Take Care of Dadís Health in Honor of Fatherís Day
Encourage Your Husband or Father to Enjoy the Gift of Good Health
Many men are uncomfortable discussing health topics, especially when it has to do with problems “down there.” But ailments such as urinary tract infections, incontinence, erectile dysfunction and an enlarged prostate or prostatitis can greatly affect the quality of a man’s life. An even more serious concern – prostate cancer – may actually be life-threatening in some cases.
In honor of Father’s Day, let your husband or father know that you care about his health, and encourage him to take better care of himself by scheduling an appointment for a thorough physical exam. To help you make the case, Dr. Mark Saleh, a urologist on the medical staff at Washington Hospital, offers the following information.
Urinary Tract infections and Incontinence
“Urinary tract infections are more common in women than in men because of differences in their anatomy, but men can get these infections for a variety of reasons,” says Dr. Saleh.
Symptoms of a urinary tract infection might include:
- Pain, burning sensations or spasms while urinating.
- Frequent urination.
- The need to urinate seems very urgent.
- Urine that is cloudy or has an unusual odor.
- Fever or chills.
- Blood in the urine.
“Blood in the urine can be a symptom of a serious problem,” Dr. Saleh notes. “You should always be evaluated if you have blood in your urine – even if it occurs only once.”
Urinary tract infections can be diagnosed with a simple urine test to see which, if any, bacteria are present. Then the lab can determine which antibiotics work best against the particular bacteria. It is important to treat urinary tract infections early, so they don’t spread to the kidneys and cause serious complications.
Urinary incontinence – the accidental release of urine – can happen for a number of reasons. The two most common types of incontinence are:
- Urge incontinence – having an urge to urinate that is so strong you can’t make it to the toilet in time, frequently caused by an overactive bladder.
- Stress incontinence – leakage that occurs when you sneeze, cough, laugh, lift objects or do something else that puts strain on the bladder.
“Most cases of urge incontinence can be treated with medications for overactive bladder,” Dr. Saleh says. “Stress incontinence is due to weak muscles that support the bladder, and it is rare in men unless they have had pelvic surgery. For mild stress incontinence, Kegel exercises may help strengthen the muscles. For more serious cases, we can perform a minimally invasive outpatient procedure to insert a ‘sling’ under the bladder.”
Erectile dysfunction (ED) is a condition that prevents a man from achieving or maintaining an erection. Causes of ED might include:
- Conditions that impede the flow of blood to the penis, such as hardening of the arteries, high blood pressure or high cholesterol.
- Problems with the nervous system, such as multiple sclerosis or Alzheimer’s disease.
- Psychological or social problems, such as depression or stress.
- Endocrine and hormone imbalances, such as diabetes, a high or low level of thyroid hormones, or a low level of testosterone.
- Lifestyle habits that impede blood flow, including smoking, alcohol abuse, or illegal drug use.
“Men who have had surgery or other treatments for prostate cancer also may experience erectile dysfunction,” Dr. Saleh explains. “For mild to moderate cases of ED, various oral medications have proven very effective. Treatment for more serious cases of ED could include vacuum pumps, a medical urethral suppository, or injections of a medication called Caverject into the penis. The injections can be self-administered after instruction by a physician.
“If all else fails, penile implants are a good option,” he adds. “A malleable implant rod with flexible joints that the man can manipulate is one type. A more ‘natural’ option is an inflatable implant.”
“Benign prostate enlargement occurs in most men to varying degrees, especially after age 50,” Dr. Saleh says. “For the majority of men, symptoms are mild, but then tend to progress with age and might eventually require treatment.”
Symptoms of Benign Prostatic Hyperplasia (BPH) may include:
• Weak urine stream.
• Frequent need to urinate.
• Urgent need to urinate.
• Increased frequency of urination at night.
• Difficulty starting or stopping urination.
• Inability to completely empty the bladder.
• Blood in the urine.
