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Men's Health



Hypogonadism (low testosterone)
Male hypogonadism is a condition in which the testes do not produce enough testosterone, a hormone that plays an important role in sperm production and in male sexual development. Sometimes males are born with the condition, but it can also develop in adulthood as a result of other medical problems. Often hypogonadism can be treated with testosterone replacement therapy.

If hypogonadism occurs during fetal development, a male will have ambiguous or undeveloped male genitals. If it occurs during puberty or in adulthood, it may alter male physical characteristics and can impair normal erectile function and sperm production, decreasing a man’s fertility. The condition can cause other physical problems, such as a decrease in muscle and bone mass, and may sometimes affect cognitive and emotional functioning.

Certain genetic conditions put males at risk for hypogonadism, including Klinefelter syndrome and Kallmann syndrome. The condition can result from illnesses such as HIV/AIDS, tumors, and some cancer treatments. A drop in testosterone is also a normal part of the aging process, and in such cases, does not necessarily require treatment.

Hypogonadism is diagnosed on the basis of symptoms and on blood tests that measure testosterone. If your testosterone level is low, your doctor will order additional tests to make sure you do not have an underlying condition such as a pituitary abnormality that requires treatment.

Adult men with hypogonadism may be treated with testosterone replacement therapy to improve sexual function and restore muscle and bone strength. Testosterone can be delivered in several ways, including through injection, patch and gel. If a pituitary problem is the underlying cause of hypogonadism, surgery or replacement pituitary hormones may be indicated. Testosterone therapy may also be used in boys with underlying genetic conditions to encourage normal pubertal growth.

Testosterone therapy is NOT a treatment for infertility. In fact, treatment with testosterone is very likely to make fertility worse. However, several other treatments are possible for men who have both low testosterone and infertility.
The prostate gland is part of the male reproductive system and is located below the bladder, in front of the rectum and surrounds the urethra (structure that carries urine from the bladder out through the penis). Normal prostate glands are about the size and shape of a walnut and weigh about an ounce. The main function of the prostate gland is to produce ejaculatory fluid. The prostate gland often enlarges with age, referred to as benign prostatic hyperplasia or BPH. This condition can cause symptoms such as difficulty emptying bladder, need to urinate frequently, straining, post urination dribbling or weak stream. These symptoms are referred to as lower urinary tract symptoms (LUTS) and occur because the gland is enlarged and blocking the flow of urine.

BPH is a common condition, estimated to affect 50% of men in their 50s and up to 90% of men over age 80. In addition to increasing age, other risk factors include family history of BPH. BPH is not prostate cancer, although the conditions can exist together. Men should be evaluated by a clinician if experiencing BPH symptoms, as this is a progressive disease and can result in bladder damage, infection or kidney damage. BPH symptoms can be treated with oral medications used to decrease the size of the prostate (5-alpha-reducatase inhibitors) or to relax the muscles of the prostate and bladder neck (alpha blockers). Procedures such as transurethral resection of the prostate (TURP), microwave ablation, needle ablation or laser surgery may need to be performed.
Hematuria (blood in urine)
Hematuria refers to the presence of blood in the urine. If the blood is visible (appearing pink, red or cola-colored) it is called gross hematuria. Blood that can be detected only when urine is examined under a microscope, is called microhematuria. Most men with hematuria do not have symptoms. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate, or urethra. It increases in frequency with . It.. It age and lifestyle factors such as smoking.

Hematuria has many causes, including vigorous exercise, sexual activity, viral illness, trauma/injury, or infection such as a urinary tract infection (UTI). More serious causes include kidney or bladder stones, cancer in the urinary tract, and medical conditions such as blood disorders, inflammatory conditions, polycystic kidney disease, or sickle cell disease.

Overall, the chance of cancer among people with hematuria is only 3-4%, but is higher in in those men with risk factors, such as smoking, older age, history of pelvic radiation, and exposure to certain medications and chemicals. Hematuria can also occur after recent urologic procedures or if you are taking anticoagulant medications (blood-thinners such as aspirin).

