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| Acknowledgments | |
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| Foreword | |
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| The Basic Prostate | |
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| Introduction to the Prostate: What Is It Good For? | |
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| The "Private Gland" | |
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| What's in a Name? | |
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| What's the Problem? | |
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| Warning for Concrete Thinkers | |
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| What This Book Will Not Do for You | |
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| In the Neighborhood: Understanding the Anatomy | |
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| Inside the Prostate | |
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| Upstairs Neighbors | |
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| Neighbors to the North, South, East, and West | |
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| Downstairs: The Pelvic Floor | |
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| Urinary Rhabdosphincter: The Doorman | |
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| In the Yard: The Not-So-Great Santorini | |
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| Northern Neighbor: The Penis | |
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| Around the Perimeter | |
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| Neighbors down the Street | |
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| Distant Neighbors: Lymph Nodes and Bones | |
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| Why Does the Neighborhood Matter? | |
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| Key Points | |
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| Symptoms: The Prostate and Its Impersonators | |
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| Urinary Frequency: Too Little, Too Often | |
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| Urgency: "Gotta Go" | |
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| Nocturia: Frequency at Night | |
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| Managing Irritative Symptoms | |
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| Limiting Fluids | |
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| Slow Stream | |
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| Hesitancy, Intermittency, and Strangury | |
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| Dribbling | |
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| Urological Bleeding | |
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| A Pain in the Backside-or Front Side | |
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| Painful Ejaculation | |
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| Impotence | |
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| Symptoms of Prostate Cancer | |
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| Key Points | |
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| Getting the Most from a Trip to the Urology Office | |
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| Getting Ready for the Urology Appointment | |
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| Checking In: Be Prepared | |
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| Urinalysis | |
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| PSA after DRE? | |
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| Cystoscopy | |
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| Biopsy and Other Tests | |
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| Key Points | |
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| A Tomato a Day Keeps the Urologist Away: Maintaining Prostate Health | |
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| The Prostate as Part of the Whole: No Prostate Is an Island | |
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| Smoking | |
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| No Easy Answers | |
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| Diet for a Healthy Prostate | |
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| Vitamins, Minerals, and Supplements for a Healthy Prostate | |
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| Medications for a Healthy Prostate | |
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| Activities for a Healthy Prostate | |
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| Key Points | |
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| The Bothersome Prostate | |
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| Prostatitis: The Irritated and Irritating Prostate | |
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| Acute Prostatitis | |
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| Treating Acute Prostatitis | |
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| Chronic Prostatitis | |
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| Prostadynia | |
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| How Can You Tell? | |
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| Traditional Diagnostic Methods | |
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| Prostatitis on Prostate Biopsy | |
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| How Common Is Prostatitis? | |
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| Changing Names | |
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| Stress | |
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| Grading Prostatitis Symptoms | |
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| Treating Chronic Prostatitis | |
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| Treating Prostadynia | |
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| Prostate Massage and Other Fallacies | |
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| Charlatans and Quacks | |
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| Hope: Moving On beyond the Prostate | |
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| Why Not Just Give Everyone Antibiotics? | |
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| Key Points | |
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| Benign Prostatic Hyperplasia (BPH): The Annoying Prostate | |
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| The Problem | |
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| What's in a Name? | |
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| Size Matters-but Not as Much as You Think | |
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| So Why All the Noise about "Enlargement"? | |
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| Why Obstruction Matters | |
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| What Actually Happens? | |
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| Lessons from Doughnuts | |
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| Why Are Symptoms Different for Different People? | |
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| Urinary Retention: Foiled by Physics | |
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| Setups for Urinary Retention | |
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| "My Hemorrhoids Saved My Life" | |
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| Making the Diagnosis | |
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| The American Urological Association (AUA) Symptom Index for BPH | |
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| Testing for BPH: Uroflowmetry | |
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| Residual Volume Measurement: The Bladder Scan | |
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| Urodynamics | |
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| Time to Treat | |
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| Key Points | |
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| Treating BPH | |
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| Watchful Waiting: The Simplest Approach | |
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| Behavioral Changes | |
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| Treating BPH: Alpha Blockers | |
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| Options for Alpha Blockade | |
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| How to Take Alpha Blockers | |
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| Two Birds with One Stone | |
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| Shrinking the Prostate: 5-Alpha Reductase Inhibitors | |
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| Other Benefits | |
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| Dutasteride: Blocking Two Receptors | |
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| Which Is Better: Alpha Blockers or 5-Alpha Reductase Inhibitors? | |
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| What about Taking Both? | |
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| Complementary Medicine | |
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| Minimally Invasive Treatment of LUTS | |
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| TUNA | |
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| Microwave Therapy | |
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| Lasers | |
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| Disadvantages of Laser Therapy | |
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| TURP: The Gold Standard | |
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| Why Not a TURP for Everyone with BPH? | |
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| Transurethral Resection In Saline: TURIS | |
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| Transurethral Incision of Prostate: TUIP | |
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| Open Prostatectomy | |
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| Dealing with Complications of BPH Treatment | |
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| Urinary Retention | |
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| Medical Management of Urinary Retention | |
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| Why Don't Symptoms Always Go Away with Treatment? | |
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| Neuromodulation | |
