That could mean finally getting around to making an appointment for that long overdue checkup, finding ways to add light movement into your day, or perhaps reaching for a blood pressure monitor rather than BBQ tongs for a Father’s Day gift.

Dr. Rahul Jain is a family physician with Sunnybrook’s Integrated Community Program and Academic Family Health Team. He shares his thoughts and expertise on men’s health.

It’s often said – and research suggests – that men are more reluctant to go to the doctor than women. Do you find that to be the case and if so, why?

I don’t want to over generalize but men are notorious for sometimes avoiding the doctor or ignoring warning symptoms. But to be honest, in my practice what I see is that it really depends on the person and their preferences rather than a specific gender.

With access to medical information at our fingertips, people have become more health literate over the years, which is great but it doesn’t replace the importance of seeing your healthcare provider for routine checkups.

Some patients might also put off going to the doctor because of time pressures, although the option of virtual as well as in-person care has helped remove that barrier.

Fear of the unknown could be another reason some patients stay away. But I believe in taking a preventative rather than a reactive approach, and the benefit of family medicine is seeing your doctor regularly for checkups and preventing things before they occur.

How often should people go to the doctor for a physical?

I encourage adult males to see their doctor for a routine checkup at least every one to two years although the specific frequency depends on their medical history, risk factors and preferences.

Routine checkups provide an opportunity to focus on preventative screening, immunizations and education.

What types of things do you look for with adult males?

We often start screening for cardiovascular risk factors such as diabetes and high cholesterol at age 40, or sooner if they’re at higher risk.

We recommend colorectal cancer screening at age 50, or sooner if there’s a family history of the disease.

And we often suggest baseline bone mineral density testing, to assess for osteoporosis, at the age of 65 or sooner if there are risk factors.

What about heart health – what preventative steps should patients discuss with their doctor?

There’s good evidence that protecting the heart and brain takes a global approach, which means addressing a number of factors early on which can increase the risk of heart disease and stroke. Risk factors include unhealthy diet, low physical activity, higher body mass index, higher alcohol intake and smoking.

Primary care providers can also screen for modifiable risk factors for heart disease and stroke such as high blood pressure, high cholesterol and diabetes.

High blood pressure is often referred to as a silent killer because it does not always present with symptoms but it is the number one risk factor for stroke and a major risk factor for heart disease. It’s important to see your doctor regularly to screen for risk factors which may or may not even present with symptoms.

What age should screening for testicular and prostate cancer begin?

Testicular cancer can present at any age, although it’s more common in younger males and peaks around age 30. We encourage males to begin regular self-examinations of their testicles in their 20s and 30s. We tell them to watch out for things like a lump or enlargement of either testicle, a dull ache or a feeling of heaviness in the scrotum.

When it comes to prostate cancer screening, this happens after a discussion with the patient about the benefits and risks of screening.

We typically begin screening for prostate cancer when patients are in their 50s, or in their 40s if there is a family history or other risk factors.

Prostate cancer often does not cause symptoms in early stages. But when symptoms occur, they can present similarly to a condition called BPH (benign prostatic hyperplasia). which is a common condition as males age. Some of the symptoms which can overlap are difficulty urinating or having a decreased force and flow of urine.

Symptoms that might be more specific to prostate cancer to watch out for include blood in the urine or semen, painful urination, erectile dysfunction, or unintentional weight loss or bone pain.

Let’s talk about mental health. How important is it for doctors to open up a conversation with their patients about their mental and emotional health and wellbeing?

Anxiety and depression are one of the top reasons patients visit their primary care providers.

Family physicians are uniquely positioned to address mental health concerns given the longitudinal, trusting relationship we have with our patients.

Life is busy but that shouldn’t be an excuse for not prioritizing wellness. Mental health is so important and shouldn’t take a back seat. Addressing wellness means taking a holistic approach to physical, mental and spiritual wellbeing.

As someone with an interest in prevention of cardiovascular disease, I would add that we know there is a bidirectional relationship between depression and heart disease. Depression can worsen heart disease and heart disease can worsen mental health. 

Another important aspect of both physical and mental wellness is staying active. How do you like to stay active?

I’m a big supporter of Canada’s 24-Hour Movement Guidelines, which emphasize the idea of making your whole day matter when it comes to movement behaviours. These guidelines suggest moving more, reducing sedentary time and sleeping well.

We know that regular physical activity at any level has numerous health benefits. If people can do more than what they are doing now, chances are this will lead to improved cardiovascular and mental health.

I often suggest simple ways for patients to become more active in their daily lives. This could involve things like replacing some of their sedentary activities with light physical activity like walking instead of driving to do errands, or standing and stretching while on their screen. Not everyone has to be doing moderate to vigorous exercise – that’s great and we should incorporate it. But even just making a shift from less sedentary behaviours to light physical activity can be beneficial.

Research suggests physicians can be powerful motivators for patients to increase their physical activity, particularly if they are active themselves. When doctors are physically active, their patients often are more active.

