Men are often told to “man up”, which could mean anything from sucking up their pain to forcing back tears and hiding their weaknesses in the deepest, darkest abyss – or far away from prying eyes at least.
This social conditioning not only determines how we view men, however; it seems to also have a hand in lowering the average life expectancy of the masculine gender.
Apparently, having the ability to ignore a problem until it morphs out of control could be one of the reasons men die sooner than women.
According to Universiti Malaya (UM) consultant urologist Brig-Gen (R) Datuk Dr Selvalingam Sothilingam, men have a way of ignoring “trouble” — when it comes to their own medical health, that is.
Awareness is still relatively low for prostate cancer, testosterone deficiency, erectile dysfunction and urological cancers like testicular and penile cancer, and bladder and renal cancer — all top health threats to men that are, in fact, treatable, and like most health concerns, benefit from being diagnosed at an early stage.
As Dr Selvalingam puts it, it’s quite common for men to shy away from discussing their “unmentionables” with the doctor, especially in Asia.
“We see this often in our clinics — where it is often the spouse who has to drag the husband to see the doctor, and the wife is the one who will elaborate on the husband’s problems.
“The husband will often say: ‘It’s nothing much’, even though the wife complains that he gets up to pee every hour at night and cannot get a good sleep,” he says.
While the need to urinate frequently among older men may not necessarily signify a problem, it does warrant a check-in with the doctor to rule out any underlying health concerns.
That being said, frequent urination is one of the earliest symptoms for prostate cancer, along with painful urination, difficulty with starting urine flow and blood in the urine.
Statistics from Universiti Malaya Medical Centre (UMMC) show that 40% of prostate cancer patients in Malaysia still present at an advanced stage. Late detection significantly lowers their survival rate to just two to three years.
“Men, as they get older, tend to keep medical problems to themselves, compared to women who are more open to talking about these problems,” says Dr Selvalingam.
Men’s health has just not been given the attention it deserves. But the tide can still turn. Just as attitudes about women’s health has changed over the years, the same can happen for men.
And the Blue Cap Movement may just be the answer to that.
As the first initiative of its kind in the country, the Blue Cap Movement was founded with the aim of promoting men’s health and raising awareness on urological cancers. Running on the tagline “Blue in cap but pink in health”, it is supported by a team of urologists and prostate cancer survivors.
On Nov 29, the non-profit movement will be having its first annual Blue Cap Relay Run and Health Carnival at UM in Kuala Lumpur.
Funds raised during the event will be channelled towards the Urology Cancer Trust Fund, to provide financial aid to Malaysian patients who may not be able to afford the costly treatment for urological cancer.
As Dr Selvalingam, who is also the event’s chairman, points out, a course of treatment for prostate cancer can cost up to RM40,000, and unless you’re a pensioner, you will not be eligible for a medical subsidy.
Part of the funds generated through the movement will also be used for urological cancer research in Malaysia.
“The truth is, we still do not have a very robust registry of cancer patients in Malaysia. For us to have this registry, we need the funds for it. A lot of the data we have now is from the West, and it may not apply to Asian patients, especially in Malaysia where we have three different ethnic groups,” he says.
It pays to know that many conditions, including the big C, are treatable nowadays, and no longer the death sentence that they are made out to be.
When retiree Santhanam Dass was first told that he had prostate cancer, his first question to the doctor was: “How much time do I have left?”
Santhanam, 76, recalls: “I didn’t know what was the purpose of the prostate gland; I didn’t know that prostate cancer was a slow-growing cancer. All I knew was: cancer meant death.”
Which isn’t always true, and the man is proof of that: with prompt treatment, consisting of hormone therapy and radiation, Santhanam has been a prostate cancer survivor for 13 years.
Of course, he does not discount the importance of having good cancer support at home from the very start. He now chairs the local Prostate Cancer Support Group at the National Cancer Society Malaysia.
Prostate cancer, like other urological cancers, often presents itself with no symptoms until it reaches an advanced stage.
If not for a friend incessantly urging him to go for a routine check-up, Santhanam would not have discovered that his prostate specific antigen (PSA) levels were way above normal levels – a sign that he may have prostate cancer.
While PSA tests are routinely used in the diagnosis of prostate cancer, elevated PSA levels do not always mean that you have cancer. The test has often been linked with a high false-positive rate – it has been said that for every 100 cases of raised PSA levels, there may be 76 who do not harbour any cancer.
Certain medical conditions, like prostatitis, urinary tract infection, enlarged prostate, injury and sexual activity, can increase PSA levels.
The baseline PSA level has also been reported to vary between different ethnicities across all age groups, as concluded by the Aug 2014 study, Ethnicity Is an Independent Determinant of Age-Specific PSA Level: Findings from a Multiethnic Asian Setting by Jasmine Lim et al.
It is important to talk to your general practitioner about your risks, and whether you actually need a PSA test before going for one, advises UM consultant urologist and Faculty of Medicine deputy dean Professor Dr Azad Hassan Abdul Razack.
He says many patients tend to walk into a diagnostic centre and expect the results to be an accurate reflection of their overall health, which may not necessarily be the case.
Without consulting a doctor, patients may end up focusing on a particular abnormality, which may not be all that significant to begin with.
“It’s good to get annual check-ups, but if you’re walking into a lab and just going for all the tests they have, then that’s not enough, plus it’s going to be costly.
“Annual check-ups should go hand-in-hand with talking to your doctor, who should be able to guide you on what tests to take based on your medical history,” says Prof Azad, who is on the board of advisors for the upcoming Blue Cap event.
Dr Selvalingam hopes that the movement will help spark an inclusive conversation between doctors and patients, as well as the youth and their families, on men’s health.
“With the Blue Cap Movement, we’re not just looking at cancers, but also benign conditions, which could have a serious impact on quality of life.
“A lot of men will start having low testosterone issues in their 40s — they’ll feel extremely tired all the time, or have bone pain or tenderness, which are all signs of low testosterone, but most are not aware that it’s something that can be treated,” he says.
UMMC has also reported that 54% of men above the age of 40 have bothersome lower urinary tract symptoms, but less than 20% have gone for treatment.
These numbers particularly reflect patients in the rural parts of Malaysia. “Our ageing population is increasing, so naturally, you will have more problems related to the ageing male, which has not been the focus before.
“We hope that the Blue Cap Movement will start changing mindsets about men’s health,” says Dr Selvalingam.
In fact, the first step to breaking taboos about men’s health could start at home — having good family support could make that tiny bit of difference in getting men to become more comfortable about sharing their health concerns.
“The whole aim of the Blue Cap Movement is to get men to pay a little more attention to their health, especially if they are over the age of 50.
“Men shouldn’t be afraid to consult a doctor, even if it’s just a general practitioner, if they are concerned about even the slightest changes in their health,” says Dr Selvalingam.
If you’re keen on doing your part to raise awareness about men’s health, join the Blue Cap Movement and take part in its first Blue Cap Relay Run and Health Carnival. All funds raised during the event will be channelled to the Urology Cancer Trust Fund.
Blue Cap Relay Run & Health Carnival
Date: Nov 29
Venue: Universiti Malaya, Jalan Universiti, Kuala Lumpur.
Relay Run fees: Free for cancer survivors and their spouse, carer or family members / RM148 for participants aged 18 and above / RM88 for families with a child under 12.
For more information or to register for the event, visit www.pacerssport.my, find BluecapMovement on Facebook or contact run director Julie Wong at 016-2284088.