The Biggest Issues Facing Men Today

Though they’re perhaps less likely to engage in annual checkups, men can reap many advantages when staying ahead of diseases. Local physicians share a few.

Parents strive to take their children to a pediatrician for a yearly wellness check for the very reason the visit is named: to check on their general health and wellness.

After 18, it’s easy to forget about an annual checkup. However, physicians believe it’s still a good idea to stop in annually, regardless of whether you’re feeling sick.

Dr. Mirza Ali Khan

“We recommend at least coming in once a year, even if you’re healthy, so we can get those basic blood work numbers – blood pressure, diabetes, cholesterol, kidney function, blood count. If that stuff is normal, we say come back in a year,” says Dr. Mirza Ali Khan, a family practice physician with OSF HealthCare. “It helps us keep an eye on you.”

The reason is simple: it’s often easier to prevent a disease than it is to treat one. For whatever reasons, though, men tend to be more reluctant to engage in these annual checkups. The consequences of waiting can be serious.

“I’ll get a man who comes in at 34 or 35 and says, ‘I was healthy, but I came in now because I have a family history of diabetes, and my girlfriend/wife says, ‘You’re feeling crummy, you should see a doctor,’” says Khan. “I’ll check them and tell them, ‘You’re prediabetic. If we had caught this earlier, we’d have been able to be on top of it and prevent it.’”

Unfortunately, men don’t always advocate for themselves.When Dr. Roger Kapoor, a dermatologist with Beloit Health System, talks to the men in his clinic, he says the conversation often can follow this pattern:

“Why did you come into the office today?”

“Well, my wife told me to.”

“What’s wrong?”

“I don’t know, I think she said there is a spot on my back.”

“I’ll take a look and tell him, ‘Your wife just saved your life,’” Kapoor says. “We commonly see that men need to be prodded by their spouses or loved ones to tend to their health.”

Doctors urge their male patients to make time for an annual physical.

“Just come in once a year, even if you’re healthy,” says Khan. “Sometimes, it can be really hard to play a catch-up game. We try to stay on top of that.”

General Screenings

Khan regularly speaks with his male patients about the importance of eating healthier. In their early 20s and 30s, both men and women – but specifically men – often find themselves with elevated blood pressure and high cholesterol, which can lead to diabetes. The ease of eating fast food to keep pace with a busy lifestyle often contributes to unhealthy eating patterns, Khan says.

“They’ve become accustomed to a routine, and it becomes hard to break that routine and make healthier food at home,” he says. “When I speak to them, I try to make sure I lock into their minds the idea that, if they have a family history of high cholesterol, high blood pressure or diabetes, they need to be watchful.”

In general, the U.S. Preventative Services Task Force recommends healthy adults 35 and older be screened for prediabetes and diabetes. If you’re overweight, screening should be done earlier.

Other screenings recommended for men include colonoscopy screenings, prostate screenings and – if you’re a smoker – possibly low-dose CT scans of your lungs.

Most colonoscopy screenings are conducted at age 50, Khan says. However, if you have a first-degree family member with a history of colon cancer, doctors try to schedule a screening 10 years earlier than when that relative was first diagnosed. If your first-degree relative was diagnosed at age 45, you should get screened at 35.

Prostate screenings, which usually entail a simple blood test that checks for prostate-specific antigen (or PSA), often fall to the discretion of individual practitioners, Khan says. Older physicians tend to do yearly screenings, but that’s not the recommended practice by modern standards. If there is no family history of prostate cancer, screenings typically start at age 50.

“When you take a PSA test, if it’s positive, it doesn’t necessarily mean you have prostate cancer,” Khan says. “But we have to send you to a urologist, and then you have to get a biopsy to confirm it, which means taking a piece of tissue out of your prostate. If we get that biopsy and it’s negative, you may have a risk of urinary incontinence going forward. So, is it really needed? I try to push not to get it you don’t need it. However, if you have any urinary issues, always talk with your primary provider.”

Often, a positive PSA can indicate an enlarged prostate, which is not synonymous with prostate cancer, he adds.

There are certain diseases – like pancreatic cancer – which affect men slightly more than women and do not have specific screenings, Khan says.

But if your general practitioner is aware of any symptoms you may be experiencing, he or she may be able to catch the problem before it escalates, he says. That’s why it’s so important to have a yearly exam – even if it’s just a video call.
“That yearly check could prevent you from having any serious complications going forward, because we’ll be able to keep an eye on it,” he says.

