As Men Age: Health Issues to Watch Out For

We all like to think we’re young at heart, but our bodies have a way of reminding us that we’re getting older. For men, three common urologic health concerns associated with aging include urinary symptoms, elevated PSA, and erectile dysfunction (ED). Roughly five percent of men under age 65 experience problems with urinary control, and the incidence increases to 15-30 percent after age 65. PSA is a blood test that can be elevated in men with prostate cancer, which is the second most common cancer affecting men, after skin cancer, and the fourth most diagnosed cancer in the world. As for ED, one study of male aging found that approximately 40% of men have some degree of ED by age 40. By age 70, that figure rises to nearly 70%.

Urinary Issues

As men age, their prostates sometimes become enlarged and obstruct the bladder, causing urinary symptoms including urinary frequency, urgency, nighttime waking, and weak stream. This is a condition called benign prostatic hyperplasia (BPH).

There are many options for treating BPH. Lifestyle changes can be helpful, including quitting smoking, reducing caffeine and alcohol, and bladder training with pelvic floor exercises. For additional help with symptoms, many men use medications such as alpha blockers or 5-ARI’s that can be effective. If a medication side effect is bothersome, then some patients consider minimally invasive procedures such as the Urolift Prostatic Urethral Lift or Rezum water vapor ablation because both are effective and allow patients to discontinue medications. Occasionally, the prostate anatomy may not be amenable to minimally invasive procedures; therefore, transurethral resection of the prostate (TURP) or robotic simple prostatectomy are better options. Choosing the right treatment option will depend on the size and orientation of the prostate, as well as each patient’s individual preference.

Prostate Cancer

Regular checkups are especially important for diagnosing prostate cancer because the disease rarely causes any symptoms until the late stages. PSA (prostate specific antigen) is a protein produced by prostate tissue. The American Urological Association recommends prostate cancer screening with a “baseline PSA test to people between ages 45 to 50 years” and at “age 40 to 45 years for people at increased risk of developing prostate cancer based on the following factors: Black ancestry, germline mutations, strong family history of prostate cancer.” Elevated PSA levels in the blood could indicate prostate cancer, prostate infection, or BPH. To distinguish the cause of elevated PSA, additional tests may be needed, as well as MRI. If those results are suspicious, a prostate biopsy will be needed to determine the presence and aggressiveness of prostate cancer.

Treatment for prostate cancer depends on the aggressiveness and stage of the cancer, the patient’s age and general health, and the patient’s preferences. Many slow-growing prostate cancers can simply be monitored with a process known as active surveillance. If treatment is needed, options include radiation, chemotherapy, hormone therapy and surgery.

Erectile Dysfunction

Erectile dysfunction, or ED, is often a progressive problem, with the ability to achieve or maintain an erection declining over time. ED can have emotional causes like depression, anxiety, stress, or relationship difficulties. However, ED can also be associated with physical conditions such as heart disease, high cholesterol, high blood pressure, thyroid dysfunction, or diabetes. Some men find that improving their overall health will result in improved erectile function.

Erectile dysfunction can be treated with prescription medications, which increase blood flow. Your doctor will review the risks of the various treatment options with you. A vacuum erection device from a reputable retailer can help achieve an erection. Counseling through a mental health provider or a sex therapist can also be helpful if the ED has emotional/psychological causes. An inflatable penile prosthesis may be recommended in certain situations.

It’s possible to minimize the impact urinary issues or ED or may be having on your life, or you may rationalize that these issues are just part of aging. However, doing so limits your ability to enjoy a great quality of life, and may also delay the diagnosis of another more serious health condition. Many treatments are available, and the earlier an issue is diagnosed and treated, the better the outcome.

MarinHealth’s expert urology team covers all urologic subspecialties. We provide highly-personalized care, encouraging our patients to collaborate on treatment plans that fit their lifestyle and personal preferences. To learn more and find a urologist near you, visit: www.MyMarinHealth.org/urology.

Dr. Benjamin Dudley is a general urologist. He sees patients at MarinHealth Urology in Novato and Petaluma.