Category: For Him

Men, Don’t Ignore This: A Consultant Endocrinologist’s Diabetes Advice That Could Improve Your Quality of Life

WORDS DR RADHAMANI RAJAKUMAR

FEATURED EXPERT
DR RADHAMANI RAJAKUMAR
Consultant Internal Medicine Physician and Endocrinologist
Columbia Asia Hospital – Bukit Rimau

Sobering Fact 1

MEN FACE NEARLY DOUBLE THE RISK OF DEVELOPING TYPE 2 DIABETES COMPARED TO WOMEN

Globally, an estimated 17.7 million more men than women grapple with diabetes mellitus.

This disparity extends to urological complications, with both genders equally susceptible once diabetes sets in. Over half of individuals with type 2 diabetes, regardless of gender, will experience urological complications.

Sobering Fact 2

UROLOGICAL DISEASES MARKEDLY INCREASED IN PREVALENCE WITH ADVANCING AGE & DURATION OF DIABETES

This marked increase is seen with advancing age of 50 years old and above and of diabetes duration of more than 10 years.

YOU MAY HAVE DIABETES & SHOULD CONSULT A DOCTOR IF YOU HAVE:

Lower urinary tract symptoms (LUTS, see below)
Erectile dysfunction and reduced libido
Fever and painful urination suggestive of urinary tract infection
Genital thrush (see below)
Overactive bladder (frequent urination, frequent nighttime urination, urine leakage, or incontinence)

Sobering Fact 3

MORE THAN 50% OF MEN WITH DIABETES EXPERIENCE BLADDER DYSFUNCTION

They develop lower urinary tract symptoms (LUTS) such as urinary urgency, frequency, nocturia (waking up at night to urinate), and incontinence due to diminished bladder sensation and/or poor contractility.

They are also at higher risk of developing bladder infections, called cystitis, and bladder cancer.

In men, lower urinary tract symptoms are common age-related complaints that are often attributed to benign prostatic hyperplasia (BPH), especially after the age of 50.

Why do these men develop lower urinary tract symptoms?

The effect of diabetes on the development or presence of lower urinary tract symptoms and benign prostatic hyperplasia remains controversial.

Some studies suggested that diabetes increases prostate size consistent with benign prostatic hyperplasia.

Other studies reported conflicting results that diabetes increases the risk of lower urinary tract symptoms due to bladder dysfunction rather than an increase in prostate volume.

Sobering Fact 4

35% TO 45% OF MEN WITH DIABETES EXPERIENCE ERECTILE DYSFUNCTION

The prevalence of erectile dysfunction is 3 times more common compared to men without type 2 diabetes.

However, the treatment for erectile dysfunction depends on the cause. It’s important to discuss the problem with your doctor. Often the answers to a few simple questions will help to determine if the problem is physical or psychological.

Sobering Fact 5

MEN WITH DIABETES COMMONLY EXPERIENCE ERECTILE URINARY TRACT INFECTION

Urinary tract infection (UTI) can occur anywhere in the urinary tract, including the bladder, urethra, ureters, or kidneys.

It typically involves bacteria entering the urinary system, leading to symptoms such as frequent and painful urination, cloudy or bloody urine, and strong-smelling urine.

Sobering Fact 6

MEN WITH DIABETES CAN DEVELOP REPEATED CASES OF GENITAL THRUSH

Genital thrush is a fungal yeast infection linked to excess sugar in the blood getting passed in the urine.

Because yeast thrives on sugar, it is more likely to grow on the penis of a man with diabetes.

YOU MAY HAVE GENITAL THRUSH & SHOULD CONSULT A DOCTOR IF YOU HAVE:

Redness, swelling, and itching around the head of the penis
Your penis has an unpleasant odour
A white, lumpy appearance to the skin of the penis
Soreness and discomfort during sexual activity

Sobering Fact 7

UROLOGICAL COMPLICATIONS, IN PARTICULAR SEXUAL DYSFUNCTION, CAN LEAD TO PSYCHOSOCIAL DISORDERS AND RELATIONSHIP DISHARMONY

While these complications are generally not life-threatening, they pose significant mental distress and limitations in daily functioning, thus decreasing one’s quality of life.

Furthermore, men living with type 2 diabetes may experience stress, anxiety, or depression related to the daily demands of diabetes management, fear of complications, or concerns about the future.

These emotional struggles can affect mood, behaviour, and interpersonal interactions.

Sobering Fact 8

HEALTH SCREENINGS ARE KEY TO MANAGING DIABETES

Health screenings provide valuable insights and early detection of potential complications.

By undergoing regular health screenings, diabetic men can also actively manage their condition, prevent complications, and improve their overall quality of life by addressing potential health issues early and effectively.

