Dr. Michael Lutz welcomes Dr. John Oliffe, Professor and Canada Research Chair in Men’s Health Promotion at the University of British Columbia, for a conversation about men’s health, mental health, prostate cancer, and the fear that often surrounds screening.
Dr. Oliffe explains that his interest in men’s health came from years working in emergency care, where he saw men deny serious symptoms even when they were clearly in distress. His grandfather’s death from prostate cancer also shaped his work. That personal and clinical experience led him to study how masculinity affects health behavior, illness management, and quality of life for men and their families.
A key theme is that men do not all respond to health concerns the same way. Some ignore symptoms or self-monitor. Others act when pain or function becomes a problem. Prostate cancer is complicated because men often have no symptoms, which can make screening feel less urgent. Dr. Oliffe says support groups can help because they level the playing field. They give men, partners, and families a place to talk honestly about diagnosis, treatment decisions, side effects, recurrence, and fear.
The conversation also focuses heavily on mental health. Dr. Oliffe says depression in men may not always look like sadness. It can show up as irritability, anger, substance use, work obsession, risk taking, or over-involvement in sports. He points to substance use, relationship breakdown, and depression as major predictors of suicide risk. That means clinicians need to ask better questions, including questions about relationships and stress.
Dr. Oliffe argues that messaging to men should be strength-based. Instead of repeating that men do not go to the doctor, health campaigns should explain the benefit of early action. He points to small, realistic changes as a useful approach. Men may respond better when health seeking is framed as staying strong for work, family, relationships, and themselves.
The prostate cancer portion centers on uncertainty. PSA screening can create anxiety, especially when messages about screening are inconsistent. Dr. Oliffe says primary care providers play a critical role in helping men understand the benefits and limits of PSA testing. Newer blood tests, MRI, and less invasive tools may reduce unnecessary biopsies and help men feel more comfortable entering the screening process.
The episode closes with a strong point: prostate cancer care should include mental health from the beginning. Men on active surveillance or going through treatment often carry the weight of diagnosis for years. Dr. Oliffe says care should account for partners, families, and the emotional toll of the disease, not just the medical pathway.
(00:00) Intro
(02:39) Running and self-managing mental health
(05:14) How men process fear and vulnerability
(07:21) Family and support after a prostate cancer diagnosis
(10:38) What health care misses about men’s distress
(13:03) Reframing mental health support as strength
(15:35) Life transitions as openings for better health
(18:04) Messaging that reaches men
(22:02) Mental health support in prostate cancer care
(27:00) Peer support and the ALEC model
(29:11) Fear before diagnosis and PSA screening
(31:24) Better messaging around PSA testing
(33:51) Newer tests and reducing anxiety
(37:35) Fear of knowing and early action
(41:14) Rethinking prostate cancer care
Dr. Michael Lutz (00:05):
Welcome to On Call for Men's Health, a PSA on PSA, and I'm Dr. Michael Lutz. And after decades in urology, I've seen how a single blood test, a difficult conversation, or the right next step can change the course of a man's life.
And if there's one thing I've learned, it's that prostate cancer detection is not as simple as one test or one number. It requires judgment, context, communication, and increasingly better tools that help us make better decisions.
In this limited series, I'll be joined by colleagues and leaders in men's health for honest conversations about how we can improve prostate cancer detection and care from access and awareness to emerging technologies and the future of testing. So, consider this our PSA on PSA, a public service announcement about what physicians, patients, and communities need to know now, and this is On Call for Men's Health.
Today, we have Dr. John Oliffe, a Professor and Canada Research Chair in Men's Health Promotion at the University of British Columbia. As founder and lead investigator of University of British Columbia's Men's Health Research Program, Dr. Oliffe focuses on masculinity as it influences men's health behaviors and illness management, and its impact on partners, families, and overall life quality.
Findings drawn from his research offer guidance to clinicians and researchers to advance men's mental health and suicide prevention.
John, welcome.
Dr. John Oliffe (01:33):
Yeah, good to see you, Michael. Nice to be on the show.
Dr. Michael Lutz (01:35):
Oh, great to have you. So, you've spent a lot of your career, if not all of your career, studying men's health. What first drew you into this field and what has really kept you focused on it?
Dr. John Oliffe (01:46):
So, I worked in the emergency room for 20 years as a clinical nurse specialist, and I saw a lot of things. One of the things that was interesting for me was the amount of guys that would show up clutching middle chest, diaphoretic, and denying chest pain, and I always wondered where that might have come from, and how we could better understand those kinds of behaviors.
