Good evening and welcome to Doctors on Call.

I'm Dr.

Ray Christensen, faculty member from the department of family medicine and biobehavioral health at the University of Minnesota Medical School Duth campus and I'm a family doc from Gateway Family Health Clinic in Moose Lake.

I'm your host for our episode tonight on men's health.

The success of this program is very dependent upon you, the viewer.

So, please call in your questions or send them in to our email address, which is askpbsnorth.org.

Our panelists this evening include Dr.

Nathan Hoffman from Essentia and Dr.

Omar Sadiki from Aspirus St.

Luke's.

Our medical students answering the phones tonight are Will Stone from Melrose, Minnesota, Alex Lingren from Fergus Falls, Minnesota, and Matt Schnell, Matt Schnell from Alura, Minnesota.

And now on to tonight's program on men's health.

Dr.

Sadiki, uh, welcome.

It's been a while.

I think we did this once before sometime in the past.

I believe I'd like to know a little bit more about your practice.

I You're an internal medicine physician and yeah I do internal medicine, addiction medicine and obesity medicine at St.

Luke's.

So addictive and obesity medicine too.

Yes.

Yep.

And and uh Dr.

Hoffman um I what you would be called a general urologist at Essentia.

Apologies to the time last time I was on here I accidentally said I was from St.

Luke's.

So I remember exactly.

Um and so but I do work at Essentia.

I do work essential and I would say I have kind of a special concentration in um I mean all urologists do prostates and kidney stones but um I have kind of a special um interest in kidney cancer and then also in incontinence would be kind of my two more specialized areas.

Well, welcome both of you.

Thanks for coming.

I want to start out talking a little bit about what good general health for men.

Uh and starting with that, Dr.

Sadiki, what's the most common thing that you see in your office with men?

And a lot of times they'll they'll have questions about whether it's normal of how much they get up at night to urinate.

Uh questions about their libido and sexual health and kind of and you know weight loss and kind of trying to get in those kind of those kind of areas trying to look better and feel better.

Do you counsel them on good health and exercise and things too at that point or almost daily?

Yeah, multiple times a day and and seeing more men coming forward about mental health and those kind of things as well.

Dr.

Hoffman in your office.

Um, I would say that, you know, I I do a lot of, you know, just as he was saying, a lot of issues with urination, a lot of issues with, you know, sexual health, sexual function.

um you know and even though I'm much more specialized I in general when you get to me you've kind of already gone down the treatment pathway of medications and things like that that you could use for um for those things and I'm kind of doing more specialized things.

It's still kind of important to I always tell people that everything that is heart healthy is prostate healthy.

So the things you've been hearing about for years, you know, eating a balanced diet, exercising, keeping your weight down, all that sort of stuff will make your prostate healthy even if that's not the specific goal that you have with it.

It does seem that the pro that the prostate is kind of the focus of men's health.

Dr.

Sadiki, uh when you when you look at your practice, I'm assuming with internal medicine you're doing all ages.

When do you start seeing difficulties with prostate in men and when do you start looking seriously at it?

Typically most patients who have concerns about are over the age of 50 for the for the most part and it kind of varies as to what they think is a problem and what that they know anyone who has had prostate cancer.

The ones who know someone who has that they're the ones who are typically more um wanting to get screened and further evaluation.

How do you screen?

I typically do a PSA test to evaluate uh for for that elevated PSA levels, but that could be from enlarged prostate.

Doesn't necessarily mean that you have prostate cancer.

It could be if you have a prostatitis or some kind of infection as well.

Rectal exams too.

Not so much.

Dr.

Hoffman.

I mean, I still do rectal exams.

Um, mostly for the fact that, uh, you know, there are certain situations, especially in people above the age of 75, where you would only act on a bad rectal exam.

You don't always necessarily go as aggressively on the PSA.

Um, but the other things that we've been adding to the AR, you know, of to the investigation are things like MRIs of the prostate.

That's kind of been an advent in about the last 10 years that really kind of helps give us a full picture.

Um, but it is it is very interesting.

there is such a wide range of of prostate growth rates and and when your prostate gets big and when your prostate gets small.

I agree that the vast majority of them happening over 50, but you know I I I remember seeing a patient who was 30 years old and his prostate was already you know the size of you would typically expect in a 70 to 80 year old.

So it doesn't mean that it can't it can't happen at younger ages.