BEST APPROACHES FOR DIABETES MANAGEMENT

Adhere to and monitor your medications
Keep up with medical appointments and health check-ups
Eat a healthy and balanced diet
Maintain a healthy weight
Perform regular physical activity
Manage stress and seek mental health support
Aim for sufficient sleep duration
Limit alcohol consumption and quit smoking

Things You Should Know About Whiteheads & Blackheads – Beneath the Skin With Dr Benji

FEATURED EXPERT
DR BENJI TEOH TZE YUEN
Consultant Dermatologist
Central Dermatology Specialist Clinic

For most skin conditions, there is always a treatment. Hence, there is no need to suffer in silence because you have a skin condition that makes you feel self conscious about your appearance. I have encountered patients that are distressed about whiteheads, blackheads, and melasma. If you have any of these skin conditions, please join me as I share with you some useful information about these conditions and available treatments.

WHITEHEADS & BLACKHEADS

Acne is a common skin disease that affects about 85% of adolescents at some time of their lives. The most common type of acne is acne vulgaris, which makes up 99% of acne cases and affects about 95% of boys and 83% of girls by the time they are 16.^1,2

Blackheads and whiteheads are common characteristics of acne vulgaris.¹

They are the result of the pores or hair follicles of the skin being blocked by dead skin and sebum (the oil produced by the skin).^1,2

The primary lesion of acne is called a comedo.³ The plural form of comedo is comedones.
Whiteheads form when the comedones are closed and follicles are completely blocked.

Blackheads form when the comedones are open and the surface is dark black in colour due to oxidation of the lipid and melanin contents of the comedones.^2,3

Acne vulgaris on its own is not associated with any mortality, but it can cause scars to form.³ These scars can cause psychosocial challenges such as depression, anxiety, and more.³

Common causes of acne vulgaris. Click on the image for a larger, clearer version.

HOW IS ACNE VULGARIS TREATED?

Be wary of treatment or management given by non-medical doctors when it comes to treating acne—there is a risk that these procedures may worsen the acne or cause scarring. Always consult a general practitioner or dermatologist first, so that you will receive evidence-based treatments and advice in line with the Malaysian clinical practice guidelines.

The following are the recommended treatment options for acne
vulgaris.

First line treatment
The first line treatment is the first recommended treatment for a certain disease.

When it comes to acne vulgaris, the first line treatment is pharmacological treatment, usually in the form of topical creams, gels, lotions, solutions, and other forms that can be applied onto the affected area of the skin.⁴

Medical topical treatments. These contain active ingredients such as benzoyl peroxide, retinoids, antibiotics, and others.4 They may be used on their own or, for moderate cases, in combination with other creams.⁴

Systemic treatments
Medications such as oral antibiotics as well as combined oral contraceptives may be prescribed by the doctor depending on the severity of the acne and other factors.⁵

Supplementary treatments
Physical treatments. Corticosteroid injection into the affected area of the skin may be helpful, either to complement existing therapy or to improve the appearance of skin after treatment.⁶

Chemical peels—in particular salicylic acid and glycolic acid peels—may be beneficial. However, they need to be carried out with care under the supervision of an experienced dermatologist.⁶

Energy-based devices. Laser treatment on the affected skin area may be beneficial when applied alongside other treatments.⁶

RETINOIDS ARE USEFUL IN TREATING ACNE VULGARIS.

‘Retinoid’ is an umbrella term for a family of chemical compounds that share structural and functional similarities with vitamin A.

They normalize shedding of the skin (desquamation) by reducing the proliferation of a common type of skin cells called keratinocytes as well as promoting the differentiation of these cells.^4,6

Topical retinoids also block several important inflammatory pathways that are activated in acne: toll-like receptor, leukocyte migration, and AP-1 pathways. Blocking these pathways can reduce the release of inflammatory cytokines and nitric oxide as well as inhibit cellular inflammation.⁷

ADAPALENE IS A RETINOID APPROVED BY THE US FOOD AND DRUG ADMINISTRATION (FDA) FOR USE IN TREATING MILD TO MODERATE ACNE.

Adapalene is a third-generation retinoid. Compared to earlier generation retinoids, it interacts with the retinoid receptors of the skin in a different manner, so it causes less irritation compared to earlier generation retinoids while remaining just as effective.⁸

How effective is adapalene?

A meta-analysis of 5 large studies with 900 patients for over 12 weeks demonstrated that gel containing 0.1% adapalene is as effective as gel containing 0.025% tretinoin, another retinoid commonly used to treat acne (Cunliffe et al, 1998). After 12 weeks, both agents were equally effective but adapalene had a faster onset of action and less irritation.⁸

Another study (Cunliffe et al, 1997) compared 0.1% adapalene and 0.025% tretinoin on 323 patients for 3 months. They found that adapalene caused more decrease in total and noninflammatory lesions than tretinoin. However, there was no significant difference in terms of inflammatory lesions.⁹

Also, there is a study (Korkut and Piskin, 2005) that demonstrated how adapalane is more effective in treating non-inflammatory lesions compared to inflammatory lesions. The use of adapalene gel may yield results in as early as two weeks, but overall, it will take some time to see significant results.¹⁰

General adverse reactions

These include dryness, redness, irritation, and burning or stinging. These symptoms usually peak at the 2nd- to 4th-week mark before subsiding.¹¹

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Acne Acne care Acne vulgaris Blackheads Blackheads and whiteheads Dr Benji Galderma Whiteheads

Things You Should Know About Melasma – Beneath the Skin With Dr Benji

FEATURED EXPERT
DR BENJI TEOH TZE YUEN
Consultant Dermatologist
Central Dermatology Specialist Clinic

MELASMA

Melasma is a common skin condition that causes brown patches and spots, usually on the face, which are darker than your natural skin tone.^12,13

Melasma is not associated with any mortality but has significant psychosocial morbidity.^12,14 It is shown in a systemic review and metaanalysis that prevalence of depression was as high 48.5% in Asia!¹⁴

WHAT HAPPENS TO YOUR SKIN WHEN YOU HAVE MELASMA?