When microscopic hematuria is identified, the next step is to diagnose the cause. Your physician will take a complete medical history and retest your urine at 48-hour intervals. If two of three urine samples reveal blood, it is important to conduct further tests to make sure that the microhematuria is not related to a serious underlying condition, such as cancer. Likewise, all cases of gross hematuria merit further testing. Hematuria evaluation may include use of cystoscopy—looking inside the bladder with a thin, flexible telescope—to visualize the bladder, and imaging with CT or MRI to visualize the kidneys and ureters. Urine tests include cytology to look for cancer cells in urine and urine culture to rule out infection.
There are different types of incontinence. It is very important to try to sort out which type is playing the greatest role in causing the incontinence because the treatment can be quite different.

Incontinence refers to loss of urine during coughing, laughing, sneezing or other movements that increase abdominal pressure and put pressure on the bladder. Damage to the structures that support the bladder and urethra, such as during childbirth, can result in stress UI. Urge incontinence refers to sudden feeling or urge to urinate with subsequent loss of urine, “can’t make it in time”. This type of incontinence is often caused by inappropriate bladder contractions (spasms). is much less common and occurs when the bladder doesn’t empty properly, causing urine to spill over. This can occur with weak bladder muscles, nerve damage from diabetes or blocked urethra.

Evaluation of UI may involve urinalysis, bladder stress test (cough vigorously and doctor watches for urine loss), ultrasound, cystoscopy or urodynamic studies. Treatment will depend on the underlying cause and type of incontinence. Treatments include bladder training, kegel exercises, medications, neurostimulation, injection of Botox into the bladder, injection of bulking agents into the urethra, surgical placement of urethral sling or surgical repair of pelvic prolapse.

Prostate Cancer
The prostate is a walnut-sized organ that is part of the male reproductive system. It is located below the bladder and in front of the rectum. It surrounds part of the urethra, the tube that carries urine from the bladder to outside the body. The gland’s main function is to produce fluid for semen, which nourishes and transports sperm cells.

Image of male anatomy including prostate
When prostate cells grow abnormally and form a mass, it is called a tumor. Some tumors are benign (not likely to be life-threatening) and others are malignant (cancerous and potentially life-threatening). Over the course of a man’s lifetime, some prostate cells may become cancerous. Sometimes, the cancer can be very small, localized, and confined within the prostate. In other cases, the cancer is present in more than one site of the prostate, often involving both sides of the gland. Through a process called metastasis, some cancer cells can spread outside the prostate to nearby regional lymph nodes or organs in the pelvic area. They eventually can spread to more distant parts of the body through the blood and lymph systems–most often to the bones. Determining whether the cancer is confined to the prostate or whether it has spread either locally or to more distant sites is often done by cross-sectional imaging and is very important in selecting treatment.

Most prostate cancers in the United States are identified through prostate-specific antigen (PSA) screening or digital rectal examination (DRE). Prostate-specific antigen is a protein in the blood produced by prostate cells. It is widely used as a screening test for prostate cancer. Your PSA level can be measured with a simple blood test. The higher the PSA level, the more likely that prostate cancer is present. In a DRE, a doctor inserts a gloved, lubricated finger into a man’s rectum to feel for any irregular or abnormally firm area in the prostate. While most prostate cancers are indicated by PSA results, some cancers produce little PSA but can be detected by DRE.

An elevated PSA may suggest an increased risk of prostate cancer; however, elevations of PSA can also occur in benign conditions. The decision to proceed to biopsy of the prostate is based on a combination of factors, such as PSA, DRE, family history, age, race and other comorbidities and should be done only after discussing the risks and benefits with a physician.

Deciding how to treat prostate cancer can be a confusing process. Each treatment has its own mix of benefits, risks and impacts on quality of life. The good news is that several treatments are very successful for many prostate cancer patients, either in providing a cure or keeping the cancer under control for many years. However, your physician cannot always tell you specifically which treatment to choose, because for most men, the choice is significantly influenced by personal preferences. We encourage you to visit our Health for Life web portal for fuller information.

