Patient-Focused Philosophy

The strength and history of innovation at Epoch Health stems from a patient-focused philosophy and a dedication to the most advanced technology.

28

November 2016

Prostate Cancer rates fall after screening advice

By: Epoch

Source: NBC News

Fewer U.S. men got prostate biopsies and surgery after new recommendations steered most men away from routine prostate cancer screening, researchers reported Wednesday.

Their findings add to a growing body of research that's adding to the debate about prostate cancer screening and often leaving men and their doctors more confused than informed. At issue is whether screening the general population of men for their second leading cause of cancer death does more harm than good.

The latest report, published in the Journal of the American Medical Association's JAMA Surgery, shows the new guidelines have indeed cut back on the number of procedures that men are undergoing.

"Practice has followed the guidelines," said Dr. Jim Hu, a urologic oncologist at NewYork-Presbyterian and Weill Cornell Medicine who helped lead the research team.

But Hu and his colleagues say they are worried that some men with dangerous cancers may be slipping through the cracks and argue that the highly controversial recommendations may have gone too far.

Hu's team was following up on 2012 guidelines from the U.S. Preventive Services Task Force (USPSTF) that recommended against using a blood test called a prostate-specific antigen (PSA) test to check most healthy men for prostate cancer.

Prostate cancer is very common, showing up in 240,000 U.S. men every year. It kills about 27,000 a year.

So the PSA test used to be a rite of passage for many men as they entered middle age. But the USPSTF said the test found very few men with prostate cancer who needed treatment, and caused men to be needlessly treated for slow-growing prostate tumors that never would have harmed them. Sometimes that treatment meant side effects, from impotence to incontinence.

It was an extremely controversial recommendation. USPSTF advisories guide health insurance reimbursement and often guide practice.

The American Cancer Society supports the USPSTF's approach to screening. But the American Urological Association doesn't.

The AUA doesn't recommend that men up to age 54 get routine PSA screening, but it says men aged 55 to 69 should consider it. Studies show that routine PSA testing saves about one life for every 1,000 men screened.

"This is a controversial issue. I think it's also politically charged," Hu told NBC News.

"I think the answer is education, and let patients decide what's best for them."

The battle is being fought out in the medical journals, with high-profile urologists and oncologists performing studies aimed at proving their points. For instance, in July, Dr. Edward Schaeffer, chair of urology at Northwestern University Feinberg School of Medicine, raised a ruckus with a study showing cases of aggressive prostate cancer were on the rise.

Hu said it is too soon to say whether some men with dangerous cancer may have missed out on treatment.

"Given that lead time associated with PSA screening is estimated at 5 to 7 years and the indolent nature of prostate cancer, a resultant increase in prostate cancer-specific mortality would likely remain undetectable for another decade," they wrote.

And it's possible some of the drop in biopsies could be due to better methods, such as the use of MRI scans, to see if the prostate looks like it has tumors on it.

The decrease in radical surgery could have come because of non-surgical methods to treat prostate cancer, such as radiation, as well as an approach called active surveillance, which delays treatment until the cancer shows signs of worsening.

"The greatest benefit of screening appears to be in men ages 55 to 69 years," the AUA says. "The AUA continues to support a man's right to be tested for prostate cancer -- and to have his insurance pay for it, if medically necessary."

Hu and colleagues looked at records from about 10 percent of practicing urologists for their study.

They found a nearly 29 percent drop in the number of biopsies done for prostate cancer since 2012. A biopsy is a small sample of tissue taken to be examined for evidence of cancer. They're usually done for prostate cancer if a man has some evidence of risk, such as an enlarged prostate, a lump or an irregular blood test called a PSA test.

And the number of radical prostatectomies dropped by 16 percent.

That suggests the USPSTF has achieved its goal of reducing the number of men treated for prostate cancer, Hu said. But he doesn't believe that is necessarily a good thing.

But Hu thinks the USPSTF recommendations went too far.

"I am not trying to paint them as the evil empire. I think they were well-intentioned," he said.

Hu also thinks a report that came out earlier this year suggesting that the recommendations have led to more men developing advanced cancers goes too far the other way.

Dr. Raj Pruthi, a urologist at The University of North Carolina at Chapel Hill who was not involved in the study, agreed.