Melasma is linked to an increase in the production of melanin, a skin pigment that gives the skin a darker tone.¹⁵

This increased production of melanin is linked the presence of ultraviolet (UV) light.¹⁵

However, the exact mechanism of how increased melanin production can lead to the development of melasma is still being researched upon.¹⁵

Common causes of melasma. Click on the image for a larger, clearer version.

SUN PROTECTION

Increased production of melanin is linked to the presence of UV light and UV light is a component of sunlight. Therefore, it is essential to reduce your skin exposure to sunlight.

Use a broad-spectrum sunscreen when you spend time under the sun. One study found that SPF 60 sunscreen is found to offer greater improvements than SPF 30 ones.¹⁶

THE US FOOD AND DRUG ADMINISTRATION (FDA) HAS APPROVED THE USE OF A TOPICAL TREATMENT FOR DARK SPOTS ASSOCIATED WITH MODERATE TO SEVERE MELASMA.

Such a topical cream includes the active ingredients fluocinolone acetonide, hydroquinone, and tretinoin.¹⁷

The cream works to disrupt pigment production in the skin and lighten the existing dark spots on the skin.¹⁸

It is considered a prescription medicine, available only with a doctor’s prescription, so you should consult a doctor to discuss whether this cream would be suitable to treat your melasma.

What’s in the cream?

Hydroquinone is considered the primary and most effective topical agent for blocking the enzyme tyrosinase, which is a very important enzyme in the pathway of melanin production.¹⁸

On top of that, it also is known to play a role in the degradation of melanin-producing cells (melanocytes) and melanin-storing cell structures called melanosomes.¹⁸

Tretinoin, a retinoid, works by motivating epidermal and dermal turnover, which may cause rapid loss of cell pigment. In addition, it inhibits tyrosinase, facilitates the penetration of hydroquinone, and neutralizes the stratum corneum thinning effects of corticosteroids.¹⁸

Fluocinolone acetonide is a moderate potent topical steroid used to reduce the irritation caused by both hydroquinone and tretinoin.

General adverse reactions

Some people may develop allergic reaction to one or more of the active ingredients. Both tretinoin and hydroquinone have been known to be cause irritation in some people. Some people may experience adverse reactions related to the general use of retinoids, which include redness, peeling, burning, dryness, or itching.

OTHER COMMON OPTIONS

Available over-the-counter creams to manage melasma commonly contain ingredients such as vitamin C, azelaic acid, kojic acid, salicylic acid, cysteamine, niacinamide, ascorbic acid, tranexamic acid, glutathione, and soybean extract.¹⁸

These ingredients help to reduce pigmentation by disrupting the pigment production process in the skin.¹⁸

These products, however, are categorised as cosmeceuticals and they may not work as well or as fast as a medical-grade treatment. The effectiveness of their use is still being researched upon, and they may also cause irritation to the skin of some people.

Chemical peel and laser treatments may also be useful for superficial melasma.¹²

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Dr Benji Galderma Melasma

A Urologist Addresses the More Controversial Aspects of Prostate Cancer Screening

WORDS PROFESSOR DATO’ SETIA DR TAN HUI MENG

FEATURED EXPERT
PROFESSOR DATO’ SETIA DR TAN HUI MENG
Consultant Urologist
Subang Jaya Medical Centre (SJMC)

Prostate cancer is the third most common cancer among the male population in Malaysia after colorectal and lung cancer.

However, despite these staggering numbers, compared to breast cancer, prostate cancer screening appears to be a very controversial topic in medicine.

THE UNCERTAINTIES SURROUNDING PROSTATE CANCER

To date, most health professionals and the public at large are still lost and uncertain on how to go about preventive measures and the treatment of prostate cancer.

Sometimes, early prostate cancers are localized and contained within the prostate. The cancer grows very slowly and may not cause problems for years or may not even become advanced cancer. In cases like these, patients do not need to be treated.

THE RECOMMENDATION FOR PROSTATE CANCER SCREENING

In the United States, the Preventive Services Taskforce (USPSTF) gave a Grade C recommendation on screening for prostate cancer, which means individuals do not necessarily need to screen for prostate cancer unless they have concerns, and they should discuss their concerns with their physicians.

This recommendation came about to reduce the overdiagnosis and overtreatment of prostate cancers.

This decision, however, has resulted in an increasing trend of prostate cancer mortality and morbidity, causing much suffering and compromising the quality of life for patients.

THE CHALLENGE THAT WE FACE TODAY

The challenge today is to come up with a strategy to screen the right population and find lethal prostate cancers.

