Male Health PDF

Male Health Learning Contents By the end of this lecture, you should be aware of and understand: ❑ Prostate Cancer ❑ Erectile Dysfunction ❑ Benign Prostatic Hyperplasia ❑ Male Pattern Baldness ❑ What is a prostate? - The prostate is a gland. It is usually the size and shape of a wal...

Male Health Learning Contents By the end of this lecture, you should be aware of and understand: ❑ Prostate Cancer ❑ Erectile Dysfunction ❑ Benign Prostatic Hyperplasia ❑ Male Pattern Baldness ❑ What is a prostate? - The prostate is a gland. It is usually the size and shape of a walnut and grows bigger as you get older. It sits underneath the bladder and surrounds the urethra. This is the tube that carries urine out of the body. The prostate is designed to help make semen – the fluid that carries sperm Prostate Cancer Symptoms only tend to develop when the prostate is large enough to affect the urethra. When this happens, the patient may experience: ❑ An increased urgency to pee ❑ Straining while you pee ❑ The feeling that your bladder has not fully emptied ❑ Blood in the urine Symptoms of Prostate Cancer The most common prostate problems are: ❑ Enlarged prostate ❑ Prostatitis ❑ Prostate cancer An enlarged prostate - most common in men over 50 - increase in size of the prostate - causes change in urination Prostatitis - inflammation of the prostate - can affect any age. Most common in younger adults - affects urination and causes discomfort. (Both of these conditions are non- cancerous) Prostate cancer is when cells in your body start to grow in an uncontrolled way – abnormal growths – causes change in urination and potential pain  ❑ PSA test is a simple blood test that measures the presence of Prostate- specific antigen circulating in your Ways of testing: bloodstream. This test is usually the first ❑ Blood tests (PSA) step in any prostate cancer diagnosis. ❑ However, blood PSA is an inaccurate ❑ Digital Rectal test for prostate cancer because cancer Examination can be present without increased PSA ❑ MRI levels, and PSA levels may be increased by conditions other than cancer (such as ❑ Biopsy benign prostatic enlargement, prostatitis, and urinary tract infection). ❑ The aim of PSA testing is to detect localized prostate cancer when treatment can be offered that may cure cancer or extend life. Testing for Prostate Cancer  Prostate-specific antigen threshold Age (years) (micrograms/L) Below 40 Use clinical judgement 40–49 More than 2.5 50–59 More than 3.5 60–69 More than 4.5 70–79 More than 6.5 Above 79 Use clinical judgement Data from: [NICE, 2021c] Benefits of PSA testing include: Limitations and risks of PSA testing Early detection — PSA testing may include: lead to prostate cancer being detected False-negative PSA tests — about 15% of before symptoms develop. people with a normal PSA level may have Early treatment — detecting prostate prostate cancer False-positive PSA tests — about 75% of cancer early before symptoms develop people with a raised PSA level have a may extend life or facilitate a negative prostate biopsy. complete cure.  Watchful waiting is aimed at people with localized prostate Radical treatments include radical cancer who are either not prostatectomy, external beam suitable for, or do not wish to radiotherapy, and brachytherapy. receive treatment, and instead involves the deferred use of Radical prostatectomy is the surgical hormone therapy. removal of the entire prostate gland and lymph nodes. This can be done by an Active surveillance is aimed open approach or by keyhole technique at people with localized External beam radiotherapy prostate cancer for whom (EBRT) is radiotherapy given by using radical treatments are suitable, ionizing radiation (for example, high- whereby only those whose energy X-rays) produced in a machine tumours are showing signs of and directed at the tumour from outside progressing, or those with a the person. preference for intervention are Brachytherapy is a type of considered for radical radiotherapy in which the radiation is treatment. given using either permanently implanted radioactive seeds (low dose rate) or temporarily inserted radioactive Treatment sources (high dose rate) directly into the prostate. Hormone therapy, chemotherapy, and bisphosphonates. Hormonal treatments: Androgen deprivation — a treatment that lowers testosterone levels, such as surgery or treatment with luteinizing hormone-releasing hormone (LHRH) agonists (such as goserelin, leuprorelin, triptorelin), or antagonists (such as degarelix). Chemotherapy is an option for men with hormone-relapsed metastatic disease. For example: Docetaxel in combination with prednisolone is licensed for hormone-resistant metastatic prostate cancer. Bisphosphonates are calcium-regulated drugs which inhibit bone resorption, used in the treatment of hypercalcemia, osteoporosis, and bone pain. Bisphosphonates should be offered to people who are having androgen deprivation therapy and have osteoporosis.  