Men's Healthcare - Q4 2023

Men’s Healthcare Q4 2023 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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“The stigma and taboo around incontinence only exacerbates the situation.”

“Prostate cancer often doesn’t cause symptoms in its early stages when it’s curable.”

Professor Eamonn Rogers, Patient Office Chair, EAU

Susan Piper, Specialist Nurse, Prostate Cancer UK

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Check in with the men in your life.

Visit movember.com

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~Matt Johnson, TV Presenter, Podcaster and Mental Health Campaigner

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Advancements in ultrasound technology ease prostate cancer diagnosis

WRITTEN BY Anne Cécile Berthier Country Director - UK and Europe, Movember

Ultrasound technology is playing an important role in helping clinicians make critical diagnoses in patients and plan onward treatment strategies.

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issue biopsies, though invasive and sometimes uncomfortable, are crucial for diagnosing conditions such as prostate cancer and liver or kidney disease. Using ultrasound technology, clinicians can decide on treatment protocols and future therapies based on collected tissue samples.

Modern ultrasound tech for prostate cancer Improvements to ultrasound are making procedures as comfortable as possible, particularly in areas such as prostate cancer. Simon Jarvis, Segment Lead (urology and surgery) within Fujifilm’s healthcare division, explains that men identified as potentially having prostate cancer from a high prostate-specific antigen (PSA) test reading will be referred by GPs to a consultant for assessment, followed by an MRI scan.

If a lesion is found on review of the MRI scan by a radiologist, the lesion is scored and then the patient would be counselled for the next stage. Potentially, this would be a prostate biopsy performed using an ultrasound-guided probe, typically under local anaesthesia.

Recent advancements, such as a 3mm size reduction in the Fujifilm probe, enhance patient comfort.

Later, Crystal technology in the probe enhances image capability; better ergonomics improve the ease of use for theatre staff and help to reduce repetitive strain injury (RSI).

guide treatment. It’s also critical that the ultrasound probe is a comfortable size for patients because if you cannot insert the probe, you cannot take a biopsy or get a report back from pathology.”

For difficult-to-locate lesions, fusion technology — such as in the Arietta 65 IntuitiveFusion — combines established ultrasound and MRI diagnostic tools with software to direct urologists to exact targets for prostate biopsies.

Smart identification software Ultrasound, a non-radioactive imaging modality, also supports the diagnostic pathway in liver and kidney disease with the biopsy needle guided by ultrasound. This is supported by 3D modelling software that links ultrasound and MRI images.

Furthermore, Fujifilm surgical planning software is available to surgeons to navigate the procedure by differentiating between tissue, tubes, vessels, veins and arteries and ensuring surgeons work within safe margins.

“We can use technology on ultrasound to guide incisions,” says Jarvis. “Ultrasound technology can show what is tissue, what is an artery and what is a smaller vessel.

We also have similar technology with 3D modelling on open cases, laparoscopically or for robotic surgery.”

Accurate imaging capabilities Ultrasound provides diagnostic imaging to identify lesions. A positive biopsy for cancer may lead to a further course of treatment.

Jarvis explains: “If you can’t see the lesion, you cannot take a biopsy or

INTERVIEW WITH Simon Jarvis Regional Sales Manager, Ultrasound, Segment Lead - Urology & Surgery

Paid for by Fujifilm Healthcare UK

Find out more at fujifilm.com/uk/en

@HealthawarenessUK

WRITTEN BY Mark Nicholls

@MediaplanetUK

The 5 signs of depression in men — and how you can help Spotting when someone you love is struggling can be difficult. Approximately one in three women and one in five men have an episode of major depression by the age of 65.

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epression can look different in men, so it’s important to be able to spot the hidden clues.

Sadness, apathy and withdrawal are often thought of as typical symptoms of poor mental health. While men can experience any of these, one reason depression is often missed is because the symptoms can look different. Here are five signs to look out for: Anger and irritability Men are more likely to experience anger and irritability as a result of poor mental health, as opposed to sadness and withdrawal.

Loss of appetite Poor mental health can affect our appetite and change our relationship with food. It can cause us to eat more than usual or lead to a loss of appetite.

Constant tiredness Fatigue is another sign of poor mental health that is often missed. It can make everyday tasks such as going to work, taking care of children or preparing meals feel insurmountable.