Equally important, we will also need new treatments that are less invasive and cause less morbidity in individuals.

IMPROVING SCREENING ACCURACY WITH mpMRI SCREENING

For more than 30 years, the medical profession did not make headway with regard to the diagnosis and management of prostate, other than developing robotic techniques and better radiotherapy to remove the tumours.

The Problem with the ‘Old System’

The diagnosis using systematic non-targeted transrectal ultrasound scan (TRUS) guided biopsy is highly inaccurate as it has high false negative rate. This is dangerous as it misses at least 50% of cancer.

The Development of mpMRI and Its Advantages

The transformative advancement in the diagnosis and treatment of prostate cancer was the development of multiparametric MRI (mpMRI) of the prostate.

Using mpMRI as a triage can spare significant number of men from undergoing unnecessary prostatic biopsies and avoiding both physical and psychological trauma and morbidity, especially if TRUS biopsies are performed.

Many studies have confirmed that mpMRI is highly reliable in identifying more than 90% of men with clinically significant and lethal prostate cancer.

This method was reported to be much more sensitive (93%) in detecting prostate cancers compared to TRUS biopsies (48%).

MpMRI as a triage also detects much fewer clinically unimportant prostate cancer (54% fewer) compared to using the traditional TRUS biopsy.

In other words, mpMRI reduces overdiagnosis of clinically unimportant prostate cancer and improves the detection of clinically significant and deadly prostate cancer.

HENCE, TO SCREEN OR NOT TO SCREEN?

Many screening studies have shown that for men diagnosed with prostate cancers, whether they are treated or not, their survival outcome is generally over 10 years or so.

This shows that a majority of the men with prostate cancer detected by screening do not benefit from treatment.

Instead, they suffer the consequences of treatment, like losing potency and experiencing urinary or rectal symptoms with occasional incontinence!

However, long-term studies show the benefits of screening are observed after consistent follow-ups for 12 years or more.

The Goteborg Randomised Cancer Prostate Screening Trial, done in Sweden, revealed that for men who have undergone over 14 years of follow-up and completed the screening, there was a 66% decrease in advanced prostate cancer in the screened population compared to the population of men who were randomized to the non-screening arm.

Therefore, one can conclude that men who have serial PSA screening and then treated if prostate cancer is detected have a 66% less chance of developing advanced prostate cancer—which often results in very painful bone metastases.

There was also a 56% lower mortality rate in the screened population.

Extrapolating from this result, in the Swedish population, PSA screening can save 5,700 out of 1 million screened men from dying of prostate cancer.

THE BEST WAY FORWARD

In summary, prostate cancer is still a significant life-threatening disease.

Early detection and early prediction of the disease are crucial, whereas screening in men with long life expectancies is beneficial.

Overdiagnosis and overtreatment issues can be addressed with targeted screening and biopsy only for at-risk patients. This aims for early detection & diagnosis of localized lethal prostate cancer, which is fully curable.

If diagnosed with non-lethal prostate cancer (especially low-grade cancer), individuals only require good active surveillance with a follow-up mpMRI. They should also repeat a biopsy of the prostate if necessary.

It is crucial for those with intermediate-grade prostate cancer (ISUP 2) or large volume low-grade prostate cancer (> 6mm core cancer tissue) to receive careful active surveillance paired with good clinical judgement and a follow-up mpMRI as well.

Men with localized lethal prostate cancer will need ablative treatment with surgery, radiotherapy or occasionally brachytherapy. Counselling for adverse events like erectile dysfunction and occasional urinary incontinence following ablative treatments should also be given.

MpMRI has greatly improved the diagnosis of clinically important prostate cancer, and better genomics will help predict the prognosis of the disease. Transperineal mpMRI – ultrasound fusion prostatic biopsy is the way forward. Focal therapy like HIFU, irreversible electrophoresis or targeted ablation will probably play an increasing role, especially for patients with favourable intermediate-risk or low-grade large-volume prostate cancer.

cancer cancer diagnosis men's health non-targeted transrectal ultrasound scan (TRUS) oncology Professor Dato’ Setia Dr Tan Hui Meng prostate cancer prostate gland Subang Jaya Medical Centre

What Happens When Your Prostate Gland Becomes Enlarged? Find Out from A Consultant Urologist

WORDS DR GOH ENG HONG

FEATURED EXPERT
DR GOH ENG HONG
Consultant Urologist
Prince Court Medical Centre

BENIGN PROSTATIC HYPERPLASIA (COMMONLY ABBREVIATED AS BPH) IS A NON-CANCEROUS ENLARGEMENT OF THE PROSTATE GLAND COMMONLY OBSERVED IN OLDER MEN

An overview of benign prostatic hyperplasia. Click on the image for a larger, clearer version.

This condition has become more common due to several factors including:

Changes in men’s attitude towards their health and well-being. These changes in attitude led to them seeking medical advice more proactively.
Advancements in healthcare have led to a longer lifespan seen among men. Because of this, there is an increase in the number of elderly individuals and consequently has a rise in the incidence of benign prostatic hyperplasia.

By the age of 50, about 50% of men experience prostate enlargement, and this figure rises to about 80% by the age of 80.

