We all know a few men in our lives who are stubborn about doctor’s appointments and having medical tests done. But we also know that avoiding the doctor’s office — and especially avoiding life-saving medical screenings — can carry a huge price.
September is Men’s Health Month, so we interviewed Dr. Robert Zimmerman, who is a urologist with Mercy Health.
Please read the information below and get your husband to schedule an appointment if he needs to be screened or if he needs to talk through any issues with a doctor. (And by all means, if he won’t do it, schedule it for him and get him to that appointment!)
If you were talking to my husband today, how would you convince him that it’s important to come in for a check-up? (Because so far my nagging isn’t working.)
The key to men taking control of their own health care is empowerment. Historically, women have been better at assuming health care for their families. Much marketing for health care is directed to women – even for men’s health. Women tend to lead lead their partners into the health care system.
Men must develop self-reliance for their health care. Empowering them through education is important. Helping men understand the need for heath maintenance and “taking charge” of their health care is paramount. I see education as a vital aspect for this. Helping men to understand this begins in the exam room and in the interactions with their physicians. Physicians should educate their patients on why they are doing what they are doing and foster an atmosphere where the patient understands their health care needs. That understanding is essential to men feeling empowered to take charge of their own health care.
What are the most common types of problems you treat in men ages 30 to 60? What are the symptoms men most often seek treatment for?
As men age their prostates continually enlarge. This enlargement is a normal part of the aging process for men and it results in reduced flow, increased urgency and frequency, increased trips to the restroom at night and, in extreme cases, cause urinary retention and the inability to void.
Approximately 60% of men at age 60 will display symptoms of an enlarged prostate. Benign Prostatic Hyperplasia (BPH) is not cancer. But it should be evaluated by a urologist who will typically offer prostate cancer screening simultaneously.
Treatment for BPH usually includes the use of medications as a first-line therapy. These medications relax the smooth muscle of the bladder neck allowing the prostate to open to allow better flow through it. Medications in this class are called alpha-blockers (terazosin, tamsulosin, e.g.).
Additional medications may be used which can assist in reducing the size of the prostate (finasteride, e.g.). If these medications do not give a satisfactory result, or if men are unable to tolerate the medications, then surgical options may be provided. There are some office-based procedures that can be done, however, most are offered a transurethral resection of the prostate (TURP). In this surgical procedure (which usually requires an overnight stay in the hospital) excess tissue is removed from the prostate allowing a larger channel for urine to flow through.
This surgery is highly successful and provides lasting results, but it may need to be repeated for any “re-growth” of tissue. There are also laser techniques which can be used to accomplish the same results. These are done as an outpatient surgery and also require limited catheter drainage for a short period after the surgery similar to the TURP. Men having urinary flow issues should seek advice from the health care provider and seek out a urologist if medical therapy is not accomplishing the desired effects.
What are the most common causes of E.D.? (Can an underlying heart problem be the cause of E.D.?) What are today’s leading treatments for this problem?
Erectile dysfunction affects millions of men. The incidence of erectile dysfunction increases with age. The major risks factors for erectile dysfunction are vascular disease (40%), diabetes mellitus (30%) and medication side effects (15%). For instance, a diabetic male who has a history of cardiovascular disease and who may be on offending medications may carry a nearly 85% risk of associated erectile dysfunction.
Treatment options for erectile dysfunction include oral medications (Viagra, Levitra, Cialis, e.g.). These medications increase vasodilation of the arteries supplying blood to the penile tissue – hopefully increasing the quality of the erection. Presently, the expense of these medications and the often limited coverage by prescription drug plans make these medications limited to patients.
If this first line therapy fails, there are multiple other modalities that can be tried including vacuum pump devices, penile injections and urethral suppository. In the event of failure of these therapies, a penile prosthesis can be utilized. This is a medical implant which is completely self-contained in the patient which provides an “artificial” erection.
These devices are surgically implanted and are generally covered by most insurance plans including Medicare. Penile prosthesis carry very high patient and partner satisfaction rates of greater than 92%. Men seeking this form of therapy to restore erectile function should seek out a urologist who does a fair amount of this type of work.
What do my husband and I need to understand about the risk of prostate cancer?
Prostate cancer epidemiology, screening and treatment is a very large subject area – too large to be completely addressed here. Some basic facts of prostate cancer are that for Caucasian males, one out of every six males may be diagnosed with prostate cancer in their lifetime. If they have a first degree relative (father or brother) with a prostate cancer history, this risk increases to one in two, or 50%.
Though highly treatable if detected early, more men die from prostate cancer than do women from breast cancer in the state of Arkansas, according to data provided by the Arkansas Prostate Cancer Foundation.
Screening for prostate cancer involves a simple blood test and a prostate exam. Though the blood test looking at Prostate Specific Antigen (PSA) is not a perfect test and its utility is debated, it is one of the best screening tools we have. We know that when done together with a simple prostate exam, detection rates are higher for prostate cancer.
The PSA test must be interpreted for each particular patient’s risk stratification. This includes family history, past values, voiding symptoms and physical exam to name a few. Presently, most urologists still advocate screening in men between the ages of 45 and 70. If the screening tests are suggestive of an increased risk, a prostate biopsy would be offered to the patient. This is a simple procedure performed in a clinic setting.
There has been recent research about the benefits of a “wait and see” approach to treating prostate cancer. How do you know when it’s more beneficial to treat it aggressively?
Treatment for prostate cancer involves many different possible modalities – all of which have good success rates when tailored to the individual’s disease state. Treatment options may include surgery which may be done through an open incision or via a minimally invasive technique utilizing the DaVinci robotic assisted surgical platform. Radiation – either alone or in conjunction with medications may also be utilized for excellent patient outcomes. The different treatment options for prostate cancer all carry some potential side-effects and risks. In minimal disease presentations, active surveillance options (also called the “wait and see approach” may be utilized.) All of these options must be discussed at length with a urologist.
Our thanks to Dr. Zimmerman for taking time out of his busy schedule to answer our questions. To schedule an appointment with Dr. Zimmerman, call the Mercy Urology Clinic at 479-636-9669. He has offices in Rogers and Bella Vista. Or click HERE for more clinic information.