Men’s health with Dr. Neil Baum

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Summary

On episode 609 of 40+ Fitness, Coach Allan sits down with Dr. Neil Baum, professor of clinical urology at Tulane Medical School and author of Men's Complete Health Guide: Expert Answers to the Questions You Don't Always Ask.

Neil walks through what actually happens to the prostate as men age, when an enlarged prostate is just an annoyance versus when PSA numbers and biopsy results point toward real risk, and why active surveillance is often smarter than rushing into surgery or radiation.

The conversation also covers osteoporosis in men, the shift toward telemedicine, and how showing up to an appointment with real questions changes the outcome of the visit.

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Key Takeaways

  • An enlarged prostate is a near-universal part of aging, not cancer. As the prostate grows it squeezes the urethra, causing a weaker stream, standing closer to the toilet, dribbling, and frequent nighttime bathroom trips. Most men over 50 have mild symptoms; by their 60s and 70s it often affects sleep and quality of life enough to seek treatment, starting with medication and moving to in-office laser or needle procedures if needed.
  • Early prostate cancer has no symptoms. The PSA blood test is the main screening tool, but an elevated PSA does not mean cancer. Doctors can check the ratio of free to total PSA (a cutoff around 25 percent) to decide whether an ultrasound or biopsy is the next step.
  • Active surveillance is often the smarter choice for low-risk prostate cancer. When cells are well-differentiated and PSA is only mildly elevated (roughly 4 to 10), close monitoring every four to six months can be more appropriate than surgery or radiation, both of which carry real risks like erectile dysfunction and incontinence.
  • Family history and genetics raise prostate cancer risk. The BRCA gene mutation, more commonly discussed for breast cancer risk in women, also raises a man's risk for prostate cancer. Men with a father, brother, or uncle who had prostate cancer, and African-American men, are at higher risk and should consider starting PSA testing in their late 40s or early 50s.
  • Osteoporosis is not just a women's disease. Declining testosterone (about 1 to 2 percent a year starting around age 30 to 40) weakens men's bones too, and about one in eight men is affected. It's a silent disease, often only noticed through height loss, a stooped posture, or a fracture, and is diagnosed with a DEXA scan.
  • Resistance training and low-impact movement protect bone density. Weights, bands, brisk walking, and joint-friendly tools like a rebounder trampoline all help build stronger bone, which matters because hip and vertebral fractures in older men often lead to worse outcomes than in women.
  • Telemedicine can handle more than people expect. Neil estimates he can manage about half of urologic problems, from enlarged prostate symptoms to UTIs to post-surgery follow-up, over video, saving patients four to six hours of travel and waiting room time for what amounts to a short conversation.
  • Being a prepared patient changes your outcome. Writing down two or three specific questions before a visit, using a secure patient portal to review lab results ahead of time, and asking a new doctor whether they offer telemedicine and how quickly they respond to messages all lead to better, more efficient care.
  • Dr. Baum's approach to getting and staying well comes down to diet and exercise. On the diet side: fresh fruit, vegetables, lean protein, high fiber, limited trans fat, no artificial sweeteners, and alcohol only in moderation. On exercise: 10,000 steps a day and 150 minutes of aerobic activity a week, paired with 7 hours of sleep, good dental hygiene, and staying current on routine screenings.

“You don't die necessarily from prostate cancer, but you die with it.”

Dr. Neil Baum

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Episode Notes

Podcast: 40+ Fitness
Episode: 609
Published: 2023-09-26
Host: Allan Misner (aka Coach Allan), author of The Wellness Roadmap
Guest(s): Dr. Neil Baum, professor of clinical urology at Tulane Medical School, Men's Complete Health Guide
Listen & Subscribe: Apple Podcasts · Spotify · YouTube (audio only)