dr. max gomez: i'm dr. maxgomez. this month we explore men's health, everythingfrom why we don't like to go see the doctor to the latesttreatments for prostate and testicular cancer, to howmarriage affects your heart. science&u! starts now.♪ [theme music] ♪ magalie laguerre-wilkinson: i'mmagalie laguerre-wilkinson. gentlemen, we know thatyou have to be pushed and dragged to that doctor'sappointment, but now there's a new health center just formen, coming up on science&u!
dr. max gomez: i'm dr. maxgomez. it's the most common cancer diagnosed in men butdoctors are actually over-treating it. how newimaging and genetic testing is changing prostate cancertreatment, ahead on science&u! mike gilliam: i'm mike gilliamfor science&u! testicular cancer affects thousands of men butit doesn't have to be a death sentence. medical professionalshave made great strides in treatment. we're going to tellyou all about it and what you can do to protect yourself aheadon science&u!
tinabeth piã‘a: i'm tinabethpiã±a. is it a real problem for men or just media hype? thetruth behind low testosterone coming up on science&u!carol anne riddell: i'm carol anne riddell.love can break your heart but could it also keep you healthy?we'll tell you about a fascinating research on marriageand cardiovascular disease, what it means for all ofus and men in particular. that's ahead on science&u!magalie laguerre-wilkinson: i'm magalie laguerre-wilkinson.urology, dermatology, internal
medicine, even plastic surgery,guys, and it's all for you right here in midtown manhattan.this madison avenue office tower is home to a trending newcurve in men's health, the nyu langone medicine center isdedicated to providing men with specialized treatment for theirspecial male needs. the challenge, though, is gettingguys to make that all-important first appointment.dr. norman sussman is staff psychiatrist here at thecenter for men's health. why are men so reluctantto go to the doctor?
dr. norman sussman: it's hardto explain fully but we know that women, as a matter ofcourse, routinely see their ob/gyn, and are more likelyto go see a doctor if they don't feel well. men, firstof all, don't have that need to see an ob/gyn so they don'tgo to their urologist routinely, but there are many men whoactually are afraid to go to the doctor. if i ask people,"why don't you go," they'll say, "i'm afraid of doctors."magalie laguerre-wilkinson: now in a place like this, again,a men's health center, does
this make it easier for men tosee a physician, to come to a place that's specificallygeared towards men? dr. norman sussman: people dofeel better being able to share some of their problems with menbecause you have to realize a lot of men come in withissues related to things they might be ashamed about. theymay feel that being anxious or being depressed, which theydon't recognize as depression but they just feel unmotivated,they're having problems at work. they really don'twant to talk about it.
magalie laguerre-wilkinson:getting men to relax and reveal their health concernsis the medial mission of the men's center.dr. steven lamm: we've created an environment thatmen feel very safe. they feel safe that we're not judgmental.we kind of really understand the philosophy of men.we understand that men don't respond well to criticism.magalie laguerre-wilkinson: as the center's medical director,dr. steven lamm is especially attuned to a male perspectiveon healthcare.
dr. steven lamm: the tragedyfor men is that most young men will graduate from theirpediatrician when they're lets say 17, 18, and willprobably not see another doctor until they're 50.magalie laguerre-wilkinson: really?dr. steven lamm: whereas women continue to be treatedbecause they get pregnant, they have to see the gynecologist,so there's no gap, there's no medical gap for women.magalie laguerre-wilkinson: um, but for men...dr. steven lamm: there's a huge
gap.magalie laguerre-wilkinson: great efforts were taken to makethe medical center as personal and asall-inclusive as possible. dr. steven lamm: chestx-rays, abdominal sonograms, pulmonary function studies.magalie laguerre-wilkinson: everything.dr. steven lamm: sleep studies, vascular studies.magalie laguerre-wilkinson: sleep studies?dr. steven lamm: yeah, outpatient sleep studies,so we do essentially everything.
