What does “men’s health” encompass from a urology perspective?
Sobel: Urologists are surgeons who operate on kidneys and bladders, as well as the prostate, the penis, and the testicles. Although we're surgeons, a big part of our clinic is medicine-based. From a men’s health perspective, Urologists treat sexual function, which includes erectile dysfunction, low testosterone and curvature to the erection (called Peyronie's Disease). Moreover, though, urologists help men with voiding or urination. All men have prostates, and as we get older, those prostates get larger and that may impede our ability to urinate well. Finally, there’s cancer screening. That involves PSA (prostate-specific antigen) testing, digital rectal exams (DREs) to check for signs of prostate cancer, and talking to men about testicular cancer and self-assessment for that.
Dodge: Another part of men’s health that's become more visible over the last several years is mental health. As we’ve started dealing more with sexual dysfunction and low testosterone, we’ve also started to see quite a bit more focus on depression, anxiety, and other concerns that guys have when it comes to mental health.
What are some of the most common men’s health issues — and the most serious?
Sobel: It’s incredibly common to develop issues with urination and erectile dysfunction. I tell my patients a rough estimate is that about 50% of men over the age of 50, 60% of men over the age of 60, and 70% of men over the age of 70 will have issues with erections.
As for the most serious, cancer is always the biggest concern, and prostate cancer is the most common cancer to occur in men. Fortunately, if we catch prostate cancer early enough, we have numerous treatment options that can reasonably result in a cure. In fact, sometimes prostate cancer is identified but felt to be a less aggressive form of cancer. In those cases, we may opt to just monitor the cancer, which is where we put the patient into an active surveillance protocol.
Why is it important to address men’s health specifically?
Dodge: Men tend to be lone wolves. We don't like to admit when we have problems, especially when it comes to sexual dysfunction or other specifically male issues. In that sense, we can be our own worst enemies. A man might not necessarily feel comfortable talking about their erectile dysfunction with the same person they talk to about their blood pressure or their diabetes. That’s why I think it’s important to make dedicated men’s health care more accessible and to foster an environment in which men can feel comfortable talking about those specific issues.
Sobel: We know that men trail women with respect to their health care. They avoid the doctor at a higher rate than women do. Oftentimes, the first entry point for a man into health care is through urology. For instance, you might have a gentleman in his 50s who hasn't seen a primary care doctor in years, but suddenly he’s struggling with erections, so he’ll go to a urologist. And from there it's not unusual that we may diagnose that patient with other medical issues. It’s not unusual to have a patient who comes to see me and then I end up making referrals to primary care or other specialists. I think urologists must accept that there are moments where we become that first touchpoint within the health care system, so we need to be welcoming and try our best to make sure that it's not an intimidating, frightening experience.
What are some of the most important things men should be doing to improve and maintain their urologic health?
Sobel: From an erection standpoint, anything that is healthy for your heart is also healthy for the penis. Eating a healthy diet, exercising, avoiding smoking, and moderating alcohol use — all these lifestyle changes can have a profound impact on sexual function.
When it comes to urination, the most important thing is not to ignore those symptoms. Go see a doctor. Every now and then I get a patient who has ignored things. They're stoic, they're a tough guy, and they'll come to me and say, “I've been struggling to urinate for 20 years.” By the time we see them, we may be past the point of being able to offer them a therapy that works. Plus, it’s important to make sure that it is just an enlarged prostate that’s causing the problem because there are certain other conditions — prostate cancer, bladder cancer — that can present with urinary symptoms.
Finally, from a prostate cancer standpoint, we know that diets higher in fruits and vegetables and lower in animal and meat products can decrease the risk of prostate cancer. It’s also important to get screened. For patients without a family history of prostate cancer or other risk factors, the American Urological Association recommends yearly PSA tests and DREs for men ages 55 to 70. If a patient has other risk factors, we may start that even earlier.
Dodge: Taking care of your global health is key. Some of the positive lifestyle changes I talk to my patients about include getting regular exercise that's age-appropriate and following recommended nutrition principles. I refer patients to dietitians quite frequently, because it doesn't really do my patients any good to tell them, “Hey, eat healthy,” because that's going to mean different things to different people. I also tell my patients to get plenty of sleep and reduce the consumption of noxious chemicals like alcohol and marijuana, both of which can contribute to sexual dysfunction. And I ask men to focus on stress reduction and taking care of their mental health as well as their physical well-being.
Can you talk about some of the ways CU and our urology division specifically stand out in terms of treating men’s health issues?
Sobel: Without a doubt, we have extraordinary providers who do wonderful work in lots of different areas. We have exceptional reconstructive surgeons who are very skilled at surgery to help with erections. We have a urologic oncology program that has created a model of prostate cancer care from diagnosis to treatment. It’s a very multidisciplinary, very streamlined process, and the number one priority at each decision point is always the patient.
Dodge: We provide a high level of personalized care here. I appreciate that in my practice I have the luxury to be able to spend time with patients. When you're talking about things of intimate concern to a man, you can't just rush in and out of a room in five or 10 minutes. You need to take the time to get to know that person so that they feel comfortable talking about those conditions and to provide them with the comfort and assurance that we're going to take proper care of them in a dignified fashion. I think we do that extraordinarily well.