FEATURE


• Active engagement with men (for example men’s social clubs and groups) to assist them with the identification of various diseases, and also to put any concerns they have about seeking help to rest


The use of printed, oral, and electronic communications can and should be used together to assist with these approaches, and should ultimately provide dividends in the improved management of male conditions across the province.


As pharmacists advertise themselves as a vital and rich source of knowledge about medical conditions and their treatments, it’s important that we function as advertised – and men’s health is no different!


Thus, it’s important to make sure that we maintain our knowledge about conditions which effect men, and keep it up to date and evidence-based. This article will highlight various details about two common conditions which are exclusive to the male of the species, and signpost areas where you could gather more information about them – it’s also worth checking out other reputable sources of information such as http://patient.info/directory/ mens-health and others, as a starting point for further reading on men’s health issues - this can provide vital info for your practice, and also your CPD!


Problems with the prostate Some of the most common male health complaints are to do with an organ which is exclusive to the male sex – the prostate. These complaints include prostatitis, prostate cancer, and benign prostatic hypertrophy (BPH).


In terms of the numbers of cases of these in N. Ireland, they are more significant than you might think – for example, more than 1000 men are diagnosed with prostate cancer every year here, resulting in 200 deaths a year, and BPH affects over 18,000 males per 100,000 men in the UK at latest count (2,3)


. In all of these cases,


enlargement of the prostate (which is responsible for the production of some parts of the seminal fluid) leads to a number of symptoms, outlined in Table 1.


These symptoms indicate that there may be difficulty in differentiating between BPH and prostate cancer on first consultation – it’s a good idea to question your patient in a full, but discreet, manner, and refer on if any suspicion of a more sinister pathology is raised. Moreover, if your patient has any of the risk factors for prostate cancer, such as:


• Age over 50 • African-American or Caribbean (of African descent) race


• Family history of prostate cancer • Obesity • Smoking


Or one of many others, then they should be referred on to rule out the presence of a prostate tumour (5)


. If


your patient should exhibit concern about what would happen if they visit their doctor for further investigation, it may be worthwhile advising them on the standard process, which can often involve a blood test for prostate specific antigen (PSA), digital rectal examination, or a prostate biopsy.


While these may seem a bit unsettling, it is worth making your patient aware that these are all common tests, and also making sure that you reinforce the importance of further investigation.


Management of these conditions is most commonly carried out with the use of prescription-only medications. On many occasions, management consists as follows:


• Prostatitis (6) • Antibiotics such as trimethoprim, ofloxacin, and ciprofloxacin • These agents are able to penetrate the prostate tissue well • Treatment duration is normally 28 days to allow for full symptom resolution


• Prostate cancer (7) • Usually involves the use of hormonal treatments • These treatments reduce androgen concentrations and the size of the prostate reduces as a result • Commonly employed drugs include, buserelin (Suprefact®), goserelin (Zoladex®) histerelin (Vantas®) and Lurproelin (Prostap®) • Normally administrated via depot injection, implant or intranasal routes


• BPH(8) • Can be managed in the pharmacy (but normally managed in conjunction with a prescriber) • Medications used often include dutasteride and finasteride (5-alpha reductase inhibitors) or alpha1- selective alpha blockers such as alfuzosin, doxazosin, indoramin, and prazosin • These medications function to reduce the effect of testosterone on the prostate, reducing its size, and reducing the hindrance of urine flow


As pharmacists should be aware, tamsulosin 400mcg capsules were deregulated from POM to P in 2009, allowing BPH to be managed within the pharmacy, if deemed appropriate.


However, the sale of this particular medication is somewhat complicated, and also requires that patients visit their GP within six weeks of starting treatment to assess their condition, and if they are allowed to continue self-treatment, the patient must visit their GP for a review on an annual basis (9)


.


Pharmacists should be aware of the full detail of how this medication should be used within the community setting, and also factor in issues such as cost before recommending this treatment to a patient.


However, the ability for this medication to be recommended and sold from within the pharmacy is hopefully the start of a government- backed culture of making it easier for men to take charge of their health.


Erectile dysfunction Erectile dysfunction (ED), otherwise known as impotence, is a condition which is common within N. Ireland as well as the rest of the UK. This condition sees a higher prevalence with increasing age, and as such affects 55% of men between the ages of 40 and 70 in Britain (10)


.