It's just more likely to happen at older ages.

Yes.

Um so that's true Dr.

Sadiki, when you when you see these young people, what kind of uh 50 year olds, I'm old, so they're young.

Uh when you see people in that 50 age group, what kind of symptoms are they coming in complaining of?

Most of the times, initially, it's my sleep is terrible because I get up four or five times a night to urinate.

That's the biggest complaint.

Any other difficulties?

They have trouble starting or starting stopping.

I feel like I I can't complete I feel like I can't I don't feel like I finished urinating and I feel like I keep having to go and when I go it's not starting and kind of they get frustrated with that too.

So as we go through this I've been struggling with Lutz L u ts which is new initials that I didn't know about till the last couple of years.

So what are Luts?

What is Luts?

So Lutz literally stands for lower urinary tract symptoms.

So like basically from the kidneys down you're having symptoms from that.

Um, and they're kind of divided into two main groups.

There's what you call obstructive symptoms, which is where it takes too long to get started.

You see intermittency, it's stopping and starting.

You feel like your stream is less.

Those types of things.

And then there's what you call irritative symptoms.

And that's generally a reaction to how big the prostate has gotten.

Your bladder knows it has to pee, and so it gets stronger, and so it becomes harder to control.

So you end up peeing more urgently, peeing more often, feeling like a sense of pressure even when your bladder just got empty.

Um, and then unfortunately there's a lot of symptoms that go into both categories.

So forget getting up to go to the bathroom at night can be a can be a symptom of the one where you're just peeing before your bladder's full or it can't get fully empty.

And unfortunately the night time is the time when your bladder is the most angry.

So Omar, how how do I separate those two?

Have you figured out uh we're both in primary care and I'm trying to decide from my standpoint how I tell the difference between LUTs and prostate a big prostate or is there a way to tell history-wise and you can both jump in on this.

So I I guess I would say that LUTS oftentimes, you know, comes from prostate.

Lutz is just LUTs can happen in women who don't have prostates.

You know, uh it just means that your bladder is giving you something that you don't like is what I would group into the massive, you know, category of lower urine tract symptoms.

So are there medications for this Omar?

Yeah, I think the most common medication that we I see used is tamillosin or flowmax uh which kind of helps to for the prostate to contract more easily and that decreases that urgency and urinary frequency and getting up at night.

So, we're not doing as many surgeries on the prostate as we used to.

No, exactly.

Because pills are way better in a lot of a lot of cases.

And you can you can always you can always stop taking a pill.

You can't always go back in time and say, "I didn't want surgery."

You know, Dr.

Sadiki, this is a question I think that would be best for you for men who are obese.

Can I get by with 700 calories a day?

No, I think why not?

Well, that that's that that's too low.

Then your body's starts shutting down kind of metabolically.

So that typically shouldn't have less than 1,200 calories a day.

But that's you should have say if weight loss is about one to two one to two pounds a week.

So if you are overweight, you ideally cut down your daily calorie requirements.

You can calculate that out with um online by 500 at least per day.

And then with that throughout the week, you will probably lose about a pound safely.

What kind of an exercise program would you put in for a 50-year-old male with that complaint?

With that complaint, one thing cardio, you know, card walking, running, cardiovascular health is exercises are great, but I also think weightlifting resistance exercises have a have a bigger impact.

One because if someone has is obese that they can lead to decreased testosterone levels as well which can lead to other you know erectile dysfunction other concerns.

So when they lose the weight and they help build some muscle they can increase the testosterone levels naturally as well.

Yeah, the the thing that people forget is that you know uh you know testosterone is met sorry metabolized in atapost tissue and so if you are overweight you know someone who has quote unquote normal testosterone will generally not have normal testosterone available to them because it'll be metabolized so rapidly is is sex good for good health?

I mean, sex is what makes the world go around.

And in general, people are happy when they are having good sex.

So, I I don't ever tell people when it's time to to to say that that's and that part of their life is over.

I've had 94 year olds literally come for me for Viagra.

So, yeah.

So, I would say yes.

So, you brought up testosterone.

Uh do you want to talk a little bit more about the testosterone?

Uh what levels, what are the concerns?

We're seeing more and more people raising that question.

We see it in the social literature, the social networks and so on.

Either one of you can jump in on that.

Well, I mean, I would say that the one thing is in testosterone world is that it's not the elixir of life.