I like to think I walk the talk when it comes to physical activity. I try to incorporate a mix of aerobic exercise, strength training, balance training and participating in activities I enjoy such as taking a walk during my lunch break with colleagues or cycling outdoors.

What else would you like to add when it comes to encouraging men to prioritize their health and wellness?

With Father’s Day coming up, why not consider gifting a gym membership, blood pressure monitor or wellness retreat? Or give the men in your life a nudge to visit their primary care physician. Whatever we can do to emphasize the importance of taking care of yourself is encouraged.

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Testicular and prostate cancer

For people with testicles and prostates, it’s important to be aware of possible signs and symptoms of testicular and prostate cancer.

Dr. Jain says testicular cancer can present at any age, although is more common in younger people and peaks around age 30. He says people with testicles should begin regular self-examinations of their testicles in their 20s and 30s, paying attention to any changes.

He says symptoms to speak to your family doctor about would be “a lump or enlargement of either testicle, a dull ache, or a feeling of heaviness in the scrotum that just doesn’t seem right.”

Family doctors will typically begin screening for prostate cancer when patients are in their 50s (40s if there is a family history or other risk factors). Prostate cancer often doesn’t cause symptoms in its early stages, and Dr. Jain says one of the challenges with diagnosis is symptoms, when they occur, can be similar to benign prostatic hyperplasia (BPH), which is a common condition in people with prostates as they age.

Some of those similar symptoms are difficulty urinating or having decreased force and flow, but symptoms that could be more specific to prostate cancer could be “blood in the urine or semen, painful urination, erectile dysfunction or even unintentional weight loss or bone pain in advanced disease,” Dr. Jain says.

Frequency of doctor’s visits

While it used to be common for patients to see their family doctor for an annual physical, Dr. Jain says the recommendations have changed over the past decade.

“We’ve moved toward appointments called periodic health visits,” he says. “And that’s where we really start focusing more on preventative screening, immunizations and education.”

He says since there are several health screenings that are recommended starting at age 40, it’s a good age to start seeing your family doctor more regularly.

“I would say, as in my practice, once someone turns 40, it’s really important to make it more of a regular routine to see your family doctor,” he says. “Every one or two years may be reasonable, although the specific interval should be discussed with your health care provider based on your unique health needs.”

Be proactive 

Dr. Jain says it’s critical to be proactive about your health. Yes, that means going for preventative health screenings and booking those doctor’s appointments, but it’s more than that.

“Watch for concerning symptoms and seek help early. Also, even though it seems simple, it’s paramount to maintain a healthy diet and exercise regularly,” he says.

Another suggestion from Dr. Jain is to monitor your blood pressure periodically, whether at a pharmacy or with an approved home blood pressure device. It can provide useful information in diagnosing hypertension.

“Honestly, having good blood pressure control is probably one of the best things people can do for themselves to prevent heart attacks, strokes and mini strokes (TIAs),” he says. “It’s often under-appreciated, as high blood pressure may not present with symptoms, although it is highly preventable and treatable.”

Whatever it looks like, though, Dr. Jain emphasizes the importance of prioritizing your health and wellness.

“It is important to not neglect taking care of yourself and ensure you continue to connect with your health care provider virtually or in person.”

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A clinical trial is a research study that involves people. After showing promise in a lab, a clinical trial is the next step. Clinical trials look at the effect of a medical action on people’s health and often compare one treatment to another. The studies often look at how well new treatments work and how safe they are to administer.

When it comes to prostate cancer — the most commonly diagnosed cancer in men — there are tons of trials with a wide range of focuses.

“There’s a trial available for every point of the prostate cancer experience – from detection to diagnosis to treatment and beyond. There’s a whole team here dedicated to this,” said Dr. Stanley Liu, a radiation oncologist at Sunnybrook. “These trials are looking for better ways to find prostate cancer, better ways to figure out whose cancer will be aggressive, and better ways to treat it at any stage.”

How can we see the cancer?

Many researchers are looking at how prostate cancer is detected and diagnosed. This type of trial might look at the use of imaging and what type of imaging can best see the cancer. Participants could be randomized to get one type of image or another.

Whose cancer will be aggressive?

Some men with low-grade prostate cancer may never go on to have an advanced form of the disease. But how can doctors determine who’s cancer will be aggressive?

“At Sunnybrook, we are involved in several trials that are looking at ways to determine who’s prostate cancer will be more aggressive – for example, looking at cells in urine to see if there’s signatures in there that indicate the cancer is more aggressive,” Dr. Liu said. This type of trial might involve blood tests, urine test or other samples being collected and examined.

How can we best treat prostate cancer? 

How you are diagnosed with prostate cancer and treated is based on many years of research, evidence and trials. Researchers constantly revisit that evidence to come and with better, safer ways to find and treat the disease.