In addition to the tumor risk factors described above, treatment choice is influenced by factors such as:

• Your age and life expectancy

• Your general health and specific medical conditions

• Cost and practical considerations

• Attitudes about cure and/or living with cancer

• Your needs, concerns, values and social relationships

• Your feelings about specific side effects

As appropriate, you and your physicians may choose a combination of treatments.

Below are brief examples of treatment options for localized prostate cancer:
Active Surveillance
As previously discussed, many prostate cancers do not pose an immediate risk to health and may not require treatment. Active surveillance is a way to monitor low risk prostate cancer (cancer that is not an immediate risk to your health or well-being) with a plan of timely intervention should the tumor progress.

Radical Prostatectomy

A radical prostatectomy is surgery to remove the entire prostate gland and seminal vesicles after a diagnosis of prostate cancer is made. Sometimes, this also entails removal of the regional lymph nodes, depending on a number of factors.

Radiation Therapy
Radiation therapy is done with the intent of curing the disease by killing cancer cells.. Radiation can be given as external beam radiation therapy (EBRT) and/or as brachytherapy (temporary or permanent radiation seed implants). This treatment is sometimes coupled with hormone therapy because most prostate cancers are driven by testosterone. Hormone therapy attempts to establish very low levels of testosterone in an effort to control the cancer progression.

Brachytherapy (Seed Implants)
With brachytherapy, radiation is given from inside the body, with radioactive seeds placed permanently in the prostate or with narrow, seed-filled tubes that are placed temporarily for one or two days.

This procedure, used to treat localized prostate cancer, kills the cancer cells in the prostate by freezing them.

What If Initial Treatment Is Not Sufficient or Your Cancer Recurs?

While the diagnosis and treatment of prostate cancer has improved significantly in recent years, the cancer can still recur. Not surprisingly, clinical studies show the likelihood is higher the more advanced the disease was at initial diagnosis, and the more time that passes since diagnosis and treatment. While differences emerge between different types of treatment, many other factors also come into play such as the original staging, Gleason score, extent of the cancer, and age of the patient. Various statistical tools called nomograms help assess this risk.

There are usually a number of treatment options that men in such situations can consider to successfully treat or control the cancer. Choosing among them will require a new decision-making process. It is still essential that you and your physician continue to monitor your PSA on a quarterly basis for some period of time, no matter how successful your treatment has seemed to be.
Kidney Cancer
The kidneys are paired bean-like organs located in the back of the abdominal cavity in the retroperitoneum. The kidneys play a large role in the regulation of wastes, electrolytes, water, blood pressure and acid-base balance throughout the body. Although it is normal to have two kidneys, it is quite possible to live with just one.

The most common type of kidney cancer is called renal cell carcinoma (RCC). Risk factors include smoking, regular use of non-steroidal anti-inflammatories such as ibuprofen and naproxen, a family history of kidney cancer, and renal disease requiring dialysis.

Most commonly, kidney cancer is detected incidentally on imaging for some other purpose and has no signs or symptoms. In cases where the cancer has formed a larger tumor, a patient may experience flank pain, a mass in the abdomen, or blood in the urine that is either visable or apparent on a dipstick test. Other tests to help stage the extent of kidney cancer may include a CT scan of the abdomen and pelvis to help characterize the size of the tumor and parts of the kidney that are involved as well as to exclude any metastatic disease in the abdomen or pelvis. Additional tests may include a chest xray or chest CT scan to rule out any spread of cancer to the lungs. A bone scan to exclude spread to the bones may be done if there is a high suspicion that these structures may be involved. A biopsy may also be performed in certain cases to confirm a diagnosis of kidney cancer.

Kidney cancer is most often treated with surgery. This can involve removal of the entire kidney or removal of the mass and part of the kidney, to spare as much normal tissue as possible. Treatment can also involve heating the tumor with radiofrequency ablation or freezing the tumor with cryoablation. If the tumor mass is small of if the patient has significant comorbidities, the mass can be monitored with active surveillance. This involves periodically imaging the mass to see if it has grown and intervening if any progression is detected. Finally, there are medications that may help to shrink mass size and tumor burden, but these have side effects, so are reserved for more advanced or metastatic disease.