You know, people come to me saying that my my testosterone's low, so therefore if I get on testosterone, everything's going to get better.

And there are so many other factors to that.

So, that's the first conversation I always have with them.

And then there is a small but very real increased cardiac risk when you go on testosterone replacement.

So, it's not a zerorisk proposition.

Having said that, there are a lot of things that run on testosterone, muscle mass, like we've been saying, skeletal mass, sexual function, all this sort of stuff.

And so, if you replace it, you generally do get these guys feeling better.

Cancer, it's a question.

You know, testosterone does have the potential to fuel prostate cancer, but the literature on that is actually getting a lot sketchier because what we thought of was like the minimum level of testosterone that would grow prostate cancer is generally where everybody lives above.

Um, and so because of that to replace people, you know, like so a certain amount is required to grow prostate cancer and then this much more is required to feel good about your life.

You're almost always above that first line.

So replacing you up to a level where you feel good about your life is still safe.

U this is going to be a little bit of a rehash but the question is what are the warning signs of an enlarged prostate?

Um how concerned should I be if I have some warning signs and I don't know let's start want to start with primary care.

I mean I think it varies what what other signs it you know do you feel like you have trouble starting or stopping peeing?

Are you just getting up at night?

Are you actually having like you know losing weight unintentionally?

Are you having, you know, night sweats, chills, more concerning symptoms, which make me think more of a malignancy as opposed to just an enlarged prostate?

It's kind of would kind of depend on how they present.

Yeah.

The and the one other thing to remember is especially in the overweight population is that sleep apnea leads to um getting up to go to the bathroom at night even if they have normal bladder function.

So, their prostate works, their bladder works, and they're still getting up to go to the bathroom at night.

And that's because they actually when you have sleep apnea, you actually have an excessive nighttime urine output.

And so you actually are getting up not because your bladder's malfunctioning, but because your bladder's filling up that many times at night.

So we've talked a little bit about medications.

Uh what are the surgical things that you do with for prostates, large prostates?

Well, because it's like a huge problem, there is a huge range because a lot of people want to get in this space technologically.

Um, and it all depends.

In general, the more you do, the longer it lasts, but the more side effects you have.

So, you go all the way down to medications, which is very low risk.

Um, but it, you know, only lasts as long as you're taking the pill.

From there, you can put little pins in the prostate to kind of just push the walls open.

You can steam the prostate to get it to shrivel up.

You can actually uh there's actually now a power washer for the prostate, if you can believe that, where you actually power wash the prostate with a saline jet.

Um, and then there's the more traditional ones that people have heard of, um, the rotorooer or the the turp where you scrape the prostate open and then it goes all the way to the level where you just basically core out the entire uh center of it called a super pubic prostctomy.

So in general again the the the higher up on that list you go the prostates tend to get bigger and the higher up on that list you go the longer they tend to last but the more the side effects you have.

What's prostatitis Omar?

It's it's an infection of the of of the prostate.

What kind of things cause that?

Is it just the big prostate or uh it can be caused by enlarged prostate.

It can be caused by poor hygiene.

It can be caused by you know STDs I suspect.

Yeah, there'll be another one.

And the other one that is is fairly typical is um you know imunosuppression.

um you because in general you're in a bacterial laden area and it can potentially you know kind of feed into that area and a lot of unfortunately um you know you know disseminate infections from IV you see it a lot in IV drug users too urinary tract infections tend to start to increase also with with the enlargement.

Is it true that prostate air correction is it true that testosterone levels in men on average are decreasing and if so why?

And I expect Nathan that might be your territory.

Um that's harder to answer because uh it's a situation where there is definitely a information bias.

More people know their testosterone levels now than at any point in history.

So because of that we are only comparing it to data in people that tend to be more concerned about it.

So there is definitely a selection bias as to that.

Having said that the range that was originally found was 240 to 960 and I believe that was in like the late 70s early 80s when we kind of defined that range.

Um and then since then we've seen much a much uh nobody's getting to 960 anymore.

We're seeing much lower levels in that range.

So is it real?

I don't know for sure, but it would seem to have some sort of that and there are a lot of thoughts as to why, you know, different toxins in the environment, etc., etc., but I don't think anybody knows really where it came from.

I'm going to take a little side turn and go back to health.

Sure, because we're getting quite a few questions on health.

What is the best thing I and I'm going to look at you, Omar.

