Male Health: Your Car Gets Regular Tune Ups, Shouldn't You?

Senior adult on the beach with a restored 1967 convertible GTO

Most men are very good providers when it comes to support of family and work. Unfortunately, men fall short when providing for themselves, at least with respect to their own health.

Data from the U.S. Center for Health Statistics demonstrate a persistence of higher male to female mortality, even controlling for populations considered to have lower death rates. In addition to mortality, the higher rate of incidence of disease (morbidity) for men further contributes to the significant economic impact of male health disparity. For example, male morbidity and mortality data demonstrate loss of wage earnings and family support, as well as the increase in dollars spent in the health care system.

Disease prevention is the primary goal

For many disease states in both men and women, the mortality and morbidity could be avoided or greatly decreased if individuals merely received regular preventive care. Disease prevention is, of course, a primary goal in healthcare, closely followed by prevention of disease progression.

Co-author Dr. Daniel Lin explains that there is still a place for the PSA test.

For men to benefit from disease prevention strategies, they must first be accountable for participating in their own health maintenance. A recent pilot study from the University of Washington Departments of Anthropology and Demography—Health Initiatives for Men by Dr. Kathleen O'Connor, Ph.D.—demonstrated multiple roadblocks preventing men from entering into the health care system. Some of these roadblocks were gender-based behavior issues, while others were secondary to obstacles within the health care delivery system itself. Thus, for men to receive appropriate and timely health care, we must adopt strategies for changing male behavior not only through early awareness and adaptation, but also by improving male access to the healthcare system itself.

Male health awareness in the U.S. lags behind other countries. Examples in support of the international efforts in male health include the Vienna Declaration on the Health of Men and Boys in Europe signed in 2005 and the National Men's Health Policy in Ireland 2009. The  Men's Health Initiative of BC, Canada 2009 enacted a mandate to provide a province-wide program through multidisciplinary efforts to enhance male health promotion, education and advocacy, disease risk assessment, disease reduction and prevention. In 2010, Australia developed the National Male Health Policy with similar goals.

Here at home in Washington State, men's health was first promoted through the efforts of the Washington State Urology Society with public seminars in 1995 focused specifically on education and awareness of key male health issues. The seminar content was then developed into portable content, both printed and online versions, as the Guide to Men's Health. This effort to promote male health then led to collaboration with Senior Softball USA (in a program titled "Safe at Home") in the development of legislation that protects men's rights to have prostate cancer testing covered by insurance.

Nationally, the Men's Health Network, incorporated in 1992, led President Clinton to sign Senate Joint Resolution 179 declaring National Men's Health Week, the week preceding Father's Day. This week has now been expanded to include the entire month of June. Advocacy efforts will need to continue and broaden with respect to diversity within subpopulations of men, access to care issues, health policy campaigns on a national, state and local level, education and research.

Comprehensive approach needed for men's health care

Of equal importance is the recognition by the medical community that men require a more comprehensive approach to their care. Within the specialty of Urology, conditions that once received directed therapies are now receiving attention to integration with other health matters. The bi-directionality of many disease states continues to reveal the necessity of integrated health measures.

One significant example is the relationship of sexual health issues to cardiovascular disease (coronary artery disease, peripheral vascular disease, hypertension), diabetes, metabolic syndrome (i.e., pre-diabetes), obesity, smoking, mental health, and androgen (male hormone) deficiency. Another relationship exists between renal tone formation and diabetes, metabolic syndrome (defined as 3 of the following 5 components hypertension, BP =/> 130/85, fasting glucose =/> 100mg/dL,male waist circumference 40 inches or >, Low HDL cholesterol men under 40 mg/dL, triglycerides = to or higher than 150 mg/dL),  and coronary artery disease.

It is fortunate that diet, regular exercise, and smoking cessation, in addition to appropriate medications if indicated, can lead to significantly improved health and better quality of life outcomes with regard to many of these problems.

The AUA Men's Health Checklist smartphone app is a free resource for health care providers and their patients.

The American Urological Association recently produced a Men's Health Checklist App for smart phones to help coordinate care between primary care and specialty access across the decades of a man's life. It can be found at no cost under AUA Men's Health Checklist in the app section of most smart phones.

What you need to know about early detection of prostate cancer

Recently, men have heard confusing and often contradictory information regarding the early detection of prostate cancer with the Prostate-Specific Antigen (PSA) blood test. Men are hearing that they do not need PSA testing, which is not the intended message. The source of much of this controversy lies in the concept of screening and guidelines from the U.S. Preventive Services Task Force (USPSTF), guidance statements from the American College of Physicians and most recently from the American Urological Association. None of these publications suggest that PSA testing is not useful.

The American Association of Clinical Urologists recently released a statement to help in clarifying the issues of early detection of prostate cancer (What you need to know to have an informed discussion regarding The Early Detection of Prostate Cancer:  Information for Patients and Medical Healthcare Providers), which concluded as follows:

"The AACU encourages men to continue to be active in achieving good health through appropriate prevention and intervention strategies. We believe that the early detection of prostate cancer with PSA testing continues to offer value with benefits and lives saved. Make certain you have a discussion regarding the early detection of prostate cancer, and continue to be proactive in your own healthcare."

Your car gets regular tune ups, shouldn't you?

By Richard S. Pelman, M.D. and Daniel Lin, M.D. Dr. Pelman is a clinical professor of urology at the University of Washington and chair of men's health for the Washington State Urology Society. Dr. Lin is a professor of urology at the University of Washington and president of the Washington State Urology Society. For information about prostate cancer, prostate cancer screening or men’s health, contact the Washington State Urology Society.