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| Less Favored Options | |
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| The Pilot Chooses Laser Surgery | |
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| Key Points | |
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| The Dangerous Prostate | |
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| Prostate Cancer Overview | |
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| Prostate Cancer by the Numbers | |
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| Prostate Cancer: Two Diseases | |
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| Prostate Cancer: Two Different Situations | |
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| Unequal Opportunity | |
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| Aging and Prostate Cancer | |
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| When Does Prostate Cancer Begin? | |
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| How Does Prostate Cancer Occur? | |
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| Genetic versus Sporadic Prostate Cancer | |
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| Key Points | |
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| Causes of Prostate Cancer: A Road to Prevention? | |
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| Looking for Causes-It's Complex | |
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| The Big Three Risks | |
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| Racial Differences in Prostate Cancer | |
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| Still No Easy Answers | |
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| Less Clear Factors | |
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| Issues That Do Not Cause Prostate Cancer | |
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| The Good News? | |
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| Potential Unforeseen Benefits to Prevention | |
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| Summary | |
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| Key Points | |
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| Suspecting Prostate Cancer: PSA and Screening | |
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| PSA: The Best Tumor Marker Known to Modern Medicine | |
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| Prostate Specific-Not Cancer Specific | |
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| What PSA Level Is Normal? | |
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| Rising PSA with Rising Age | |
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| Be Wary of Percentages: They Are Only Predictors | |
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| What Are the Percentages? | |
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| Free Your PSA | |
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| PSA Density, Velocity, and Other Confusions | |
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| Making It Even More Complex | |
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| Like a Pro | |
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| Who Needs a Biopsy? | |
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| What Level PSA Assures There Is No Cancer? | |
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| Screening: The Dilemma | |
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| Screening versus Early Detection | |
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| Reasons to Screen | |
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| How Often to Screen? | |
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| What about the Warnings about Screening? | |
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| When to Stop Screening? | |
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| Tom's Decision | |
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| Key Points | |
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| Diagnosing Prostate Cancer: Transrectal Ultrasound and Biopsy | |
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| What Is a Biopsy? | |
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| Sticking to the Point: Biopsy | |
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| Preparing for the Biopsy: Antibiotics and Enemas | |
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| Blood Thinners | |
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| Transrectal Ultrasound: Guide to the Biopsy | |
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| To the Point | |
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| The More the Merrier? | |
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| How Many Are Enough? | |
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| Does Biopsy Hurt? It Depends on Which End of the Needle your're On | |
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| Managing Complications of Prostate Biopsy | |
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| After the Biopsy | |
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| What If Something More Serious Occurs? | |
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| Can Biopsy Spread Cancer Cells? | |
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| On the Road to Pathology: What Happens to the Removed Tissue? | |
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| Drumroll, Please: Getting the News | |
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| When Cancer Is the Answer: Understanding the Gleason Score | |
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| What Else Might the Biopsy Show? (Mostly Good News) | |
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| When the Biopsy Is Negative | |
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| Repeat Biopsy | |
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| Time after Time | |
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| Saturation Biopsy | |
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| When Do I Quit Worrying? | |
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| Key Points | |
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| The Biopsy Shows Cancer | |
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| Step One: Denial | |
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| Are You Sure? | |
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| How Serious Is It? Stage and Grade | |
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| Understanding Pathological Stage versus Clinical Stage | |
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| Understanding Grade | |
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| Other Things the Biopsy Might Tell You | |
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| Why Do We Hardly Ever See Gleason Scores Lower than Six? | |
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| Searching for Cancer Spread | |
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| Why Not Just Do It? | |
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| When Metastatic Workup Is Indicated | |
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| Considering Options | |
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| Where Do I Get Information? | |
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| Where Do I Get Good Information? | |
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| Second Opinion | |
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| Key Points | |
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| Watchful Waiting and Complementary Medicine: The Simplest Options | |
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| Does Treatment Actually Prevent Prostate Cancer Death? | |
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| Candidates for Watchful Waiting | |
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| Watchful Waiting: Not Blind Ignoring | |
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| Deferred Therapy | |
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| Complementary Medicine | |
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| Alternative or Complementary? | |
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| No Regulation | |
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| What Dose Did I Get? | |
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| PC-SPES: Complementary Therapy Turns Deadly | |
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| Is There a Role for Complementary Therapy? | |
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| Key Points | |
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| Radical Prostatectomy | |
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| Options to Remove the Prostate | |
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| Nerve Sparing versus Nonnerve Sparing | |
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| Other Reasons to Perform Nerve Sparing | |
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| Nerve Sparing or Cancer Sparing? | |
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| Sural Nerve Graft | |
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| Pelvic Lymphadenectomy | |
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| Radical Retropubic Prostatectomy (RRP)- the Gold Standard | |
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| Laparoscopic/Robotic Radical Prostatectomy | |
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| Radical Perineal Prostatectomy | |
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| How Do I Decide Which Operation? | |
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| How Do I Choose a Surgeon? | |
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| Resident Involvement | |
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| Why Not Just Take Out the Cancerous Part? | |
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| Preparing for Surgery | |
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| The Final Countdown | |
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| Anesthetic Options | |
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| Blood Issues | |
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| Methods to Minimize the Chance of Needing a Transfusion | |
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| Jehovah's Witnesses | |
