Men’s health: what every man should know

Jess: Good afternoon, everyone and welcome to today's webinar. So, it's men's health what every man should know. And today we are lucky to be with Luke Mitchell and Michael Mortensen, who is our MS nurse advisor.

An acknowledgement of country. So, in the spirit of reconciliation, MS Plus acknowledges the traditional custodians of country throughout Australia and their connections to land, sea and community. We pay our respect to their elders, past and present, and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

And so today we have Luke, who is a men's health nurse practitioner with a background in sexual health and urology. He has a special interest in men's sexual dysfunction, with an emphasis on holistic sexual rehabilitation following prostate cancer. And so, Luke has previously conducted research into the impacts of body image on men's sexual behaviours. And he's the current chair of the ANZUNS Sexual Health Special Interest Group and is an active member of Healthy Males Health Practitioner Advisory Board. And he currently works in private practice and as a prostate cancer specialist nurse in Melbourne.

Michael Mortensen is a registered nurse here with MS Plus, and his career includes roles at the Royal Hobart Hospital with the MS, what used to be the MS Society of Tasmania, now MS Plus, and his experience with medications, education, symptoms, and a whole range of things. And so, Michael is one of our MS Plus nurse advisors, and he was actually recently awarded the lifetime membership with the MS Nurses Australasia Association for exceptional service to the MS community. So, I will pass you over to Luke.

Luke: Hi everyone. So, my name's Luke and like we said I'm a sexual health, a men's health nurse practitioner located here in Melbourne.

When I was asked to do this presentation, I sort of got a little bit lost and confused. They asked me to speak about men's health and it's such a broad topic and I was trying to figure out a way that we could sort of narrow it down and give you some points to take home that don't sound so preachy and boring.

So, I came up with what is my penis trying to tell me, which seems a little bit weird but bear with me. As a general rule, when we're talking about men's health, there's a few things that we need to keep in mind. First and foremost is that cancer and heart disease are among the leading causes of ill health in men.

So, from a cancer perspective, prostate cancer is the most common cancer now in Australia. But also, testicular cancer is very common among, or it's not very common, but it is the more common cancer among younger men. We're also really concerned about mental health concerns and alcohol use, particularly among younger men. And you know, we know that this doesn't necessarily go away with age, but there are other comorbidities that come into it. We know that 49 percent of men who are aged over 15 years old live with at least one chronic health condition, and obviously that increases with age and with ill health. And men account for 55 percent of all new cancer diagnoses in Australia, including testicular cancer and melanoma, you know, skin cancer from the sun. So, it's worth keeping an eye on that.

And so, when you're thinking about all of this, you're like, oh my God, there's so many things that could possibly get me. I wish there was a way that I could know if I'm at risk of anything. And the good news is your body does have a built-in check engine light. And that's your penis. Which sounds really weird, but your penis is sort of like a little microcosm, and it requires lots of really small systems in your body to be working well to function properly, and then when something changes in that function, that in my head triggers, okay, well let's go and have a look and see and what's going on here.

So, when we're looking through the anatomy of the penis, it sort of makes sense why I say your penis is a check engine light. When you look at how the penis works, you sort of get an idea of why I'm saying it's a bit of a check engine light in your body. Because you need all sorts of different systems to work really well.

So having a look here, you can see the bladder. The bladder is that little pink thing that's sitting above that little blue bone and your bladder is responsible for storing urine and also excreting urine. Coming out of the bottom of the bladder you've got the urethra which runs right through the middle of the prostate and the prostate is the organ that creates seminal fluid and ejaculate when you orgasm. The urethra runs right down through the middle of the penis, sort of through this light part of the penis here, and then the darker parts of the penis are your erectile caverns. They're called your corpora cavernosum and they are filled using little, tiny blood vessels and nerves and tiny little veins going into the penis as well.

To get an erection, what happens is you need to get a nerve signal that runs through from your brain, down through the nerves into your penis, the corporeal nerves, which go down through the back out of your spine, around the prostate, down the length of your penis, which triggers an erectile response, which causes all the blood to start to filling up into your penis and then traps in using some skin in there which stops the blood from flowing out. So, you need a good blood supply. You need a good nerve supply and then you also need the mental health desire to have sex. So, when we're talking about the check engine light something in those little mini systems isn't working properly and that is causing issues.

