Evo Terra (Host): For all of medicine's advances, we still age. Today, a conversation about common issues men should be aware of as time passes by with my guest, Dr. Stephen Mannas, a urologist at San Juan Health Partners Urology.

Host: This is Celebrate Health, a podcast from San Juan Regional Medical Center. Thanks for listening. I'm Evo Terra. Thanks for joining me, Dr. Mannas.

Dr Stephen Mannas: Thanks for having me. I'm excited to be here.

Host: Now, I know from listening to some other podcast episodes that you have been featured on, that you and I share a common state where we are from. Tell me about growing up in Oklahoma-- Oh, wait, I changed my mind. Don't tell me about growing up in Oklahoma, because I know all about growing up in Oklahoma. Tell me a little bit about your background, education and what led you to get into urology.

Dr Stephen Mannas: Yeah. So, originally from Oklahoma and ended up going up to Notre Dame for college, which I kind of had it backwards. I spent all my winters up there and all my summers down in Oklahoma, which was not the smartest move, but came back to Oklahoma for all my medical training. And then, urology, it's kind of a funny specialty. I don't think a lot of people think about it, certainly not as a career option. So, my older brother is in urology and I feel like a lot of the people I know in the field have some sort of family connection that exposes them to it. Because otherwise, people wouldn't really consider it, and that was certainly the case for myself.

Host: Yeah, I know. I didn't think anything at all about urology until I needed to talk about urology with someone.

Dr Stephen Mannas: Yeah. And when you need it, it's important for sure.

Host: Oh my God, it sure did. Mine was the first year of the pandemic and I had kidney stones.

Dr Stephen Mannas: Not fun.

Host: Kidney stones don't run in my family. I mean, my stepdad has them, but I'm pretty sure I didn't get the gene from him. And I had nothing to go off of, other than a handful of friends who've said, "I've done this," and I wound up with a nine-millimeter stone, that clearly I'm not going to pass.

Dr Stephen Mannas: Yeah, that's legit.

Host: So, I went through two urologist, one I fired, and one I'm a big fan of right now. So, I like urologists.

Dr Stephen Mannas: They can be a little bit helpful.

Host: Yeah. No, they certainly can. Well, let's get into this urology. And as we get older, as I certainly get older, I know that this is something that many men are going to face, if not every men at some point in time is going to face. Let's talk about urology and men's health. What are some common issues that you see in your clinic as we start getting to middle age, let's say.

Dr Stephen Mannas: Sure. So more broadly, kind of just urologists in general, we specialize in medical and surgical management of the male reproductive tract as well as the urinary tract. So as you can imagine, there's a lot of different health factors within that realm that can start to go sideways as we age, particularly for men. For men specifically, a lot of these are urinary issues related to the prostate. So, you always hear about older men getting up in the middle of the night stumbling to the bathroom several times, which is certainly bothersome. And that's definitely a prostate-related issue. Obviously, screening for prostate issues like prostate cancer is important as well. But then, there's other things like erectile dysfunction, which is common; low testosterone and, you know, several other things that can pop up here and there.

Host: Yeah. And again, those are things that I know I have had to experience as we go through all of this in life, yeah. A lifetime supply of Flomax or the generic for that particular drug. All of these things are sometimes in the wheelhouse, but that's good news. Well, let's talk about some of these as a concern. I mean, some of these things are benign. Some of these things are normal, but some of them are more worrying. What should we be worried about?

Dr Stephen Mannas: So, I think the most important thing is just dealing with these things in a timely manner. So, there's things like erectile dysfunction that men are pretty hesitant to talk about, but it's not going to hurt you if you put it off. Obviously, we want to be able to help you as soon as we can to get your quality of life back. But there are some other things that if you delay, it can make it tougher. Like, obviously prostate cancer, if you're not screened for that appropriately, you could miss a diagnosis that early on could be treatable, and maybe later on not so much. But even things like just prostate enlargement, which important to know that prostate enlargement is a benign process that's separate from prostate cancer and one does not predispose you to the other. So, that's something I always stress to my patients. And prostate cancer can be tricky without screening tests because it usually doesn't cause symptoms, whereas obviously prostate enlargement does. So, management of those urinary symptoms that comes with prostate enlargement is something we deal with quite a bit. And like you alluded to, a lot of times it means medications. In some severe cases, it can mean surgery, things like that. The key is that we treat it early because rarely, but it can happen if those things get bad enough and they're left untreated for long enough, the bladder can stop functioning appropriately and you can really start running the issues that become irreversible over time.

Host: And we certainly don't want to have that. So, good preventative medicine, regular checkups is always a really good idea.

