mens’ health rpsm january 7, 2005 peter meacher md
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MENS’ HEALTHRPSM January 7, 2005
Peter Meacher MD
MENS’ HEALTH ?
MENS’ HEALTH
Prostate cancerProstate cancer screeningscreening Testicular cancerTesticular cancer Erectile dysfunctionErectile dysfunction
prostatitis, BPHprostatitis, BPH
HIV counseling and testingHIV counseling and testingSTDsSTDsLipidsLipidsSmokingSmoking
OBJECTIVES
At the end of the session participants will be:
1. Able to discuss the pros/cons of prostate cancer screening with patients
2. Able to evaluate and treat erectile dysfunction
3. Understand the recommendations for/against testicular cancer screening
Roberto
28 year old man asking for urine drug screen required for his job as security officer
History of mild intermittent asthma
Asks about “getting prostate cancer check”
Father diagnosed prostate cancer aged 60
PROSTATE CANCER
USPSTFInsufficient evidence to recommend for or
against routine screening for prostate cancer using PSA or DRE
DRE – unclear sensitivityPSA – sensitive, non-specific, no survival
benefit demonstrated
BACTERIAL PROSTATITS
E Coli, Klebsiella, Chlamydia, Ureaplasma
BactrimCipro
4 weeks
BPHINCIDENCE = 10-30% of men in 70s
Acute urinary retention occurs in 1-2% of symptomatic men/year
PHARMACOLOGICAL• alpha blockers (eg terazosin)• 5 alpha reductase inhibitors (eg finasteride)• Saw palmetto
SURGICAL• Trans urethral resection
TESTICULAR CANCER
USPSTFInsufficient evidence to recommend for or
against routine screening for testicular cancer in asymptomatic men in general population by physician or patient self exam
TESTICULAR CANCER
Commonest cancer in men <35Seminoma and non-seminoma95% intra-testicular masses are malignantTumor markers – BHG, AFP, LDHMets to retro-peritoneal LN, lung, liver, brain Rx orchiectomy/pathology/staging 1-3Seminoma – radiotherapyNon-seminoma – chemotherapy95% cure rate, recurrence rare after two years
Jose
66 year old man “problem with erection”
Jose
66 year old man “problem with erection”
NIDDM 23 years
Smokes
ERECTILE DYSFUNCTION
ERECTILE DYSFUNCTION
• Psychological ~ 20%
• Physiological ~ 80%– Vascular– Neurological– Hypo-testosteronism
• Primary• Secondary
SMOKING CESSATION
SMOKING CESSATIONBRONX COMMUNITY AND RATES OF SMOKING 20 million smokers try to quit each year 70% report they want to quit Physician’s advice is an important motivator Half of current smokers report ever having been asked about their
smoking or urged to quit Same rates of nicotine addiction and desire to quit across all racial
and ethnic groups Socio-economic deprivation, depression and ‘feeling persistently
threatened by violence’ positively correlate with rates of smoking Tobacco companies most recently targeting poor communities and
LGBT communities
SMOKING CESSATION
SYNERGY OF INTERVENTIONS • Group sessions• One-on-one visits to provider• Phone support• Literature• Nicotine replacement• Zyban
Ernest
48 year old man with HTN for BP check
Ernest
48 year old man with HTN for BP check
Mother died colon cancer age 51
Sexually active with men
COLON CANCER
HEPATITIS
HIV COUNSELING/TESTING
HIV COUNSELING/TESTING
ASSESS
CONSENT
TEST
SUPPORT
LIPIDS
STDs
VACCINATIONS
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