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| In the Hospital | |
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| Catheter Care | |
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| Beware Catheter Duration Claims | |
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| Drainage Issues | |
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| Blood Clots | |
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| Going Home | |
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| Bladder Spasms | |
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| When to Be Concerned | |
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| The Follow-up Visit | |
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| Getting the Pathology Report | |
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| Vanishing Cancer Phenomenon | |
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| Al's Decision for Surgery | |
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| Key Points | |
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| Radiation Therapy: Two Options for One Treatment | |
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| External Beam Radiation | |
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| Logistics | |
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| Measuring Success | |
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| Success Expected with Radiation | |
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| Follow-up | |
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| Side Effects | |
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| Secondary Malignancy | |
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| Radiation for Surgical Failures | |
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| Timing of Salvage Radiotherapy | |
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| Proton and Neutron Beams | |
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| Seeds: Brachytherapy | |
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| The Isotopes | |
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| PSA: All Over the Map after Brachytherapy | |
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| Urinary Retention | |
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| Combination Radiation | |
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| Improving (or Lessening) the Likelihood of Success | |
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| Radiation for Bone Metastases | |
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| Key Points | |
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| Cryotherapy: Freezing Cancer | |
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| An Unsavory History Precedes a Hopeful Future | |
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| How Cryotherapy Works | |
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| Protecting the Neighborhood | |
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| The Procedure | |
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| Who Is a Candidate for Cryotherapy? | |
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| Success with Cryotherapy | |
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| Complications | |
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| Key Points | |
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| Making the Decision on Localized Prostate Cancer | |
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| Second Opinions | |
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| Seeking Advice | |
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| Wives, Children, and Other Interested Parties | |
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| How Long Do I Have to Decide? | |
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| Choices, Choices | |
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| How Old Is Too Old? | |
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| The Second Fork in the Road | |
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| Third Decision Point: Surgery | |
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| Third Decision Point: Radiation | |
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| Previous Hernia Surgery: An Unanticipated Problem for Some | |
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| No Free Rides | |
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| Nomograms | |
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| Other Ways to Know How Serious the Cancer Is | |
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| Doc, What Would You Do If You Were Me? | |
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| Making the Call | |
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| No Looking Back | |
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| Key Points | |
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| Maintaining Sexual Function | |
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| The Problem | |
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| Specifics with Prostate Cancer Patients | |
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| A Successful Outcome Is at Hand | |
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| Medications | |
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| Considering Other Options | |
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| Making the Choice: The Progressive Treatment Model | |
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| Successful Outcomes | |
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| Key Points | |
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| Dealing with Other Side Effects | |
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| Incontinence | |
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| If Incontinence Persists | |
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| Surgery for Severe Incontinence | |
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| Bladder Neck Contracture and Stricture | |
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| Side Effects Specific to Radiation | |
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| Unusual Side Effects | |
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| Impact of Dual Therapy | |
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| Key Points | |
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| Living with Cancer | |
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| Follow-up | |
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| Rising PSA after Treatment | |
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| Urological Follow-up | |
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| Dealing Emotionally with Cancer | |
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| Vitamins, Diet, and Activities | |
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| When Can I Relax? | |
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| What about Miracle Cures? | |
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| Key Points | |
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| Hormonal Therapy: A Nobel Effort for Advanced Prostate Cancer | |
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| Advanced Prostate Cancer | |
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| An American in Paris | |
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| Effect of Hormonal Blockade | |
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| Surgical Orchiectomy | |
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| Medical Castration | |
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| Testosterone "Flare" | |
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| Side Effects | |
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| A Kinder, Gentler Hormonal Ablation? | |
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| The Hidden Side Effect: Cost | |
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| Timing of Hormonal Therapy | |
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| Hormonal Ablation as an Adjuvant to Local Therapy | |
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| Hormonal Ablation as Primary Therapy | |
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| Hormone Resistance | |
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| Key Points | |
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| Advanced Prostate Cancer: Chemotherapy and Other Options for Hope | |
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| What Is Advanced Disease? | |
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| What about Margin Positive Status? | |
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| What Happens in Hormone Refractory Disease? | |
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| Should I Participate in Research? | |
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| Treatment Options | |
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| Assistance to Chemotherapy | |
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| Is Therapy Always Appropriate? | |
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| Hospice | |
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| Key Points | |
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| Hope for the Future | |
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| Future Directions for Diagnosis | |
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| Future Directions for Staging | |
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| Future Directions for Prevention | |
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| Future Directions for Information Transfer | |
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| Future Directions for Treatment | |
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| Future Directions for BPH | |
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| Paying for the Future: No Free Rides | |
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| Future Directions for Hope | |
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| The 10 Biggest Prostate Myths | |
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| Glossary | |
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| Resources | |
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| Notes | |
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| Index | |