Review and manage: Any complications such as pain, lower urinary tract symptoms, and symptoms of spinal cord compression. Adverse effects from treatment, including sexual dysfunction and urinary incontinence. Adverse effects of androgen withdrawal include change in body shape and weight gain, tiredness, hot flushes, loss of libido. Impact on quality of life. Refer men with evidence of significant disease progression (rapidly rising PSA level or bone pain) to a urological cancer specialist. Follow Up Erectile Dysfunction  Erectile dysfunction is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance [Hackett, 2018] [EAU, 2022] What is Erectile Dysfunction?  In some men, certain medicines can cause erectile dysfunction, including: Diuretics – these increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease Antihypertensives Fibrates Antipsychotics Antidepressants Corticosteroids H2-antagonists Anticonvulsants Causes of E.D  Risk Factors ❑ Peyronie's disease (distortion or curvature of the penis) ❑ Priapism (inflammation of the penis) ❑ Depression ❑ Alcohol use ❑ Lack of sexual knowledge ❑ Poor sexual techniques ❑ Inadequate interpersonal relationships ❑ Smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension  Lifestyle changes Erectile dysfunction can often be improved by making changes to your lifestyle: ❑Losing weight ❑Reducing smoking ❑Reducing alcohol intake ❑Not taking illegal drugs ❑Regular exercise ❑Reducing stress Phosphodiesterase-5 Sildenafil – sold/prescribed under (PDE-5) inhibitors the brand name Viagra Tadalafil – sold/prescribed under Phosphodiesterase-5 the brand name Cialis (PDE-5) inhibitors are Vardenafil – prescribed under the one of the most widely brand name Levitra used and effective types Avanafil – prescribed under the of medication for brand name Spedra treating erectile Sildenafil, vardenafil and avanafil dysfunction. They work work for about eight hours and they by temporarily are designed to work ‘on demand’. increasing the blood Tadalafil lasts for up to 36 hours and flow to your penis. is more suitable if you require treatment for a longer period of time Medication  Side effects Headaches and migraines Flushing Indigestion Nausea Vomiting Back pain Vision disturbances Muscle pain Drug Action and S/E  ❑ Unstable angina or angina occurring during sexual intercourse. ❑ Regular or intermittent use of nitrates in any form — risk of severe, life- threatening hypotension ❑ Hypotension (systolic blood pressure below 90 mmHg). ❑ Recent history of myocardial infarction ❑ Recent history of stroke ❑ Heart failure ❑ Uncontrolled arrhythmias ❑ Uncontrolled hypertension ❑ Severe hepatic impairment ❑ Renal impairment Contraindications Benign Prostate Hyperplasia Stromal and epithelial cells increase in number, causing the prostate to get bigger. Large discrete nodules compresses the urethra. Symptoms include hesitancy during urination, interrupted or decreased urine stream, nocturia, incomplete voiding and urinary retention.  Men with the following factors are more likely to develop benign prostatic hyperplasia: ❑ 40 years and older ❑ Family history of benign prostatic hyperplasia ❑ Medical conditions such as obesity, heart and circulatory disease, and type 2 DM ❑ Lack of physical exercise ❑ Erectile Dysfunction Risk Factors  Lifestyle Changes ❑ Reducing intake of liquids, particularly before going out in public or before periods of sleep ❑ Avoiding or reducing intake of caffeinated beverages and alcohol ❑ Avoiding or monitoring the use of medications such as decongestants, antihistamines, antidepressants, and diuretics ❑ Exercising pelvic floor muscles ❑ Preventing or treating constipation Treatment Options Alpha blockers: Doxazosin, Tamsulosin, Alfuzosin Phosphodiesterase-5 inhibitors: Tadalafil, Sildenafil, Vardenafil 5-alpha