A short presentation on topics specific to men's health such as prostate cancer, BPH and testicular cancer.
- 1. TOPICS INMENS HEALTH Marcos Pienasola PA-S
2. LEARNING OBJECTIVES Outline some of the health problems specific to men. Common terminology pertinent to caring for such problems. Basic anatomy, physiology and pathophysiology of commonconditions affecting men. Diagnostic studies and treatments available. 3. TOPICS INMENS HEALTH Across a broad range of indicators, men report poorer health than women. Although men in all socioeconomic groups are doing poorly in terms of health, some especially high-riskgroups include men of low socioeconomic status (SES) of all racial/ ethnic backgrounds, low-SES minority men, and middle-class African American men. David Williams, PhD, MPH 4. WHY MENS HEALTH? Life expectancy shorter than women(75.6 years vs. 80.8.1 years) More likely to die at earlier ages from: Chronic diseases (heart disease, CA, stroke) Communicable diseases Injuries (both accidents and homicides) Highest-income men have mortality rates equal to those of thepoorest women (Rieker and Bird 2000) 5. DIAGNOSIS ADDRESSED TODAYBPHProstate cancerTesticular cancerColorectal cancer 6. BPH WHAT IS IT? Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. BPH occurs in almost all men as they age. BPH is not cancer .An enlarged prostate can be a nuisance, but it is usually not aserious problem. About half of all men older than 75 have some symptoms. Benign prostatic hyperplasia is also known as benign prostatic hypertrophy. 7. PROSTATE 8. CAUSES AND SYMPTOMS Causes: Not really sure. Better understanding of risk factors Advanced age Obesity FmHx of BPHSymptoms: Obstructive Irritative Hesitancy Intermittent voiding Urgency Diminished stream Frequency Incomplete bladder Nocturia emptying Postvoid leakage 9. WHAT BPH DOES NOT DO: does not cause prostate cancer does not affect a mans ability to father children. does not cause erectile dysfunction. 10. BPH DIAGNOSIS AND TREATMENT How is BPH diagnosed? Present + past health history and a physical exam. Tests may include Urine test (urinalysis) Blood tests Digital rectal exam How is it treated? Treatment may not be necessary unless the symptoms are bothersome enough or there are other problems such as backed-up urine, bladder infections or bladder stones. 11. BPH TreatmentMedical therapy HerbalWatchfull Alpha blockerspreparations:waiting. Alpha reductaseinhibitorsSaw Palmetto 12. PROSTATE CANCER 13. PROSTATE CANCERMost common cancer found in American menafter skin cancer.It tends to be a slow-growing cancer, butthere are also aggressive, fast-growing types.Highly treatable with early detection. 14. RISK FACTORS Advancing age African Americans FmHx of Prostate cancer Geneticfs Possible risk factors Obesity Fatty diet Red meats 15. SYMPTOMS AND SIGNS Very similar to BPH, including asymptomatic. Signs Nodular posterior prostate Hard in consistency Irregular shape Other associated with CA Coagulopathy Spinal cord compression 16. PROSTATE CANCER - TESTINGDRE - digital rectal examPSA - prostate specific antigenDiscussions at age: 50 for average-risk men 45 for men at high risk. This includesAfrican-Americans. 40 for men with a strong family history of prostate cancer. 17. PROSTATE CANCER - + PSA F/UTRUSAbdominalMRI CTBoneScans 18. ELEVATED PSA DDX BPH Post Prostate biopsies Prostatitis Post DRE Prostate Cancer 19. TESTICULAR CANCER Uncommon cancer Usually curable Most occurrences between ages15 and 35. Whites > African american 20. TESTICULAR CANCER RISK FACTORS No one cause has been determined but there are know linksbetween testicular cancer and other factors. Undescended testicle (cryptorchidism). Personal history of testicular cancer. Infertility Klinefelters syndrome and Downs syndrome. Smoking Suspected risk factors: sedentary lifestyle, early puberty, previous mumps,testicular injury, elevated scrotal temperature, and overexposure to pesticidesor radiation. 21. SIGNS,SYMPTOMS AND WORKUP Classic presentation: Painless testicular mass. Other sxs occur in special circumstances A testicular mass should be considered cancer until proven otherwise. Testicular exam during CPE US recommended for any suspicious masses or persistentpainful testicular swelling . Lab work you may come across hCG, LDH, AFP 22. PREVENTION Noncancerous growths in the testicle are rare, so all masses should be assumed to be a cancer until proven otherwise. 23. WHAT IS COLORECTAL CANCER? Colon cancer vs rectal cancer. Most arise from polyps 2nd highest cause of cancer death. Generally > 50 y/o More common and more morbidamongst African Americans Higher mortality in males (43%) 24. RISK FACTORS Older than 60 African American and eastern European descent History of cancer Colorectal polyps Have inflammatory bowel disease Family history of colon cancer Genetic syndromes: hereditary nonpolyposis colorectal cancer (HNPCC) Familial adenomatous polyposis (FAP). Diet: animal fat Obesity, smoking cigarettes and drinking alcohol. 25. SYMPTONS Many asymptomatic Abdominal pain and tenderness in the lower abdomen Blood in the stool (hematochezia) Dark, tarry stools (melena) Diarrhea, constipation, or other change in bowel habits Intestinal obstruction Narrow stools Unexplained anemia Weight loss w/o other identifiable cause 26. TESTS AND DIAGNOSISPhysical exam May reveal abdominal mass DREFOBT: Fecal occult blood testColonoscopy vs Sigmoidoscopy biopsyBlood tests: Complete blood count (CBC) Liver function tests CEA, CA19-9 (tumor markers)CT or MRI scans of the abdomen, pelvic area, chest, or brain may beused to stage the cancer. 27. TREATMENT AND PREVENTION Treatment Treatment depends partly on the stage of the cancer. In general, treatments mayinclude: Chemotherapy Surgery Radiation Prevention: Screening: Statins Colonoscopy >50 y/o Dietary and lifestyle modifications DRE age 40 are important. Removal of precancerous polyps Folic acid, Calcium, fiber NSAIDs may help reduce the risk of colorectal cancer. 28. TEN LEADING CAUSES OF DEATH IN MEN Heart disease Cancer (lung, prostate, colorectal, skin) Stroke Accidents and unintentional injuries Lung disease Diabetes Pneumonia and influenza Suicide Chronic liver disease and cirrhosis Kidney disease 29. References American Cancer Society MerkMedicus www.emedicine.com Harrisons Medicine Practice Manual Epocrates Prostate Cancer Foundation www. mayoclinic.org