So, one of the biggest things that I've noticed in my practice is people coming in to me saying, what's this spot and what could this possibly be on my penis? And there's all sorts of different things that a spot can be. The first and foremost thing is to know what is normal for you, because every single penis has normal anatomical variants, what we call it. So little lumps, little bumps, freckles, moles, whatever. What is normal for you? It could be very different to what is normal to you know old mate down the road. If however, you notice a spot that's new, that's developing and it's quite painful, red, raw and raised, go in and see a GP and get someone to have a look at it. It's also worth knowing if you get small red spots, particularly on the head of the penis, if you're an uncircumcised man in particular, it can indicate something that's called balanitis, which is an overgrowth of bacteria on your penis. If it is consistent and doesn't go away, it can be an indicator for diabetes. Because all the excess sugars in your blood feed this bacteria up and it stops it from being treated properly. It's also worth keeping an eye on your hygiene practices, making sure you're keeping a nice easy clean penis, avoiding allergies and irritants to the skin, and looking into lifestyle factors like smoking and obesity. If you do have recurrent spots though, get them checked out and get a doctor to have a look and see what's going on there.

For men with a foreskin, again, there's a lot of different variations to what your foreskin can look like. Something to consider though, is that if you start to notice that your foreskin is swelling, it's starting to get quite painful, it's not retracting properly, then you should definitely get it looked at. And it's probably more of a priority thing, because if your foreskin gets caught underneath the head of your penis, that can be a pretty significant medical condition. Inflamed foreskin or tightening of the foreskin can be a result of diabetes, again. It can reduce the small blood vessels feeding into the penis, which can tighten the foreskin and make it difficult to retract. And it can also be because of inflammation and infections to the penis, such as a lichen sclerosis. or a scarring that can form that makes it difficult to retract again. So, if you find that you can no longer retract your foreskin properly, that is a sign that you need to go get someone to have a look at it.

Something as well to consider is bending and buckling of your penis. Now it's normal, absolutely normal for a penis to have a slight curvature to it, but sometimes you can notice that your curvature changes. For example, if you didn't have a curve before and suddenly, you're noticing that it's developing, there are a few things that could be happening. There's something called Peyronie's disease, which is some scarring of the tissue on the inside of the old fella that causes basically a pinch and a curve. This can be an indicator for some connective tissue disorders, such as what's the word? It's like a contraction of the hand. It also can be a result of high blood pressure and diabetes again. So, if you're noticing a new curvature and you've not actually spoken to your GP recently, it's worth going in and having a chat to them saying, yes, I've got this issue with my penis, but can you please also check my blood sugar and my blood pressure because we know that there is a strong association there.

We also know that Peyronie's disease is strongly associated with erectile dysfunction. So, if you are noticing a new curvature and you're noticing your erection is weaker, it's worth definitely going and getting someone to have a look at it because there are some things that can be done about it, it's not one of those things that you can just sleep on.

A lot of patients will come and talk to me about their urine flow. In particular, a big issue that people particularly with spinal cord concerns will talk to me about is an overactive bladder where they find that they go to the toilet very often, they find that they either can't empty their bladder appropriately or they find that they get a feeling where they need to go, and they need to go right now.

Lots and lots of things in your body can impact your waterworks. It's not necessarily one simple answer that will be how to fix it. If you have an issue with your urinary flow and you're, you know, in your mid to late 40s plus, it's worth getting your GP to start checking out your prostate health. Your prostate enlarges as part of normal male aging and part of that enlargement can put pressure on that urethra running right through the middle of it. When that happens, it's sort of a little bit of roadworks on the highway, and then everything behind it's working well, but it's coming up to these roadworks, everything slows down, makes it really difficult to pass through, and then everything behind that starts to get irritated. Your bladder starts to spasm, everything going through slows down, sometimes you can find that you're not emptying properly, and it's worth getting your prostate checked out for that reason.

You also need to rule out things like bladder infections, any neurological changes and any particular heart disease as well. We know high blood pressure is associated with regular urination, as well as lower lymphedema as a result of heart failure can mean that you pass urine, particularly a lot overnight, so it's worth getting that checked out. Passing urine quite frequently as well is a very common side effect of a lot of medications, particularly medications to treat fluid overload related to your heart disease. So, if you are noticing that your urine flow is changing in any way, whether it's too often, not often enough, slower, what have you. It's worth getting it checked out because there are quite a few things that could be going on that should be investigated and treated appropriately.