reductase inhibitors: Finasteride, Dutasteride. These medications can prevent progression of prostate growth or shrink the prostate in some men. Combination medications. Several studies have shown that combining two classes of medications, instead of using just one, can more effectively improve symptoms, urinary flow, and quality of life. A combination of alpha blockers and antimuscarinics for patients with overactive bladder symptoms may be useful. Overactive bladder is a condition in which the bladder muscles contract uncontrollably and cause urinary frequency, urinary urgency, and urinary incontinence. Antimuscarinics are a class of medications that relax the bladder muscles. Medications Phosphodiesterase-5 inhibitors: ❑ Hives, rash, itching ❑ Shortness of breath ❑ Rapid, irregular heartbeat ❑ Painful erection of the penis that lasts for hours ❑ Swelling of the eyes, face, tongue, lips, throat, arms, hands, feet, ankles, or lower legs ❑ Chest pain ❑ Dizziness or fainting when standing up suddenly ❑ Sudden decrease or loss of vision Alpha blockers: ❑ Dizziness or fainting when standing up suddenly ❑ Decreased sexual drive ❑ Problems with ejaculation Side effects Male Pattern Baldness  In susceptible hair follicles, dihydrotestosterone (a testosterone metabolite) binds to the androgen receptors and activates the genes responsible for the shortening of the hair growth phase and the gradual transformation of large terminal hair follicles to miniaturized follicles. With each successive hair growth cycle, the hair follicles become smaller, and shorter, finer, which replace thicker, pigmented terminal hairs. What is MPB?  The diagnosis of male pattern hair loss is supported by careful history taking and physical examination. The age of onset of ❑ Rapid onset of hair loss hair loss is usually ❑ Temporal hair thinning between 20–25 years, ❑ Inflammation, papules or pustules, and the prevalence and scaling, or scarring of the scalp severity of the disease ❑ Absent or reduced eyebrows or increase with age. eyelashes ❑ Systemic disease, such as a recent severe infection, iron deficiency, or hypothyroidism ❑ Exposure to medication ❑ Change in dietary habits Diagnosis Male hormones are ❑ It's normal to lose hair. We can lose involved in causing these between 50 and 100 hairs a day, changes: often without noticing. ❑ Some types of hair loss are permanent, like male pattern Cells in the skin of the baldness. This type of hair loss scalp convert testosterone usually runs in the family. into another hormone called dihydrotestosterone. Other types of hair loss may be temporary. They can be caused by: ❑ Illness Affected hair follicles ❑ Stress become more sensitive to dihydrotestosterone, ❑ Cancer treatment which causes the hair ❑ Weight loss follicles to shrink. ❑ Iron deficiency Causes Other possible treatments for hair loss Treatment Description Steroid injection Injections given into bald patches Steroid creams Cream applied to bald patches Immunotherapy Chemical applied to bald patches Light treatment Shining ultraviolet light on bald patches Tattooing Tattoo used to look like short hair and eyebrows Hair transplant Hair is removed from the back of the head and moved to thinning patches Scalp reduction surgery Sections of scalp with hair are stretched and stitched together Artificial hair transplant Surgery to implant artificial hairs Treatment Prostate Cancer UK | Prostate Cancer UK Prostate cancer | Health topics A to Z | CKS | NICE PSA Testing for Prostate Cancer | ZERO Prostate Cancer (zerocancer.org) Prostate cancer - NHS (www.nhs.uk) Prostate Enlargement (Benign Prostatic Hyperplasia) - NIDDK (nih.gov) Erectile dysfunction | Health topics A to Z | CKS | NICE Erectile dysfunction - Illnesses & conditions | NHS inform Erectile Dysfunction | Johns Hopkins Medicine Erectile dysfunction | Treatment summaries | BNF | NICE Prostate Enlargement (Benign Prostatic Hyperplasia) - NIDDK (nih.gov) Benign Prostatic Hyperplasia (BPH) | Johns Hopkins Medicine 2 The condition, current treatments and procedure | Transurethral water-jet ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia | Guidance | NICE Benign prostatic hyperplasia - Symptoms, diagnosis and treatment | BMJ Best Practice Male Pattern Baldness: Causes and Treatment | Patient Finasteride | Prescribing information | Male pattern hair loss (male androgenetic alopecia) | CKS | NICE References