Treatment options for BPH might include medications, laser therapy to shrink the prostate, or – in more advanced cases – surgery.
“Medications for BPH have improved in recent years, with fewer adverse side effects,” says Dr. Saleh. “The first choice would be medications called alpha blockers, such as Flomax. These medications relax the muscles of the prostate and the bladder neck to produce a better urine stream and reduce the ‘hesitancy’ in starting to urinate.
“If the patient’s symptoms are more severe, or if he has a very large prostate, we would add medications called 5-alpha-reductase inhibitors such as Proscar or Avodart,” he continues. “These medications actually reduce the size of the prostate.”
Because early prostate cancer generally causes no symptoms, regular prostate screenings have long been considered an important diagnostic tool. Such screenings generally include a digital rectal exam (DRE) and a blood test to measure the level of prostate specific antigen (PSA) – a protein made by prostate cells.
A controversy over PSA screenings erupted in 2012, however, when the U.S. Preventive Services Task Force (USPSTF) released recommendations against PSA-based screenings for prostate cancer and discouraged the use of the test.
“The recommendations of the American Urological Association (AUA) differ from those of the task force,” says Dr. Saleh. (Urologists are the specialists who diagnose and treat the majority of prostate cancers in the U.S.) “The decision to have PSA screenings is one that a man should make with his doctor after a careful discussion of the benefits and risks of screening.”
The current AUA guidelines for PSA screenings include:
- PSA screening in men under age 40 years is generally not recommended.
- Routine screening in men between ages 40 to 54 years at average risk is not recommended. For men younger than age 55 years at higher risk, such as African American men or men who have a first-degree relative who was diagnosed with prostate cancer before age 65, decisions regarding prostate cancer screening should be individualized.
- Shared decision-making between the man and his doctor is recommended for men age 55 to 69 years who are considering PSA screening. A routine screening interval of two years or more may be preferred over annual screening in those men who have decided on screening. Additionally, intervals for rescreening can be individualized by a baseline PSA level.
- Routine PSA screening is not recommend for men age 70 or older, or for men with less than a 10- to 15-year life expectancy. Some men over age 70 who are in excellent health may benefit from PSA screening, however.
Dr. Saleh notes that if a patient’s PSA is high and remains elevated, or if the DRE detects any swelling nodules or lumps in the prostate, a biopsy would be needed to determine if cancer is present.
“Today we generally perform minimally invasive needle biopsies to diagnose prostate cancer, and we always take care to reduce the risk of post-biopsy infection or inflammation,” he says. “Complications from biopsy procedures are extremely rare, and they certainly are less onerous than the complications of late-stage prostate cancer.”
Treatment options for prostate cancer generally depend on how aggressive the tumor is, the patient's general health and the patient's preference. Age at diagnosis is an important factor, since aggressive treatment generally is not recommended for patients with a life expectancy of 10 years or less.
“For older men and for younger men with low-grade early stage tumors, the most likely recommendation would be to actively monitor the cancer’s progress with more screenings and repeated biopsies as indicated,” Dr. Saleh explains. “Hormone therapy to stop production of testosterone might also be considered to relieve symptoms and slow the growth of tumors.”
For younger men with more aggressive prostate cancers, radiation therapy might be appropriate in the form of external beam radiation therapy or brachytherapy – the implantation of radioactive “seeds” into the prostate. For many patients, surgery to remove the prostate may be the most effective treatment.
“In the right surgeon’s hands, the results of surgery can be very good,” says Dr. Saleh. “Current surgical techniques allow surgeons to preserve the nerves necessary for maintaining erectile function and urinary continence in the majority of patients.”
Encouraging your husband, father or other significant man in your life to pay attention to his health and schedule a doctor’s appointment for a thorough exam might be one of the best Father’s Day “gifts” he’s ever received. If you need help finding a physician, visit www.whhs.com and click on the tab for “Find My Physician.”