Below the Belt

October 01, 2012

Listen up, men. It’s time for you to step up. Don’t let procrastination or embarrassment prolong your suffering from common “below-the-belt” problems. Providence experts offer the latest treatments for prostate cancer, erectile dysfunction and incontinence.

Prostate Cancer

As senior vice president of communications for the Prostate Cancer Foundation, Dan Zenka has used keyboards, cameras and social media to get the word out about prostate cancer. At 4:30 p.m. on April 13, 2010, a single look from his urologist confronted him with the cruelest of ironies—he would also be using his own experience. “The cancer communicator jumped the fence and became the cancer patient,” he says.

Zenka, 53, turned to Providence Little Company of Mary Medical Center Torrance, which, along with Providence Little Company of Mary Medical Center San Pedro, is a recipient of the HealthGrades Prostatectomy Excellence Award.

There, Zenka underwent a robotic-assisted laparoscopic radical prostatectomy performed by urologist Garrett Matsunaga, M.D. Dr. Matsunaga has performed more than 700 robotic surgeries to remove the prostate. “The instruments offer greater range of motion than a human hand,” he says. In addition, the robotic procedure, which is also available at Providence Saint Joseph, usually results in minimal blood loss and faster patient recovery.

In Zenka’s case, Dr. Matsunaga discovered that the cancer had spread to the lymph nodes, upgrading his condition to stage 4 cancer. “This is not the kind of upgrade I’m used to,” Zenka admits. However, the fact that his Providence team has managed his radiation therapy and hormone treatment with expertise and compassion has enhanced his already positive outlook. “Everyone in urology, oncology and radiation oncology has been fabulous— very caring and professional,” he says.

For his part, Zenka hopes that men, especially older men, will get serious about prostate cancer. “Men my age are often hesitant to talk about diseases below their belts,” he says.

Erectile Dysfunction

Based on data from the National Health and Nutrition Examination Survey, erectile dysfunction (ED) affects 18 million men in the U.S. Prevalence increases with age, as a whopping 70 percent of men 70 and older live with ED.

To Zenka’s point, ED can be embarrassing to discuss. Martin Gelbard, M.D., a Providence Saint Joseph Medical Center urologist who specializes in ED, encourages men not to suffer in silence. “In the 1950s, it was thought that the majority of cases were psychological,” he says. “Contemporary research shows that 90 percent of men with ED have a physical basis.”

In fact, Dr. Gelbard says ED can generally be traced to two types of causes: endocrine or vascular. Providence hospitals treat both.

On the endocrine or hormonal side, younger men with low testosterone typically respond well to testosterone replacement. Many older men find that diabetes is a culprit for ED. “Fifty percent of men who get to middle age and beyond with diabetes will have some degree of ED,” Dr. Gelbard says. In fact, ED is sometimes the first warning sign of a serious health condition.

From a vascular standpoint, Dr. Gelbard says high cholesterol, high blood pressure and Peyronie’s disease—a connective tissue disorder for which Dr. Gelbard’s work has been recognized—can affect blood flow to and from the penis.

Depending on the cause, treatments can range from simple lifestyle changes, phosphodiesterase inhibitors (such as Viagra or Cialis), injections that stimulate erections, a vacuum erection device that pumps blood into the penis or implant surgery.

Urinary Incontinence

About one in 10 men ages 45 to 64 suffer—sometimes for years— from urinary incontinence (UI). In fact, in recent membership surveys, the National Association for Continence found that people wait an average of seven years before seeking treatment for incontinence. Asghar Askari, M.D., a urologist at Providence Little Company of Mary Torrance and Providence Little Company of Mary San Pedro, urges men not to suffer.

Whether due to an enlarged prostate, a side effect of surgery or a consequence of a medical condition, UI can be treated in several different ways.

For example, if an enlarged prostate, or benign prostate hyperplasia, is the cause, treatment to reduce the size of the prostate may help. “Then, the bladder can empty itself,” Dr. Askari says.

Other treatments include medication to relax the bladder muscles, Interstim therapy to stimulate bladder muscles or tibial stimulation, in which an electrical impulse is sent through the tibial nerve to regulate urinary function. “This can decrease the frequency, letting urine be collected in the bladder rather than a patient needing to go every 10 minutes,” Dr. Askari says.

Whether you’re living with symptoms affecting your lifestyle or sex life, or you’re due for a PSA exam, don’t wait any longer. Providence hospitals are here to help today.