This highlights a significant correlation between age and the prevalence of benign prostatic hyperplasia.

COMMON SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA

Seek medical attention when you experience any of these symptoms over a long period of time or when they interfere with your daily routines.

Frequent trips to the restroom
A need to wake up from sleep to urinate (nocturia)
Weak urine flow
Painful urination
Blood in the urine
A feeling of incomplete bladder emptying
Symptoms of more advanced stages of benign prostatic hyperplasia can include high fever and/or an inability to urinate.

SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA CAN WORSEN OVER TIME

This is especially true as individuals age and potentially encounter other health problems that can worsen their prostate issues, such as diabetes and stroke.

However, if one’s underlying health issues are well-managed and infections are treated effectively, there is potential for improvement in the prostate condition.

AVAILABLE TREATMENT OPTIONS FOR BENIGN PROSTATIC HYPERPLASIA

Treatment involves a comprehensive approach for managing any underlying conditions and considering the extent of the enlargement and its impact on the patient.

If the prostate enlargement is minimal, usually we will monitor for the time being for any further enlargement.

However, if symptoms cause significant discomfort, the doctor will prescribe the appropriate medications to manage these symptoms.

If medications are not effective, we can consider surgery. There are several surgical options to consider, depending on individual circumstances and preferences.

LIFESTYLE & SELF-CARE MEASURES TO MANAGE THE SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA

Adopt a lifestyle regimen that includes reducing the intake of irritants like caffeinated beverages—these irritants can increase the urge to urinate.
Reduce consumption of liquids and foods high in water content during the evenings, to help avoid nighttime bathroom visits.
Maintain proper hygiene to prevent infections, especially since prostate enlargement increases one’s risk of infection.

TIPS TO REDUCE ONE’S RISK OF BENIGN PROSTATIC HYPERPLASIA

Benign prostatic hyperplasia is associated with ageing. Good habits as above could prevent worsening of the condition.

Additionally, one should seek regular medical check-ups, such as blood and urine tests, to monitor kidney function and identify potential infections early.

benign prostatic hyperplasia Dr Goh Eng Hong good habits to adopt men's health Prince Court Medical Centre prostate gland urology

How Much Do You Know about Male Breast Cancer? Let’s Find Out!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR NIK MUHD ASLAN ABDULLAH
Clinical Oncologist
Sunway Medical Centre

BREAST CANCER AFFECTS MEN AS WELL AS WOMEN

Breast cancer in both men and women share many similar attributes.

The most common kinds of breast cancer in men are the same kinds that are present in women, namely:

Invasive ductal carcinoma
Invasive lobular carcinoma
Ductal carcinoma in situ (or DCIS)

Dr Nik Muhd Aslan Abdullah says that breast cancer is, however, rare among men.

WARNING SIGNS

According to Dr Nik, many of the most pressing early warning signs of breast cancer in men are also similar to those found in women, such as:

Lumps in the breast tissue
Skin dimpling or puckering
Nipple retraction
Unusual discharge from the nipple

HORMONAL CHANGES CAN GIVE RISE TO BREAST CANCER

One reason why breast cancer is rare among men is that the hormone testosterone inhibit the growth of breast tissue, while oestrogen stimulates breast tissue growth.

While men and women have both hormones in their bodies, men have higher levels of testosterone compared to women. On the other hand, women have higher levels of oestrogen.

Some breast cancer cells have special structures at the surface, called hormone receptors. These cells are called hormone-receptor positive (HR positive for short). Oestrogen can bind to these receptors to cause the growth of these cells. Dr Nik explains that men have a higher possibility of developing breast cancer cells that are HR-positive, when compared to their female counterparts.

“Breast cancer cells in men are sensitive to hormonal imbalances,” Dr Nik explains, “so any factors or conditions that can lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”

What can cause the raise in oestrogen levels in men?

Klinefelter syndrome, a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens
Injury to the testicles
Use of androgen inhibitors
Liver cirrhosis (scarring of the liver)
Obesity

Family history also plays a factor

About 1 out of 5 men with breast cancer is found to have had a family history of the disease.

This is because men can also inherit a mutation in the BRCA1 or BRCA2 genes or in other genes, such as CHEK2 and PALB2. These mutations will highly increase their risk for breast cancer.

“Unfortunately, we do not have a say in the types of genes we inherit,” Dr Nik says.

He recommends that men with a family history of cancer should consider seeking counsel from their doctors about going for genetic screening tests as soon as they can, especially those over the age of 50.

Genetic screening tests involves taking a blood sample for analysis. A genetic counsellor will then advise the person, based on the results given, on what the next best steps would be for him.

How to conduct self-breast examination for men. Click the image for a larger version.

MEN WITH HR-POSITIVE BREAST CANCER ARE MORE LIKELY TO RESPOND TO HORMONE TREATMENTS

Dr Nik explains that hormone therapy can be used to help lower the risk of the cancer cells spreading or treat cancer that has come back after treatment.

Why then do men with breast cancer have lower survival rate compared to their female counterpart?

“Through many of the studies that I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women,” Dr Nik says.

He attributes this to the fact that men with breast cancer are often diagnosed late.