They may even start speaking or moving more slowly than usual.

Indecisiveness Difficulty in making decisions that once would have come easily might be a sign someone is feeling low.

Loss of interest in favourite activities It’s normal to feel sad and lack motivation sometimes, but if a loved one is opting out of activities they used to enjoy, it can be a sign something is wrong.

How to help • Arrange a time to chat in person.

If someone finds it difficult to talk, remember that some find it easier to open up during a walk or bike ride than if they’re sitting opposite you.

• Offer empathy and support, not solutions. You don’t need to have the answers. Listen and ask openended questions. Movember produces free interactive resources at Movember Conversations on how to support a friend who might be struggling. This year, Movember is launching SpeakEasy workshops for UK and EU workplace and community groups on how to support the men in their lives.

• Reduce the stigma. Some men find it difficult to talk about their mental health or get the help they need.

Remove the stigma by sharing your own experiences.

• Encourage men to seek help.

Remind them that seeking help is a valid and necessary investment in their wellbeing.

• Follow up. Check on them regularly, even if they seem to be doing better.

Reference 1. https://ourworldindata.org/depression-lifetime-risk

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Choosing the right treatment for benign prostatic hyperplasia in the UK Men are receiving robotically assisted benign prostatic hyperplasia treatment in the UK. Aquablation therapy has been proven to preserve continence and sexual function for patients.

INTERVIEW WITH Prof Nikhil Vasdev Consultant Urological and Robotic Surgeon at Pinehill Hospital, Hitchin

INTERVIEW WITH Mark Rochester Clinical Director of Urology, Norfolk and Norwich University Hospital

WRITTEN BY Mark Nicholls

Find out more at aquablation.co.uk aquablation.com/ safety-information/

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We’re seeing quicker patient recovery compared with traditional treatment, an improvement in outcomes and a reduction in side effects.

growing number of men are receiving revolutionary treatment to relieve the debilitating symptoms of enlarged prostates. The procedure utilises robotically assisted surgery and a targeted heat-free waterjet to tackle benign prostatic hyperplasia (BPH), where the prostate gland enlarges and causes difficulty passing urine.

Relieving symptoms caused by benign prostatic hyperplasia Around 3 million men are affected by BPH, with more than 30,000 a year needing surgery, resulting in a backlog of NHS cases. However, with National Institute for Health and Care Excellence (NICE) recommendation of Aquablation therapy, surgeons are hopeful they can not only cut waiting lists using the technique but also provide better outcomes for patients. It was developed by Procept BioRobotics and available for private and NHS patients.

The procedure takes approximately one hour, has little or no impact on sexual function for men and is normally provided as a day case or one-night stay in the hospital. The treatment, also known as transurethral waterjet ablation, is being made more widely available on the NHS. Treatment options for benign prostatic hyperplasia Norfolk and Norwich University Hospital introduced the procedure earlier this year. The hospital’s Clinical Director of Urology, Mr Mark Rochester, says offering a range of treatments remains important as every patient is different in terms of priorities and what they want from the treatments.

One standard treatment for BPH is Trans Urethral Resection of the Prostate (TURP), which is effective in relieving urinary symptoms but can damage parts of the prostate gland essential for sexual function. Other options include a three-hour laser technique known as Holmium Laser Enucleation of Prostate (HoLEP) or using steam or stents to open the prostate to allow passage of urine.

Aquablation therapy surgically removes tissue using a robotically-assisted, heat-free waterjet to resect a channel through the prostate while preserving critical anatomy and sexual function. It’s proving to be a fast and cost-effective option with few side effects.

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Images provided by Procept BioRobotics

Rochester says: “After creating the surgical plan, the waterjet’s removal of tissue was robotically executed. It’s efficient use of theatre time, and we’re able to send many patients home the same day.” It can have a positive impact on waiting lists and help reduce NHS backlogs.

Quicker recovery with fewer side effects Professor Nikhil Vasdev, Consultant Urological and Robotic Surgeon at Pinehill Hospital in Hitchin, Hertfordshire, has recently started conducting the procedure. He says: “With Aquablation therapy, patients notice that improvement in their waterworks after surgery is quick, and none have had incontinence, ejaculatory or erectile complications so far.

