Ask the experts
WHAT’S THE DIFFERENCE BETWEEN ACTIVE SURVEILLANCE AND WATCHFUL WAITING WHEN TREATING PROSTATE CANCER?
Prostate cancer often grows slow and should not be treated unless it’s likely to cause a patient harm during his lifetime. Based on the traits of a patient’s prostate cancer, their overall health and medical condition, a game plan which avoids surgery and radiation may be best.
Active surveillance is where the patient and physician defer surgery or radiation right away, and instead track the cancer’s status. With active surveillance, you and your doctor will follow clues from routine PSA tests, DREs (Digital Rectal Exams), biopsies and imaging (i.e. MRI) to determine if the cancer is growing or getting more aggressive. If that happens, then you and your doctor will work out the next steps for you.
Active Surveillance is best for men with small, low-risk tumors without symptoms. It is also good for men who are at a higher risk from surgery or radiation. Action is taken only if the cancer changes or grows. Active surveillance may require you to have multiple biopsies to track cancer growth.
Watchful waiting is a less aggressive system of monitoring prostate cancer without treating it. It does not involve regular biopsies or other frequent testing. Watchful waiting is best used for men with prostate cancer who do not want or cannot have treatment therapies, especially those men with other lifethreatening medical conditions.
The main benefit of watchful waiting is that it avoids many treatment and surveillance-related risks and side effects. However, with this approach the cancer could grow and spread between follow-up visits and ultimately make it harder to treat. Patients should talk with their doctors about which method is best through “shared decision-making.”
Dr. Danil Makarov is a urologist focused on caring for men with prostate cancer at NYU Langone Medical Center in New York City.
WHAT IS NOCTURNAL ENURESIS?
When children urinate without control, it is called enuresis. This is also known as bedwetting. The medical term for when children cannot control their bladders while sleeping (bedwetting) is nocturnal enuresis. Most children can control their bladder during the day and night by the age of 4. About 15 percent of children age 6 or 7 still can’t stay dry while sleeping and they have nighttime “accidents.” If a child has bladder control problems after the age of 7, it’s worth reaching out to your health care provider to find out why.
Nocturnal enuresis (nighttime bedwetting) is common for more than 5 million children in the U.S. It is slightly more common in boys than girls. As children spend more nights away from home (at camps, sleepovers and field trips), it’s important to look for solutions. With patience and tools for treatment, most children will stop bedwetting.
You and your health care provider will want to learn the cause of bedwetting. Try to keep track of your child’s bathroom habits in a bladder diary. If your health care provider needs more information, your child may have a urinalysis, blood test, bladder scan or other tests.
Often, treatment starts with simple changes like reducing the amount of fluids your child drinks 1-2 hours before bed, creating a schedule for bathroom use (changing toilet habits) or prescription drugs. These treatments may be tried one at a time, or together.
T. Ernesto Figueroa, MD, is Division Chief of Pediatric Urology at the Nemours Children’s Health System in the Philadelphia area.
WHAT DOES THE COLOR OF MY URINE MEAN ABOUT MY HEALTH?
As a general rule of thumb, it’s usually a good sign for your health when the color of your urine is a pale shade of yellow. If you have urine that resembles another color, you should be aware that this is not normal. Abnormal colored urine may look clear, orange/brown/amber, pink/red, or even green/blue. Certain foods, medications, dyes, infections, and other conditions may affect the color of your urine.
When your urine appears as a darker shade of yellow, or even brown, it could be a sign that you have low urine volume. Low urine volume may come from dehydration (loss of body fluids) from hard exercise, working or living in a hot place, or not drinking enough fluids. When urine volume is low, urine is concentrated and dark in color. A major risk factor for kidney stones is constant low urine volume. Brown or orange colored urine could mean you have a liver condition or an issue with your bile duct.
If your urine has no color at all, you are most likely drinking a lot of water. You may want to cut back on the amount of water you’re taking in until your urine appears as a pale or transparent shade of yellow. Certain types of medications, known as diuretics, may also cause your urine to have no color.
Blue/green urine may be caused by infection, or more likely food dyes or medications. Pink or red urine might resemble blood in the urine. This is a condition called hematuria. Sometimes the amount of blood is very small and can only be detected with urine tests or under a microscope. Do not ignore blood in your urine. Causes of blood in the urine may include a stone in your urinary tract, an infection or a tumor among other possibilities. Get checked by your health care provider to make sure there is not a serious underlying health issue.
Anne Calvaresi, CRNP specializes in urology and urologic oncology at the Thomas Jefferson University Hospital in Philadelphia.
UrologyHealth.org | WINTER 2017/2018 | UROLOGYHEALTH extra