Male Health

• Prostate


  A gland the size and shape of a walnut that grows bigger the older a person gets. It sits underneath the bladder and surrounds the urethra, the tube that carries urine out of the body. The prostate is designed to help make semen, the fluid that carries sperm.
• Prostate cancer


  When cells in the prostate start to grow in an uncontrolled way - abnormal growths - and causes change in urination and potential pain.
• Enlarged prostate


  The most common prostate problem, most common in men over 50, leads to a change in urination.
• Prostatitis


  Inflammation of the prostate that can affect any age, but is most common in younger adults. It affects urination and causes discomfort.
• Both prostatitis and an enlarged prostate are non-cancerous.
• Testing for prostate cancer

  1. Blood tests PSA

  2. Digital rectal examination

  3. MRI

  4. Biopsy
• PSA test


  A simple blood test that measures the presence of prostate-specific antigen circulating in your bloodstream. However, it's an inaccurate test for prostate cancer because cancer can be present without increased PSA levels and PSA levels may be increased by conditions other than cancer, e.g. benign prostatic enlargement, prostatitis and urinary tract infection.
• Aim of PSA testing


  • To detect localised prostate cancer when treatment can be offered that may cure cancer or extend life.
• Benefits of PSA testing

  • Early detection - PSA testing may lead to prostate cancer being detected before symptoms develop
  • Early treatment - detecting prostate cancer early before symptoms develop may extend life or facilitate a complete cure.
• Limitations of PSA testing

  • False-negative PSA tests - about 15% of people with a normal PSA level may have prostate cancer
  • False-positive PSA tests - about 75% of people with a raised PSA level have a negative prostate biopsy.
• Management/Treatment of prostate cancer

  1. Watchful waiting - aimed at people with localised prostate cancer who are either not suitable for, or don't wish to receive treatment and instead involves the deferred use of hormone therapy

  2. Active surveillance - aimed at people with localised cancer for whom radical treatments are suitable, whereby only those whose tumours are showing signs of progressing or those with a preference for intervention are considered for radical treatment

  3. Radical treatments - radical prostatectomy, external beam radiotherapy and brachytherapy

  4. Hormonal treatments - Androgen deprivation

  5. Chemotherapy - for men with hormone-relapsed metastatic disease

  6. Bisphosphonates - for people who are having androgen deprivation therapy and have osteoporosis
• Review and manage


  1. Any complications such as pain, lower urinary tract symptoms, and symptoms of spinal cord compression

  2. Adverse effects from treatment, including sexual dysfunction and urinary incontinence

  3. Adverse effects of androgen withdrawal include change in body shape and weight gain, tiredness, hot flushes, loss of libido

  4. Impact on quality of life

  5. Refer men with evidence of significant disease progression (rapidly rising PSA level or bone pain) to a urological cancer specialist
• Erectile dysfunction


  The persistent inability to develop and maintain an erection sufficient for satisfactory sexual performance.
• Causes of erectile dysfunction

  • Certain medicines can cause it, including diuretics, antihypertensives, fibrates, antipsychotics, antidepressants, corticosteroids, H2-antagonists, and anticonvulsants
  • It tends to have an organic or psychological cause. Organic causes broadly fall in to blood flow problems, conditions affecting nerve impulses and hormone regulation or structural abnormalities. Psychological causes range from depression to performance anxiety.
• Risk factors for erectile dysfunction

  • Peyronie's disease (distortion or curvature of the penis)
  • Priapism (inflammation of the penis)
  • Depression
  • Alcohol use
  • Lack of sexual knowledge
  • Poor sexual techniques
  • Inadequate interpersonal relationships
  • Smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension
• Management/treatment of erectile dysfunction

  1. Lifestyle changes - losing weight, reducing smoking, reducing alcohol intake, not taking illegal drugs, regular exercise and reducing stress

  2. Phosphodiesterase-5 (PDE5) inhibitors - Sildenafil, Tadalafil, Vardenafil, Avanafil
• PDE5 inhibitors


  One of the most widely used and effective types of medication for treating erectile dysfunction. They work by temporarily increasing the blood flow to the penis.
• PDE5 inhibitors


  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)
  • Avanafil (Spedra)
• Contraindications for PDE5 inhibitors


  Don't take if: Unstable angina or angina occurring during sexual intercourse, Regular or intermittent use of nitrates in any form, Hypotension (systolic blood pressure below 90 mmHg), Recent history of myocardial infarction, Recent history of stroke, Heart failure, Uncontrolled arrhythmias, Uncontrolled hypertension, Severe hepatic impairment, Renal impairment
• Benign Prostatic Hyperplasia (BPH)


  A non-cancerous enlargement of the prostate gland.
• Cause of BPH


  This occurs when stromal and epithelial cells increase in number, causing the prostate to get bigger. Large discrete nodules compresses the urethra.
• Risk factors for BPH

  • Being 40 years or older
  • A family history of benign prostatic hyperplasia
  • Medical conditions such as obesity, heart and circulatory disease, and type 2 DM
  • Lack of physical exercise
  • Erectile dysfunction
• Management/treatment of BPH


  1. Practical advice - Reducing intake of liquids, particularly before going out in public or before periods of sleep, Avoiding or reducing intake of caffeinated beverages and alcohol, Avoiding or monitoring the use of medications such as decongestants, antihistamines, antidepressants, and diuretics, Exercising pelvic floor muscles, Preventing or treating constipation

  2. Alpha blockers - Doxazosin, Tamsulosin, Alfuzosin

  3. Phosphodiesterase-5 inhibitors - Tadalafil, Sildenafil, Vardenafil

  4. 5-alpha reductase inhibitors - Finasteride, Dutasteride

  5. Combination medications - Alpha blockers and antimuscarinics for patients with overactive bladder symptoms
• Male pattern baldness


  A distinctive pattern of hair loss that may occur in genetically predisposed people and is thought to be androgen dependent.
• Cause of male pattern baldness

  Male hormones are involved - cells in the skin of the scalp convert testosterone into another hormone called dihydrotestosterone (a testosterone metabolite), which binds to the androgen receptors and activates the genes responsible for the shortening of the hair growth phase and the gradual transformation of large terminal hair follicles to miniaturized follicles. With each successive hair growth cycle, the hair follicles become smaller, shorter and finer, which replace thicker, pigmented terminal hairs. Affected hair follicles become more sensitive to dihydrotestosterone, which causes the hair follicles to shrink.
• Management/treatment of male pattern baldness

  1. Steroid injection - injections given into bald patches

  2. Steroid creams - cream applied to bald patches

  3. Immunotherapy - chemical applied to bald patches

  4. Light treatment - shining UV light on bald patches

  5. Tattooing - tattoo used to look like short hair and eyebrows

  6. Hair transplant - hair is removed from the back of the head and moved to thinning patches

  7. Scalp reduction surgery - sections of scalp with hair are stretched and stitched together

  8. Artificial hair transplant - surgery to implant artificial hairs

  9. Regaine - contains minoxidil that works by aiding the blood flow to the hair follicles on the scalp