One patient was back at work two weeks after the treatment while another, who had a catheter and could not pass urine, returned to work in four weeks and was catheter-free after 24 hours. “We’re seeing quicker patient recovery compared with traditional treatment, an improvement in outcomes and a reduction in side effects,” adds Professor Vasdev.

“That is down to precision of the operation.”

Patients reporting on the outcomes and efficacy One patient who underwent Aquablation therapy for BPH was retired engineer Surjit Sandhu. He was initially admitted to a hospital in Stevenage where his prostate-specific antigen (PSA) levels were found to be high, and he was placed on intravenous antibiotics before being discharged several days later.

With delays in further investigations, he made an appointment with Professor Vasdev at Pinehill Hospital, where it was confirmed that he had an enlarged prostate. “This was the first time I had medical confirmation that it was BPH and that the growth wasn’t cancerous. This was a huge relief,” says Surjit, 71. After discussing treatment options, the Aquablation therapy procedure was carried out.

“I would recommend this treatment to others who are suffering from an enlarged prostate because the recovery period is less compared to other treatments,” he says. “It’s less invasive and more precise.”

INTERVIEW WITH Surjit Sandhu Patient

Paid for by Procept BioRobotics

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Enlarged prostate symptoms are distressing: here’s what you can do about it Benign prostatic hyperplasia — or an enlarged prostate — is not cancer, but its symptoms can be severely lifelimiting. Thankfully, a safe treatment is available.

INTERVIEW WITH Dr Clare Bent MBBCh FRCR, Consultant Interventional Radiologist, University Hospitals Dorset

WRITTEN BY Tony Greenway

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he likelihood of developing an enlarged prostate — or benign prostatic hyperplasia (BPH) — increases with age. More than 50% of all men in their sixties and as many as 90% aged between 70 and 89 will have some symptoms of BPH. Symptoms of benign prostatic hyperplasia BPH is not cancer and doesn’t raise your risk of developing prostate cancer. However, the symptoms can significantly change the way you live; impacting daily activities, hobbies and sleeping patterns and altering your enjoyment of life.

Normally, the prostate gland is the size of a walnut; but, when it gets bigger, it can compress the urethra (tube where urine passes). The bladder wall then needs to squeeze harder to remove the urine, becoming thicker and irritable; it can begin to contract even when it contains only a small amount of urine.

People with BPH may therefore need to urinate more frequently, especially at night. They may also be unable to urinate; strain while urinating; have a weak urine stream; have a urine stream that starts and stops; experience dribbling at the end of urinating; or be unable to empty their bladder.

PAE is usually performed as an outpatient procedure, and no general anaesthesia is required.

Prostatic artery embolisation: a safe treatment for BPH While BPH is common, it shouldn’t be ignored. “Left untreated, it could lead to health complications such as kidney stones, recurrent infections, lack of bladder control and complete bladder outlet obstruction or blockage,” says Clare Bent, Consultant Interventional Radiologist at University Hospitals Dorset.

“If your healthcare provider determines that you have benign prostatic hyperplasia, it’s a good idea to discuss the various treatment options available, including prostatic artery embolisation (PAE).” This is a safe treatment option and, like other minimally invasive procedures, has significant advantages over conventional surgical options.

Find out more at ask4pae.com

Prostatic artery embolisation process and benefits With PAE, a tiny incision is made in your groin or wrist to gain access to your arterial system. A catheter is then guided to the vessels that supply blood to your prostate. Embolic material (particles about the size of a grain of sand) is injected through the catheter and into these blood vessels, decreasing blood flow to your prostate. This causes it to shrink, thereby improving urinary symptoms.

“PAE is usually performed as an outpatient procedure, and no general anaesthesia is required,” explains Clare Bent.

“During the procedure, you’re given a mild sedative but remain awake. A year after PAE, average prostate size is seen to shrink by approximately 30%, easing urinary symptoms, sparing erectile function and increasing quality of life.” By ensuring men are aware of all treatment options available, they can make informed and empowered health decisions.

WRITTEN BY Prof Eamonn Rogers Patient Office Chair, EAU

Institutional support is central to the future of European continence care

Patient voices are leading the way to better continence care in Europe. Momentum is building and patients are demanding policy change and institutional support.

