Men’s Health

Why delay treatment for slow-growing prostate cancer?

DEAR DOCTOR K: I was recently diagnosed with prostate cancer. My doctor says my cancer is slow-growing and that we should just monitor it for now. Why not treat it right away?

DEAR READER: I know this will sound odd, but cancer is not always bad for your health. There are types of cancer that can cause no symptoms, that grow slowly (if at all) and that are unlikely to spread. There are types of cancer that you will never know you had. You will die with these cancers, but you won't die from them.

Does testosterone therapy really work?

DEAR DOCTOR K: I've seen a lot of commercials advertising testosterone therapy for "low T." Does it live up to its promise? Should I be on it?

DEAR READER: I've seen the commercials, too. They promise that testosterone therapy for low blood levels of testosterone, or "low T," will make you feel more alert, energetic, mentally sharp and sexually functional. Testosterone therapy is a good option for some men, but there are also risks.

Does eating fish help prevent prostate cancer?

DEAR DOCTOR K: Does eating fish help prevent prostate cancer?

DEAR READER: You've certainly heard me encourage readers to eat plenty of fish, particularly fatty fish such as salmon and mackerel. That's because many good studies have found that people who eat fish frequently have lower rates of many serious diseases, including heart disease and several types of cancer. A recently published study from the Prostate Cancer Prevention Trial (PCPT) was described in the media as coming to the opposite conclusion. I don't agree, but to explain why, I first need to talk about the substances in fish that are thought to be beneficial for humans.

What are the different options of penile implants?

DEAR DOCTOR K: Can you discuss penile implants? I haven't had success with other treatments for erectile dysfunction.

DEAR READER: Medications, injectable drugs and devices such as vacuum pumps can effectively help most men who cannot get or maintain an erection. In particular, the three different pills for erectile dysfunction (ED) are effective about 70 percent of the time. Have you talked with your doctor about increasing the dose of the medicines you have taken? And has your doctor done tests to determine the cause of your erectile dysfunction?

I’m a 52-year-old man — What causes a stinging sensation and dripping after I urinate?

DEAR DOCTOR K: I am a 52-year-old man. When I finish urinating, I drip much more then I used to. And I have a stinging sensation in my urethra. What could cause this?

DEAR READER: What you're experiencing is a very common complaint. As we age, several things happen. One is some enlargement of the prostate gland. This is called benign prostatic hyperplasia, or BPH. Your doctor can perform a digital rectal exam to assess the size and texture of your prostate gland.

Is acupuncture an effective treatment for erectile dysfunction?

DEAR DOCTOR K: Is acupuncture an effective treatment for erectile dysfunction?

DEAR READER: During an erection, arteries supplying blood widen, and veins leading blood away from the penis clamp down. As a result, more blood is inside the penis, causing it to swell and become firm. It sounds simple, but getting to an erection requires extraordinary orchestration of blood vessels, nerves, hormones and, of course, the psyche. Here is an illustration of this process:

I’m a man– Why are my breasts suddenly bigger?

DEAR DOCTOR K: I'm a man. Why are my breasts suddenly getting bigger?

DEAR READER: Everything that happens to a woman's breasts can also happen to a man's breasts, including cancer. Enlargement of a man's breast is known as gynecomastia (guy-ni-co-MAST-ia). It is usually harmless and is often reversible. It's an oversimplification, but basically a breast is filled with breast glands and fat.

Why is it complicated to test testosterone levels?

DEAR DOCTOR K: I've been having symptoms that may be caused by low testosterone. I figured it would be easy to test my testosterone levels, but my doctor says it's complicated. Why?

DEAR READER: Testosterone is one of the main male hormones. Blood levels of this hormone start to sag in early adulthood, and then creep lower. In some men, the levels become low enough to cause symptoms. The classic symptoms of low testosterone ("low T") are low sex drive, erectile dysfunction, poor muscle tone, poor concentration and memory, and low energy.

What can a doctor tell by a digital rectal exam?

DEAR DOCTOR K:I'm a healthy man in my 50s. I dread having a physical because of the digital rectal exam. What can the doctor even tell by doing this? Is it really necessary?

DEAR READER: The digital rectal exam isn't fun -- I speak as both a doctor and patient. But it is a risk-free way to check for abnormalities of the anus, rectum and prostate gland. Your rectum is the last few inches of your bowel, just above the anus. As you know, during the exam, your doctor inserts a gloved and lubricated finger into your rectum.

I was diagnosed with prostate cancer and now my doctor wants an MRI– what new information will the MRI provide?

DEAR DOCTOR K: I recently had a prostate biopsy and was diagnosed with prostate cancer. Now my doctor wants to do an MRI. Why? What new information will the MRI provide?

DEAR READER: I can understand why you're puzzled. A biopsy is the gold standard for diagnosing prostate cancer, so why do you need any other test?