And the erectile concerns, this for me is the biggest check engine light of your body. So, like I said your penis requires all these micro systems to work properly and the biggest thing that guys will notice and complain about is that their erections are no longer stronger and strong enough or able to maintain, particularly as they age. Now we know there's a lot of really good evidence to suggest that erectile dysfunction is a really good predictor for heart disease in the next five years. So, if you have never had an erectile problem before, and you have a particular family history of heart disease, the first thing you want to do is to go into your GP and get a regular heart checkup to rule that out.

Nothing might be wrong now, but if you're showing erectile concerns, then it's worth getting it checked out and seeing if there's anything going on early. Particularly with guys with spinal cord concerns such as obviously MS or any spinal cord trauma that can impact your erections, but guys with degenerative spine disease as well can notice a weakening or a complete absence of erection as well.

Erections are also strongly related to your physical health and fitness. If you aren't moving around a lot, if you're not exercising a lot, if you're feeling quite slack and lethargic, your body's going to show it but it's also going to show in your penis and you're not going to be able to get an erection effectively. Erections are impacted by your lifestyle, stress, anxiety, depression, all have an impact on erectile strength. As well as some medications that you can take, particularly for depression, anxiety and enlargement of your prostate can impact your erections.

There is a lot of concern at the moment talking about testosterone and how testosterone can impact your general health. The general advice we give to patients when we're talking about testosterone is that testosterone, the biggest impact you're of testosterone in your health is a decrease in sexual desire, but erectile dysfunction as well can sometimes indicate some hormonal disturbances that you might need to get checked out.

And the last thing is erectile dysfunction can indicate that you've got a bit of an enlarged prostate. There's some new evidence coming out that has linked erectile dysfunction to very large prostates. So, if you again are noticing that and you've got some, particularly if you've got some urinary side effects, then it might be worth going in and having a chat to your GP or a urologist to see what's happening with your prostate.

Scrotal symptoms. One thing I regularly ask my patients to do is to again know what is normal for you and to check regularly, particularly my younger patients. It's something that often goes by the wayside, but doing a regular testicular self-examination and knowing what normal is for you makes it a lot easier than when you come into a doctor's office saying, I've noticed this, and this is not what is my normal.

It's also really important to know that if you have any sudden onset of pain in your testicles, go straight to the emergency department and don't just wait and see if anything goes away. One of the biggest emergencies that we see in men's health is a twisted testicle that can strangulate and cut off the blood supply and that can, if it's left untreated, can kill that testicle. So, it is a medical emergency and any sudden onset of pain, please go straight into the emergency department.

If you notice any symptoms on your skin, any new lumps or bumps, it's worth getting looked at. And if you've noticed over your lifetime that you've got very, very small testicles, it's also worth getting that looked at as well, because that can indicate something called Klinefelter syndrome which is a decrease in testosterone production. So, you might need to get someone like an endocrinologist to have a look at that and see what's happening with your testosterone production.

So, when we're going through and talking about men's health as a general rule, the first thing I say to everyone is know what is normal for you. So that way when you go in and speak to someone, you can straight away indicate this is not normal for me, this is a new thing and I know what's going on. Everyone's body is different. Everyone experiences health differently, but if you know what is normal for you, you can then act on something that's not normal and that's new.

Be mindful of your general health. If you talk to anyone who works in health in general, the first thing they'll tell you to do is to diet right and exercise correctly. And unfortunately, we say that because it's important and it does work. So regular diet and regular exercise, sorry, trying to get around half an hour of regular anaerobic exercise and trying to do some resistance training three times a week does have a very significant impact on your health.

Even if you don't have time to get to the gym, just going on doing walks around the park or mowing the lawn can have a really good impact on your mental and physical health. So be mindful of your general health and do take care of your body as best you can.

