I’ve learned over the years that men, generally speaking, are not big fans of coming to see their clinician. As the prostate exam in particular has been a common source for sitcom material, we find we have to do a lot of encouraging with men of all ages!
But I have good news: what we test, how we test and how often we test have changed. I’ve listed some key areas of men’s health and our current thinking about the approach to screening and care. I hope this prompts some to think back, “When did I last see my clinician?” and schedule that appointment today!
Prostate Cancer
I have some definite good news here: approaches have changed, and if you’re low risk, a general exam is not what it used to be and far less invasive these days.
Prostate cancer detection can be difficult because we don’t have great screening tools. The PSA (prostate specific antigen) blood test, while used, is not the most reliable screening tool for prostate cancer. The test was created to monitor benign growths in the prostate over a period of time. The PSA test is a helpful as a tool for those who are undergoing post prostate cancer treatment to make sure the PSA levels are not rising.
But based on a recommendation by the American Urological Association, we don’t screen men for prostate cancer with the PSA test anymore unless they are high-risk, such as age (prostate cancer occurs mainly in older men, with about 6 cases in 10 diagnosed in men aged 65 or older, and it is rare before age 40), being an African American or having a family history. For high-risk men, we do screen once a year – both with a PSA blood test and a digital rectal exam to check for lumps or irregularities in the prostate.
But bottom line: most men do not need to worry about coming in on an annual or bi-annual basis to have their prostate checked unless there are symptoms that might warrant it such as changes to urination (for example, you get up 3x per night to go to the bathroom or your stream isn’t as strong as it used to be) – these might signal to check a PSA.
Colon Cancer
Over the years, I’ve found that men seem to be more a bit more reluctant to schedule a colonoscopy than women, but screening is so important for early detection! Colon cancer screening is one of the few screening tests we have that actually can identify pre-cancerous growths, called polyps, and remove them before they ever turn into cancer. Usually, screening for men and women should start at age 50 and be done every 10 years, but if you have a family history or if a polyp is found, you may need to start earlier or be screened more frequently.
Patients who have never had a colonoscopy can be apprehensive, so I counsel men extensively on the fact that you will be sedated and won’t feel anything in order to alleviate that “fear of the unknown.” The “prep” – the liquid you need to drink to prepare and clean out your colon before the exam – is another area of concern. Current prep guidelines are going to smaller amounts of prep for shorter timeframes. I offer as many tricks as I can; one of my tricks is to pour the prep over ice and add ginger ale on top.
There is a newer procedure called Fecal Immuno Testing (FIT) that has been developed to screen for cancer of the colon based on a stool sample that’s evaluated in a solution to isolate possible cancer cells. It’s been found to be less reliable in detecting polyps, the precursors to colon cancer, and if cancer is suspected, a colonoscopy would still be required.
Coronary Artery Disease
Coronary artery disease (CAD) is the most common type of heart disease and is the leading cause of death in the United States for both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. Prevention of heart disease is crucial, and I review the risk factors with my patients: family history, smoking, high blood pressure, high cholesterol, diabetes, obesity, physical inactivity and high stress.
I do a lot of lifestyle counseling to reduce these risks such as assistance with smoking cessation, tips for healthy eating, suggestions for increased physical activity and working to get blood pressure and cholesterol levels under control.
Erectile Dysfunction and low T
It feels as if it’s become THE topic of conversation when I see men in the office! There’s so much advertisement of new medications and a lot of emphasis on low testosterone. There’s also a myth that higher testosterone helps with sexual function; this isn’t necessarily or always the case. The reality is that testosterone levels in men drop over time naturally. There are ranges and those are age-specific – therefore, what’s normal for a 25-year old is much higher than the normal range for a 75-year-old man. If levels are low for your age, we do have shots and topical gels that can be used in those cases.
Two large studies have recently come out that indicate testosterone replacement therapies in older men can lead to bad consequences, such as an increased risk of heart attack, CAD, and higher prostate cancer rates. Since this is a new area of controversy, we have generally stopped testosterone replacement but where appropriate, are prescribing clomiphene, based on the hormone clomid, that in men stimulates natural production of testosterone without the risks that we now believe are linked to testosterone replacement.
Gay Men’s Health
Acceptance, trust and knowledge of gay men’s needs and concerns are critical, and I’m very proud of the fact that Harvard Vanguard has been named in 2014 (for the fourth year in a row) as HEI Leader in LGBT Healthcare Equality, the fourth year in a row we have earned this distinction.
In particular, I have a large practice of gay men and am passionate about providing them with a secure, comfortable place to come to talk about their health. I do a fair amount of health education on:
- STDs (syphilis, gonorrhea, chlamydia) – counseling and treatment
- Encouraging my patients to “play safe.” I ask several questions to ascertain what level of risky behavior a patient might engage in and take the time to educate and counsel patients about the risk of HIV and AIDS.
Harvard Vanguard also has an expert team of dedicated physicians and nurses who care for patients infected with HIV, and I refer my patients to this team when appropriate. Comprised of infectious disease physicians and nurses who specialize in HIV, the HIV Resource Team’s main mission is to provide high-quality, focused care for patients who are HIV-positive.