Cypress Edition | June 2023

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Let’s talk about the “Big Four.” And we’re not referring to the number of major American pro sports leagues or top accounting firms. Instead, we’re alluding to medical conditions of the prostate that may be embarrassing for men to bring up with their doctors. But discussing them, and any related symptoms, may just save their lives. “A man’s symptoms may be due to an easily treated urinary infection or something serious, such as prostate cancer,” says Evan Lacefield, MD, a urologist with Memorial Hermann Medical Group who is affiliated with Memorial Hermann Cypress Hospital. Speaking to a doctor can help rule out – or diagnose – these four conditions: an enlarged prostate, erectile dysfunction, low testosterone or prostate cancer. Many can have similar symptoms. Dr. Lacefield answers commonly asked questions about these symptoms and when to get help. Should I worry that I need to use the restroom during the night? Why it’s important to discuss : By far and away, the most likely culprit is an enlarged prostate gland, but it’s important to rule out scar tissue in the urethra which shares symptoms. Plus, addressing the problem will improve quality of sleep and life. Untreated symptoms may only rise with age. Signs : The prostate gland gets larger with age, starting in the 40s. This can block normal flow from the bladder or urethra (urinary tract). That leads to a slower, delayed or intermittent urine stream, incomplete emptying and dribbling. This can lead to bladder infections or an inability to urinate. Common signs include weak stream, urgency, straining to pee and getting up at night. How Common : One-third of men are bothered by symptoms by age 60 and half by age 80. Diagnosis : A urologist will look inside the prostate and bladder with a tiny camera. This takes all of 30 seconds. Treatment : Medications can help, but many men end up requiring or preferring minimally invasive surgeries to correct the issue. Why has my sex drive or energy dropped? Why it’s important to discuss : Men may suffer low levels of the male hormone testosterone, which can be improved. Signs : Men may have less energy, a lower sex drive or fewer erections. They might also be sad, angry or less focused, or be gaining weight. : By far and away, the most likely culprit is : The prostate gland gets larger with age, starting in the 40s. This can : One-third of men are bothered by symptoms by age 60 and : A urologist will look inside the prostate and bladder with a tiny : Medications can help, but many men end up requiring or : Men may suffer low levels of the male How Common : Testosterone fuels puberty, hairiness, lower voice and other signs of manhood. Testosterone levels often drop slightly as men age. Diagnosis : Blood tests reveal low hormone levels (hypogonadism). Why it’s important to discuss : By far and away, the most likely culprit is an enlarged prostate gland, but it’s important to rule out scar tissue in the urethra which shares symptoms. Plus, addressing the problem will improve quality of sleep and life. Untreated symptoms may only rise with age. Signs : The prostate gland gets larger with age, starting in the 40s. This can block normal flow from the bladder or urethra (urinary tract). That leads to a slower, delayed or intermittent urine stream, incomplete emptying and dribbling. This can lead to bladder infections or an inability to urinate. Common signs include weak stream, urgency, straining to pee and getting up at night. How Common : One-third of men are bothered by symptoms by age 60 and half by age 80. Diagnosis : A urologist will look inside the prostate and bladder with a tiny camera. This takes all of 30 seconds. Treatment : Medications can help, but many men end up requiring or preferring minimally invasive surgeries to correct the issue. Why has my sex drive or energy dropped? Why it’s important to discuss : Men may suffer low levels of the male hormone testosterone, which can be improved. Signs : Men may have less energy, a lower sex drive or fewer erections. They might also be sad, angry or less focused, or be gaining weight. Speaking to a doctor can help rule out – or diagnose – these four conditions: an enlarged prostate, erectile dysfunction, low testosterone or prostate cancer. Many can have similar symptoms. Dr. Lacefield answers commonly asked questions about these symptoms and when to get help. Should I worry that I need to use the restroom during the night? Let’s talk about the “Big Four.” And we’re not referring to the number of major American pro sports leagues or top accounting firms. Instead, we’re alluding to medical conditions of the prostate that may be embarrassing for men to bring up with their doctors. But discussing them, and any related symptoms, may just save their lives. “A man’s symptoms may be due to an easily treated urinary infection or something serious, such as prostate cancer,” says Evan Lacefield, MD, a urologist with Memorial Hermann Medical Group who is affiliated with Memorial Hermann Cypress Hospital. Four men’s health conditions men may not want to talk about but should. Four men’s health conditions men may not want to talk about but should. How Common : Testosterone fuels puberty, hairiness, lower voice and other signs of manhood. Testosterone levels often drop slightly as men age. Diagnosis : Blood tests reveal low hormone levels (hypogonadism). : Testosterone fuels puberty, hairiness, lower voice and other : Blood tests reveal low hormone levels (hypogonadism).

