Choosing Wisely: Medical Recommendations Specifically for Men

Jennifer Yttri, PhD
August 2013

 

Men have their own set of health concerns but it can be daunting to ask a doctor for help. From prostate cancer to erectile dysfunction, these are very personal and important problems. But what you hear in TV advertisements isn’t the whole story. Sometimes asking your doctor for a new medicine or test you heard about can do more harm than good. Not every test, medication, or procedure is appropriate for every patient, and many are over-used. What is beneficial for one man isn’t worth the risks for another.

The best health decisions can be made when doctors take time to talk with their patients and patients ask questions rather than just assuming the doctor always knows best.

Consumer Reports magazine and the ABIM Foundation are working with medical specialty societies to create lists of “5 Things Physicians and Patients Should Question” as part of a Choosing Wisely campaign (www.choosingwisely.org). These medical groups represent more than 500,000 physicians. The lists are recommendation from experts based on the latest scientific evidence. Here is the list of their recommendations that are important for men’s health.

 

Enlarged Prostate or benign prostatic hyperplasia (BPH)

As men age, it’s common for their prostate to become enlarged, a condition called benign prostatic hyperplasia or BPH. Usually BPH does not cause problems until men are near age 60.  If patients are having problems urinating with limited or no other symptoms, evaluation beyond the standard prostate exam is not recommended. Patients are unlikely to have problems in the future due to their current condition. Should symptoms change, follow up tests, such as ultrasound, biopsy, or cystoscopy, may be useful for deciding on treatment.

Cryptorchidism

Ultrasound is not recommended for boys with cryptorchidism, a condition where the testes do not descend into the scrotum. A physical exam is more effective at locating testes.

Erectile dysfunction

Testosterone treatment is not effective as therapy for erectile dysfunction in men with normal testosterone levels. Erectile dysfunction is rarely caused by low testosterone levels. Testosterone therapy is costly and has high risks, including enlarged prostate, lower fertility, heart disease, and more aggressive prostate cancer.

Prostate cancer screening

Men who do not have symptoms generally should not be screened for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam as it can lead to treatments that may do more harm than good. Gleason and prostate-specific antigen (PSA) tests are used to measure how aggressive prostate cancer is and how likely it is to spread. Imaging tests can then be performed to identify exactly where cancer has spread. These imaging tests, such as bone scans, PET, and CT, are not recommended for detecting disease in men who are newly diagnosed with low-grade prostate cancer. Imaging tests are expensive, can expose men to high levels of radiation, and are unlikely to provide more information about early prostate cancer. Only men with Gleason scores above 7 and PSA levels above 10 nanograms/mL should consider imaging tests.

Prostate specific antigen (PSA)

High PSA levels may be a sign of prostate cancer. However, having a low PSA level does not prevent prostate cancer nor does it mean there is no cancer. It was thought that antibiotics might lower PSA and protect men from prostate cancer. This has not been proven in clinical tests and is not recommended as an alternative preventive therapy.