MENS’ HEALTHRPSM January 7, 2005

Peter Meacher MD

MENS’ HEALTH ?

MENS’ HEALTH

Prostate cancerProstate cancer screeningscreening Testicular cancerTesticular cancer Erectile dysfunctionErectile dysfunction

prostatitis, BPHprostatitis, BPH

HIV counseling and testingHIV counseling and testingSTDsSTDsLipidsLipidsSmokingSmoking

OBJECTIVES

At the end of the session participants will be:

1. Able to discuss the pros/cons of prostate cancer screening with patients

2. Able to evaluate and treat erectile dysfunction

3. Understand the recommendations for/against testicular cancer screening

Roberto

28 year old man asking for urine drug screen required for his job as security officer

History of mild intermittent asthma

Asks about “getting prostate cancer check”

Father diagnosed prostate cancer aged 60

PROSTATE CANCER

USPSTFInsufficient evidence to recommend for or

against routine screening for prostate cancer using PSA or DRE

DRE – unclear sensitivityPSA – sensitive, non-specific, no survival

benefit demonstrated

BACTERIAL PROSTATITS

E Coli, Klebsiella, Chlamydia, Ureaplasma

BactrimCipro

4 weeks

BPHINCIDENCE = 10-30% of men in 70s

Acute urinary retention occurs in 1-2% of symptomatic men/year

PHARMACOLOGICAL• alpha blockers (eg terazosin)• 5 alpha reductase inhibitors (eg finasteride)• Saw palmetto

SURGICAL• Trans urethral resection

TESTICULAR CANCER

USPSTFInsufficient evidence to recommend for or

against routine screening for testicular cancer in asymptomatic men in general population by physician or patient self exam

TESTICULAR CANCER

Commonest cancer in men <35Seminoma and non-seminoma95% intra-testicular masses are malignantTumor markers – BHG, AFP, LDHMets to retro-peritoneal LN, lung, liver, brain Rx orchiectomy/pathology/staging 1-3Seminoma – radiotherapyNon-seminoma – chemotherapy95% cure rate, recurrence rare after two years

Jose

66 year old man “problem with erection”

Jose

66 year old man “problem with erection”

NIDDM 23 years

Smokes

ERECTILE DYSFUNCTION

ERECTILE DYSFUNCTION

• Psychological ~ 20%

• Physiological ~ 80%– Vascular– Neurological– Hypo-testosteronism

• Primary• Secondary

SMOKING CESSATION

SMOKING CESSATIONBRONX COMMUNITY AND RATES OF SMOKING 20 million smokers try to quit each year 70% report they want to quit Physician’s advice is an important motivator Half of current smokers report ever having been asked about their

smoking or urged to quit Same rates of nicotine addiction and desire to quit across all racial

and ethnic groups Socio-economic deprivation, depression and ‘feeling persistently

threatened by violence’ positively correlate with rates of smoking Tobacco companies most recently targeting poor communities and

LGBT communities 

SMOKING CESSATION

 SYNERGY OF INTERVENTIONS • Group sessions• One-on-one visits to provider• Phone support• Literature• Nicotine replacement• Zyban 

                       

     

 

            

Ernest

48 year old man with HTN for BP check

Ernest

48 year old man with HTN for BP check

Mother died colon cancer age 51

Sexually active with men

COLON CANCER

HEPATITIS

HIV COUNSELING/TESTING

HIV COUNSELING/TESTING

ASSESS

CONSENT

TEST

SUPPORT

LIPIDS

STDs

VACCINATIONS