Discuss prostate cancer screening with your physician as a shared decision-making process, as there is no universal formal recommendation and stopping aggressive screening has led to a rise in advanced disease.
Consider using the 4K score or Prostate Health Index (PHI) test to assess the percentile chance of having high-grade, aggressive prostate cancer, as these tests help discriminate between cancerous and benign cells.
If undergoing a prostate MRI, ensure it is a multi-parametric MRI with high-quality diffusion-weighted imaging (DWI) performed and interpreted by skilled professionals, as DWI is the most important parameter.
Follow an algorithm where a biopsy is recommended for abnormal MRIs or negative MRIs with high PSA density (>0.15), but may not be needed for negative MRIs with low PSA density, which can reduce unnecessary biopsies.
If diagnosed with metastatic prostate cancer, consider genetic testing for DNA damage repair pathway mutations (e.g., BRCA1/2, ATM), as these mutations are enriched and may indicate sensitivity to PARP inhibitors.
Physiologic testosterone replacement therapy is not clearly shown to accelerate or cause prostate cancer development, and aggressive tumors often have low androgen output.
If experiencing non-bacterial prostatitis (chronic pelvic pain syndrome), focus on managing symptoms and adjusting risk factors like constipation, as antibiotics may not be necessary for inflammation without infection.
For non-bacterial prostatitis, a prostatic massage may help alleviate symptoms by reducing inflammation, potentially providing relief without antibiotics.
If experiencing recurrent bacterial prostate infections, discuss direct antibiotic injections into the prostate or seminal vesicles with your urologist, as these areas can harbor persistent bacteria.
MD-PhD students should do clinical time before their PhD to gain a practical understanding of important clinical questions and the human condition, which can inform their research.
Establish a regular ‘adult only’ journal club with colleagues (medonks, radonks, urologists) to review new research articles in your field and related specialties, fostering continuous learning and staying current.
Do not order a medical test unless you know what you will do with the results and how they will alter your management plan for the patient.
Never walk by an open door without looking inside; view new opportunities as exploration rather than risk to foster personal and professional growth.
If considering a vasectomy, consider sperm banking beforehand, and ensure a skilled professional performs the procedure, as reversal rates are high with good technique.
Use protection (e.g., condoms) for safe sex, not just for contraception, especially if dating, to prevent sexually transmitted infections.
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