“Men will sometimes wait too long to seek out a diagnosis for the symptoms they may be experiencing,” he explains, “or not recognize the warning signs of breast cancer in their bodies.”

As a result, they delay seeking help, and tend to do so only when the cancer has become advanced and spread to other parts of the body.

Dr Nik encourages men to seek a doctor’s opinion if they find themselves experiencing any of the mentioned symptoms related to breast cancer. “Breast cancer can be cured, and it is very treatable if detected early on,” he says.

breast cancer cancer Dr Nik Muhd Aslan Abdullah ductal carcinoma in situ invasive ductal carcinoma invasive lobular carcinoma male breast cancer men's health oncology Sunway Medical Centre

A Man’s Swimmer Problems

A Man's Swimmer Problems

May 8, 2022 Return

WORDS LIM TECK CHOON

Man’s Health and Fertility with

Dr Agilan Arjunan

Consultant Gynaecologist & Fertility Specialist KL Fertility Centre

According to the Guinness Book of World Records, Moulay Ismail ibn Sharif who ruled Morocco during the 17th century likely fathered 1,042 children during his lifetime. Some historians believed that the number might be as high as 1,171!

These days, it may not be possible to have this many children, even if the man is crazy enough to want to, as there are reports that, overall, the sperm count for men in America, Europe, Australia and New Zealand has dropped by more than 50% in less than 40 years. However, we have yet to find out the exact reason(s) for this fall. It is speculated that perhaps it is due to exposure to chemicals or pollutants, smoking, stress, obesity or maybe even all of them.

This month, we join fertility specialist Dr Agilan Arjunan in looking at what men can do to ensure that their fertility is still up there to create that little bundle of joy with their beloved partner.

Reference: Kelland, K. (2017). Sperm count dropping in Western world. Scientific American. Retrieved from https://www.scientificamerican.com/ article/sperm-count-dropping-in-western-world/

EAT BALANCED MEALS AND MAINTAIN A HEALTHY WEIGHT

Too much! “The heavier you are, the more fat you will have stored in your body,” says Dr Agilan. As a result, there is more testosterone, the male sex hormone, converted to oestrogen, the female sex hormone in the fat. This will significantly affect sperm production, which is driven by a cascade of hormones that include testosterone.

Too hot! Another issue that comes with having excess weight is that it causes the temperature in the testicles to increase. Optimal sperm production requires a temperature that is slightly lower than that of the rest of the body, which is why nature has designed a man’s testicles to dangle between the legs instead of being an internal organ. The hotter it gets inside the testicles, the lower is the rate of sperm production.

“So … eat less?”

Not just that. To maintain a healthy weight, total energy obtained through food should be equal to total energy used by the body. So, there are two components to consider here: eating healthy, balanced meals and being physically active on a regular basis.

“How can I eat less? I’ll starve!”

We don’t have space in this article to fully dwell on the principles of healthy eating, but you can consult a dietitian for more advice. Basically, you should eat foods from all food groups, according to the recommended portion size based on your age, sex, current body weight, level of physical activity and any existing health condition you may have.

Some hunger is inevitable at the early stages of your new diet, but you will survive and adapt. Hang in there – over time, you will feel healthier, happier, and sexier!

“EAT RIGHT + REGULAR EXERCISE = HEALTHY WEIGHT”

“I’m already hungry and now you want me to exercise? Are you joking?!!”

Daily physical activity is important, as it strengthens the muscles and keeps the body working in good condition (all these are great for many things, including making babies). It also burns away any unused calories from your meals, ensuring that you do not gain weight. Furthermore, exercise is a great stress reliever. The gains far outweigh any momentary discomfort you may experience when you begin your new exercise routine.

DON’T DRINK LIKE A FISH!

If you like your alcohol, brace yourself as there is no way to break it gently: abstaining from alcohol is always better when it comes to trying for a baby. Even moderate consumption of alcohol can affect fertility in a significant manner.

Alcohol affects both sperm count and quality. This is because it can disrupt the ideal conditions in the testicles needed for optimal sperm production. Over time, it can even cause the cells in the testicles responsible for sperm production (Sertoli cells) to deteriorate. Alcohol may also affect the production and regulation of hormones that regulate sperm production.

All in all, drinking is not a good thing when it comes to ensuring that a man’s swimmers are in good condition and numbers!

“Sober up, huh? You think that’s simple? HAH!”

Don’t be so pessimistic! These days there are programmes to help people quit drinking successfully. A psychiatrist specializing in treating addictions will be the best person to turn to, but if one is not available near you, you can try asking a family medicine specialist for help. There are also many support groups available both in real life and online.

STOP SMOKING! (IF YOU DON’T SMOKE, DON’T START!)

“It’s been known for many years that smoking can reduce both sperm count and the quality of the sperm produced by the man,” Dr Agilan points out, adding that the sperm count is especially affected by this habit.

It is found that the tobacco in cigarette contains substances that can negatively affect the ability of a man to produce normal amounts of sperm.

In the sperm cells that are produced, it is found that many have lower motility than sperm cells produced by non-smokers – which is to say, these sperm cells are less capable of traveling along the woman’s womb to successfully reach the egg cell.

