Men’s Health Information Session Program Recap

Written by Andrew Dauphinee
Published on November 17, 2023

The most unique issues related to men and their health center on the prostate, penis, and testicles.

Thank you to Dr. Eddie Akrout from Capital Health for a candid and very informative session covering some of the health concerns that are specific to men.

Many of the conditions specific to men do not have required screenings, which makes seeing your doctor regularly and communicating any changes all the more important.  So let’s dive in and learn more about men’s health.

Routine Screenings

The type of routine screenings men should consider depend on age.  For those between ages 18-45, general annual physical exams with routine bloodwork are sufficient.  For those between 45 and 65, additional screenings are recommended including colonoscopies, prostate screenings (if symptoms or family history necessitate), and low dose CAT scans for lungs if you are/were a 20+ pack year smoker (a pack a day for 20 years).  Age 65+ should get routine colonoscopies, continue their annual physicals or Medicare Annual Well visits, and if you are/were a smoker, an abdominal ultrasound to check for an abdominal aortic aneurysm.

Prostate Issues

There are three main conditions that can develop related to the prostate that men should be aware of:

Prostatitis

Prostatitis refers to a bacterial infection of the prostate that causes inflammation, which can be acute or chronic.  In many cases, this condition won’t show up on a normal urinalysis which requires a digital rectal exam for conclusive diagnosis.  This condition is treatable through a class of antibiotics called fluoroquinolones.

Benign Prostatic Hypertrophy (BPH)

BPH is the most common prostate-related issue men face as they age with 90% of men aged 80+ experiencing some degree of the condition.  As men age, their prostates tend to grow, which can lead to development of BPH.  Symptoms include more frequent urination, hesitancy to empty your bladder, nocturia (waking 4 or more times a night to urinate), incomplete emptying of the bladder, immediate urges to urinate, and weak stream.

Treatment options for BPH (and their side effects) include:

• Alpha blockers, such as Flomax – dizziness, hypotension, fatigue, ejaculatory dysfunction
• 5 Alpha Reductase Inhibitors – erectile dysfunction, ejaculatory dysfunction, decreased libido, and increased risk of high grade prostate cancer
• Phosphodiesterase 5 inhibitors – dizziness, headache, back pain
• Transurethral resection of the prostate – normal surgery complications

Prostate Cancer

Like many other parts of the body, the prostate is susceptible to developing cancer.  There are currently no screening guidelines for prostate cancer so it is important to speak with your doctor if you experience any of the following symptoms:

• difficulty starting urination.
• weak or interrupted flow of urine.
• urinating often, especially at night.
• trouble emptying the bladder completely.
• pain or burning during urination.
• blood in the urine or semen

Treatment options for prostate cancer include:

• active surveillance – very low risk patients and life expectancy less than 20 years
• radiation therapy – downsides include bowel and bladder issues
• radical prostatectomy – localized disease, highest survival rates but highest chance for decreased quality of life side-effects
• Androgen Deprivation Therapy (medical or surgical castration) – recommended for metastatic prostate cancer
• chemotherapy – ADT resistant metastatic prostate cancer
• cryosurgery – any grade

The 5 year survivability rate for local or regional (surrounding lymph nodes) prostate cancer is 100%, but should it spread to other parts of the body and become metastatic, the survival rate drops to 30%.

Testicular and Penal Issues

Testicular Cancer

Testicular cancer is most prevalent among men ages 20-34.  There are no recommended screening practices for testicular cancer, but you should speak to your doctor if you have any of the following symptoms:

• painless swelling
• lump in a testicle or a change in size and shape
• feeling of heaviness in the scrotum
• feeling of unevenness
• pain or ache in the lower abdomen, testicle, or scrotum
• back pain
• enlargement or tenderness of the breast tissue (due to hormones created by cancer cells)

Treatment options include an orchiectomy (surgical removal of the testicle) along with chemotherapy or radiation therapy.  The survival rate of testicular cancer is 95%, regardless of what stage the cancer is in.

Hypogonadism – Low Testosterone

As men age, their body naturally produces less testosterone; levels generally decrease by 1-2% each year after 30.  This can lead to a host of issues, including:

• decreased sex drive
• decreased energy
• depression
• erectile dysfunction
• infertility
• decrease in hair growth on the face and body
• decrease in muscle mass
• development of breast tissue (gynecomastia)
• loss of bone mass (osteoporosis)

If you experience these systems, consult with your doctor about testing your testosterone levels; if your levels are under 300ng/dl, you may be experiencing hypogonadism.  A reminder when testing, testosterone should be checked first thing in the morning while fasting; additional tests may be required for a definitive diagnosis.

There are a variety of treatment options, including:

• injections – weekly or biweekly
• patch – daily
• gel – daily (possible increased hair growth in area)
• subcutaneous pellets – every 3-6 months
• Buccal tablet – 2x day

Side effects can include:

• increase risk of prostate cancer
• worsening BPH
• Erythrocytosis – increase in red blood cells (increase risk of heart attack or stroke)
• testicular atrophy
• liver disease and tumor
• Gynecomastia – enlargement of breast tissue

Erectile Dysfunction

As men age, it can become difficult to get or maintain an erection.  Studies have shown that the cause of roughly 70% of erectile dysfunction cases is organic rather than psychological.  In most organic cases, the cause of erectile dysfunction is cardiovascular, or a lack of blood flow to the penis.  Other organic conditions that might cause this problem include medications.  Risk factors for erectile dysfunction include:

• age
• diabetes
• obesity
• cardiovascular disease (smoking)
• sedentary lifestyle
• antihypertensive medications

Treatment options vary and can include:

• Phosphodiesterase 5 inhibitors – Viagra, Cialis, etc.
• injection
• prosthesis
• lifestyle modification

More Information

If you would like more information related to men’s health, please contact Dr. Eddie Akrout at EAkrout@capitalhealth.org.  You can view a recording of this webinar on our YouTube page at https://youtu.be/KE_3gH6RLe0.