BYLINE: Michael Stifelman, MD, chair of Urology at Hackensack University Medical Center

Newswise — The recent MENtion It poll, a project of the Cleveland Clinic, revealed some startling statistics about men’s attitudes toward their own health:

  • 72% of men surveyed say they would rather do household chores -- including cleaning toilets -- than visit their doctor
  • 65% say they try to avoid going to the doctor at all possible costs
  • 37% have withheld information from their physicians

Why are so many men so reluctant to visit and be honest with their doctors? A major factor is fear: even when they suspect they may have a disease, many men are afraid to be diagnosed because the disease might be serious. Another hindrance is the so-called Superman Complex: many men pride themselves on taking care of everything – their spouses, families, finances, and home upkeep – and they feel that going to the doctor means giving up their “Superman of the House” persona.

There is also a societal component to men’s attitudes towards their health. Generally speaking, women tend to be more open when discussing sensitive topics such as their fears about the symptoms they’re experiencing.

As a doctor, I want to assure everybody that we’re not in the business of giving bad news; we’re in the business of helping people, of prolonging and improving their lives. There are severe consequences to men’s reluctance to engage in their own health; such behavior can unnecessarily delay diagnosis and life-saving treatment. The sooner we know a patient has a disease, the more quickly we can intervene and possibly change its course. 

Improving outcomes in prostate cancer

Prostate cancer is one of the leading causes of cancer death among men of all races. Ten years ago, prostate cancer screening consisted solely of a digital rectal exam and prostate-specific antigen (PSA) testing, and if either method revealed anything abnormal, we’d go straight to biopsy. Today, urologists can obtain a clearer, more detailed view of the prostate via advanced imaging technologies such as multiparametric magnetic resonance imaging (mpMRI) and fusion-guided ultrasound. When combined with more sophisticated blood tests including 4K scoring and the prostate health index (PHI), these technologies can yield a deeper understanding of PSA levels and other disease markers, thereby reducing the need for biopsy.

Better risk assessment helps tremendously in terms of avoiding over-treatment and facilitating precision medicine, which not only results in better cancer control, but also minimizes disruptions to patients’ lives. Rather than radiating the entire prostate, as we used to do 10-15 years ago, we can now employ more sophisticated imaging technologies to minimize collateral damage. We can employ in select patients advanced techniques such as focal ablation, high-intensity focused ultrasound (HIFU), and cryosurgery to more precisely target the diseased area and minimize collateral damage to surrounding tissue and remaining prostate.

When surgery is deemed appropriate we have far less invasive techniques which are easier to recover from.  Surgeons no longer need to make a seven-to-eight-inch incision and use headlamps and long instruments; nor do they need to go through the abdomen to reach the prostate;. Today’s software-guided, single-port surgical techniques require only a one-inch incision through the patient’s navel, sparing the structures that control urinary continence and erectile function, while lowering the risks of infection and other complications. With surgical trauma thus minimized, many patients can go home the same day. In short, it’s not your father’s operation anymore. When prostate cancer is more advanced and has metastasized (spread) to other tissues, advanced technologies such as prostate-specific membrane antigen (PSMA) testing can help locate metastases, even in cases of recurrent prostate cancer. Additionally, it may soon be possible to attach a radioisotope to a PSMA test to deliver treatment directly to the targeted cells while sparing surrounding tissue and limiting potentially debilitating side effects.

Genetics: The next frontier in precision medicine 

To a great extent, recent medical advances are designed to personalize care based on the patient’s genetic makeup. New technologies such as next-generation sequencing (NGS) are helping to advance personalized medicine by identifying who is at risk of certain cancers and other diseases as well as the best way to treat them. Such advances are being driven by enhanced understanding of hereditary mutations, which are changes in the genetic sequence that are passed from parent to child, as well as of somatic mutations, which are alterations in DNA that occur after conception. With NGS, along with blood tests that illuminate the genetic signatures of cancer cells, we can screen patients for both types of mutations, a capability that can help us assess patients’ individual risk more accurately and intervene more quickly with treatments that specifically target the identified mutations.

Harnessing the power of multiple disciplines

Improving men’s health is truly a multidisciplinary pursuit. In addition to urology, the fields of oncology, hematology, radiology, robotics, and nuclear medicine are just a few of the medical specialties that are driving advances in men’s health, aided by the related disciplines of nursing and social work. Their contributions are expanding the knowledge base surrounding new diagnostic technologies and therapeutic approaches, and informing the appropriate use of these innovations.

Hopefully, with that knowledge and the support of their spouses and loved ones, men will be motivated to see their doctors sooner than later, when medical intervention has the greatest chance of producing positive outcomes. And if the doctor’s office still feels like a scary place, men can take advantage of pop-up health screenings at local parks, civic centers, ballparks, bars, and social clubs. By bringing the benefits of health consciousness to wherever men happen to be, such initiatives show men that taking taking charge of their health is easier than they may think.