Evo Terra (Host): Hey, fellas, real talk time. When is the last time you made an appointment with a doctor when you were not feeling sick or were injured? Yeah, I thought so. Let's talk about men's health, shall we?

Host: This is Memorial Health radio with Memorial Health System Ohio. I'm your host, Evo Terra. Today, I'm joined by Dr. Carson Wong, a urologist with Memorial Health System, to talk about men's health. Dr. Wong, welcome to the show.

Dr. Carson Wong: Thank you very much. I appreciate the opportunity to be here.

Host: Well, you're welcome. And, listen, I think this is probably a question that we should leave to public health officials or psychologists, or maybe even philosophers, but why, in your opinion, don't more men see their doctors on a regular basis?

Dr. Carson Wong: Well, that is an age-old question. Traditionally, women have been much better than our male counterparts at preventative healthcare and seeking healthcare when there are issues of concern, whether it's the traditional I-can-tough-it-out mentality or the machismo that prevents one from seeking help. All these factors can come into play for men to be hesitant to seek medical advice. That has changed in recent years fortunately. There has been a huge impetus in the media for men's health issues advertised by celebrities, there are men's health magazines that have been introduced. And the fact that you and I are sitting here having this conversation on a podcast on this very topic suggests that men are becoming more receptive to seeking healthcare. That is a relative statement in that there's still a significant proportion who tend to shy away from doing what they should be doing.

Host: Yeah, I'll agree with that statement. I'm just thinking of my father and stepfather right now who they will go to the doctor, but, you know, after they've fallen off a grain silo or something else along those lines that I've read up there and it's great to hear from a medical professional that you're also seeing a trend that men are now seeking out help before something gets too crazy. So, let's narrow the focus a little bit. I mean, men's health is a pretty broad topic. What are you seeing most of the time now when men are coming to see you? What are the issues they're concerned about?

Dr. Carson Wong: Well, as we men have more birthdays, the one organ that tends to become more of a problem is something called the prostate. And that is a walnut-shaped organ that's located just outside the bladder in the urinary tract. And it really has one sole function for a man, and that's for procreation. Beyond that, it really doesn't have much to offer. However, as we men have more birthdays, our prostates can give us problems in that it tends to enlarge at different rates.

With that enlargement, it can give rise to what I call quality of life issues, that is symptoms as far as difficulty with urination, weak stream, peeing frequently, having an urge to pee or getting up at night to go pee or not even emptying your bladder after voiding. So, these are what I call quality of life issues, which typically should prompt someone to seek attention. You want to address it when it is a quality of life issue, so that it doesn't become what I call a medical issue. And by that, I mean, those that get into difficulty with blood in the urine, recurrent urinary tract infections or the most extreme is you get into a situation where you are unable to pee when you want to. That requires an emergency room visit in which case a catheter of some sort will need to be inserted into your bladder to drain the bladder, to give you some relief.

Host: And that's definitely something that gives a lot of men pause thinking about the process that you just underlined there. But there's something I want to underscore because I've been in this position myself. There's no history of prostate cancer in my family. It must be because we all died too quickly, who knows what the case is. But there's not really been a prostate issue that was brought up with my father or my uncles or anyone like that. But when those symptoms began happening to me, my thought was, "Well, it's nothing because I don't have a history of prostate cancer luckily." I actually went to go see them and they ran some blood work and they said, "Oh look, you actually have BPH" and the rest of that. So, I guess if I have a message to the listening audience, just because it's not a major issue that you're facing, those challenges are something that if that prompts you to have some issues, it's definitely worth seeing a doctor about that.

Dr. Carson Wong: Right. The point I was trying to make was that you want to address it when the symptoms are mild, because you want to prevent it from progressing into either more serious symptoms or more serious medical problems. On the flip side, you may not have symptoms. But you mentioned the C word or cancer and you mentioned BPH. So, the symptoms that we've talked about are typically due to, as you call BPH, which stands for benign prostatic hyperplasia, which is a non-cancerous enlargement of the prostate. However, there is also something called prostate cancer, which you have highlighted. And it's important to differentiate between the two because obviously treatment options and longevity can be affected based on which diagnosis that very well may be.

Typically, the only way that one can diagnose prostate cancer is early screening. And it's generally recommended that for men at the age of 50 in the absence of symptoms that screening should be undertaken in terms of two components. One is a digital rectal examination, and two is a blood test called a serum prostate specific antigen or PSA level. That is something that should be performed annually on patients who have no symptoms. If you have symptoms like the ones that we outlined earlier, then definitely regardless of the age with those symptoms, you will undergo this evaluation. The only caveat is that for patients who have a family history of prostate cancer or, B, who are of African-American descent, those individuals have a higher risk than the general population of developing prostate cancer and, as such, should undergo screening starting at the age of 40 instead of 50.

Host: And as someone who has been through those screening processes, let me say that the mental picture you have in your mind, listener, of how bad they can be, it's not that bad. It's really not. I mean, honestly, it's a straightforward thing. The poke in the arm to get your blood drawn or get my blood drawn is more protracted and drawn out and painful than the digital rectal exam. It's quick, it's fast, and it's something that, you know, I keep doing because I need to do this. And I think, as you're mentioning right here, all men of a certain age likely need to have this done just to make sure and screen out any potential problems.