"The trends of a reduction in screening, a decrease in diagnoses, and an increase in advanced disease create a natural concern that we may indeed have turned back the clock in the care of patients with prostate cancer," Pruthi wrote in a commentary on the study.

The USPSTF is reconsidering its guidelines on prostate cancer screening now, but has not said when revised guidelines will come out.

"My hope is they will reconsider the scope of the evidence," Hu said.




 

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20

October 2016

Hypogonadism: Expert panel adopts nine resolutions

By: Epoch


Source: Urology Times

An international group of physician and scientific experts, including several urologists, recently approved nine resolutions that offer physicians and patients what they say is evidence-based clarity on the topic of male hypogonadism and its management.

"The medical and scientific communities are still largely unaware of the major negative impact of testosterone deficiency on general health. The media-driven focus on unproven risks has obscured the known health risks of untreated testosterone deficiency: obesity, reduced bone mineral density, and increased mortality,” panel member Abdulmaged Traish, MBA, PhD, of Boston University Medical Center, Boston said in a press release.

The nine resolutions, published in Mayo Clinic Proceedings (2016; 91:881-96), begin with defining testosterone deficiency (TD) as a “well-established, clinically significant medical condition that negatively affects male sexuality, reproduction, general health and quality of life.” The others include:

  • Symptoms and signs of TD occur as a result of low levels of testosterone and may benefit from treatment regardless of whether there is an identified underlying origin.
  • There is no scientific basis for any age-specific recommendations against the use of testosterone therapy in adult males.
  • The evidence does not support increased risks of cardiovascular events or prostate cancer with testosterone therapy.
  • The evidence supports a major research initiative to explore possible benefits of testosterone therapy for cardiometabolic disease, including diabetes.

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11

October 2016

Ben Stiller goes public with his fight against prostate cancer

By: Epoch

Ben Stiller opened up for the first time about being diagnosed with prostate cancer at 48. He visited the Stern Show on Tuesday morning and told Howard how he and his doctor were able to detect and treat the disease. Come to any one of our Epoch Health locations to get tested today! 


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6

July 2016

From Arkansas Business: Epoch Men's Clinic Expanding in Arkansas

By: Epoch

Although Epoch Health touts that it can treat symptoms related to low testosterone in men, it maintains it’s nothing like the low-T retail outlets that are gaining scrutiny from some members of the medical community.

Epoch Health of Little Rock is “just not testosterone therapy,” said E. Scot Davis, the CEO of Arkansas Urology. Epoch Health is a subsidiary of Arkansas Urology.

If men complain about gaining weight, being tired or having a low sex drive, they will be given a free screening to determine what’s going on, he said.

“It may not necessarily be low testosterone,” he said. “If they’re truly low-T, we’ll treat them. If they aren’t, then we’re going to get them to an appropriate doctor that they need to see. That’s what really makes us different.”

Epoch has opened four locations in Arkansas since December 2013. Davis said more clinics in the state are under discussion, but he declined to say where they might be located. There are also Epoch locations in Missouri, Arizona and Alaska. Epoch partners with urologists in those states, and it retains 5-10 percent ownership in the clinics.

Meanwhile, the increased use of testosterone treatments is raising alarm bells for some doctors.

“The idea that large numbers of men should be treated with testosterone is not supported by the science. It’s very risky,” said Dr. Steven Nissen, the chairman of the department of cardiovascular medicine at the Cleveland Clinic in Ohio. “These kinds of entrepreneurial operations, frankly, are not in the best interest of patients.”

Nissen wasn’t talking specifically about Epoch.

Testosterone therapy is approved to treat a “very rare condition” of men who don’t make testosterone, he said, but “it’s now being used as sort of a general tonic for men.”

“This is American medicine at its worst,” Nissen said.

He also said there are concerns about the cardiovascular safety of the testosterone treatments.

“There are no definitive safety studies,” Nissen said. “The studies that we do have are pointing in the wrong direction, suggesting an increase of heart attack and stroke.”