And I also had a grandfather who unfortunately passed away of prostate cancer, and I was a young bloke, and shared a lot of holidays with him and actually shared a room with him when we'd stay with him as well, and I saw up close how tough he did it.
So, there's a few things that sort of tilted me in the direction of men's health. I was always very interested in the things I didn't know, just trying to better understand behaviors. And so, yeah, I've been lucky enough for that to play out a little bit.
Dr. Michael Lutz (02:39)
I'm just kind of curious, what do you do in your own life when you say you self-manage your mental health? How do you go about that?
Dr. John Oliffe (02:46):
Yeah, I'm a bit of a runner. Not like a land speed record kind of guy, but a 3k guy. So, that's one of the things I routinely do. So, four or five days a week, get out there and get amongst it in terms of a bit of exercise. That would be one of my primary pieces.
As time has gone on, managing my own moods and how I show up has probably become a little bit more challenging. I think we accumulate experiences, and sometimes we've got to sort of change our tactics a little bit.
So, I used to sort of just go hard and work a second shift and all the rest of it, and over time, it's really about just being a bit of a seasoned campaigner and getting the things in that sort of satiate you, and it turns out that running's been one of those.
Dr. Michael Lutz (03:35):
I would have to say that without a doubt, running has probably saved my life. When I was in the first year of medical school, going back to 1978, I got seriously ill and had to leave medical school for a month. And when I came back to school, I said, "I'm going to get back in shape and never get this sick again," and I started running.
Well, needless to say, running around the block exhausted me, and so, I build up from a block to ending up eventually doing a marathon and have done those since. And I can tell you, I've tried not to miss a day of running since I was 21 years of age, and I have used that not only for health, but also for my mental health.
It allows me to find my place and kind of realign my thoughts and kind of reflect in the privacy of my own running. And so, I like you, find that running is such a huge asset, and I don't expect others to find running as their cure all, but I do think that finding times where you have a way to get your own solace and get your own physical reprieve is a really wonderful way to go through your life.
Dr. John Oliffe (04:41):
Yeah, I so agree. And I think for me, one of the underrated parts of running is the warm down, like the walk back. So, I'll usually run the 3k and then walk 3k back, and that 3k on the way back is really influential for my day.
So, I'm an early morning guy, and so just sort of unpacking the day and thinking about it thoughtfully in terms of what's to come. And if I'm end of day, it's a great debrief on a day as well, just that warm down when you're just coming off the run. So, it's been really good for me, too, so yeah.
Dr. Michael Lutz (05:14):
In your research and conversations with men, what have you learned about how men tend to process their fears or vulnerability or their uncertainties about health?
Dr. John Oliffe (05:24):
This is a continuum, and it's quite contextual, but the dichotomy of it would be typically we see guys who will tend to ignore and tend to just self-monitor. They might worry, might not, and tend to stand off addressing potential issues.
And then we might have the group that's a little bit more proactive in terms of if there's any functionality that's kind of diminished or cardinal sign being pain, then they'll show up looking for some professional advice. So, it exists across a continuum and context.
I think when we talk about prostate cancer, it's always interesting to me that a lot of times, blokes will show up with no symptoms. So, then their call to action might be less than some other things. But we know that in emergency departments, we see them more often by about 3% more of our traffic is male because pain is a cardinal sign, and acuteness in terms of issues that bring them in for medical care tend to be more severe.
And like I say, it is a continuum, but we see a lot of guys who sort of are resistant to professional help as well.
Dr. Michael Lutz (06:37):
Do you think that reactive versus proactive behaviors are generational?
Dr. John Oliffe (06:42):
I'd like to think that we are doing a better job of engaging guys in the younger generations. They certainly seem a lot more health savvy, and part of the reason for that, I reckon, is the internet sort of opened up the world.
I mean, once upon a time, all our medical knowledge when we're going through med school, nursing school, was kind of like it was hidden, it was very textbook orientated, and it really wasn't out there. So, I think health is a kind of a commodification these days.
So, I do think that there's more influence out there. I think there's more knowledge out there for younger generations. And you would hope that that would translate to accessing professional services when they need it.