One thing we're talking to a lot of patients about at the moment is mental health and social isolation. A lot of men are feeling very alone out there and feeling quite listless. So, it is very important to make sure you stay connected with your friends and your family and community. And if you are feeling low in any way, then reach out, have a chat to someone. If you're noticing that your friend is feeling a bit different or a little bit low reach out and see how they're going, because sometimes just asking that question of are you okay can make or break a man's health outcomes. And also engage with your GP and your health team. A lot of people sort of look at the GP and think, oh you know what, I've got specialists, I don't really need to see my GP so much, but your GP is the linchpin of the health system. They're the ones that conduct the orchestra, they're the ones that glue everything together and if you can't see them regularly if they're not up to date with what's going on then they can't do that job. So, engaging with your GP is incredibly important and, you know, they will be your first point of call when something's not quite right.

And I think that's me.

Michael: I'll hop in the driver's seat for a bit. In relation to males living with MS and pregnancy, more often than not it's the female that has to be concerned about the medication that they're taking. But with males there are two specific medications that do interfere with the conception process.

Aubagio is definitely one that we need to be mindful of if there's a male who is taking the Aubagio treatment, teriflunomide, there is a need to practice double contraception, i. e. so the male's wearing the condom and we would hope that the female is on the contraceptive pill. It's got the worst pregnancy category of any of the disease modifying therapy, so it's certainly not something to muck around with. And we're very rigid about ensuring that there is double contraception practice. If you were to come off Aubagio if you were saying let’s plan for pregnancy, I want to stop this medication. It has a very long washout period of up to two years. So, it's a phenomenal long time to have a medication in your system if you're wanting to proceed and go on to have a child. Oh, father a child that is. You're not going to be having the child yourself.

There is an accelerated elimination procedure that can be done. So, if you decide now is the time I want to have a try for pregnancy with my partner, you want to get on with it quickly, then you can go through this 11 day accelerated elimination procedure. Which involves cholestyramine or activated charcoal. What that does, it binds to the medication and actually eliminates it from your body. So that's a good way of at least, you know, getting that, the medication out of your system quickly so that then you can proceed with the attempts to have pregnancy with your partner.

The other medication that you need to be mindful of is Mavenclad Cladribine, which is a newer agent, been around for a couple of years. Does stay in your system for a while, but there's a lot of research data that supports that for the females, it's six menstrual cycles, for the male, it's basically six months. So, the medication is given once a year for a two-year period. So, it's basically six months after you've taken the last dose of medication, you would be in an acceptable position to be able to then go on to engage in sexual activity with your partner so that you would be able to get the person pregnant without any issues having any, probably concerns around birth defects is that the big issue? So, they're really the two medications that we need to be careful of for males who live with MS.

Skin cancer and bowel cancer, Luke has already had a bit of a chat about the need to be wary of skin cancer and bowel cancer as well. Some disease modifying therapies definitely do lead to an elevated risk of skin cancer. Gilenya is probably the one that comes to mind, but I think some of the other newer agents are equally as need to take care with those things. The best thing to do is just make sure that you engage in an annual skin check. It doesn't have to be just once a year, but you know, get your partner to have a look across your body and make sure that there's no noticeable changes in moles or that there are development of new moles or lumps that are on your skin that look a bit suspicious. Either get off to your GP or to a dermatologist and get them checked out, most important.

Also, bowel screening is very important, making sure that there's no faecal occult blood that's happening from changes in your bowel. I think I actually saw the other day; I'm saying 50th birthday, but I believe it's actually dropped now down to the 40, 45 year olds are able to get the faecal occult testing as well. That's the nice little poo, poke and post-test that comes out in the mail once you turn 50 it was for me and I guess it's probably as I said they've dropped that back to 45 now, so definitely engage in that test. It's easy to do and it could save your life or at least pick up that there's some abnormality in your bowel that needs to be investigated.

Luke's just mentioned about social isolation and loneliness. It's certainly become a big issue for many people in this COVID and post COVID space we've been through. There was a certainly an elevation in all sorts of depression and mental health conditions during COVID and I think for people living with MS, it's probably no different. The general population certainly need to keep an eye on what's happening with your mental health, it's just as important as your physical health. MS may lead to you leaving the workplace early, to retiring due to inability to work because of your MS, whether it's a functional thing, whether it's you're not able to get around because of your mobility, or whether it's some cognitive issues that may have you leaving the workplace early. But you must be mindful that whilst we're working, we have wonderful social connections. We get up each day, we head off to the workplace, we're engaging with people. People, once you step away from that workspace, a lot of people find it very difficult and they find themselves a little bit lost because they've lost that connection with their work buddies, maybe going out to the pub for a drink after work on a Friday, anything like that. So, it's really important to keep a check of your mental health if you're having to leave work early due to your MS.

