Living Well

Men, It's Time to Take Your Health Seriously

Fellas, it's time to fess up... When is the last time you went to the doctor? Months? Years? Decades?

As I wrote recently, more men succumb to COVID-19 than women. That's in part due to genetics – women have more robust immune systems.

But it's more than that. Men have worse health behaviors: We wash our hands less often and are more likely to smoke. Worse, men also fail to seek medical attention at the same rate as women.

A survey from health care research foundation the Commonwealth Fund found how big of a problem this is. It found that 25% of men wanted to "wait as long as possible" before getting help for a medical problem. That could be anywhere from a few days to a few weeks. In some cases, that's the difference between life and death.

Right now, COVID-19 still has folks panicked. That means people who really need medical help aren't getting it because they're afraid to go to the ER or to their doctor's office.

In light of all this, and since June is Men's Health month, I wanted to take today to revisit prostate cancer – what the symptoms are, when to seek treatment, and what to ask your doctor.

Right now, about one in nine men will receive a prostate cancer diagnosis in his lifetime. And the longer we live, the more likely we are to get prostate cancer. But the good news is, if you get it, you're likely to die of something else before the cancer ever gets to the point of killing you.

Genetics only play a small role in risk, but the more family members you have, the more your risk grows. Age is a much bigger factor, as is race. African American men have the highest risk while Asian men have the lowest risk. There's also some evidence that a sedentary lifestyle, poor diet, and living in an urban area all may increase risk as well.

Prostate cancer has some embarrassing symptoms. But don't ignore them. Bring them up to your doctor.

Here are the six common symptoms:

  • Frequent urination
  • Hesitancy with urination
  • Erectile dysfunction
  • Burning with urination
  • Pain in the lower back
  • Stiffness in the upper legs

If you have these symptoms and risk factors, see your doctor to discuss the possibility of prostate cancer. Ask your doctor to do a digital rectal exam ("DRE") – it's not quite as bad as it sounds, just awkward. He should also get the blood level of your prostate-specific antigen PSA. These tests are simple and inexpensive... but be wary of the timing.

Longtime subscribers know I've warned against getting an unnecessary PSA test for years. These tests are notorious for giving false-positive results because benign factors can cause elevated PSA levels. Inflammation, infection, recent ejaculation, and even riding a bike can increase your PSA levels.

So have a candid conversation with your doctor about your concerns regarding anything that may artificially elevate your PSA and see about getting another PSA for comparison a few days later.

And one important point: take the time to find a good doctor. You want a doc with a good record of catching prostate cancer early. Call a couple local oncologists (cancer doctors) and find out who sends them the most prostate cancer patients. Yes, just call up and ask for the information. Use it to find the best doctor out there.

Finally, understand your treatment options. Don't be afraid to ask questions and get a second opinion. Overtreatment can have serious side effects.

About 30% of men with prostate cancer have a simple treatment: watch and wait. This is called active surveillance, and it means these folks simply keep a close eye on their cancer and PSA levels. Many don't need any treatment.

A 2015 study using data from Johns Hopkins found that fewer than 1% of men with low-risk prostate cancer on active surveillance died from prostate cancer. A similarly small number progressed to a metastatic phase of cancer where treatment is more difficult.

But some forms do require treatment.

You should know, however, that most treatments can lead to incontinence and erectile dysfunction... sometimes permanently. You'll need to discuss with your oncologist what the best standard of care is for your type of cancer and how to manage any side effects.

Know your risks, recognize the symptoms, and find a good doctor. You don't want to ignore this problem and hope it goes away. If you're nervous about an in-person visit, see if your doctor will do a phone call or an online-video appointment to talk about the problems you're having.

What We're Reading...

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
June 4, 2020