Dr. Michael Lutz (07:21):
You talked a little bit about your dad, or your grandfather, I mean, in prostate cancer. And the one thing I found since I started my practice back in the ‘80s, that when a man is diagnosed with prostate cancer, the other family members and friends kind of process it differently. They don't all receive the diagnosis and mentally cope with it, and help the person with the diagnosis in the same way.
And I was just wondering how do you see those support groups and other opportunities for men when they're being faced with acute illness such as a prostate cancer diagnosis?
Dr. John Oliffe (08:01):
Yeah, it's interesting. I mean, if the guy's partner generally, they tend to express more emotions and fears, including fear to their partner, tend to sort of get a bit of solace that way. Less so in terms of peer, guys with other guys, we tend to keep it superficial, don't go a lot of depth and certainly don't ever want to bring the party down in terms of getting dire and dour on one-hour experiences. So, there can be limits there.
Support groups are really interesting to me. We've studied them over the years, and what they're really good at, in my experience, is leveling the playing field. So, there's no hierarchy, there's just an embrace of a challenge.
And it brings people, brings guys into the space to be able to talk about things they might not ordinarily be able to talk about with other guys. And a lot of the groups are mixed as well. And I think that there’s a benefit for some of the folks in guys' lives who are affected by this as well.
So, there's a few contexts there. I think what we need to be careful of as guys is not burdening our partners too much with all of the things that we're feeling, kind of this weight that goes with the diagnosis and treatment. And so, it's about spreading the layer of it in terms of talking to other guys and manufacturing those friendships and those peer places, and also, the support groups work for a lot of guys, quite helpful.
Dr. Michael Lutz (09:34):
Well, it's interesting, some of the original support groups were narrowly focused, such as the American Cancer Society's Man to Man, realizing that as time went on, it wasn't just about men with men, it was really a family, friends, it was really an extended group of people that need to be involved in the support network versus just an individual, men who are actually diagnosed with prostate cancer.
Dr. John Oliffe (09:58):
Yeah, so back in the day, we did a study, one of the early studies, when I first got to Canada and looked at the support groups, and we were interested to find that about a third of the people who were showing up to prostate cancer support groups were women, like as in female partners.
Again, yeah, they do a really nice job and a nice spread. You get a lot of guys showing up with a diagnosis, trying to make treatment decisions, but you also get a lot of stayers who continue on to give back to the group, and also, work through some of the additional kind of challenges that come with side effects of treatments, but also, recurrence if that occurs. So, they do a really good job.
Dr. Michael Lutz (10:38):
Yeah, yeah. Your work has helped guide clinicians and researchers around men's mental health and suicide prevention for years. What do you think health care still gets wrong about this distress that shows up in men?
Dr. John Oliffe (10:52):
One of the things we might want to think about is how a guy shows up with an initial kind of depressive symptoms or a depression, we're convinced that they show up with irritability, anger, overuse of substances, over-involvement in sports and work and risk taking. And your PHQ-9 and regular generic screens will not pick up that.
So, there's nothing better than having a bit of a conversation with guys would be my suggestion to get a bit of a sense of them. The three biggest predictors of suicidality in a guy are substance use, relationship breakdown and depression. So, again, just trying to think upstream about those things.
And one of the things we don't do well, we don't ask about relationships, there's something about the sanctity of relationships. And I think that sometimes if we just insert a question about how other people are going in the guy's life and how's the relationship tracking, how's the partner tracking — I think we can find out a lot about risk factors.
And so, it's trying to think beyond what shows up clinically to interpret what underpins it. So, it's not to excuse irritability, anger and things like that and substance use, but it is to say contextually, underneath those behaviors, we often see early depressive symptoms and depression, yeah.
Dr. Michael Lutz (12:16):
Do you think something has changed with regards to the stigmas of mental health?
Dr. John Oliffe (12:21):
I reckon it might be generational as well, Michael. I think there's certainly some Xers and Boomers that still stick to the notion of just self-reliance, remain stoic. I think the younger generations coming through certainly are experiencing a lot of mental health challenges, and I think there's more openness to talking about those challenges and plus or minus talking about talk therapy, and the opportunities that that might bring.
So, I'd like to think it's shifting, and it does appear to me to be fairly generational specific and I'd like to think that younger guys coming through a little bit more open to it.
Dr. Michael Lutz (13:03):
In any way, you think we can change seeking out mental health support from being a weakness to a real sign of strength?
Dr. John Oliffe (13:08):
So, if you think about the performativities wrapped up in being a bloke, usually the things we value are work and showing up well in our relationships. So, if you think about it from that perspective, the way to do it is to be able to keep your mental health in check and do the things that satiate.