In March, the U.S. Food & Drug Administration cautioned that prescription testosterone products are approved only for men who have low testosterone levels caused by certain medical conditions “due to disorders of the testicles, pituitary gland, or brain that cause a condition called hypogonadism,” the FDA said on its website. “However, FDA has become aware that testosterone is being used extensively in attempts to relieve symptoms in men who have low testosterone for no apparent reason other than aging.”

Davis agreed that a number of men who are being treated for low-T shouldn’t be. But at Epoch, he said, patients there are screened and “probably half” don’t get the testosterone.

He also said that there are a number of studies to show that testosterone treatment is not risky.

Davis said Epoch conducts proper testing and monitoring of its patients. The clinics that are receiving the bad reputations are the ones that don’t, he said.

Dr. Adam Cole, the national medical director for Epoch, says in a video posted on the Epoch website that he looks at testosterone as “not a treatment but more of a tool that a patient can use in order to help turn their life around.”

He also boasted about the benefits of testosterone treatments, including sleeping better and a reduction in body fat. “As we progress through this,” Cole says in the video, “they’ll lose 10-12 percent body fat. They’ll gain 10-15 percent more muscle mass.”

Epoch’s Davis declined to say what the cost for treatment is, but Epoch’s website says a patient without insurance can prepay $220 for a month of service.

Nissen said that testosterone clinics “are for-profit operations designed to lure men in and charge them and keep them in the system.”

He said once the men come in for the treatments, they have to keep coming back for more treatments.

That’s not Epoch’s goal, Cole said: “Hopefully, you don’t have to be on this therapy for the rest of your life.”

Cole said in an interview with Arkansas Business that the goal of Epoch is to get men healthy and do it as safely as possible.

“If we just wanted to make money, we would do the shot box,” he said. “Our motto really has been from the beginning, you do what’s right for the patient and everything else will take care of itself.”

Published by Arkansas Business on Monday, May 18, 2015
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6

July 2016

Free 100% Men's Health Screening

By: Epoch

CALL 1-844-GoEPOCH For a FREE SCREENING!




Do you want to be more focused at work and at home? Feel more energized and enthused? Epoch can help!

Epoch Men’s Health clinics are offering free, fully comprehensive Men’s Health Screenings. Call 1-844-GoEPOCH (1-844-463-7624) today to set up your free screening and experience men’s healthcare the Epoch way – that’s the right way of getting your body healthy. 


The free 100% Men’s Health Screening is an integral part of Epoch’s mission to keep men healthy. Screening takes about two minutes and is as simple as the prick of a needle. Consumption of food and/or beverages does not impact screening results. The screening includes:

  • PSA
  • Total Testosterone
  • Free Testosterone
  • TSH
  • CBC
  • CMP

Our lab also analyzes men’s bodies for other potential problems:

  • Heart
  • Blood Pressure
  • LH
  • FSH
  • Metabolism (including diabetes)
  • Vitamin and Nutrient Levels (including iron, B-12 and D)
  • Hormones (including testosterone, estrogen, thyroid function and prolactin)
  • Potential Internal Bleeding
  • And much more.


We’ll use these screening and lab results to determine if you have any testosterone deficiencies. We’ll also discuss how you’re feeling and what symptoms – such as low energy, exhaustion, weight gain, sadness, forgetfulness, and hair loss – you might be experiencing. Your test results and symptoms could indicate
Low T or they may show that you’re suffering from a different condition altogether. Either way, our goal is to get to the root of your problem, create a treatment plan tailored to you, get you feeling great and help you experience the best possible quality of life.

Owned and operated by the physicians at Arkansas Urology, Epoch Men’s Health is a healthcare experience unlike any other in Arkansas. Our clinic environment is relaxed and professional, with men squarely in mind, intended to energize and inspire. And we’re conveniently located throughout central Arkansas – in Little Rock on South Bowman Road, in North Little Rock on East McCain Boulevard, in Conway on Exchange Avenue, and in Benton on Medical Park Drive.

Epoch Men’s Health isn’t another shot-box, Low T store; it’s real medicine. Check out EpochMensHealth.com to get the facts. And the call 1-844-GoEPOCH toll-free to set up your free, no obligation 100% Men’s Health Screening. Experience real men’s healthcare, the Epoch way.

Together, we are Epoch Health. Men’s Healthcare. Evolved.







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