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ncontinence is a pervasive issue with a heavy physical and psychosocial toll on patients and their loved ones. Incontinence is also connected to higher rates of anxiety and depression.

Support for patients with incontinence The stigma and taboo around incontinence only exacerbates the situation, causing many patients to ignore symptoms or delay diagnosis, particularly in men who hesitate to seek help with their continence health. Support for patients living with incontinence should be forthright and readily available.

EU Continence Health Summit A new multistakeholder campaign, An Urge to Act, seeks to take strong policy action towards achieving this support. In a huge step forward, on 8 November 2023, the EU Parliament hosted the first EU Continence Health Summit in Brussels.

The summit, as a first step of the Urge to Act campaign, is focused on policy reform in the EU to support those living with incontinence. The manifesto released at the Summit addresses the current impact of incontinence — not only the personal impact on the 55–60 million Europeans who suffer from continence health problems but also the larger economic impact for society.

Cost of incontinence in Europe In collaboration with the EAU’s Urology Week, some of the findings by the Urge to Act campaign were shared, including the alarming number

that incontinence costs European society over 40 million euros per year. Without action, this number is expected to increase, furthering the economic and environmental burden of incontinence.

The manifesto calls for swift and strong policy action to tangibly improve continence care in Europe.

By identifying 10 key points, it advocates for a systemic response to incontinence care, calling for equitable access to facilities and care, better patient education outreach and funding for the research of healthy and sustainable solutions. The manifesto is a huge step forward in patient-centric solutions in continence health.

Continence health is driven by patients The patient voice is a key driver in shaping the future of continence care. The risk of continence problems often correlates with conditions that develop or intensify as people age; as Europe ages, that number is only expected to rise.

Patient advocacy groups and dedicated patient resources like the European Association of Urology’s Patient Office continue to amplify the patient voice and drive change through collaboration, empowerment and action. The Urge to Act campaign is a much-needed step in growing the movement towards patient-centric care.

Learn more about EU Continence Health Summit: uroweb.org/an-urge-to-act For Urology Week 2023: urologyweek.org/for-press

Paid for by Merit Medical

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Why men should talk openly about erection difficulties (it isn’t). What’s more, 78% aren’t aware that the condition could be a sign of heart disease. Of course, if you’ve had problems getting a full erection once or twice, it doesn’t necessarily mean you have ED. Still, if you have any concerns, it’s always best to speak with your pharmacist.

Paid for by Opella Healthcare (T/A Sanofi)

Anyone experiencing erection difficulties may feel ashamed and anxious, but generally, the tendency is to pretend it’s not happening.

Erection difficulty is more common than most people think. People may feel awkward talking about it, but opening up about the subject can help find solutions to treat it.

ARTICLE ATTRIBUTED TO Opella Healthcare (T/A Sanofi)

WRITTEN BY Tony Greenway

MAT-XU-2305654 v1.0 December 2023

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sually, men aren’t shy when it comes to talking about sex.

However, there’s one sexual topic that remains a taboo subject that they would rather forget about completely: erection difficulties (ED).

Ways men experience and deal with erection difficulties Erection difficulties (or erectile dysfunction) refer to the inability to achieve and/or maintain an erection for satisfactory sexual performance, and it’s more common than you might think. In the UK, one in three men will experience some degree of erection difficulty at some point in their life.

It can be a distressing condition and can happen at any age. It occurs when the blood vessels in the penis are narrowed, and the blood flow is not sufficient to get and keep an erection.

Anyone experiencing erection difficulties may feel ashamed and

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anxious, but generally, the tendency is to pretend it’s not happening. Of 3,445 UK men experiencing ED surveyed, 56% say that sex is a very important part of their relationship, but 63% of them would rather keep their ED issues to themselves.* Opening up the conversation about erection difficulties People have to put aside their awkwardness and be more open about ED. Admittedly, it may not be easy. If you’re unable to get or maintain an erection, you might feel extremely uncomfortable discussing it with a healthcare professional. More recently, The Urology Foundation surveyed 2,000 UK men and found that, if they were having ED problems, 46% of them would NOT visit their doctor.

