Men's Health: What You Should Know About Common Issues

June is Men's Health Month and we are cutting through the noise to bring you essential insights, straight from Brian Sninsky, MD, a board certified-urologist from Cone Health Urology. Dr. Sninsky sheds light on common men's health issues, emphasizing the profound impact of diet and lifestyle.

"Everybody wants a magic pill or a magic lab test to fix things," Dr. Sninsky notes, "but what you eat every day, the activity, and kind of your basic lifestyle stuff probably has a much bigger impact on your overall health and really all these topics."

What is a PSA Screening?

Prostate cancer is remarkably common, affecting about one in eight men. However, it's crucial to remember that men are ten times more likely to die from cardiovascular disease. Early detection is key, as prostate cancer is highly curable in its early stages.

The PSA screening is a blood test.It's not perfect; a high PSA doesn't automatically mean cancer. Factors like an enlarged prostate, inflammation, or even recent ejaculation can elevate it.

• Normal PSA for men under 70 is typically less than 4.
• Always repeat the test if the initial result is high.

When Should I be Screened?

• High-risk individuals: African-American men or those with a family history of prostate, breast, or ovarian cancer should consider screening around age 40.
• General population: Screening typically starts around age 45 or 50.
• Frequency: Guidelines suggest checking PSA every two to four years due to the slow growth of most prostate cancers, though many primary doctors still check annually or every other year.
• When to Stop: Generally, around age 70, as prostate cancer in older age is often slow-growing and unlikely to cause symptoms.

What if My PSA is High?

• Your urologist will likely repeat the blood test.
• If still high, options include a prostate biopsy (a quick in-clinic procedure) or a prostate MRI. A normal MRI might allow you to skip a biopsy.
• If cancer is found, it's categorized as low, intermediate, or high-risk. Low-risk cancers can often be actively watched (active surveillance) with regular PSA checks and occasional repeat biopsies, avoiding unnecessary treatment side effects like urinary leakage or erectile dysfunction.
• Treatment for Intermediate/High-Risk: Options include robotic surgery (Da Vinci robotic prostatectomy) or radiation (external beam or brachytherapy "seeds"). The best approach depends on individual factors and is decided collaboratively with your doctor.
• Metastatic Cancer: If cancer has spread, it's managed by a medical oncologist with chemotherapy, hormone blockers, immunotherapy, or radiation, not surgery.

What is BPH?

An enlarged prostate (BPH) is a common cause of urinary symptoms in men, but it's not the only culprit! Dr. Sninsky highlighted other contributing factors:

• Overactive Bladder (OAB): Leads to urgency and frequency.
• Dietary Choices: Diet drinks, artificial sweeteners, sodas, tea, coffee, and caffeine can irritate the bladder.
• Sleep Apnea: A common cause of nocturia (waking up at night to pee). If you get up frequently at night but are fine during the day, get tested for sleep apnea!
• Diabetes: Can increase urination frequency and damage the bladder long-term.
• Leg Swelling: Can lead to increased overnight urination.
• Obesity: Extra weight pushing on the bladder can worsen symptoms.

How Can I Prevent BPH?

• Cut back on irritating drinks.
• Reduce fluid intake 3-4 hours before bed.
• Empty your bladder right before sleep.
• Consider weight loss.

Treatment for BPH includes:

• Medications: Common options include Flomax (relaxes the prostate) and finasteride (shrinks the prostate), though they can have side effects.
• Surgical Options: Numerous procedures can open up the prostate to improve urination if medications aren't effective or preferred. A cystoscopy (looking into the bladder) often helps determine the best approach.

What About Kidney Stones?

Kidney stones are painful crystals that form in the urine.

• Most Common Cause: Dehydration.
• Symptoms: Sharp back or groin pain if a stone gets stuck.
• Treatment: Small stones (under 5mm) often pass on their own. Larger stones may require shockwave lithotripsy (sound waves to break them up) or ureteroscopy with laser (a common outpatient procedure to break up and remove stones).

Kidney stones can be prevented through:

• Hydration: Drink plenty of fluids (avoid dark sodas).
• Citrate: Add lemon juice or drink crystal-light lemonade (citrate helps prevent stones).
• Low-Salt Diet: Calcium follows salt into the urine, forming stones. Be mindful of processed foods.
• Limit Oxalate-Rich Foods: If you're a frequent stone former, reduce intake of spinach, almonds, rhubarb, and beets, which are high in oxalate.

What Causes Erectile Dysfunction (ED)?

Testosterone levels naturally decline with age, causing symptoms like fatigue, weight gain, decreased sex drive, and ED. Testosterone Treatment requires two blood tests showing levels below 300. 

Caution: Testosterone treatment can lead to dependence as your body stops making its own, and it causes infertility. Younger men or those wishing to have children should prioritize natural approaches.

How Can I Boost My Testosterone?

• Healthy Diet: More plant-based, less red meat and dairy.
• Exercise: Especially weightlifting and heavy weight training.
• Adequate Sleep: Prioritize good sleep hygiene.
• Quit Smoking & Reduce Alcohol: Both negatively impact hormone levels and blood vessel health.
• Stress Reduction: Chronic stress can lower testosterone.
• Vitamin D: Correcting low Vitamin D levels can help.
• Erections & Vascular Health: Over 50% of ED cases are due to vascular disease. A healthy diet, regular exercise, and avoiding smoking are crucial for blood vessel health.
• Medications for ED: Cialis and Viagra are generic and generally safe (unless taking nitrates for chest pain). Avoid unregulated over-the-counter supplements and "testosterone boosters," as they can contain hidden prescription drugs and have dangerous side effects.

Dr. Sninsky reiterated his core message: "What you eat every day and the activity and kind of your basic lifestyle stuff probably has a much bigger impact on your overall health."

• Heart Health = Prostate Health: Anything good for your heart (and preventing heart attacks/strokes) is good for your prostate.
• Plant-Based Focus: Less red meat, less dairy, less processed foods. Even small changes (e.g., reducing meat/dairy to once or twice a week) can have a significant impact.
• Exercise: Aim for 7,500-10,000 steps daily. Incorporate weight training 2-3 times a week.
• Quit Smoking & Reduce Alcohol: These significantly reduce the risk of various cancers and cardiovascular disease.

Resources:

• ForksOverKnives.com: A great resource for plant-based diets.
• Documentaries: "The Game Changers" or "Forks Over Knives" (available on streaming platforms) offer compelling insights.

Dr. Sninsky emphasizes that long-term health comes from consistent habits, not quick fixes. By embracing a healthier lifestyle, you can feel better, reduce your risk of common men's health issues, and improve your overall quality of life.