Dr. Neil Fleshner on Prostate Cancer (Benefits Canada)

Unequal funding and treatment for cancer costs employers

Moira Potter | May 4, 2015

Cancer is an equal opportunity disease. But the way it’s treated is not—and we’re all paying the price. In February, Benefits Canada’s 2015 Employers Cancer Care Summit brought physicians, employers, insurers, pharmacists and healthcare advocates together in Toronto to hear why there are huge nationwide disparities in the quality of available cancer care and access to new medications, as well as in provincial policies toward funding existing tests and emerging treatments.

The PSA Controversy

Prostate cancer is the most common male malignancy, but governments—and men themselves—seem to be ignoring it.

Dr. Neil Fleshner, University of Toronto and University Health Network
Dr. Neil Fleshner, University of Toronto and University Health Network

“Getting prostate cancer is like getting grey hair and wrinkles,” said Dr. Neil Fleshner, chair of urology at the University of Toronto and chief of urology for the University Health Network. “Eighty percent of men will develop some degree of prostate cancer as they age, and one in four will die from it.”

A simple blood test—the prostate-specific antigen (PSA) test—can dramatically reduce, through early detection, a man’s chance of dying from the disease. Since the test’s introduction in the early ’90s, there has been a 40% decline in mortality for Canadian men battling the disease.

So why, then, did the Canadian Task Force on Preventative Health recently say PSA testing isn’t necessary for men of any age? “I think this is an abomination,” said Fleshner. “These guidelines even recommend against the digital rectum exam—even when a man has symptoms such as difficulty urinating. So [the Task Force] is essentially saying we should let any man destined to die of prostate cancer do so.”

Rocco Rossi, president and CEO of Prostate Cancer Canada, agreed. “This is the same organization that, a couple of years ago, suggested mammograms weren’t necessary for women under the age of 50. Guess what happened? Provincial legislators across the country received visits from our colleagues in the breast cancer movement who told them, in no uncertain terms, that if they defunded mammograms, they did so at their peril.” The pressure worked. Governments across Canada continue to fund mammograms for all women.

So why aren’t men mobilizing in the same way? Why aren’t they outraged that the Ontario and British Columbia governments refuse to fund the PSA test for men without symptoms?

“Because men are their own worst enemies,” said Rossi. “We ignore our health. And if it concerns anything below the waist, if we’re not bragging, we’re not talking about it!”

Both Fleshner and Rossi agreed men are being sent the message that the PSA test is optional. “And when men don’t have to take a test, they won’t,” Rossi said. “Because of that, they are dying and suffering unnecessarily.”

The solution is to raise awareness. While the Movember campaign has been hugely successful in doing that, Rossi wants women and workplaces to be more involved. “Women will ask the tough questions and push their men to take this seriously,” he said. “And employers can help by promoting PSA testing and including it in their workplace health plans.”

Moira Potter is a freelance writer based in Toronto.

Source: http://www.benefitscanada.com/benefits/health-benefits/unequal-funding-and-treatment-for-cancer-costs-employers-66246

Dr. Dean Elterman on Men’s Health (The Globe and Mail)


For me, improving men’s health is personal. I am a man in my mid-thirties and the statistics for living a life free of disease and health complications are not in my favour, unless I take action now. I know this because I am urologist. Every day I see male patients and colleagues who have put off taking care of their health because we live in a society where masculinity forces us to focus on our careers, abuse our bodies and neglect our health-care needs. Across all age groups globally, men die earlier and live more years in poorer health compared to women. Men are at increased risk of premature death related to heart disease, stroke, workplace accidents, suicide and risky behaviour such as drunk driving.

In some respects I’m about to make sweeping generalizations that don’t apply to all men. But bear with me.

Is there a faulty or self-destruct gene on the Y-chromosome or does being “manly” lead men to engage in riskier physical activities and socially-influenced neglect of their own health? Historically, men’s health seemed to fall off a cliff once they reached their late teens. After the days of routine pediatrician visits, boys are noticeably absent from doctors’ waiting rooms.

We become men. And men don’t see doctors. Men are fearless and strong. Men avoid asking for help or acknowledging vulnerability or weakness. We get caught up in life, starting careers and families. And society doesn’t make it easy for us. When’s the last time you ordered a kale salad and carrot juice at the hockey game? Exactly.

Men eat poorly, drink and smoke too much, don’t get enough sleep or exercise, and don’t see doctors regularly. They vanish only to show up at my office door 30 years later with a urologic complaint or in the emergency department with something much more serious.

These generalizations, I’m pleased to say, appear to be on the wane.

More young men are being inspired by campaigns like Movember to know their health risks and make changes earlier in life. Boomers are turning back the clock and men of all ages are taking a more open and proactive approach to their health.

Men never used to talk about their erections or the way they urinated. Now I have men coming in to my office, who after seeing their family doctor for the first time in decades, are asking about their testosterone or ways to improve their urinary/sexual health after hearing about it from friends. As a urologist, working in collaboration with my primary care colleagues, I am in a unique position to talk to men for perhaps the first time in many years about their cardiovascular health, lifestyle habits as well as urologic concerns.

Urologists used to see men for a single system complaint, such as an enlarged prostate, cancers or infertility. Problems were isolated and treated in a targeted fashion with little consideration for the interrelatedness of bodily systems. We now recognize the association between metabolic dysfunction, such as diabetes, and urologic disorders like lower urinary tract symptoms, low testosterone and erectile dysfunction. We also know that these urologic complaints can be the early warning signs for more serious, life-threatening conditions just a few years down the road. When a middle aged man comes into my office with a new complaint of erectile dysfunction, the first thing I think of his is heart, cholesterol, blood sugar and blood pressure, not which little erection pill I can prescribe him.