So, yeah, we often talk to guys about finding the thing that satiates and the activity that the thing that really buoys them, and then mapping that and putting it into their week, like building it in as routine.
So, again, it's a strength-based approach to being the best you can be for all of the other reasons. For work, for yourself, but for partners and alike. So, again, I think it can be strength-based from that point.
When we wait, mental health issues are severe, and that's often where it feels like weakness because number one, we've left it too late, we haven't been able to control for ourselves, and then we're indebted to looking for help.
So, I think the idea is to really think about it as build the team before you need the team, but as in nourish and nurture your mental health, and if that involves counseling, then so be it, it's going to be really helpful.
Dr. Michael Lutz (14:22):
Do you think we're at a point now where mental health has now become fully intertwined with overall health, or do you think that there's still ways to go?
Dr. John Oliffe (14:30):
There's always ways to go. I'm sure you know that thing about the difference between what people say and what people do, and the accommodations of mental health in the workplace and the like. So, I think there's definitely an openness to the conversation, really important. I think we're doing a better job of an openness to it.
But some of the research we've done suggests that some of the biggest stigmas are self-stigmas on guys who have experienced mental health challenges, they're really tough on themselves. So, there's this societal stigma, and then there's this self-stigma that comes with it. Their work's in progress, both those things, but I would like to think we're at least on the other side of being able to have a forthright conversation.
And if you look at the workplace absenteeism and compensations, they are predominantly in the space of mental health. So, again, mental health issues are foremost, and I think employers are aware of it, too. So, hopefully, we're getting into a place of being able to be a little bit more candid about the challenges that we all face.
Dr. Michael Lutz (15:35):
You know, getting guys engaged in men's health overall has always been such a challenge. I remember about 20 years ago, I met a gentleman named Darryl Davidson who ran Men's Health for the city of Milwaukee. And what he did is he decided that when men become fathers, or are about to become fathers, they want to become more engaged in their own health and well-being.
So, he set up men's health opportunities in all of the birthing centers in the underserved communities throughout the city of Milwaukee to try and engage more men into becoming more proactive about their health, and I thought that was just a genius idea.
So, I'm just kind of curious, from your perspective, if you think there's particular moments like fatherhood, aging, retirement, illness, when you think men might be more open to talk about their overall health or mental health.
Dr. John Oliffe (16:29):
Yes, spot on. Absolutely spot on. So, they're all transitions, and if you think about it, the transitions are guys generally crave routine and purpose, and so transitions, if they're unexpected especially, can sort of throw us out.
Even when they're expected, like you're anticipating for nine months becoming a dad, the things that go with that, those transitions might be unseen. There might be some real changes there to your primary relationship with a partner. Also, there's a third party involved, so all of those things.
So, again, we find that transitions are a good time to sort of to bolster your team a little bit in terms of working through some of those changes around acceptance, but also around strategy. So, back in the day, we actually did a lot of work with dads who were smoking, and we were working with them to reduce and quit because their partners would oftentimes reduce and quit because they're carrying the fetus, but the guys, not so much.
And so, we did some work with them but it's very true that the transition to fatherhood is a big motivator for a lot of guys, like kind of moving away from the hedonistic practices and getting a bit more into these thoughts about other people and tangibilities of being a good role model for kids growing up and being able to work with them.
So, yeah, it's definitely a space where to show up well, your mental health is really significantly important for getting some strategy in there.
Dr. Michael Lutz (18:04):
Whenever we do things into the men's health community, we think of what kind of messaging can we do to really get the message out there? And there have been campaigns like MEN WHO SPEAK UP that was done by Bayer and just how to get help. But based on your work, do you think there's a certain kind of messaging that actually reaches men?
Dr. John Oliffe (18:27):
I think we've known for a long time that if you do the weakness part or you do deficit part, like the bit where, oh, well, guys don't go to the doctor and you keep reifying that, I think it's really unhelpful, because it's kind of the tail wagging the dog, so to speak. It becomes a self-fulfilling prophecy. So, my suggestion would be strength-based messages.
So, the strength base of like what benefit do I get by finding this early? What benefit do I get by monitoring this? What sort of runway do I get by being on top of the basic things, your blood pressure checks and a lot. I think that's really important because we're selling benefit that way, and we're also messaging them about things they can do rather than what they have not done.