Peer support groups are a fantastic way of keeping in touch with others out there. You don't necessarily have to be in the same space as them, but MS Plus runs regular peer support groups for men. I've spoken on a couple of them recently and said they do a really fantastic job at connecting people. You don't necessarily have to leave your house, but it's an opportunity to speak with people that are living a life similar to yourself. They've got MS. Just a chance to chat about how MS affects them. Sometimes you can pick up some really nifty tips and tricks about how to manage some of your symptoms through other people. I've been nursing in this space for a long time, but it doesn't mean to say I know every little tip or trick about symptom management. So often you can pick up those, some really great tips from fellow people living with MS as well.

Another point there, looking into joining a men's shed, if you're feeling that you're a little bit disconnected, you can get out there and catch up with the fellas. Most men's sheds have a really great reputation of engaging with other men, allowing you to perhaps pick up a craft or a hobby that you can work on whilst you're at the shed, or if you're not interested in building or anything like that, just go along for a chat.

Men's Table is another great organisation where men get to go out for a meal and sit around the table and talk to other men, not necessarily about MS obviously, but just health in general. It's a really great opportunity to get out there and engage with other likeminded fellows in your neighbourhood. It's certainly a big thing down here in Tasmania and I hope it's the men's table also takes place across the rest of Australia as well.

And volunteering is a fantastic thing to do if you've finished work and you've still got a skill set that perhaps you want to be able to pass on to others or just an opportunity to catch up with others. That helps to increase that social connection and give you a reason to get along to things. Lions’ clubs, if you're still able to drive even things like meals on wheels. they're always looking for people to drive the cars around. If you're fit enough to be able to get out and do that then that's a really great thing plus, you're giving back. So that gives you a lot of social work as well and makes you feel good. Look around in your local area and see if any volunteering organisations perhaps that you can get involved with.

Social isolation loneliness, as we just said, there's lots of stuff on the slide there. It's a very busy slide, lots of information there. I think it's just really important, as I said, for your mental health and your physical health to ensure that you are actively engaging with the community in whatever way you can find. It's a great supporting evidence that says that if you're looking after your social isolation, if you're engaging with others, then it certainly puts you at a decreased risk of developing dementia and other cognitive issues as well. Keeping yourself engaged is a really good way making sure that you're keeping a good mental health.

And I've got a few tips and things there about things you should be doing regularly, regular exercise, you know, engaging, just getting up and moving around, gets the blood flowing, and when the blood flows, it's delivering oxygen to all parts of your body, including your brain, often when you exercise, it releases endorphins that make you feel good. So that's a really good reason for engaging in exercise. And I'm saying not just physical exercise, brain exercises as well, really good getting into doing puzzles. Learning an instrument, for instance, learning a musical instrument or learning another language, anything that's encouraging your brain to be thinking, to creating side abscess, just to make sure that it's keeping in its optimum health.

Smoking cessation, unbelievably important in the MS space. So, if you're a smoker, please do your absolute best to get rid of them. Move it on because it's a huge body of evidence that smoking has a an incredibly negative impact on MS, so the sooner you can give it up the better. Alcohol in moderation, absolutely fine to have a few drinks, but just don't overdo it. Not necessarily related to your medication. I think these tips and tricks go for all sorts of chronic diseases, not just specific to MS, but we certainly know in the MS space that these are some things that you could probably do to improve your general health.

Good diet, lots of diets bandied around in the MS space, but there's no one real diet that gets recommended more so than the Mediterranean diet. So, good food in tends to mean that your general health is going to be good as well. There's a quite a bit of research happening at the moment as well around the microbiome of the gut and the axis between the gut and the brain. So, we're kind of Looking to see whether introducing probiotic into the gut and therefore improving your gut health, does that have a positive impact on your brain health as well? So, it would be interesting to see when those studies get completed, what sort of results we get from that.

