The recent concerns in the medical world involve over-diagnosis and over-treatment of prostate cancer and have resulted in a new recommendation from the U.S. Preventative Task Force to discourage the usage of PSA as a screening tool.
The American Urological Association strongly disagrees with this and believes that discouraging the use of PSA would result in a great disservice to men’s health by disparaging what is now the only widely available test for prostate cancer. Rather than discouraging men from having a PSA test, the focus should be on appropriate targeted screening and, most importantly, involving the patients with counseling and education regarding the risks and benefits of prostate cancer screening.
I do believe, however, that everyone agrees that a better more specific screening tool is needed to find the dangerous cases of prostate cancer.
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PBN: What are the major presenting health issues at The Miriam Hospital’s Men’s Health Center?
HWANG: At The Men’s Health Center here at The Miriam Hospital, we provide clinical and psychological specialized care focusing on sexual dysfunction. The major health issues that we care for include erectile dysfunction, premature ejaculation, Peyronie’s disease (penile curvature), reducing cardiovascular risk factors, male testosterone deficiency, and psychological support for these issues.
PBN: What are the links between obesity and diabetes and male infertility and sexual dysfunction?
HWANG: The link between obesity and sexual dysfunction stems from conditions related directly to obesity, such as high blood pressure and its effects on your body’s blood vessels. Being overweight can put excess stress on your cardiovascular system. Similarly, diabetes may damage nerves and arteries making achieving an erection more difficult.
Obesity induces hormonal changes that play havoc with fertility in men. While there is not a whole lot of evidence to suggest that diabetes is the primary cause for sperm failure, the vast majority of diabetic subfertile men suffer from nerve damage in their genitourinary tract leading to ejaculatory dysfunction, making it more difficult to conceive naturally.
PBN: Have you encountered any difficulty being a female urologist in the field of men’s health?
HWANG: No. Honestly, I absolutely love what I do and feel incredibly lucky to be able to help my patients. While most patients are comfortable and just happy to be able to speak to a specialist about their sexual health issues, there are some patients who initially are uncomfortable and then there are some that will always be uncomfortable having a female physician.
Of those patients who are unsure in the beginning about having a female urologist who specializes in men’s sexual health, I think that they quickly realize that I am professional and just as easy to talk to about their sexual dysfunction as they would with a male physician.
PBN: What kinds of research are you currently involved with at the Men’s Health Center?
HWANG: My current research targets issues within men’s sexual health. One of my projects focuses on demonstrating the ability of both the prostate and penile tissue to produce testosterone (male hormone) and the effect that it may have on diseases such as erectile dysfunction and prostate cancer. Our hope is to be able to identify another mechanism to target for treatment.