However, the bigger problem is not talking about it at all because of the several misconceptions. Many men — 63% of those surveyed by The Urology Foundation — think that ED is an inevitable consequence of ageing

Managing the condition with an over-thecounter medicine Even though some men won’t visit their doctor, there are some positive signs that people would be keen to explore solutions to manage their ED. The Urology Foundation study makes clear that 64% would consider a pill or non-prescription medicine to address the condition.

Also, studies have shown that effective treatment for ED can significantly improve sexual satisfaction for men and their partners and increase sexual self-confidence, resulting in better relationships and an enhanced quality of life.

Cialis® Together is an ED brand available without a prescription at pharmacies, and it is committed to helping men get a fulfilling and healthy sex life. Until recently, the over-the-counter treatments for ED available in the UK have only lasted up to four hours. Cialis® Together is the first non-prescription ED medicine that is effective for up to 36 hours. It works by widening the blood vessels in the penis and will help men get an erection when sexually aroused, and then the erection should subside after sexual activity.

The main advantage of having up to 36 hours to decide when to have sex is that it fits into the realities of a relationship by allowing you to decide when the moment is right for both of you, helping make spontaneous sex an option.

So, don’t be embarrassed.

Pharmacists can give you advice about the appropriateness of any medication, its potential side effects and if you need to see your GP. Effective treatment for ED is a beneficial approach. That’s why we need to talk about it more.

Cialis® Together 10mg tablets contain tadalafil.

Always read the label. *Source: Irrational Agency, quantitative survey UK, 2021, N=10,197 adult men; 3,445 men qualified either as suffering erectile dysfunction or identified through IIEF-5 screening (IIEF – International Index of Erectile Function).

Find out more at cialistogether. com/en-gb

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About 1 in 4 Black men will get prostate cancer — regular tests save lives Around 1 in 4 Black men will get prostate cancer, and shockingly, they’re twice as likely to get the disease compared with other men.

A WRITTEN BY Susan Piper Specialist Nurse, Prostate Cancer UK

man with Black African or Black Caribbean getting a regular PSA blood test, which is a simple test that heritage is also at risk of prostate cancer from an can help to diagnose prostate cancer. earlier age than the rest of the population. We don’t yet know all the reasons behind these stark Cutting-edge prostate cancer research facts, but we do know that if every Black man is aware of To help us understand why Black men are at higher risk, his higher risk — and learns what he can do we’re funding crucial research. The PROFILE about it right now — more precious lives will study aims to discover why some men, A Black man is at be saved. including Black men, are genetically more likely to get prostate cancer than others. higher risk from What you need to know about prostate cancer Understanding this could lead to more the age of 45, With other cancers, we often hear talk of the effective tests that identify those men with a symptoms to look out for. However, prostate higher risk based on their genes, so more of especially if he has cancer often doesn’t cause symptoms in its them can get early, lifesaving diagnoses. a family history of early stages when it’s still curable, so you We’re also actively working with our Black might feel completely well but still have the communities across the UK to raise risk the disease. disease. awareness and to break down any barriers When symptoms do appear, it usually that they might face when opening up about means that the cancer has spread beyond the prostate and, their health and talking to a GP. With a quarter of Black men sadly, has become harder to cure. That’s why it’s so important likely to get prostate cancer, getting tested and diagnosed to know your risk and to get checked out by a doctor or nurse, early is critical to being successfully treated and surviving the regardless of how you feel. disease.

Regular PSA tests from age 45 A Black man is at higher risk from the age of 45, especially if he has a family history of the disease.

If this applies to you, we strongly recommend that you talk to your GP as soon as possible about your risk and ask about

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Prostate cancer advanced radiotherapy: how five-day treatment works

Check your risk in 30 seconds: prostatecanceruk.org/risk-checker If you have any questions about prostate cancer, chat with our Specialist Nurses by calling 0800 074 8383 or using the webchat on the Prostate Cancer UK website: prostatecanceruk.org

Five-day prostate cancer treatment is available using smart technology, which enables men to return to their normal lives quickly, with peace of mind.

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he MRIdian SMART technology is an exciting step in treating a disease affecting more than 52,000 men each year. Prostate cancer, caught at an early stage before it’s spread, has a good outlook.