We’re all aware that this condition is attached to a social stigma, which yet again can make it more difficult for men to seek out help if they are suffering. When it is considered that ED can often be comorbid with other, more serious conditions such as diabetes, hypertension, hypercholesterolaemia, or depression in around 90% of sufferers, pharmacists must act to remove this stigma, and stress the importance of seeking help straight away to men who are affected.


In a lot of cases, the treatment of ED can occur as a by-product of the underlying condition being resolved. However, in some cases, and when the condition is idiopathic, medications such as Viagra®, Cialis® or Levitra®, which are all phosphodiasterase type-5 inhibitors, and improve bloodflow to the penis in order to assist with the maintenance of an erection, may be prescribed.


In all cases, the use of these medications carry a number of associated risks, particularly if the patient has one of more underlying conditions, and as such, pharmacists should offer this information to men who receive these medications on prescription, whilst being as discreet as possible.


In addition to this, and like many conditions in the medical world, ED can also be alleviated by lifestyle changes. These include stress reduction, smoking cessation, avoiding alcohol and drugs, weight loss and increased exercise, and the patient should be advised as such in order to assist with their treatment(11)


.


Importantly, pharmacists should also be aware of concomitant medications which can lead to sexual dysfunction as a side effect, and work together with the patient and prescriber to find a suitable alternative to the causative treatment if this is possible.


A MANdate for change? The two conditions outlined above are particularly common, and will be some of the men’s health queries that you’ll have to deal with most often.


However, many other ailments which affect men do exist, and pharmacists can assist with them all, in some capacity or another.


This includes the diagnosis and treatment of sexually transmitted infections, and other “non-genital” conditions which affect men more regularly than our female counterparts, such as depression, vascular diseases and obesity.


Pharmacists are in a great position to make conversation about these conditions with men more commonplace, remove any taboos, and facilitate a change towards a healthier future for the males of the population.


We need to ensure that we are taking every possible action to promote health services to men, and make it as easy as possible for men to make sure of them. If this becomes a common approach, the issues generated by male health problems may become a thing of the past. 


References (1) BBC News. Women 'more likely to report ill


health than men'. 2010; Available at: http://news.bbc.co.uk/1/hi/health/8588686.stm. Accessed 05/12, 2015. (2) Prostate Cancer UK. About prostate cancer. 2015; Available at: http://prostatecanceruk.org/prostate- information/about-prostate-cancer. Accessed 08/11, 2015. (3) Men's Health Forum in Ireland. Men's Health in Ireland. 2004; Available at: http://www.mhfi.org/fullreport.pdf. Accessed 08/11, 2015. (4) Prostate Scotland. Diseases of the Prostate. 2014; Available at: http://www.prostatescotland.org.uk/diseases-of- the-prostate.html. Accessed 05/12, 2015. (5) American Cancer Society. What are the risk factors for prostate cancer? 2015; Available at: http://www.cancer.org/cancer/prostatecancer/de tailedguide/prostate-cancer-risk-factors. Accessed 08/11, 2015. (6) NICE. Prostatits - Acute. 2009; Available at: http://cks.nice.org.uk/prostatitis-acute#!scenario. Accessed 008/11, 2015. (7) NHS Choices. Prostate cancer - Treatment. 2015; Available at: http://www.nhs.uk/conditions/cancer-of-the- prostate/pages/treatment.aspx. Accessed 08/11, 2015. (8) NHS Choices. Benign prostate enlargement - Treatment. 2015; Available at: http://www.nhs.uk/Conditions/Prostate- enlargement/Pages/Treatment.aspx. Accessed 08/11, 2015. (9) Royal Pharmaceutical Society. Reclassification - Tamsulosin. 2015; Available at: http://www.rpharms.com/support-resources-a- z/otc-tamsulosin-guidance.asp. Accessed 08/11, 2015. (10) British Association of Urological Surgeons. Erectile dysfunction (impotence). 2014; Available at: http://www.baus.org.uk/patients/symptoms/imp otence. Accessed 05/12, 2015. (11) NHS Choices. Erectile dysfunction (impotence) - Treatment. 2015; Available at: http://www.nhs.uk/Conditions/Erectile- dysfunction/Pages/Treatment.aspx. Accessed 08/11, 2015.


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