Treatment : Testosterone can be restored via creams, injections or long-lasting pellets inserted beneath the skin of the lower back. While men should undergo normal prostate cancer screening, there is no evidence of increased risk for developing prostate cancer. Why is my sexual performance changing? Why it’s important to discuss : Men don’t have to suffer. “If there’s a will, there’s a way. Don’t be embarrassed to ask somebody for help,” says Dr. Lacefield. Also, hypertension, blocked arteries and other conditions may be to blame for changes in sexual performance. Signs : Erections may become less firm or not last long enough. Treatment : Testosterone can be restored via creams, injections or long-lasting pellets inserted beneath the skin of the lower back. While men should undergo normal prostate cancer screening, there is no evidence of increased risk for developing prostate cancer. Why is my sexual performance changing? Why it’s important to discuss : Men don’t have to suffer. “If there’s a will, there’s a way. Don’t be embarrassed to ask somebody for help,” says Dr. Lacefield. Also, hypertension, blocked arteries and other conditions may be to blame for changes in sexual performance. Signs : Erections may become less firm or not last long enough. How Common : All men have the occasional bout of impotence, but incidence rises 10% per decade after age 40. Thus, 50% of men in their 50s and 60% of men in their 60s experience some erectile dysfunction. Diagnosis : Simple blood tests can help identify factors not related to age: low testosterone, insulin resistance, high cholesterol. Treatment : Pills, injections, vacuum erection devices and penile prosthesis can restore function. Could it be prostate cancer? Why it’s important to discuss : While urinary symptoms are almost never a sign of prostate cancer, enlarged prostate and prostate cancer often occur around the same time in life. Signs : A primary care doctor will check a man’s PSA (a blood test) every year, usually starting at age 55. How Common : Typically, 10% of men will be diagnosed with prostate cancer, though African Americans and those with a family history of the disease are at greater risk. The likelihood of prostate cancer increases with age. Diagnosis : Men’s blood levels of prostate-specific antigen, or PSA, should be checked yearly after the age of 55 in most men. Normal PSA ranges vary with age. If the PSA is elevated, the doctor will recommend meeting with a urologist who will schedule an MRI and a possible biopsy to sample suspicious areas. Treatment : Prostate cancer grows slowly, so doctors may check more regularly to see if further treatment is needed. Many men are best treated with active surveillance because the majority of men diagnosed with prostate cancer will die WITH it but not FROM the disease. For more aggressive cases, surgery and/or radiation may be necessary. Memorial Hermann offers a wide range of innovative treatments for prostate cancer. Men can discuss with their doctors which treatment is best for them. Treatment : Prostate cancer grows slowly, so doctors may check more regularly to see if further treatment is needed. Many men are best treated with active surveillance because the majority of men diagnosed with prostate cancer will die WITH it but not FROM the disease. For more aggressive cases, surgery and/or radiation may be necessary. Memorial Hermann offers a wide range of innovative treatments for prostate cancer. Men can discuss with their doctors which treatment is best for them. Evan Lacefield, MD Urologist Treatment : Testosterone can be restored via creams, injections or long-lasting pellets inserted beneath the skin of the lower back. While men should undergo normal prostate cancer screening, there is no evidence of increased risk for developing prostate cancer. Why is my sexual performance changing? Why it’s important to discuss : Men don’t have to suffer. “If there’s a will, there’s a way. Don’t be embarrassed to ask somebody for help,” says Dr. Lacefield. Also, hypertension, blocked arteries and other conditions may be to blame for changes in sexual performance. Evan Lacefield, MD Urologist How Common : All men have the occasional bout of impotence, but incidence rises 10% per decade after age 40. Thus, 50% of men in their 50s and 60% of men in their 60s experience some erectile dysfunction. Diagnosis : Simple blood tests can help identify factors not related to age: low testosterone, insulin resistance, high cholesterol. Treatment : Pills, injections, vacuum erection devices and penile prosthesis can restore function. Could it be prostate cancer? Why it’s important to discuss : While urinary symptoms are almost never a sign of prostate cancer, enlarged prostate and prostate cancer often occur around the same time in life. Signs : A primary care doctor will check a man’s PSA (a blood test) every year, usually starting at age 55. How Common : Typically, 10% of men will be diagnosed with prostate cancer, though African Americans and those with a family history of the disease are at greater risk. The likelihood of prostate cancer increases with age. Diagnosis : Men’s blood levels of prostate-specific antigen, or PSA, should be checked yearly after the age of 55 in most men. Normal PSA ranges vary with age. If the PSA is elevated, the doctor will recommend meeting with a urologist who will schedule an MRI and a possible biopsy to sample suspicious areas.

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Signs : Erections may become less firm or not last long enough How Common : All men have the occasional bout of impotenc rises 10% per decade after age 40. Thus, 50% of men in their 50 men in their 60s experience some erectile dysfunction. Diagnosis : Simple blood tests can help identify factors not rel low testosterone, insulin resistance, high cholesterol. Treatment : Pills, injections, vacuum erection devices and peni can restore function. Could it be prostate cancer? Why it’s important to discuss : While urinary symptoms are al sign of prostate cancer, enlarged prostate and prostate cance around the same time in life. Signs : A primary care doctor will check a man’s PSA (a blood t usually starting at age 55. How Common : Typically, 10% of men will be diagnosed with pr though African Americans and those with a family history of t at greater risk. The likelihood of prostate cancer increases wit Diagnosis : Men’s blood levels of prostate-specific antigen, or be checked yearly after the age of 55 in most men. Normal PS vary with age. If the PSA is elevated, the doctor will recommen with a urologist who will schedule an MRI and a possible biop suspicious areas. Treatment : Prostate cancer grows slowly, so doctors may chec regularly to see if further treatment is needed. Many men are with active surveillance because the majority of men diagnos prostate cancer will die WITH it but not FROM the disease. For aggressive cases, surgery and/or radiation may be necessary. Hermann offers a wide range of innovative treatments for pro Men can discuss with their doctors which treatment is best fo

Advancing health. Personalizing care. To learn more about men’s preventive care, visit memorialhermann.org/menshealth To learn more about men’s preventive care, visit memorialhermann.org/menshealth

Advancing health. Personalizing care.

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