We are making great strides in both health policy and technology in the domain of men’s health. Australia and Ireland, as well as British Columbia have national/provincial men’s health initiatives that approach the issues facing men through a uniquely gendered lens, just as had been done for women’s and children’s health in the late 20th century. New minimally invasive technologies, like the laser surgery that I perform for benign prostate enlargement, are making the prospect of medical treatment and recovery that much easier for men to palate.

Men’s health is a personal issue for me. But it should be a personal issue for everyone. Men’s health affects spouses, families and communities. The health of men impacts our economy, culture and social fabric. Having healthy men is a women’s health and children’s health issue. It’s time to think about your health or the health of the men in your life. It’s never too late to make a change.

Dr. Dean Elterman is a urologic surgeon at the Toronto Western Hospital/University Health Network with a special interest in men’s health. He is the Medical Director of the Prostate Cancer Rehabilitation Clinic at Princess Margaret Hospital Cancer Centre. Dr. Elterman specializes in voiding dysfunction, sexual dysfunction and pelvic reconstruction in both men and women.

Original publication:


Dr. Lesley Carr on Urinary Tract Infections (The Chronicle Herald)


Urinary tract infections more often plague women

By SHERYL UBELACKER The Canadian Press
Published March 8, 2013 – 8:06pm
Last Updated March 8, 2013 – 8:08pm

Condition can be painful, cause embarrassing symptoms

Dr. Lesley Carr, a urologist at Sunnybrook Health Sciences Centre in Toronto, recommends simple ways to prevent urinary tract infections which commonly occur in women. (THE CANADIAN PRESS)

TORONTO — It’s not something most women want to talk about — well, maybe to their closest gal pals — but as medical conditions go, this one is pretty common and irritatingly so.

Urinary tract infections, or UTIs, can not only be painful, but also cause embarrassing and anxiety-provoking symptoms. They are a particular scourge for women, who for anatomical reasons are far more susceptible than men to developing the pesky disorder.

Indeed, about half of all women will experience a UTI at some point in their lifetime, and some women get them over and over again, making them more than just a nuisance.

Urinary tract infection is a non-specific term that refers to a bacterial infection in any part of the system responsible for removing urine from the body, including the bladder and kidneys, says Dr. Lesley Carr, a urologist at Sunnybrook Health Sciences Centre in Toronto.

UTIs typically start in the urethra, the narrow tube that runs from the bladder to the opening where urine is released. If the infection moves upwards to the bladder, it too can become infected, causing a condition known as bacterial cystitis.

Should the bacteria invade the kidneys, which are linked to the bladder by two long tubes called ureters, the infection is considered more serious. Left untreated, a kidney infection can lead in very rare cases to sepsis, a blood infection that can be fatal.

“The most common is bladder infection,” says Carr. “It often irritates the bladder so there’s increased frequency of having to void or urgency, having to get (to a bathroom) quickly.

“Often there’s pain and that could be pain in the bladder area, felt above the pubic bone, and also what we call dysuria, which means pain during the actual act of voiding, often radiating down along the urethra.”

That pain is often described as burning. And depending on the extent of the infection, it can be so excruciating that women will desperately try to limit how much they pee.

Other signs of a UTI can include foul-smelling and cloudy urine. “There could even be blood in the urine or blood on the toilet paper,” Carr says.

Despite noticing some abdominal pain, Eileen Woods had no idea she was experiencing her first urinary tract infection three years ago. It wasn’t until she went to the bathroom and spotted blood on a light pad she was wearing that she realized something was wrong.

“It panicked me a bit,” admits Woods, 80, of Burlington, Ont., just southwest of Toronto. “It was frightening.”

Woods went to the hospital emergency room, where doctors performed a number of tests and concluded she had cystitis.

She was immediately started on a course of oral antibiotics, the standard treatment for most urinary tract infections.

Some women with a UTI will get what Carr calls an overactive bladder — needing to urinate frequently and with an out-of-the-blue and not-to-be-denied urge to go — but little pain.

And some women, typically those who are postmenopausal, will have no apparent symptoms at all. Often their infections are so low-grade, doctors don’t actively treat them but ask women to keep an eye out for any sudden onset of symptoms.

“If they’re getting fever, worsening pain, blood in the urine — that’s a different story,” says Carr. “They really should be on antibiotics at that point.”

Urinary tract infections are usually caused by a strain of E. coli, a type of bacteria commonly found in the gastrointestinal tract that migrates to the urethra and up into the bladder.

Men get UTIs, but the incidence in females is 10 to 20 times higher due to the female anatomy — specifically, the close proximity of the anus to the urethra.

Sexual intercourse may also promote cystitis, and because the urethra is close to the vagina, sexually transmitted bugs like herpes, gonorrhea and chlamydia can also infect the urinary tract.

Postmenopausal women are often more prone to UTIs because diminished estrogen levels cause changes in the urinary tract that make it more vulnerable to infection. Doctors may prescribe a vaginal cream containing estrogen to reduce that risk.

Sexual activity, regardless of age, increases the risk,” says Carr. “It’s probably multifactorial, but the act of intercourse will push the bacteria that are in the vaginal area up into the urethra.

“So that’s why we often talk about behavioural strategies: drinking more and then voiding after intercourse to flush out any bacteria that got introduced into the urinary tract.”

For women who get repeated UTIs, she suggests drinking a glass of unsweetened cranberry juice each day or taking a daily cranberry extract caplet.

Cranberries contain compounds called proanthocyanidins, which are thought to prevent bacteria from adhering to cells lining the urethra and bladder, so they can’t get a foothold to cause infection. While there’s no evidence that ingesting the fruit can treat an active UTI, studies suggest daily doses may prevent recurrence.