So, I think strength-based is just a very, very basic principle, and we know that that works in terms of health belief models and change behavior change. We know that that works, but it works especially well with guys. If you can sell a benefit, I think that they're far more likely to engage.
Dr. Michael Lutz (19:36):
Well, one thing we've always enjoyed is humor. And so, we once did a comedy night saying Fifty Shades of Blue, the Mangina Monologues, and we did a night of comedy poking fun at men's health overall, we did a campaign for testicular cancer awareness called “Got Nuts? Check Them.” Oh, we thought that was a great idea.
We put that on the back of trucks all over southeastern Michigan and we thought we're going to get great notoriety and attention and lots of phone calls about guys who want to get screened for testicular cancer, and all we did was get complaints about why would you want to have this on the truck? And how am I going to explain this to my young son when they see this?
And it was like I don't understand how we can have a society where we can do so many things in such a bombastic way, but we can't talk about health and screening and wellness in such a fashion to poke fun at ourselves just a little bit, to get the message out there, to help bring attention to it, to get more guys engaged. It seems like such a challenge, I just don't know how to navigate this sometimes.
Dr. John Oliffe (20:43):
Humor is a calling card for a lot of guys. I guess the challenge is always if you're somehow diluting or losing the message in there, and maybe that's part of the critique, is that it is such a tough one because we want to be a call to action and we want to be forthright, and we want to be able to say, "Hey, here's the benefit, here's the best part about knowing and showing up and performance-wise and health promotion-wise harm reduction."
But yeah, I agree with you, the humor part should work — doesn't always work because sometimes the message gets lost in there.
Dr. Michael Lutz (21:24):
And yet, the Canadian Men's Health Foundation did the Don't Change Much campaign, and I love that campaign. And I thought it was spot on how as a man, you don't have to change everything, you just have to change something, and that something can lead to other benefits in your health. And I thought it was a great campaign.
Dr. John Oliffe (21:41):
And I agree, the idea of not making wholesale changes in terms of incremental gains is a really, really clever way of introducing the idea of just changing one or two things, or just adjusting for a couple of things, can make a real difference.
Dr. Michael Lutz (22:02):
When we think about prostate cancer, urologists are oftentimes the gateway for men going through the prostate cancer screening and the diagnosis, but they're not really a trained or resourced opportunity to address the mental health aspect of it. What could or should be changed to make this better?
Dr. John Oliffe (22:21):
It's a bit of a health care system one, a bit of a question in and around that. So, depending on what kind of health care system you're in, the pathways are very fragmented to mental health. And a lot of the guys that we work with and speak to, they are wedded to the idea of talk therapy. And of course, as a urologist or a specialist in prostate cancer, haven't got 50 minutes to have a dedicated session to working through kind of issues and alike. So, it would seem to me to be a referral issue, and also a navigation issue.
So, again, part of what we might be able to do better as clinicians at frontline on primary health care and specialist care such as yourself is just be cued to some of the language, because I'm convinced that a lot of guys show up talking about stress, and I think they're actually talking about mental health challenges.
I actually think they're talking about depressive symptoms a lot of times, and even just a couple of questions about what they're just trying to prod them in terms of what they're worried about in terms of future, which is often like a PSA, or what they're regretting about the past, which is often maybe about a treatment decision potentially, I think those things can cue us to the idea of referral.
And then I always say to guys, it's more than a one-time thing. We can refer you, but you've got to have the match with the person we refer you to. So, it might take a couple of guys, might take two or three guys. You might not get lucky the first time in terms of a good match.
So, again, it's about sometimes asking for a little bit of help more than once. It's not a cross-sectional moment. It's a bit of a long game, and so, again, just thinking about that. But from a provider point of view in primary care, it's just being cued to some of the language they use because it's kind of like stress-related, asking a couple of open-ended questions, and I'm sure you'll be able to pick up depression, anxiety really quite quickly, and then make the value referral.
Dr. Michael Lutz (24:21):
And with the prostate cancer diagnosis, there's a significant correlation of anxiety, depression, not only with the diagnosis, but also for those men who are maintained on active surveillance. They have a significant higher incidence of anxiety, depression, associated with that long-term course.
And I think it's unfortunate that urologists in the United States really don't make that as part of the focus of the care, having mental health support, analysis and support for these men as they go through this active surveillance and or management of their diagnosis.