WRITTEN BY Dr Philip Camilleri, Clinical Director of Urology and Consultant Clinical Oncologist, GenesisCare

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Benefits of five-day radiotherapy Surgery or radiotherapy are equally effective in treating prostate cancer, but both treatments have side effects, and you also need to factor in the length of treatment and recovery time. Recent advances in radiotherapy technology now provide men with treatment, which minimises side effects and is completed in just five days — enabling a quick return to normal life. A recent study also

reported that five-day treatment delivered similar prostate cancer control when compared with standard radiotherapy.

Real-time tumour tracking Treatment is done using Stereotactic Ablative Radiotherapy (SABR or SBRT) — a modern treatment for localised prostate cancer. We use a machine called the MRIdian MR linac, which has a built-in MRI scanner to track the tumour and view the area being treated on a live feed, allowing us to accurately target radiation at the prostate.

Targeted radiotherapy reduces side effects Standard radiotherapy might cause long-term side effects, as the bladder

and bowel sit close to the prostate.

During treatment, radiation can also reach these areas due to normal body movements, which can lead to more noticeable urinary and bowel side effects.

However, using MRIdian MR linac radiotherapy, we can see and adjust the radiotherapy target throughout treatment. If the tumour moves out of range, the radiotherapy beam automatically switches off.

This advanced technology protects the bladder and bowel. No other radiotherapy machine has this capability.

The ability to see the tumour means we can give higher doses of radiotherapy over just five consecutive days, compared to the standard 20–39 days of a smaller daily dose of radiotherapy. The overall dose given is the same in both types of treatment.

We’re also confident in the accuracy; men who’ve already received radiotherapy to the prostate can return in the future, known as prostate cancer reirradiation.

Fast return to everyday life You can start on a Monday, and by the weekend, treatment is complete.

Many men receiving this treatment experience minimal impact on their lives; they’re able to continue working or even play sports without any longterm side effects.

Paid for by GenesisCare

For more information, visit genesiscare.com/ uk/5dayprostate

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Let’s talk about bladders — you might help someone become a cancer survivor Bladder cancer is the 8th most common cancer for men in the UK and predominantly affects the elderly; it is highest in people aged 85 to 89.1

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iscussions with men about their health can sometimes be challenging for many reasons, from stigma to attitude, preconceptions, personalities and relationships. Some topics, however, cannot and should not be avoided.

Changing trends in how men seek support and advice online Increasing numbers of men have been seeking support through an online forum. Has the switch to online helped men open up about health?

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ur private online forum at Fight Bladder Cancer now has over 5,000 members and is supervised by administrators and 10 moderators from around the globe, 24 hours a day, seven days a week.

Accessible information and safe space “The communication methods people were used to were hugely impacted during the pandemic. Many had no option but to use smartphones or learn how to do things online for the first time,” says Melanie Costin, Fight Bladder Cancer Support Manager.

The evolution to online support “Historically, women have been Over recent years, potentially sparked more likely to chat on our private Men are openly by the pandemic and the switch to forum or join online discussions, but online, we’ve seen more men seek we are now seeing more male bladder talking about support through our forum, webinars cancer patients and carers finding us their treatment and online meetings. In previous and talking openly and supporting years, it was mainly women seeking each other.” in a way that we support. Now, more men are coming She explains that with older men forward to seek support — whether having the highest incidences of rarely saw a few for themselves or their partners. bladder cancer, how they also seek years ago. help online is encouraging. “This Men supporting men, online paradigm shift means that many Previously, our forum felt like a of our deprived and hard-to-reach predominantly female space, at least in terms of populations of patients and carers are now having the people engaging with posts, asking questions more opportunities to gain support and access and offering support. This has changed in recent meaningful information from our online resources,” years and now feels much more diverse — with she concludes. men supporting other men, checking in on each other and championing each other as treatment progresses.

Men are openly talking about their treatment in a WRITTEN BY way that we rarely saw a few years ago. Considering Melanie Costin that men seeking support about bladder cancer Support Services Manager, are typically older, this feels like an attitude and Fight Bladder Cancer behaviour change in a group who likely were not previously used to engaging in this way.

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Challenges in bladder cancer care Merck has built up expertise in bladder cancer, which is difficult to treat, but we can make a difference. We often hear how hard it can be to discuss symptoms such as frequent urination or blood in urine with patients.

In the UK, 1.3 million men aged 65 and over are living alone — a 67% jump between 2000 and 2019.2 While the role of loved ones remains vital, we must also be mindful of those who may live in isolation.