i can walk over to thecardiologist and say, "what do you think about this ekg?what do you think about this sonogram? what do youthink about this story?" and the cardiologist can come to usand say, "look, thanks for letting me see the patientwith heart disease, but you know, their real problemis their obesity." magalie laguerre-wilkinson:the idea that a patient can literally walk down the hallto consult with any number of medical specialists is appealingto men, and meets an
important need. dr.sussman sums it up best. dr. norman sussman: thisis a one-stop mall for men's healthcare.magalie laguerre-wilkinson: so gentlemen, don't put offthose doctor's visits any more. make that appointment foryour sake and that of your families.i'm magalie laguerre-wilkinson for science&u!dr. max gomez: i'm dr. max gomez. prostate cancer strikesnearly a quarter of a million men every year in this countrybut the vast majority of
those cases are slow-growing,non-lethal cancers, and treating those can lead tooften unnecessary and unpleasant side effects,but now researchers are starting to figure out how to tell thereally bad cancers from the ones that can just be watched.gilbert horn: i noticed over a period of time thatit was increasing slightly.dr. max gomez: your psa? gilbert horn: psa wasincreasing, right. dr. max gomez: that's thescenario hundreds of thousands
of men face every year.their psa, which stands for prostate-specific antigen, isgoing up, but despite its name, psa is a blood test thatisn't all that specific for prostate cancer.dr. herbert lepor: you could have an elevated psa and nothave cancer, and a low psa and have cancer.dr. max gomez: so like most men in his situation,gilbert horn decided to have a prostate biopsy.the results did show cancer but-gilbert horn: it is a low score.
it's a very slow, slow-growingtype of cancer. dr. max gomez: which all soundslike good news unless you understand how prostate biopsiesare done. a dozen needles take tiny slivers of tissuesfrom the prostate at random. the problem is that aprostate gland often harbors multiple small cancers.dr. herbert lepor: there is a significant cancer in one areaand our needle misses it. there's all these tinyinsignificant cancers and our needle hits it. what we reallywant to happen is where that
significant cancer is,our needle goes right through it, and now we can reallyassess the risk of that cancer. dr. max gomez: until recently,there was no good way to aim the biopsy needles at areas inthe prostate that were the most likely to actually bea lethal cancer as opposed to indolent, relatively harmlessones that make up the vast majority of prostate tumors;but the prostate team at nyu langone has pioneered anew technique that uses a special mri scan to identifythe most suspicious areas
in the prostate. then computersoftware fuses that image with a 3d ultrasound of the prostateso that the biopsy needles now target and sample thosepotentially deadly areas. when dr. lapor did thattype of targeted biopsy on mr. horn, the results werevery different. dr. herbert lepor: we weren'tdealing with this sort of insignificant disease but onethat we certainly felt over his lifetime would certainly andlikely become a lethal problem. dr. max gomez: those resultschanged mr. horn's mind about
active surveillance of what hadbeen thought to be a relatively harmlesscancer. gilbert horn: i'm much moreconcerned so the decision was to go with a surgical,the prostatectomy. dr. max gomez: those targetedbiopsies mean that a pathologist can look at the most suspiciouscells under the microscope and give it a gradecalled the gleason score. the trouble is...dr. peter scardino: some cancer which under the microscopelook very innocent, gleason
6 cancers, some of them,a small percentage, maybe 10%, have a biological profilethat's much more aggressive, and we know those tumorsare the ones that need to be treated.dr. max gomez: and vice versa. some cancers that lookaggressive under the microscope turn out to be fairly innocent.how to tell the difference? dr. peter scardino,chairman of surgery at memorial sloan-kettering cancer center,says by looking at the genetics of the tumor itself.myriad genetics, the same
company that developed thebrca gene tests for breast cancer, has come up with atest for prostate cancer that analyzes 46 genes to generatea molecular fingerprint of a prostate cancer.dr. peter scardino: somewhere around 20%, 30% of the patientswho seem to have a more aggressive tumor actuallyhave a more favorable result when measured by thisbiological test. dr. max gomez: and a number oflarge clinical studies of this prolaris test have shown that ina significant number of cases,