What is the best thing I can do to ensure that I stay healthy as I age?

like one a good a good diet a protein rich a protein richch diet you know walking running at least you know at least 120 to 150 minutes a week plus doing at least you know weight resistance weightlifting exercises at least 150 minutes a week in the in the long run because that not only improve your muscle mass bone density helps improve you know decreases inflammation helps you know improves cardiovascular health blood pressure increase improves your cholesterol there's so many benefit benefits and and the control that you have.

You know, you don't have to depend on your doctor to prescribe this.

Something that you can do for your own health.

So, those are things that you can do to lower your risk and that that'll help you lower your risk for heart disease.

That's another question.

Heart disease, all cause mortality.

What's what about alcohol and smoking and things like that?

And I mean as we look at men's health I mean so I mean alcohol there's no there's no safe amount of alcohol to drink you know and alcohol itself you know decreases increases risk of every type of cancer increases your risk of you know decreased testosterone levels and just increases your risk of overall heart heart disease blood pressure any kind of you know cardiac events cerebrascular events so really know those things are putting yourself at risk for Nathan I remember Doesn't smoking increase your bladder cancer risk also?

I mean for for me it it it actually increases bladder and kidney cancer risk both um because they think there's you know concentration of the toxins in the urine and and the reason why it happens most in bladder is just because your urine spends more time in your bladder than it does in your kidneys.

So the toxins have the toxins have more time to time to accumulate.

What about vaping?

Any any information on vaping?

I don't know.

Yeah.

I don't know of anything about vaping.

In terms of the recent advents of of risk for bladder cancer and kidney cancer and things like that, meth use has been shown to to increase your your bladder cancer risk fairly significantly in a much younger population.

You know, it used to be if you saw bad bladder cancer in a 40-year-old, that was an event.

But now it's, you know, it's common enough in people who have, you know, that type of use.

Omar, what's I'm back to your good health stuff again.

What this person wants to know what a what is a healthy weight, blood pressure, cholesterol and blood sugar.

So the the four big ones there.

I mean healthy weight again not depends on your on your your body habit how how tall you are and other other factors because um and as far as what the other parts um blood sugar blood pressure and cholesterol I mean blood pressure I think we we all kind of you know the 120 over 80 this kind of like the ideal blood pressure blood sugars you you know fat fasting you you want between 80 and 120 you don't want it to be higher than that cholesterol you know you want the LDL, the bad cholesterol, and be ideally less than 100.

Would you would you mind if I ask a follow-up question on that?

I know that there has been talk of different ways to measure healthy weight other than BMI.

What at the you know, as somebody who does obesity science, I just curious what has if anything has there been a thought in that?

I I don't necessarily agree with BMI.

I think because it was initially I think it was invented in England based on British soldiers in the late 1800s.

Obviously, that's a completely different type of people than we are today.

That doesn't take into account your your muscle mass or or your bone density or any of those kind of things.

You can there's there's different ways to kind of evaluate that to give you more accurate body composition than BMI.

I think waste has gotten in there and things like that into that formula if you did that.

I mean, the rock is would be considered obese, right?

But he's pretty much 100% muscle, right?

Exactly.

Yeah.

I was just curious if they've if they've come up with a new calculation that is as back of the envelope quick calculation for it.

They they do they kind of do like a like a water displacement but that's more specialized and kind of not as easy to takes time.

Yeah.

Gotcha.

I'm just curious.

Thank you.

No, that's that's a really good question because there's more and more discussion on that one.

I think I've seen that also.

Should I be taking uh supplements?

I'm going to stay with you for a minute.

Like calcium or vitamin D?

Yes.

I mean calcium and vitamin D of course for for bone health.

But I think also taking a multivitamin in in general you don't think you need to go buy these specialized you know magnesium things.

You can take a one a day and we'll get most of your requirements there.

Yeah it was interesting because there was a there was a a prostate researcher who decided to go into you know what supplements are good for prostate and so he tested like all these things and did as much science as he could and what he came back to is exactly that if you're going to do anything just do multivitamin you know and and calcium.

That was it, you know.

Well, the rest of us generally just go to the fruit and vegetable section of your store.

Yeah, exactly.

How does finasteride affect the prostate size and what are its side effects and how does it work?

So, finasteride is a medicine that blocks testosterone conversion into a more potent form in your prostate.