Dr Stephen Mannas: And I would throw in there as well that this is something that I think is a particular challenge for men, because women often get plugged into the medical system kind of naturally very early on, you know, especially by the time they start having children. So, taking care of health issues as they pop up is just kind of a normal part of their lives, whereas men, in comparison, a lot of times they may be healthy throughout early life. So when these things do start popping up later in life, it's kind of foreign to them that the concept of going to a doctor is something that they're maybe uncomfortable with or averse to. So, having to overcome that is something that we as medical providers have to stress the importance of.

Evo Terra (Host): I can definitely relate with that. And you're right. my wife, my mother, my sisters, everybody has had this lifetime relationship with their doctors. And guys, we go when we're not feeling well, that's it. So then, some of these things are very hard to talk to someone about even a medical provider. I totally understand that. Let's focus on prostate cancer for a moment. And let's talk about when someone should be screened. So, I know you just said there is not really a correlation between having BPH and having prostate cancer. But still at some point in time, men should be screened for prostate cancer. What's that process like?

Dr Stephen Mannas: Fortunately, it's pretty minimally invasive. It's a blood test that we do call prostate-specific antigen or PSA for short. And again, it'd almost be easier to screen if it didn't cause symptoms, because ears would perk up anytime you hear those symptoms. But in the absence of any symptoms, we have to rely on a blood test, which is fortunately easy to get. And we recommend men get this blood test every one to two years, usually between the ages of 55 to 70. But that can vary a little bit. So if you've had family members with prostate cancer for example, we may get it as early as 45. And if you're in exceptional health, you may get it as late as say 75 or so. And there've been times in the past where we've gotten it in men older than that and urologists have really started to kind of shy away from that because what we've found is that, fortunately, prostate cancer tends to be very slow growing. So in elderly men, we were a lot of times overtreating them and exposing them to side effects from invasive treatments for a disease that may not have ever caused them a problem. So, we've shied away, you know, as men get older than that 70 to 75 range, but certainly the men within that range could definitely benefit in identifying a cancer early on that would, again, be susceptible to treatment.

Evo Terra (Host): That makes sense. And you're right, it is a very easy test. I mean, it's part of my annual checkup that I go through as I get a PSA panel done as well. And my doctor always says, "You're fine," which is great news to hear, obviously. So, let's get into some preventative maintenance because as we get older, you know, we know we should do things like eat well, we should exercise regularly, we should drink more water, those basic things. But do you have any tips for men to help people at my age, you know, in their early 50s perhaps improve their health and stay out of the office of a urologist in the case we don't need something done right away?

Dr Stephen Mannas: Absolutely. And a lot of those things correlate with things any doctor would advise, you know, just basic health practices like you alluded to. Touching back on prostate issues, unfortunately, that's one thing where there's not a lot of diet or exercise things that you can do to prevent, say, prostate cancer, which tends to just be luck of the draw or genetics or prostate enlargement, which is kind of a similar issue. But for other urologic issues, for example, erectile dysfunction, a lot of times that can come up in the setting of vascular or cardiac issues that kind of extend to erectile function as well. It's good cardiovascular health, good diet practices. Certainly, diabetes can contribute to erectile dysfunction, so preventing or managing diabetes can play a role like you alluded to. For kidney stones, drinking lots of water, trying to stick to just water if you can. But certainly, staying hydrated can play a big role in preventing stones. And then, even things like low testosterone as we get older, there's actually enzymes in fat that convert testosterone basically to estrogen. So as we get larger, if we gain weight, as we get overweight, that can cause a decrease in testosterone. So, maintaining a healthy weight can help on that front as well.

Host: Great information there. Let's talk about things that we might notice. You mentioned that, you know, we really don't have much of an idea when prostate cancer is occurring, but certain things we certainly do. Any symptoms or warning signs that we haven't covered that we really should mention to people in the event that they're experiencing these that might need to come see you?

Dr Stephen Mannas: So for prostate cancer specifically, a lot of times you won't have symptoms until it's spread elsewhere in the body, which can cause things like bone pain, hip and back pain, things like that. Certainly, those are common things as we age anyway though, so it's hard to predict when someone comes in with back pain that is related to that as opposed to just a musculoskeletal issue. But it just goes to show how it's all the more important to catch these things before they get to that point, which means sticking with the screening tests

Host: Yeah, I think makes all the sense. Anything to cover we've not talked about yet on the show?

Dr Stephen Mannas: You know, obviously, there's lots of other things we dealt with as urologists. But as far as men go and the aging process goes, I think those are definitely the highlights.

Host: Excellent. Well, Dr. Stephen Mannas, thanks for joining us here in the program today.

Dr Stephen Mannas: Absolutely. I had a good time.

Evo Terra (Host): Once again, that was Dr. Stephen Mannas, a urologist at San Juan Health Partners Urology. To learn more about the services available at San Juan Health Partners Urology, please call 505-609-6380. Again, 505-609-6380. If you found this episode of the podcast helpful, please share it on your social media. And thanks again for listening to Celebrate Health, a podcast from San Juan Regional Medical Center. Hoping your health is good health. I'm Evo Terra.