“Hmm, so I should quit. That’s hard, right?

These days it’s easier to quit compared to the past, thanks to a combination of nicotine replacement therapy and counselling. You can consult your neighborhood pharmacist for more information.

“Wait … if the problem is nicotine, I can then vape instead, right?”

Dr Agilan points out that research on vaping is still at early stages, and it’s likely that other chemicals present in vape juices may also affect sperm count and quality. Why risk the chance?

DON’T STRESS IT!

There is evidence that high levels of stress can affect sperm production, according to Dr Agilan. Furthermore, stress also makes it hard for couples to experience the mood to make babies!

When you are stressed, the body reacts as if you were in danger and releases stress hormones, which trigger the fight-or-flight response. You will feel your heart beating faster, your breathing will become shallower and you feel tensed up. The fight-or-flight response also closes off other functions that the body considers to be of lesser importance when dealing with the stress, and one of these functions is reproduction. Therefore, the more stress you experience, the more your sperm count may be affected.

Stress can come from a variety of external sources outside the bedroom – work, family finances, relationship woes, health issues. However, it can also come from the bedroom.

Dr Agilan cautions against what is called “medicalizing” the process of making babies. This occurs when couples are so determined to have a baby that each planned sexual encounter ends up becoming a stressful chore.

“But… but… AAAH! I JUST CAN’T ANYMORE!!!”

Calm down! Challenges and frustrations are inevitable parts and parcels of life. Often, stress relief can be obtained by stepping back for a while to focus on relaxation activities such as exercise, yoga, keeping a journal or anything else that can bring you a sense of peace.

But do reach out for help when you need to!

There are counsellors, hotlines and support groups out there that can help, and some of them offer free support. If trying to have a child is causing you and your partner undue stress, it may be time to seek a fertility specialist for advice.

DOES IT MATTER HOW YOU WRAP THE FAMILY JEWELS?

It’s well known that boxers are supposed to be the underpants of choice as the tighter briefs- style underpants can elevate the temperature around the testicles and affect sperm production. Interestingly, there are studies which conclude there isn’t any significant difference in sperm production and quality among men who wear either type of underpants. However, Dr Agilan believes that there is no harm in choosing to wear boxers over briefs – anything that can increase the odds of success can be a good thing!

What happens if a man is born with low or zero sperm count? Dr Agilan will focus on such a situation in the next column, so don’t miss it! HT

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GUYS, WATCH OUT FOR THESE SILENT HEALTH THREATS!

May 8, 2022 Return

WORDS HANNAH MAY-LEE WONG

HEART DISEASE

Heart disease is the primary cause of sudden death among men in Malaysia. According to Dr Tee Chee Hian, sudden death can be caused by a variety of heart problems such as arrythmia (having an irregular heartbeat), congenital heart disease, or more commonly, coronary artery disease.

Know the signs and symptoms

Catching heart disease early may help prevent sudden death. Dr Tee says that men experiencing symptoms such as palpitations, fainting episodes, lethargy, shortness of breath on exertion, chest pain, postprandial angina (chest discomfort after meals), or reduced exercise tolerance should see their doctor immediately, as these may be signs of heart issues.

Men should also get screened regularly for the common risk factors of heart disease such as dyslipidaemia (abnormal cholesterol levels), hypertension, and diabetes.

Keep a heart-healthy lifestyle

Lifestyle changes that include quitting smoking, having a balanced diet with more vegetables and fruits, and doing exercises that promote cardiovascular fitness like running, jogging, and cycling can help lower the risk of heart disease.

PROSTATE CANCER

Dato’ Dr Selvalingam Sothilingam notes that prostate cancer is the 3rd most common cancer in Malaysian men. It is often diagnosed in the late stages, due to the asymptomatic nature of the disease in its early stages.

Get screened

“The most common age for diagnosis of prostate cancer is men in their 60’s and 70’s. However, we have also detected cancer cases in men as early as in their 50’s. Early diagnosis is key as it is potentially treatable if detected at an early stage,” Dr Selvalingam explains.

Men that have a family history of prostate and/or breast cancer should get screened for prostate cancer from the age of 45.

The right diet may lower risk of prostate cancer

Dr Selvalingam shares that frequent consumption of foods such as cooked tomatoes, soya products, green tea, vegetables, and fruits may lower a person’s risk of prostate cancer.

On the other hand, having a diet high in red meats and processed foods as well as low in fibre may increase the risk of prostate cancer.

Just Guy Things

April 28, 2022 Return

Ask people what defines a man and, chances are, the first thing that crosses the mind are those body parts down below. There are at least 174 ways to describe the penis using the English language, and at least 100 for the testicles. We said ‘at least’, because there is no doubt that more slangs and creative euphemisms are created for those body parts with each passing year.

We may talk and think quite a lot about those body parts, but just how well do you really know the male reproductive system? Our grandparents often tell us that to truly know something is to love it, so guys, if you really want to love those parts down below, let’s take a while to know them better.