A Sunnybrook-trial led to the widespread use of “active surveillance” for prostate cancer, where men with early stage disease are closely monitored rather than treated aggressively. The 15-year results were recently published by Drs. Andrew Loblaw and Laurence Klotz from Sunnybrook, and they demonstrated that this is a safe and effective approach to manage early stage prostate cancer. This key trial helped make active surveillance a standard-of-care in North America.

At Sunnybrook and around the world, researchers such as Dr. Loblaw have been looking at newer forms of radiation that target the tumours more precisely. One example of this is stereotactic body radiation therapy (SBRT),  where high levels of targeted radiation are given over a short period of time. This type of treatment is already used for other cancers. At Sunnybrook, we are involved in several SBRT trials, looking at if a shorter course of higher dose radiation (e.g., 5 days versus 20 days) can improve prostate cancer cure while minimizing effects on a patient’s quality of life. This would involve radiation treatments as well as surveys or interviews to help determine how your quality of life is after treatments.

How can we treat prostate cancer that comes back or is advanced?

These types of trials might add an additional chemotherapy drug or a targeted agent to the current standard of care (radiation, surgery or chemotherapy) to see if there are better patient outcomes.

How do I know if a trial is right for me?

At an academic health sciences centre, there are many options for trials. There is infrastructure in place to allow involvement with lots of trials. Some of Sunnybrook’s doctors are the lead investigators or the site leads on an international trial. Talk to your doctor for more information about what trials you might be eligible for.

Do I have to join a trial?

Being a part of trial is a personal decision. It can be overwhelming to learn about them all, but ultimately it’s up to you as the patient.

“Your care team can offer you information about whether you are eligible for a trial so that you can make an informed decision on whether you want to join a trial,” Dr. Liu said.

If you are not in a trial, you will receive the standard treatment. By participating in a clinical trial, you may be among the first to receive a new treatment that is otherwise not available. But, the new treatment has not yet been proven to be better than the current standard. It’s important you discuss this with your care team.

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Seems like a reasonable – and achievable – command, doesn’t it, gentleman?

And when it comes to testicular cancer, it could mean catching the disease early.

I noticed the #knowthynuts hashtag in a tweet by Movember Canada last week and had a little chuckle (who doesn’t love a good pun?) It’s quite a catchy campaign and great way of putting it in order to raise awareness of this highly treatable cancer: Fellas, be familiar with your testicles and any changes down there.

Dr. Danny Vesprini, radiation oncologist at the Odette Cancer Centre, says self-screening really is the best – and actually the only – way to find testicular cancer early.

“There are no other screening tests for it. And it’s best when we find it early,” he said “The best way to find testicular cancer early is to touch your testicles and feel for it.”

A rare cancer

“Testicular cancer is not very common,” Dr. Vesprini says. It affects about 1,500 men per year in Canada. Although it can happen at any age, it is most common in young men – peaking between the ages of 20 and 40 years old. For reasons not yet known, that number is on the rise — but it’s still considered a rare cancer. When caught early it is usually confined to the testicle, but can spread to other parts of the body as well.

A family history of testicular cancer or an undescended testicle as a child are both risk factors.

Go ahead, give ’em a feel

Many men find testicular cancer because they notice something is different about their testicles.

“We know that men might be down there for other reasons,” Dr. Vesprini says. “Next time you are, feel your testicles for a painless mass.”

Actually, he says, you should do a self-exam each month.

You might want to do this self-test after a warm shower, the folks at Movember recommend. This helps “get you in the mood”, they say. (actually, it relaxes your scrotum.)

Do this one at a time: Use both hands to hold your testicle between your fingers and thumbs. Look and feel for any lumps, bumps, hardness, or irregularities on the skin or inside your testicle. Your testicle should feel firm and sensitive, but not painful. (Here’s more detailed info on how to do a self-test).

Testicular cancer doesn’t necessarily cause pain in the testicles – that’s why feeling for a hard lump or bump and looking for changes is the best way to find this kind of cancer early.

The prognosis

If you do feel something suspicious or different, make an appointment with your family doctor. You’ll likely then undergo an ultrasound to look at the testicle to see if there’s a tumour.

Testicular cancer is a highly treatable cancer. Most often it is treated by removing the cancerous testicle and sparing the other. Most men do not require chemotherapy or radiation, though some do (to stop the cancer if it is spreading).

“The management for men who have the disease confined to the testicle is called ‘Surveillance’ and involves regular scans and check-ups,” Dr. Vesprini said. “Having cancer in one testicle increases the chance of developing a new tumour in the other testicle, so regular self and professional testicular examinations remain vital.”

Removing one testicle won’t affect a man’s fertility. But men who want to have children are usually advised to bank their sperm, Dr. Vesprini says, just in case something happens to the remaining healthy testicle.

Catching cancer early is key. Gentleman, know thy nuts. And if you notice any changes, lumps or bumps on your testicle(s), make an appointment with your doctor.

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