Sleep hygiene is very important. Luke was talking before about your mood and things like that. If you're tired, then obviously your libido is probably going to be a bit low, and your erectile dysfunction might particularly be a bit heightened as well because of that. Easy to say for people with MS to try and get a really good sleep. We know that fatigue is probably one of the more significant symptoms that many people living with MS experience. And we also know that people living with MS do have a higher than norm level of sleep disorders, dysfunction, restless leg syndrome often can be one. There's nocturia, having to get up multiple times overnight to go to the toilet that's certainly an issue. And as we've already discussed, if you've got bladder issues, I think once or twice a night is probably acceptable as we get older. But if you're saying that you're getting up, you know, multiple times, four or five or six times a night, then that's definitely not normal and needs to be investigated.

Stress management and mood management increasingly seem to be an important way of managing your MS as well. Mindfulness pops up all the time, getting involved in Pilates or yoga, really good for your physical and your mental health as well. So, if there's a space close by to you or somewhere, a community hall or somewhere where they have regular sessions of Pilates or yoga, then definitely go and check them out. A great thing to be doing to help with stress management.

We've talked before about the GP being the linchpin between you and your neurologist and looking at your general health. Or sitting around thinking about your MS don't assume that every symptom that you ever experience is related to your MS. Make sure that your GP knows what's going on for you and also then make sure that the GP is not popping everything in the MS basket as well that we need. So often blood tests or other simple tests that can be done to determine if there's something else that's going on and make sure that the GP does go out of their way to investigate other causes that could be related to the symptoms that you're experiencing.

Annual skin checks but an annual blood tests as well, liver function, cholesterol levels, diabetes checks, and also the very important PSA check for your prostate health. And as I already mentioned, bowel screening is certainly something that should be regularly attended to as well. That's pretty much it.

Jess: Thank you both. We actually did have a question around what is involved with a prostate check. What would they do if you have an enlarged prostate?

Luke: Yeah, all sorts of different things. Baseline check recently has become the PSA, so the Prostate Surface Antigen Blood Test. Now, we recommend getting that tested depending on your risk profile, your family history. Usually from the time you're about 40 to 45. Michael said annual and for some people, yes, annual is appropriate. For other people, every two years is appropriate. So routinely, it's just a blood check. If that number, the PSA is elevated, there are lots of reasons why it can be elevated, such as infection, enlarged prostate, prostate cancer, etc.

So, a high PSA doesn't necessarily mean, oh my god, you've got cancer. It means you need to go and get a further check-up. The further checkup will often involve the dreaded finger up the bum test. So that does still happen and it's just a quick examination where they put the finger up the bum and they're really just feeling the prostate to see if it feels abnormal or weird. It's a really great way of testing to see if there's any potential cancers in there. But they can also get a rough gauge on the size of the prostate. You may also, if a urologist is concerned about the size of your prostate, send you for an ultrasound where they can get a good idea of what's going on. They'll do a few urine tests, typically, where they'll get you to do the pee in the pot test, seeing how strongly you can wee, what the pee flow looks like, and they'll also do a scan, like an ultrasound afterwards, to see how well you're emptying your bladder. And if you are having difficulties passing urine because of an enlarged prostate, first line is to change a few lifestyle things.

Reduce your coffee, reduce your tea, make sure you're drinking enough water, checking your medications and making sure that's okay. They may start you on some new types of medications to help improve or flow through. And if those medications don't work, then they may need to do the rebore operation where they go through and remove any additional prostate tissue to open that channel up again to make it a little bit easier to wee.

Michael: So, if you did have an elevated PSA and your urologist, for instance, you'd probably be at that point, you'd be going to your urologist for a consult to see what's going on. What would be the outcome? So, if there was a determination that you may have prostate cancer and they needed to do something about it, obviously to manage it, what are the options then for people who do end up with a diagnosis of prostate cancer?

Luke: Okay. Well, if you've got an elevated PSA and the doctor is thinking that you may have prostate cancer, the first thing that they'll do, apart from the finger up the bum test, is send you off for an MRI. And the MRI can tell you if they think that there's potential cancer growing in there. And for some guys, that's all they'll need. They just need to get that MRI done, check and see if there's anything suspicious there. And if that comes back clear, all good, we'll just keep an eye on that. If the MRI comes back suspicious, you'll then need to have a biopsy, where they take small samples of the prostate, which is done under an anaesthetic. You don't want to be awake for it, because they pass needles up between your testicles and your anus, to take small samples of the prostate, and to determine if there is cancer there, and to degree, and what to do. degree of cancer is there.