tumors that looked relativelyinnocuous were likely aggressive and neededmore treatment. dr. peter scardino: well,it doesn't require a new biopsy. it doesn't even require a bloodsample. it can be done on the biopsy you've already had.dr. max gomez: while these advances have helped doctorsidentify which prostate tumors really need treatment,the treatments themselves have not changed all that much,so dr. lepor is developing a laser technique to destroy justthe aggressive tumors within a
prostate, while dr. scardinosays the genetic testing will help identify drug targets forless invasive treatments, all of which will help avoid the mostfeared side effects of even the most successful prostatetreatments, and that's impotence and incontinence.for science&u!, i'm dr. max gomez.mike gilliam: i'm mike gilliam for science&u!surviving testicular cancer is a lot easier today than itwas years ago, but you have to know what to look out for.we came to new york presbyterian
columbia university medicalcenter to learn more. dr. james mckiernanis a professor and chairman of the urologydepartment at new york presbyterian columbiauniversity, and an expert when it comes to testicularcancer. it's a disease that usually strikes young menbetween the ages of 15 and 30. dr. james m. mckiernan:testicular cancer is cancer that affects exclusively men, and wealso refer to it as germ cell cancer because it's a tumorthat affects the cells that are
designed to be a part ofthe reproductive tract in men, specifically the cells that giverise to sperm in the testicle. mike gilliam: so what causesit? dr. james m. mckiernan: we don'tknow exactly what causes testicular cancer but one of theknown risk factors is something called cryptorchidism orundescended testicle. about 1% to 2% of male childrenare born with one or both testicles that have not actuallymoved down into the scrotal sac, and those children tend tobe at higher risk of testicular
cancer later on in life. beyondthat, a large number of patients who get testicularcancer do not have that condition, and we don'tfully understand why they get testicular cancer, whether it'san environmental exposure, a genetic predisposition, andthere have been even been some wild theories about things likecell phone usage or exposure to high-tension wires, but noneof that's really been proven to be associated withtesticular cancer. mike gilliam: what are thesymptoms? how would a person
know that they might be gettinginto a danger zone on this? dr. james m. mckiernan: mostoften when a patient comes in to see us at the hospital,they say, "i felt something on my testicle and it doesn't quitefeel right." a lot of patients will come in and not havenoticed anything, and it's either noticed by their sexualpartner or it's noticed on a routine exam by a doctor. andthen another group of patients will actually present withwide-spread spread throughout their body, or metastatictesticular cancer, and that can
cause symptoms such as coughingor back pain or weight loss, far more ominous and concerningsymptoms, and that's usually a sign that the detectionof the disease has been at a very late state.mike gilliam: testicular cancer is relatively uncommon.dr. mckiernan says each year in the united states,roughly 7,000 men are diagnosed with it compared with230,000 to 240,000 cases of prostate cancer, and he saysgreat progress has been made in treating the disease.in the 1970s, the mortality
rate was about 50%.he says it's now down to between 2% and 4%.a lot of the decline is due to research and awareness.much of that has been due to publicity surroundingtour de france cyclist lance armstrong and his very publicbattle with the disease that began in 1996 and ended withhim cured a little over a year later.dr. james m. mckiernan: he was diagnosed with quite anadvanced case of testicular cancer, and he presentedactually with coughing, and
coughed up blood after ridinghis bicycle, and they detected that he had testicular cancerwhich had already spread to his lungs, so a very advancedstage testicular cancer, and was essentially completely curedby a combination of surgery, chemotherapy, and radiation,and went on to win six tour de france races after all thattreatment. so if there's a poster child for a successstory, lance armstrong is it for sure, and testicular cancercan have a great outcome even when detectedat a very advanced stage.