Bladder cancer conversations can be lifesaving It is uncomfortable, but vital to talk about; bladder cancer has an extremely high mortality rate of around 50% and as many as 1 in 4 cases will only be diagnosed at a late stage.3 Recent data from the ESMO cancer conference showed that 69% of UK patients are not receiving a first-line treatment; one of the lowest rates in Europe. To make matters worse, bladder cancer has a high recurrence rate of up to 80%, so it can often be an ongoing, strenuous and exhaustive saga for patients.

This all means that being aware of potential symptoms and speaking up about them can help survival. Fight Bladder Cancer UK and Action Bladder Cancer UK have resources on their website, and GPs can always help. Each one of us has or will be touched by cancer in some way in our lives, so let’s keep talking and help more cancer patients become cancer survivors.

References 1. Cancer Research UK, Cancer Statistics. Available from https:// www.cancerresearchuk.org/health-professional/cancer-statistics/ statistics-by-cancer-type/bladder-cancer#:~:text=Bladder%20 cancer%20risk&text=1%20in%2050%20UK%20males,are%20 caused%20by%20workplace%20exposures. Accessed October 2023.

2. Centre for better ageing, Summary the State of Ageing Report 2022. Available at https://ageing-better.org.uk/summary-stateageing-2022 . Accessed October 2023 3. Action Bladder Cancer UK, The Facts About Bladder Cancer.

Available from https://actionbladdercanceruk.org/the-facts-aboutbladder-cancer/ . Accessed October 2023.

WRITTEN BY Dr Jit Saini BSc, MBBS, Senior Vice President, Head of Medical Affairs Europe, Merck Healthcare

Paid for by Merck Find out more at merckgroup.com/en/ expertise/oncology.html

Job code: UI-ONC-00004 Date of prep: November 2023

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Male factor infertility — what is it?

Around 15% of couples do not achieve pregnancy within one year.

Infertility is when a sexually active, non-contracepting couple does not achieve spontaneous pregnancy within one year.

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lthough 50% of infertility is associated with a male factor, investigation and treatment of men often remain rare as an initial step in the journey of a couple wishing to seek infertility treatment.

WRITTEN BY Mr Vaibhav Modgil BM MSc FRCS (Urol), Consultant Urological Surgeon & Andrologist, Manchester University NHS Foundation Trust, Honorary Senior Lecturer – University of Manchester, University of Salford, Edgehill University

Key male infertility terms The World Health Organization (WHO) has standardised semen parameters, which often prompt investigation in men.

• Azoospermia is the absence of sperm in the ejaculate and can be found in 10% to 15% of men with infertility.

• Oligospermia is too few sperm in the ejaculate (less than 15 million/ ml).

• Asthenospermia is a reduction in sperm motility.

• Teratospermia is the abnormal structure of sperm (<4% normal).

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Common causes of male factor infertility • Lifestyle factors • Use of steroids and testosterone supplements • Smoking, excess alcohol intake, recreational drug use (eg. cannabis) • Hormonal imbalance, including low testosterone • Excess heat exposure to the scrotum and testicles (eg. laptops, hot baths) • Previous trauma/surgery to the testicle or groin • Cancer or cancer treatment • Infections, including sexually transmitted infections or mumps affecting the testicle • Sexual dysfunction: inability to develop an erection, orgasm and ejaculate • Structural abnormalities; some of which the patient may have from birth and others that may be acquired (eg. varicocele enlarged veins in the scrotum, which raises temperature) • Genetic abnormalities, such as those causing cystic fibrosis and Klinefelter’s syndrome

Assessment of men with infertility This should ideally be done by a men’s health specialist (urologist).

It involves a thorough history and examination of the patient to explore what the underlying cause may be.

This also provides an opportunity to treat reversible causes like reducing alcohol and stopping smoking. It is highly recommended that all men have a semen analysis, testicular scan and hormonal blood tests as well.

Infertility treatment options Treatment varies from improving lifestyle choices to procedural interventions like varicocele corrections in men with too few sperm. For men with no sperm in their ejaculate, once all other aspects have been optimised, there is often the chance of surgical sperm retrieval.

This can be achieved through a variety of techniques, including microsurgical retrieval in specialist units.

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