Monitoring for Cancer

Prostate cancer is the most common cancer among men worldwide, says Dr. Bobby Koneru, a radiation oncologist who regularly provides services at the Leonard C. Ferguson Cancer Center at FHN Memorial Hospital but is not an employee or agent of FHN.

Dr. Bobby Koneru

As Khan noted, Koneru finds it’s debatable when the best time is to to begin prostate screenings.
“If you begin screening too early, studies have shown it doesn’t add any benefit,” Koneru says. “The real question is: what’s your risk for getting prostate cancer? Certain groups are at higher risk; for them, we screen earlier.”

In particular, doctors pay close attention to African-American men, those who have a strong family history of prostate cancer, or those who have been diagnosed earlier in life with any type of genetic mutations. For men who fall into these categories, doctors may begin screening earlier in life, likely between ages 40 and 45, Koneru says. However, an average-risk man who doesn’t fall into those categories shouldn’t need to start screening until 50.

There are other risk factors physicians monitor because certain behaviors can increase a person’s risk for all cancers. Smoking, obesity, having a poor lifestyle in general – all of these can increase your risk of any range of cancers, Koneru says.

However, there aren’t any risk factors specifically for prostate cancer, other than age.

“It’s kind of a cancer of older age,” Koneru says. “That doesn’t mean you have to be scared, because there are a lot of prostate cancers that are indolent and benign, and nothing has to be done.”

When something does need to be done, patients usually have an option between radiation therapy or surgical removal of the prostate.

“Radiation tends to be even more popular than surgery because it’s noninvasive,” Koneru says. “We’re targeting the prostate with targeted radiation, and it’s tolerated really well. Cure rates are pretty similar to surgery. A lot of men like to go the noninvasive route, especially as they get older.”

However, it’s important to understand the risk and side effects of both types of treatments, he says.

“With surgery, when you take the prostate out, you also have to cut the muscle within the bladder that opens and closes to prevent urinary leakage,” says Koneru.

Therefore, urinary leakage is typical; men usually wear a pad for several months until their bladder control increases, he says.

Impotence is another side effect of surgery.

“The prostate is wrapped around several nerves that control erection,” Koneru says. “It’s very difficult to preserve erection after surgery. If you are sparing nerves, you’re sparing prostate tissue, and there could be cancer there, too.”

The biggest “pro” for surgery is that it’s a one-day procedure. Most men go home the next day.

Radiation treatment, meanwhile, takes place every day for a couple of weeks, so the process is drawn out compared to a surgical procedure, Koneru says.

“Side effects of radiation are the opposite of surgery,” he says. “There’s no urinary leakage, but you do feel like you have to go to the bathroom more often. Usually, that’s temporary and resolves.

“There’s not guaranteed impotence,” he continues. “It doesn’t happen immediately – there’s a 50% chance nerves can get damaged with radiation.”

“What’s important is that a patient has a very balanced perspective,” he says. “In some situations, surgery is the better option, and in some situations, radiation is better.”

Skin Cancer Doesn’t Play Fair

While most men have certain health issues on their radar, like prostate cancer, they often forget about the most common form in the U.S. – skin cancer.

Dr. Roger Kapoor

“This is an often forgotten-about entity under the umbrella of men’s health,” says Kapoor, at Beloit Health System. “It can be inappropriately viewed as only a female issue. Men don’t view skin cancer or skin screening as a regular conversation point in terms of preventable health issues that can have serious consequences, up to and including death.”

But the numbers don’t lie.

By age 65, men are twice as likely as females in the same age group to develop melanoma, the most serious type of skin cancer, according to the American Academy of Dermatology. By age 80, men are three times as likely as women their age to develop melanoma.

“Men are unfortunately more likely to pass away from melanoma than women, at every age group,” Kapoor says. “And there is even a study in which white adolescent males are two times as likely to die from melanoma when compared to white females of the same age group. It’s a real issue.”

As physicians have learned more about the science of skin cancer and melanoma, they have found that men are physiologically at a disadvantage compared to women.

“Based on gender alone, men literally have a higher risk of skin cancer partly because they have thicker skin with less fat and more collagen,” Kapoor says. “What research has shown is that this makes skin more susceptible to sun damage from the same amount of UV light when compared to women. So, a man and woman standing under the same sun will have a greater negative impact on the man.”