mike gilliam: dr. mckiernansays testicular cancer is not a death sentence, andeven though they remove the diseased testicle, mostpatients go on to lead normal lives after they're cured.dr. james m. mckiernan: most men retain the ability tohave sexual function and most men retain fertility, so thefunction of the testicle in a normal situation is toproduce testosterone, which is a male hormone,and to produce sperm cells, both of which are criticalto fertility and male sexual
function, and the use of justone testicle is usually adequate to provide fertilityand normal hormonal function to most men.mike gilliam: in fact, lance armstrong would later fathera child after undergoing chemotherapy for testicularcancer. dr. mckiernan says the message is check yourself out,and if you think something is wrong, see a doctor.don't wait. dr. james m. mckiernan: it'shighly treatable. don't be afraid of it. don't be afraidto call the doctor if there's
something slightly abnormalabout the testicle. the checkup is easy. there's absolutelyno side effects or toxicity to going in and getting checked,and if they find something early, the treatment could bequite a bit less burdensome to you than ifit gets detected late. mike gilliam: they can survive?dr. james m. mckiernan: absolutely. survival is thetheme, and it's almost always achievable.mike gilliam: and we can't emphasize enough how importantearly detection is. while
doctors say testicular cancer isalmost always curable, they like to catch it early so theycan minimize the stress on the body.i'm mike gilliam for science&u! tinabeth piã‘a: i'm tinabethpiã±a. low t, it's something we're hearing more and moreabout in media ads, but it is true? is it real? andis it something men should be concerned about?dr. steven lamm: now with a lot of the awareness of"the testosterone issue," it's another reason that men go tothe doctor. it then behooves
the medical profession toevaluate them properly. tinabeth piã‘a: testosteroneis a hormone. it's basically what puts hair on a man's chestand the driving force behind his sex drive. it's what makesa man a man physically. with an aging male populationand more openness about discussing sexual issueswith their doctors, a diagnosis of low testosterone isbecoming more common, and so have those adspromising great things. ad: so you can be more likethe guy you used to be,
with over 700,000 bottlesshipped. ageless male is the smart choice to supportyour free testosterone levels. tinabeth piã‘a: but can aprescription for low testosterone literallybe an anti-aging cure-all? dr. john mitias: it is not acure-all, and there are people that don't respond to it, don'tneed it. if it doesn't take care of their problem, we're upfront about it and we tell them, "look, this is not your problem,and this isn't going to make you 20 years old, and this isn'tgoing to make you a giant
at the gym. we're going to getyou back to your normal level, to your safe level."tinabeth piã‘a: according to report from the mayo clinic,testosterone levels gradually decline throughout adulthood.in fact, once a man turns 30, his levels decline about1% a year on average. dr. steven lamm: in menwho have a significant drop in their testosterone, what thesemen will often complain about is a decrease in libido. italso may translate in decreasing erections. they may haveincreased fatigue. they may
have increased body fat. theirworkouts in the gym may not be as powerful. the effectsof their workouts may not be as great. they may have alittle irritability, but many of those as very nonspecific.they also may have a drop in bone density, which isimportant. just as you hear about in osteoporosis in womenand fractures, well men get that as well. that's a veryimportant role for testosterone.tinabeth piã‘a: but doctors are quick to point out that whileit may well be low t, sometimes
these symptoms can besomething completely unrelated to hormones.dr. john mitias: and this drug isn't for everybody,and that's why you really need to monitor everything verycarefully, evaluate them carefully, and treat themcarefully. a lot of people are worried that people arebeing treated for no reason. well, most, i don't believethat. i think most of them really do need it, and that'swhy the number of prescriptions are going up because theyare responding to it, their
symptoms are getting better.eric slayton: where you were like at 30 years old isdifferent than at 40, so this is just sort of, it's a verysubtle, consistent way to get things to where they were.this is a very healthy -- this is not a risk that i'm taking.i look at it i'm enhancing an already healthy lifestyle.tinabeth piã‘a: there can be side effects, however.testosterone therapy can cause blood clots, acne, and inyounger men, limit sperm production, plus the effectsof long-term use have
yet to be established.jason bernstein: i'm a well man, it's my body, and i have noproblem coming here, and i am not hesitant whatsoever aboutgetting my injections once a week, and it makes me feel alot better in a lot of different areas. and to me i think,like i said before, this is natural, you know?it's not synthetic chemicals that they're giving.it's naturally-produced hormones that my body just doesn'tmake as much any more on its own, so-tinabeth piã‘a: normal
testosterone levels range from300 to 1,000 nanograms per deciliter.dr. john mitias: there is no one level that's right foreverybody. what we do is make sure that we don't go beyondthe normal range. the physiologic normal range that'sset by the labs, we don't go beyond that here.when they get normal, they feel better. it has been abusedby so many people for so many of the wrong reasons that ithas somewhat still a bad reputation, although less now.it really can be a
transformative medicine ifused as a medicine. tinabeth piã‘a: testosteronereplacement therapy is only appropriate and safe for menwho have below normal levels of testosterone and who don'thave any medical conditions that would be made worse bytaking testosterone, such as an enlarged prostate gland orevidence of prostate cancer. for science&u! i'mtinabeth piã±a. carol anne riddell: i'm carolanne riddell. love can be heartbreaking but could italso keep you healthy?