Dr. Carson Wong: Correct.

Host: So, we're talking a lot about the prostate here with men's health because it is a common issue. What else would a regular visit to a doctor, whether it be a urologist, a primary care physician, what else should we be thinking about as we men have more birthdays on the calendar?

Dr. Carson Wong: Well, that is obviously the biggest one because it has the biggest potential impact on both one's quality of life in the case of BPH or longevity when it comes to prostate cancer.

Host: Absolutely.

Dr. Carson Wong: Other issues that affect aging men are erectile dysfunction, which has been widely discussed and promoted one way or the other with the advent of the blue pill. And then, the most recent buzzword is something called low T or a low testosterone. And that is something that, as you say, as we have more birthdays, that can effectively become an issue that affects one's energy level and other aspects of one's life.

Host: Is it just energy? I mean, you said other aspects of life, so I know the answer is no. But the reason I asked my question this way is I've had several friends around my age. We're getting older, we're sharing ideas of how we feel and whatever else, and I know quite a few of them have had low testosterone levels. And every time I mention to them, "I'm feeling tired," "You should go get on testosterone." But so far, it's not the case. My blood work says that I'm fine. But I am curious beyond things like fatigue, what's wrong with having low testosterone? And isn't that natural your testone levels to drop as you age?

Dr. Carson Wong: Well, I guess the analogy would be the change of life that women undergo, right? That's well known, that's well discussed. And again, that's again due to the fact that women are better at talking about their own health than we men have been. So, it will affect not only energy, but it'll also affect your erectile function if your testosterone levels are low, muscle mass, bone health. I mean, these are all things that potentially can have downline effects and is something that is absolutely treatable. There are different ways to replenish that. And again, you're right, tiredness or fatigue does not necessarily mean your testosterone levels are low. And, you know, you didn't sleep well because you had a couple of late nights, that does not translate to a low testosterone. But this is talking about over time not getting any relief from sleeping per se necessarily that you would normally would and that sort of thing. It is not unreasonable for those who have erectile dysfunction to check their serum testosterone. That is typically whether one chooses to do it initially or try to give them something orally to see if it'll resolve the symptom first. And if it doesn't, then you kind of say, "Hmm, maybe there are other things that we need to look for." So, it's not always a cut and dry, "Gee, that's the first thing that you check." But at the same time, these are issues that are evolving.

I want to mention one more thing, which I think has been more recent as far as the next thing to talk about is Peyronie's disease or curvature of the penis. I've seen advertisements regarding that on prime time, which is something kind of unusual now. We see a lot of national marketing campaigns, which are condition-oriented typically put on there by a vendor of a product, whether it's pharmaceutical or surgically related product to advertising to the consumer, which is the patient themselves.

Host: Right. Right. I would love to have a forever conversation about Peyronie's disease. Something I only learned in the last few years of my life. And as you say, the advertising itself is fascinating. But I would love to get into a longer conversation at a future date with you on how we treat Peyronie's disease. And I know the answer to that question is there's lots of ways we can treat Peyronie's disease. Is there anything you want to highlight real quickly? I mean, are we talking surgery always or can there be something done with a pill?

Dr. Carson Wong: Yeah, I mean, there are something as simple as topical medications that you can put on. And again, Peyronie's disease is something that can be categorized as far as something that's acute, meaning the short term or chronic, meaning over the long term. And it has implications as far as when exactly or how far along the spectrum one is with the disease process.

If it's in the acute phase, they tend to be more susceptible to certain treatments and potentially can be reversible. Whereas in the chronic stage and things have been formalized, for lack of a better word, then the ability for some of the less invasive treatment options to have success becomes somewhat diminished. So, options can be as simple as a medication that you can put on topically. There are oral medications from simple, I say, minimally invasive surgical procedures to something slightly more aggressive as far as requiring excision of some scar and potentially putting a graft to fill that void, to putting in the inflatable penile implant, which is a foreign body. So, there is a spectrum of treatment options. And again, it depends on how the degree of severity, the direction of the severity and also whether or not you're in the early stages or the latter stages.

Host: So, we've covered three different primary things on this conversation. We started talking about prostate issues. We talked about erectile dysfunction. And now, we're talking about Peyronie's disease. And I think the common thread you said over and over, Dr. Wong, is go get yourself checked early, guys, because early treatment is better than these chronic conditions. Did I catch that properly?

Dr. Carson Wong: Early is always better. And a lot of it as far as the prostate screening is sometimes not even at a point where you have anything. So, the earlier you can detect something, the general rule is that you have more options available to you at your disposal. But later on in any disease process, the fewer options you have and potentially the lower likelihood of the desired outcome can be achieved.

Host: Well, this has been a fascinating conversation, Dr. Wong. Thank you very much for all of your time today.

Dr. Carson Wong: Well, I certainly appreciate the opportunity.

Host: Once again, that was Dr. Carson Wong, a urologist with Memorial Health System. That wraps this episode of Memorial Health Radio with Memorial Health System Ohio. For more information about urological services, please visit mhsystem.org/urology. Please rate and review this episode and check out the prior episodes of Memorial Health Radio in your favorite podcast listening app. I'm Evo Terra. Thanks for listening.