Dr. John Oliffe (24:55):
Yeah, really important, massively important. If you think about it, I often refer to it as the wait and wait. So, there's that temporal wait, so that amount of time that you're doing. So, you get a diagnosis, you might go on active surveillance, and then you wait and you PSA.
You get a diagnosis, you decide a treatment, then you're still wedded to your PSAs. So, there's this kind of this temporal piece, it doesn't go away. Like it's a re-injuring around diagnosis that often occurs.
And if you think about the weight (well, the weight as in the weight of something, the actual weight of it), they carry that around, like it's in the back of their mind. For a lot of guys, they're not able to blunt it, they're not able to bracket it, so it is one of those tough ones. So, it should, in many ways, be kind of mandatory.
One of the ironies is that we often wait for crisis before we access mental health help. And so, you would imagine within the context of prostate cancer, as a diagnosis, plus or minus treated or on active surveillance, however it plays, there would be a good rationale for engaging mental health care right from the start, because there's a bit of a crisis there, but it doesn't dissipate. Like it doesn't go away entirely. So, it's a bit of a chronic condition in terms of just its management.
So, yeah, I agree, it would be great to build it in in a way that was kind of tailored to the specificities of prostate cancer, because prostate cancer is quite unique, quite unique, its whole trajectory. Even when we kind of talk about it as the bastion of men's health, it's actually the outlier in many ways. If you think about the things that take men in terms of morbidity, mortality, it's one of the ones that's quite unique.
Dr. Michael Lutz (26:50):
So, how can we create a better support system for the men who may never seek out traditional mental health care, but still need help coping with this major diagnosis?
Dr. John Oliffe (27:00):
One of the things we can think about is how we show up for our mates. So, the peer support, I think, can be helpful. And it doesn't have to necessarily be in a prostate cancer support group; it can be more general. I think we can be better for each other.
So, we often talk about something called ALEC. So, A is for ask. Ask open-ended questions to try and get a bit of a sense of how your mates are tracking, how they're doing. That L is for listen. And it's hard to do because most of us want to jump in and solve problems, kind of orientated that way, it's kind of a masculine thing to do. But generally, you've got to stand off it, and just maybe throw out a few prompts to keep the guys talking.
And the E is for elaborate. So, get them to talk a little bit more about what's going on, but you're also encouraging action. So, things I'll do is I'll sort of say, "Oh, what's worked for you in the past?" And if that doesn't sort of prompt them to sort of get back into this problem-solving piece themselves, I might say, "I've got a mate and he did this and it worked really well for him, what do you think about that?" So just to drop it into third person.
And then the last one is the C, and it's to check back in. So, oftentimes when we get a guy to sort of disclose to us and share with us some of the deeper stuff that's going on, they get a little bit coy on it and they feel like they've maybe said too much.
So, the trick is to text them or to give them a call not too far out from that disclosure to make it normal, to just make it like, yeah, I want to continue this conversation, thanks for confiding, thanks for chatting, really appreciated the chat. Norm(alize) it so the next time you're back in, having a yap, it can continue on, and you get some depth. So, it's giving permission.
So, some of the things we can do from a peer point of view — and we can show up really well for our mates time and again. We’re pretty good for other people, guys, a lot of times. So, just to formulize it, and to actually work through it, I think is a really good strategy.
Dr. Michael Lutz (29:11):
For many men, the fear starts even before the diagnosis, or it really starts with the screening. What do you think men are really afraid of when they avoid prostate cancer screening with a PSA test?
Dr. John Oliffe (29:24):
Yeah, there's a bit of a history, Michael, isn't there, in terms of uncertainty about the legitimacy of the test, and there's this backdrop of a lot of men die with it rather than of it, so do I need to die? So, there's a bunch of things that are at play there.
I think part of the conversation, I think that we need to have broadly is like advanced age as being a risk factor, familial predisposition if you've got a dad or an uncle or whoever who've had prostate cancer, it's certainly a calling card to get going early. I think also, that temperance around the idea that you can have a PSA test and it provides a baseline from which we work and we monitor over time.
So, it's sort of due diligence, and I think once upon a time, there was a bit of a rush to jump into a treatment decision with a raised PSA, and the world's settled down a little bit in terms of prostate cancer management.
So, making those things clear, I think, would help to engage us, to give us the context by which it's useful to have a test as in knowing what you're potentially dealing with, or knowing that you're okay at the moment and you've got to follow up in 12 months or two years, whatever gets worked through.