Additionally, estrogen assists the immune response to fight against melanoma, Kapoor adds.

“Those with higher levels of estrogen respond better to treatments and have a higher degree of survival,” Kapoor says. “Obese men who have more estrogen tend to do better in their response to melanoma.”

It’s not just sunburns that increase your risk of skin cancer, Kapoor says. Any time your skin is exposed to the sun, it can cause damage.

While a tan, or a “healthy glow,” is aesthetically pleasing to many, it represents skin that is damaged, not skin that is healthy, he says.

“Regrettably, the cause and effect of sun exposure and the development of skin cancer is separated by so much time that it’s difficult to hook one to the other and demonstrate in real time the harm that sun exposure has to the skin,” Kapoor says. “If you’re in your 20s and you’re at a beach and you’re getting tan, the harmful effects of that tan, such as skin cancer development, likely won’t appear until you’re in your 50s or 60s.”

Kapoor says the best advice to minimizing the risk of skin cancer is simple: stay out of the sun or limit your exposure between 10 a.m. and 2 p.m., when UV intensity is at its peak; wear a wide-brimmed hat to provide a physical block to UV rays; and use a sunscreen that’s at least 30 SPF while getting continuous sun exposure.

Regular skin exams also are recommended for all age groups. Remember that dark spots, leathery skin and wrinkles all can be byproducts of sun exposure.

“If you find melanoma early, it can be highly treatable and even curable,” Kapoor says. “Melanoma can be a preventable cause of death, but time is of the essence.”

Minimally Invasive Therapies

As an interventional radiologist at Mercyhealth in Rockford, Dr. Raj Kakarla handles image-guided procedures that are minimally invasive. That means he and his team use different formats of imaging – ultrasounds, CT scans, angiograms – to perform procedures without making major incisions.

Dr. Raj Kakarla

“Because interventional radiology treatments do not require large incisions, they can often be safer and, at times, more effective than open surgery,” Kakarla says. “In addition, most men will be treated and discharged within the same day, getting back to their lives as quickly as possible.”

Minimally invasive procedures can be used to treat diseases in every organ system of the body. Some treatments are used on the male population more frequently than females, like the procedures for peripheral arterial disease (PAD), which is a narrowing or blockage of the blood vessels that carry blood from the heart to the legs.

“We do see a lot of arterial disease in the older male population,” Kakarla says, noting those with a history of smoking or a higher risk of diabetes are more prone to developing PAD. “Most people think of narrowing vessels in the heart, or coronary disease. But mostly issues in the legs are presented to us because patients have difficulty walking.”

PAD is called the “window shopping disease” because it creates pain – think of it like a charley horse, Kakarla says – that makes people stop walking at frequent intervals, much like someone who is window shopping.

For most patients, exercise is the best PAD therapy to increase blood circulation. But for those who require heartier efforts to open up the blood vessels, angioplasty is an option. In this minimally invasive procedure, interventional radiologists often utilize live X-rays to maneuver a balloon-tipped catheter into a vessel to open the blockage.

An enlarged prostate gland, also known as benign prostatic hyperplasia, or BPH, is another male-focused health issue that can be treated with a minimally invasive procedure.

BPH patients tend to be older than 50, but once they reach 70, they’re usually not great candidates for general anesthesia, Kakarla says.

This is another reason why minimally invasive procedures can be a good option, he says. A prostate embolization, a procedure performed for benign prostatic hypertrophy (BPH) can be done with a patient under “twilight sleep,” in which the patient never loses consciousness but doesn’t feel pain.
“If you don’t have to do major surgery for these things and we can keep these incisions to a minimum, you’ll usually be able to be discharged the same day or have a short hospital stay for a day or two,” Kakarla says.

Younger men can benefit from minimally invasive procedures, as well.

Male infertility due to varicocele, an enlargement of the veins within the scrotum, is easily correctable in patients who are 30 to 50 years old, Kakarla says. They’re normally done with the procedure in a matter of hours and on their way home.

Ultimately, fewer procedures – minimally invasive or not – would be needed if men were more self-aware and didn’t automatically dismiss abnormal pain as symptoms of aging.

“I think guys probably don’t do their own male medical exam to look for varicose veins or varicoceles – not until they notice leg swelling or pain in the legs or pain along the scrotum,” Kakarla says. “In women’s health, female breast exam is promoted robustly. But in men’s health, self-examination is not promoted.”