research shows marriedpeople are less likely to have cardiovascular problems,so why is that, and what does it mean for the men in ourlives? love and marriage, they are said to gohand-in-hand, and there might just be acardiovascular benefit as well. a recent large-scale study byresearchers at nyu langone medical center shows thatbeing married can affect the risk of heart disease.dr. jeffrey berger: our study demonstrated that maritalstatus is important for your
health. it found that if you aremarried, you have a lower prevalence of havingvascular disease. what was really interesting was that wefound that it didn't matter what type of vascular disease,whether you look at your heart arteries or your lowerextremity arteries or your arteries in your legs,aneurisms inside your abdomen or your belly,or your carotid arteries, arteries in your neck,it really didn't matter. being married wasassociated with a lower risk.
carol anne riddell: cardiologistdr. jeffrey berger explains it's impossible at this pointto say exactly why, but marriage clearly seems tohave its benefits. dr. jeffrey berger: i definitelythink there are things that a spouse can do, whether it'sencouraging you to see your doctor every year, whether it'sencouraging you to take medicines that you're alreadyon. these are small things that are really difficult toquantify that actually make a very big deal.carol anne riddell: and
that brings us to men.is there a specific benefit for them, given that we often thinkof men as more reluctant patients than women andless likely to seek medical care. dr. carlos alviar,cardiology fellow and also a researcher in the study,says in his case marriage makes a difference.carol anne riddell: and you're married yourself,you said, right? dr. carlos alviar: i am.i'm happily married, yes. carol anne riddell: doyou think that it's
protecting your heart?dr. carlos alviar: oh, absolutely. my wife is alwaysmaking sure i eat the right thing, i exercise, or i see thedoctor, so i think it's a key part of it.carol anne riddell: so do you think all this sort of reaffirmsthat women nagging their husbands is in factvery good for them? dr. carlos alviar: i think i'dsay that it's an effective way to keep patients on track.carol anne riddell: and as i explained to the doctors,i've done my own unscientific
research on this topic.for my birthday this year, i asked my husband the one thingi wanted was for him to get his physical. that's how itgoes in our house. dr. jeffrey berger: and did he?carol anne riddell: he did! dr. jeffrey berger:there you go. carol anne riddell: but let'snot get ahead of ourselves, ladies. our healthis also potentially improvedby marriage. dr. jeffrey berger: i thinkpeople normally tend to think
that men need that marriage,they need that sort of relationship to sort of helptheir health. clearly that was true, but i think what's reallyinteresting is that we've found that also for women, that ourdata was not only showing that men did better if they weremarried. we found the same benefit if you were a man aswell as if you were a woman. carol anne riddell: this diagramdetails some of the specific findings of the study, whichincluded more than 3.5 million adults. it compares marriedpeople to those who are single,
divorced, or widowed. formarried people, the rate of coronary artery disease, themost common type of heart disease, was 6.3% compared toabout 7.5% for unmarried people. cerebrovascular disease,which affects the circulation of blood to the brain, affected8.8% of married people and 10.8% of those not married.and take a look at the rates of peripheral artery disease.that's a narrowing or blockage of the vessels that carry bloodfrom the heart to the legs. among married people, therate was 5.7% compared to
more than 8%among unmarried people. dr. jeffrey berger: whenyou're in a relationship, you have someone who is watchingyour back. you have someone who will sort of give youthat little added push. carol anne riddell: so,gentlemen, the next time your wife badgers you to see adoctor or stop ignoring those aches and pains, listen moreclosely. she might just be telling you she loves you and itcould be good for your health. i'm carol anne riddellfor science&u!
dr. max gomez:that's our show for today. i'm dr. max gomez. see you nextmonth on science&u! ♪ [theme music] ♪
No comments:
Post a Comment