Dr. Michael Lutz (30:44):
Most men would rather get bit by a cobra than have a rectal examination. And so, I will say that the recent campaign from Novartis of Just a Blood Test was a huge campaign and they launched it during the halftime show of the Super Bowl, and I thought that was a fantastic campaign.
The problem with prostate cancer screening is that there's so many confusing and inconsistent messages about the role, the benefit and the risks of screening as you've already kind of mentioned. What do you think we can do regarding the messaging now that we're stuck with some of the information from the United States Preventative Services Task Force and the NHS in the UK?
Dr. John Oliffe (31:24):
I mean, plain and simple, I think it's interesting, the blood test has always been more acceptable as you mentioned, so the idea of I think for me, at least, it would be just giving that forthright conversation, having that conversation if you've got a family history, definitely initiating the conversation with your doctor, your GP and having a bit of an informed way forward around deciding on the PSA test. So, I think that piece is so important.
So, primary health care and your GP is a massively important gateway for these conversations. So, I don't know if it answers the question, but it's a challenging one. But I do think that gatekeeper piece that the GPs fulfil and a lot of NPs as well is really important to have a forthright conversation and understand eyes wide open the benefits of the test and the potential limitations of the test as well.
Dr. Michael Lutz (32:29):
Well, I think this is without a doubt the most challenging part about taking care of communities of men across the country and across the globe, particularly those that may be at risk for developing prostate cancer. Do you think there is someone or something that can take a leadership role in this messaging of the inconsistencies that we're dealing with?
Dr. John Oliffe (32:49):
We certainly haven't had the coordination of maybe some of the other cancers in terms of screening, and men's health as a general rule of thumb has not had necessarily policies and frameworks to support some of the work more broadly. So, I would like to think there's going to be some changes in that direction.
I think the men's health report that got released in the States with Derek Griffiths in November last year was important. We've got some traction here in Canada that we're moving towards a federal framework for men's health.
And you'd like to think that that would be a place where we could get a bit of a placeholder for some of these definitive tests and some definitive guidelines around it that would translate to policy and start impacting clinicians in a useful way. So, I'd like to think that we're in the right direction there, but I think it actually comes from policy.
Dr. Michael Lutz (33:51):
I do, too. Testing for prostate cancer can create a lot of anxiety. But we think that perhaps better testing may reduce some of this unnecessary follow-up biopsies and even the quintessential uncertainty.
How do you think we should think about the role of some of these newer tests in reducing the stress for men?
Dr. John Oliffe (34:13):
So, some of the newer tests, fidelity-wise, might be some benefits there, certainly in terms of it used to be the PSA came back and you would literally, if you had an abnormal kind of result, you were headed for a biopsy was really the only way of kind of knowing.
And I think the field has advanced. So, if there's an interim blood test, if there's an MRI potential that is not so invasive as a trust biopsy, then there's some options there that might make that a little bit less invasive and a little bit more engaging with guys around working through some of that protocol.
But a lot of times, it used to feel quite rapid and quite quick, like you were on a trajectory you couldn't stop. And I think that we can stop it now. I think we're far more open to active surveillance and alike, and to monitoring. So, again, just to say, I think there's been good shifts in the field, and maybe we need to make those more transparent.
Dr. Michael Lutz (35:17):
I think that without a doubt, these advanced blood tests, which can function as a liquid biopsy, have really changed the way that we can help reassure men and quell some of their anxiety without going down the road of putting them through potentially unnecessary testing that would be more invasive.
And I think that the more we can do that, the more that men will say, "Yep, I'm okay to get screened. I'm okay to go through this process because I know that not everything leads to potentially more expense and physical personal involvement." So, I think that that's really a great direction we can head in.
Dr. John Oliffe (35:57):
Yeah, back in the day, we did a few papers around trust biopsy, and it was tough on a lot of guys. So, again, anything that's going to reduce the invasiveness, it's got to be a positive and a benefit for sure.
Dr. Michael Lutz (36:15):
And the real benefit is democratizing the screening process so that men all across the globe can have the same equal access to care and follow up opportunities, so that they can all have the ability to ameliorate some of the anxiety and stress that it comes with, and the necessary testing.
Dr. John Oliffe (36:33):
Absolutely.
Dr. Michael Lutz (36:34):
So, I always say knowledge is power. Do you think men really believe that?