Depending on the severity of cancer, you know, it's not just you've got one diagnosis of prostate cancer, there's a wide variation of prostate cancers. A low-grade cancer can often be managed by just watching it and keeping an eye on it, doing regular checkups, keeping an eye on your PSA, regular biopsies and seeing if it's changing. And for some guys, that's all they'll ever need. If it's a more aggressive cancer though, they may need to go down and do what they call a radical prostatectomy where they remove your prostate, or they may need to do radiation treatments to sort of zap and microwave the prostate to stop that cancer from spreading and developing.

Lots and lots of treatments. There's no one, one is better than the other. It's all just about what's the most appropriate for the person sitting in front of you.

Michael: Thanks Luke. I think on the news, just might have been last week or the week before, the UK that they've come up with a saliva test to check what the prostate specific antigen levels are in the body which they're saying is a little bit more effective than the good old PSA blood test. Have you heard much about that at all?

Luke: Look, there’s new technology and I mean, I always say take new technology with a grain of salt because they need to get a decent evidence backing behind it. Like I said, there's lots of reasons why your PSA can be elevated. Like, your PSA can go up if you've had a urinary tract infection recently, if you've just ejaculated, you know, if you're a gay man who has anal sex, that can increase your PSA. All sorts of different things can impact it. So, I'm really dubious about these at home tests, and I always say, if you want to get something done properly, get someone who's trained to do it to look over it for you and don't just rely on doing things at home and just assuming.

My wife, when I first met her, hurt her finger at boxing and then got an x ray done but never followed up with the results. And then I saw the x ray four years later and there was a very clear fracture, but she and her mate looked at it and thought everything looked fine. So, you always want to have the right person having a look at the results.

Michael: Absolutely, couldn't agree more with that. Thanks, Luke.

Jess: And Luke, we've actually had a question that is right up your alley. It's someone, you know, who has had a good sex life, but since having MS it has stopped. You know, trouble getting and maintaining erection. Had tried taking Viagra, which partially helped. You know, otherwise health and bloods are done, prostate health is good, taking Baclofen, you know, on an MS medication and blood pressure is good. So, what would your sort of, I guess, general advice be around that?

Luke: I suppose that really depends on what your goals are and what you're trying to achieve. So, there's other medications that you can try. So, you can try, if Viagra didn't quite do it, you can use Cialis, which can be really effective. And you can use that as a low dose daily medication that can be really effective for some people. These medications though, when there's a spinal cord involvement, do tend to be less effective. Because like I said, you need the message to be able to get what properly through the brain to the penis that triggers the erectile response.

So sometimes you may consider something like a penis pump with a ring. Sometimes a vibrator can be really effective and sometimes there's even the option of injections that go directly into the penis that sort of bypass the body's normal way of getting an erection and help give you one that looks and feels normal but is then reliant on a drug. And that can be a really good option for some people.

First thing that I always recommend is to have an open chat with your partner. Talk to them about what's going on with you, what you're experiencing and what your concerns are. Find out what they want to achieve and find out what you want to achieve as well. What does your ideal sex life look like? And see if there's a match up there. And then from that, you can start working towards meeting those goals together. Oftentimes, a lot of patients will come and talk to me and the first thing I'll ask them is does your partner know that you're here? And they'll always say, no, I don't want to talk to them until I've got an answer. But having a partner with you, who's there to support you, makes everything easier. But yeah, there are definitely some treatments that we can use, it just depends on what you're comfortable with.

Jess: Great. Thank you both for that. That is really, really helpful. Thank you both so much to Luke and Michael for sharing all of that information today.

These are just some of the supports and services that we offer. Particularly around men's health, we actually have a tag on our website you can filter by on the resource hub, and you'll actually see there is an erectile dysfunction with Luke that we have just recently done, which is really, really good. It's got some great information in there, so if podcasts aren't your thing, and you they're not for everyone, but this one is really good, and you can even read the transcript, so it's well worth looking at. And all of Luke's details and information are there as well. And so those are all of our contact details.

So, thank you, Luke and Michael, both so much for speaking, you know, presenting today. It's been really good.

Michael: Thank you, Jess. And thank you, Luke.