Here are the Guy Bits

Comedians and other people who think they are so funny often describe men as simple, uncomplicated creatures. Well, compared to the fairer sex, there may be some truth to that. For one, biology has decided that the human male reproductive system is less complex than the female reproductive system!

You are no doubt familiar with the penis and scrotum as they are the visible components of the male reproductive system. Hidden from view and less well-known are structures inside the body, such as testes and prostate gland

The structures of the male reproductive system serve three important functions – to let you look like and function as a man, allow you to make babies and get rid of urine.

The testicles produce sperm cells, which are then sent to the epididymis to mature. The prostate gland (which technically is part of the exocrine system) produces a fluid that make up a big part of the semen. This fluid serves to nourish sperm cells, so that they function properly to allow the conception of new life.

The testicles also produce and release male sex hormones such as testosterone. These hormones play key roles in the regulation of many important functions to give men their distinctive characteristics (facial hair, huskier voice, etc) and maintain the function of their reproductive system.

The penis also helps to expel urine, which contains excess water and unwanted waste products.

What Can Go Wrong?

Men are naturally concerned about the possibility of things not working properly, especially when it comes to making babies. However, let’s not overlook the dreaded ‘C’ word – cancer. Find out more in the next article.

Reference: WebMD. Available at www.webmd.com

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Grief to the Prostate

April 28, 2022 Return

Dr Sulaiman Tamanang Consultant Radiologist and Nuclear Medicine Physician, The National Cancer Society of Malaysia

Prostate cancer may not be the most common cancer among men in Malaysia – that would be lung cancer – but it is nonetheless common in men over 50, according to Dr Sulaiman Tamanang, a consultant radiologist and nuclear medicine physician. To date, we have not identified the actual cause(s) of prostate cancer.

No early symptoms

When it comes to prostate cancer, there are usually no specific symptoms during its early stages.

Symptoms usually show during advanced stages

Symptoms may occur at later stages, and even then, things are complicated by the fact that these symptoms may be the same as those of other conditions, such as benign prostatic hyperplasia (BPH, swelling of the prostate glands).

Therefore, see a doctor as soon as symptoms occur

Some symptoms to watch out for are:

Urinary problems – blood in the urine, difficulty in urinating, weak urine flow, frequent need to urinate (especially at night), pain or burning sensation while urinating.
Problems achieving or maintaining an erection.
Pain in the hips, back, chest and other areas; this may be a sign that the cancer has spread to the bones.

Even better, go for screenings

Dr Sulaiman recommends every man over 50 to take the prostate-specific antigen (PSA) test once a year. Getting screened is just a matter of having some blood taken to be tested in the laboratory. This test is available at most medical establishments, and can be requested as an add-on to standard health screening packages.

“While this screening is not 100% accurate, it gives us some indication that there may be something wrong,” Dr Sulaiman explains. Therefore, this screening can be a good way to detect prostate cancer at an early stage.

Treatment

Early is better

Just like with other types of cancer, early detection often means an improved chance of recovery and a lower possibility of the cancer returning (recurrence).

Treatment options

There are usually three options available – surgery, hormone therapy and chemotherapy.

For a patient of advanced age, however, Dr Sulaiman says that a “wait and see” approach is usually adopted. This is because at that age, there are other diseases that will pose a bigger threat to the man’s health.

Prostate surgery

For early stage prostate cancer, it is usually recommended to have the affected prostate removed via surgery. Parts of the surrounding tissues (including lymph nodes) may also be removed, so that they can be examined to determine whether the cancer cells have spread.

“There may be side effects,” explains Dr Sulaiman, “such as poor urine stream and dry ejaculation (no ejaculate is released during orgasm). However, not everyone will experience them, and we have means (medication, therapy, etc) to address them when they occur.”

Hormone therapy

Hormone therapy is usually offered to patients whose cancer has reached an advanced stage, or if the patient is unable to undergo surgery for medical reasons.

Dr Sulaiman explains that, in a patient with prostate cancer, the testosterone hormone can stimulate cancer cells to grow. Hormone therapy acts to either reduce the amount of testosterone produced in the body, or to stop testosterone from reaching the cancer cells.

As a result, the cancer cells grow slower or, in some cases, the tumour may shrink in size. However, hormone therapy will not cure prostate cancer.

Hormone therapy may cause side effects due to the changes in testosterone level in the body, such as decreased libido, erectile dysfunction and growth of breast tissue (gynaecomastia).

Chemotherapy

Chemotherapy is usually a “second resort” treatment, given when the patient does not respond favourably to hormone treatment, or when their cancer has spread to other parts of the body.

This therapy involves the use of drugs to kill the cancer cells in the body. Depending on the severity of the cancer, the patient may be offered a combination of different drugs. These drugs will help to slow the growth and spread of the tumour(s), and in the process give the patient more time and improve his quality of life. However, they will not cure the cancer.

Chemotherapy has side effects, caused by the fact that the drugs cannot tell healthy cells apart from cancer cells. Healthy cells will also be affected by the drugs, leading to side effects such as changes in physical appearance (loss of hair, nails, bloating, skin blotching, etc), nausea, fatigue and weakened immune system (which may increase the risk of infections). The good news is that these side effects will eventually go away once treatment is over.

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