Dr. John Oliffe (36:39):
Well, in a health promotion sense, we know the difference between what people do and say is massive. And so, you can spruik it out, you can you can certainly give the wise counsel. It's how people engage it. So, I'd sort of go back to the idea of benefit, how do we sell benefit? What's the advantage here by doing this? Beyond peace of mind, what are the real benefits? And I think we can sell those.
So, again, the knowledge is absolutely the basis because empirically, we should be coming from that viewpoint. I think with the way social media is, I think it's even more important that we have a legitimate voice that is empirical these days, that does share knowledge that's proven and understood. So, that's key, but also the benefit of acting on what is known is part of the sale.
Dr. Michael Lutz (37:35):
What is something that you wish more men understood about fear, especially the fear of knowing when it comes to their own health?
Dr. John Oliffe (37:43):
Just the notion that we can do a lot early. Our options early on in something, if there's sort of something slightly off our treatment options or our remedies — much more opportunity to sort of make good on those wider selections. When we wait for things and they progress and they get more severe, it cuts down our options and I think that most of us would want to nip it in the bud, so to speak.
And a lot of this gear, a lot of the things that happen for guys are quite manageable. Prostate cancer is manageable. So many depressive symptoms are manageable. So, if we engage the help a little bit earlier, and I'd love to change it from help seeking to health seeking, because I think that's really what we want to do, is just health seek — I think we could sell it really well. I think it could be a much better way of engaging because you're engaging with your health, you're not actually indebted for help.
Dr. Michael Lutz (38:50):
I love your messaging. You once said that your personal mission statement was not to confuse legacy with grandiosity. So, I'd like you to explain how that is relative to your career.
Dr. John Oliffe (39:03):
In the twilight, Michael, probably, got maybe 7 to 10 years left in the working life anyway, health being well. But I have a real interest in not losing everything that we built in terms of the research and in terms of the way we conduct ourselves and do the work. And so, it's kind of self-taught that the legacy moment is that I don't want to lose that, I'd love to be able to hand that over.
The grandiosity would be thinking that there'd be an “Oliffe 2.0” and just step in. I actually think the field in men's health has changed drastically over the last sort of five years, even the last 12 months. So, my idea would be that it wouldn't be at all about me, it would just be about providing an opportunity for someone contemporary on the block and mentoring them in and nurturing them into a space to do their own thing within the whole men's health piece here at UBC.
And so, it's managing to let go, and that idea of being able to have some kind of legacy, but it's actually not about you. A lovely thing that was said to me many years ago is, yeah, when you're at work hands in the bucket and the bucket's full of water and you take your hands out, and the bucket's still full of water.
And I think it's just a reminder that it's not really about you, it's actually about trying to continue something that's worked well, but understanding that it's got to change with the times as well.
Dr. Michael Lutz (40:47):
It's about the bucket of water. So, you kind of touched on it. So, what are your thoughts when it comes to legacy, what are your thoughts on how you'd like to be remembered?
Dr. John Oliffe (40:57):
(Laughs) I hope they're that enamored with my replacement that I don't even think about that. But no, just as a someone that maybe wasn't the brightest bloke, but worked hard, that'd be good enough for me.
Dr. Michael Lutz (41:14):
And I would agree with that 100%. So, I want to ask you, this is our second opinion segment and I'm going to ask you what is the one thing in prostate cancer care that you think we need to rethink? Anything from how we screen to how we communicate risk or how we guide men through the next step after an elevated PSA?
Dr. John Oliffe (41:33):
Well, I think, this is my bias, but the baseline in and around mental health and then anticipating that everyone's going to be challenged, and that it's going to be dyadic, it's going to be partners as well and it's going to be family, and weaving that into the management. I do think it's critically important.
Like there’s empirical evidence that that's the case, but it's in the day to day, it's those things that can help people through a journey and give them a little bit of a sense of control of themselves within it. So, that would be my bias, I think, Michael.
Dr. Michael Lutz (42:14):
Thank you so much. I would like to give thanks to Dr. John Oliffe for this incredible conversation about men's health and prostate cancer. And I'd like to thank you for joining us.
I'm Dr. Michael Lutz, urologist and founder of the Michigan Men's Health Foundation. And it's through our events, resources, and this podcast that we are dedicated to men's health advocacy and awareness. We're focused on education, research and treatment of prostate cancer and men's health related issues.
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For more information about the work that we do and how you can get involved, visit us online at michiganmenshealthfoundation.org.