So, that's the reason why people will um see their prostate shrink because they're not under that influence of that more powerful testosterone.

the potential.

We used to think it would only act in the prostate, but there is actually some growing evidence that that small amount of that higher potency testosterone goes throughout your whole body.

So, when you have low testosterone symptoms, you can get low testosterone symptoms like low libido, low energy, muscle loss when you're just taking finasteride.

Um, but the but it does shrink the prostate by basically starving it of its growth factor.

So, it works.

No, it does.

It definitely shrinks people's prostates.

So, if you quit taking it, then what?

It'll it will grow back.

uh it takes about six months to a year to go in each direction.

So if you start taking it, it takes about six months to a year before you kind of bottom out on this low as low as it gets and then it takes about six months a year to bring it back.

Gleason score stay with you for a minute.

Sure.

Um Gleon, so the question is about a gleon of nine.

Take it from there.

Sure.

So Gleason score was developed a long time ago and it's just basically a measure of how aggressive a prostate cancer is.

So I always tell people uh aggressiveness is how fast the plant is growing and and stage or is is how big the plant has gotten.

So when you talk about a gleon 9 you have a very fast growing cancer but in general you don't know how much it's grown.

So in general gleon 9 prostate cancers are one you have to be aggressive about.

You have to think about doing multiple things hormone manipulation surgery radiation to try to get it to stop and even chemos nowadays.

This is a great question.

I'll start with you, Omar.

It's one that wakes me up a little bit also.

What information can be gained through testing my urine?

And I don't think we test urines as much as we used to.

And I don't know if we're doing it enough.

I mean, you can get a lot of information testing urine from whether or not you have an infection, if you're excreting protein, any kind of kidney dysfunction can help.

Drug screens.

Um, there's a variety of tests.

It's kind of hard to kind of just such a broad range of things you can test the urine for.

Yeah, we've we've developed a lot of other, you know, blood test surrogates, you know, looking for sugar now became an A1C, etc., etc., but there is still a lot to be gained for that.

Well, the other thing that we used to really look and follow were red cells and things like that.

And it it just seems like over the last maybe 20, 30 years, we've just kind of shifted.

Yeah.

I mean, the idea of screening people's urine that way did get a lot less frequent.

Um, we only do it in people who have risk factors now, but you know, I mean, still one risk factor is age above 50.

So, it's you pretty much everybody who's getting a yearly physical should get a UA.

Your analysis, how safe is the long-term use of nicotine chewables even after quitting smoking?

Thank you for taking a That's yours.

I mean, that's hard to say.

Nicotine itself is not get the addictive port, but the cancerous portion of the toxins in cigarettes and vapes.

So can't can't say it would be too detrimental to your health overall, but I don't I can't say I know enough about people.

Yeah, I don't know any of that data either, unfortunately.

Omar, what vaccines do I need after age 50?

Vaccines you need after age 50 annually?

The the flu shot?

Uh you need uh co COVID boosters are RS RSV shingles.

Um they're RSVP65 shingles numovax pneumonia vaccines the big ones.

We got a little bit of time left.

The Peronis disease.

Oh that's that's a tough one.

So that's curvature of the penis with erection.

And the the big question is, is it stopping you from having sex?

Uh, if it's stopping you from having sex, that's when we generally intervene.

And it can go anywhere from just using a a specialized stretcher to try to stretch the penis to go back to straight again all the way up to surgery to straighten the penis out.

So, you got a broad range there as to what you can do there, but it's basically a scarring of the penis that when you get an erection, it kind of doesn't allow it to stretch as much, so it bends toward the scar.

There's been a lot of advertising and Yeah, the bent carrot.

Yeah, exactly.

The bent carrot is I've I and I'm one of the main one of the people who does more of the pronies work.

Me and my partner Dr.

Angleser do a lot of the ponies work and they um yeah we get a lot of bent carrot talks.

This has been a really nice discussion gentlemen.

I really thank you both for coming in.

We appreciate it a lot.

We've covered a lot.

We've done a lot of discussion about just good men's health.

I want to thank our panelists tonight for uh joining us.

Dr.

Omar Sadiki, Dr.

Nathan Hoffman.

Please join Doctors on Call next week when Mary Mhouse leads a special program on mental health with a panel of experts from around the region.

Thank you for watching and joining us this evening and for this joining us this 44th season of Doctors on Call.

Have a great night.