“We were really looking forward to it, discussing what kind of parents we’d be,” Sarkis said. “But we hardly ever talked about how hard it was going to be.”

Then the emotional challenges began.  

The couple’s first attempt to start a family ended in an ectopic pregnancy that required Seakly to have emergency surgery. The results of the procedure left the couple wondering if they would even be able to have a child.

But within the year, the Manukyans were elated to discover Seakly was pregnant again. During labor, however, the couple faced another frightening ordeal when complications led to an emergency cesarean section. After his birth in December of 2024, Masis, their son, had to spend 11 days in the Neonatal Intensive Care Unit at Cedars-Sinai Guerin Children’s (NICU).

After they brought their baby home, the couple worked on adjusting to the major changes in their lives. Sarkis said the emotional weight of the experience began affecting him.

“Two months later, these fears started surfacing: Am I doing enough to protect my family?” he said. “Are we doing everything we can to keep something bad from happening?”

Sarkis said the fearful thoughts increasingly consumed him, fueled by stress, sleep deprivation and the pressure he felt to protect his wife and child.

Experts say growing awareness around maternal mental health is widening the conversation to include the emotional wellbeing of the entire family—especially fathers—during pregnancy and the postpartum period.

“You can’t predict the impact of having a new baby, especially after a difficult childbirth and time in the NICU,” Sarkis said. “Sleep deprivation and everything else just begins piling up.”

Seakly said she began noticing signs that her husband was struggling emotionally after the traumatic birth, as both parents devoted nearly all their energy to caring for their newborn son.

“I saw it pretty quickly, but I think I was in denial because all of our attention was on the baby,” she said. “Sarkis lost a lot of weight after Masis was born, and a few months later, when he finally verbalized how he was feeling, it clicked for me that partners can be just as affected by birth trauma as mothers.”

Drawing from her own positive experience of getting therapy during the ups and downs of their journey to become parents, Seakly, who is a registered nurse at Cedars-Sinai, encouraged Sarkis to seek professional support as well.

“I learned that taking care of ourselves and each other is vital to the physical, emotional and mental health of our child,” she said. “Without Sarkis’ support mentally and emotionally, the domino effect of all the negative things we experienced could have been detrimental to our family.”

With his wife’s encouragement, Sarkis sought support through the Reproductive Psychology Program at Cedars-Sinai.

Sarkis worked with therapist Ruth Maouda, PsyD, a postdoctoral fellow in the program. Maouda says new parents often experience self-doubt, anxiety and emotional overwhelm during the transition from pregnancy to postpartum—particularly after traumatic birth experiences or severe sleep deprivation.

“One of the most important things I tell first-time postpartum parents is that they are entering an experience of ‘firsts,’” Maouda said. “Nothing can fully prepare you for becoming a parent and acknowledging that learning curve can help relieve some of the anxiety and pressure parents place on themselves.”

Sarkis said that during his sessions with Dr. Maouda he also learned practical coping strategies such as breathwork and mindful meditation, techniques that have helped him manage anxiety and obsessive thinking during high-stress moments.

“Therapy helped me to show up better for my son because now I feel equipped,” Sarkis said. “I have tools I can use every day.”

Maouda said supporting a parent’s mental health can have a positive ripple effect throughout the household.

“Raising a child takes a village,” Maouda said. “Supporting a parent’s mental health allows them to better support their partner and child. Protecting your own mental health helps prevent stress from rippling across the entire family system.”

Sarkis believes that talk therapy and developing coping strategies helped him become more emotionally present and patient, allowing him to enjoy everyday moments with Masis and feel more connected to his family.

Eynav Accortt, PhD, director of the Cedars-Sinai Reproductive Psychology Program, said studies estimate paternal postpartum depression affects about 10% of fathers, and the risk doubles when mothers are also experiencing perinatal mood or anxiety disorders.

“If one or both parents are struggling with their mental health, it affects the entire family,” said Accortt, a clinical psychologist who supervised Maouda’s care of Sarkis. “Supporting the emotional wellbeing of both parents is essential to building strong family bonds during the transition to parenthood.”

Sarkis believes seeing a therapist ultimately strengthened not only his mental health, but also the couple’s communication and partnership.

“My husband’s decision to get professional help was one of the most impactful acts of love—for himself and for our family,” Seakly said. “It helped him become the father he wanted to be for Masis and the partner he wanted to be for me.”

Sarkis hopes other fathers will recognize that they, too, may need support during the transition to parenthood.

“I think that having children is romanticized a lot. It’s beautiful but it’s also life-altering, It’s OK to ask for help if you are struggling,” he said. “That made all the difference for me and my family.”

Read more from Cedars-Sinai Stories and Insights: Research Aims to Improve Maternal Health Equity

The research findings were published in the peer-reviewed journal JAMA Internal Medicine.

Prostate cancer is the second-most common cancer in the U.S., exceeded only by breast cancer. About one-eighth of U.S. men are diagnosed with prostate cancer at a median age of 67 according to the National Cancer Institute. Most patients have slow-growing, localized tumors, confined to the prostate gland, that are unlikely to threaten their lives. Instead of immediate treatment, these low-risk patients can be monitored through “active surveillance,” in which examinations and tests are performed on a regular schedule to make sure the disease is not progressing.

“Use of active surveillance has increased over the last 15 years for men with low-risk prostate cancer, and it is now the most common treatment for these men,” said Timothy Daskivich, MD, director of Urologic Oncology Research for the Cedars-Sinai Department of Urology and corresponding author of the new study. “This approach allows these patients to avoid the risks of urinary incontinence, erectile dysfunction and other potential side effects of surgery and radiation therapy.”

Conservative management, which includes active surveillance or watchful waiting, is also recommended for men with limited life expectancies who likely will not live long enough to benefit from aggressive local treatment, even for higher-risk cancers. However, for these men, the trend is going in the opposite direction, as measured by the investigators’ analysis of extensive data from the Veterans Affairs health system. They found that for men with limited life expectancies and intermediate- and high-risk cancers, conservative management was being employed less often and that more were receiving aggressive local treatment with surgery or radiation.

“We found this pattern surprising,” Daskivich said. “Prostate cancer patients with life expectancies of less than five or 10 years were being subjected to treatments that can take up to a decade to significantly improve their chances of surviving cancer, despite guidelines recommending against treatment.”

For their study, the investigators analyzed medical data on 243,928 men in the Veterans Affairs health system who were diagnosed with localized prostate cancer between 2000 and 2019.

Among patients with average life expectancies of less than 10 years, the proportion who underwent treatments such as surgery or radiation for low-risk prostate cancer rather than receiving active surveillance decreased from 37.4% to 14.7%; but treatment for intermediate-risk disease increased from 37.6% to 59.8%. Among patients with average life expectancies of less than five years, treatment for high-risk disease increased from 17.3% to 46.5%. Among men who were overtreated, roughly 80% were treated with radiation therapy.

Solving the issue of overtreatment in higher-risk prostate cancer patients with limited longevity requires a multifaceted approach involving better estimation, communication, and integration of life expectancy into decision-making, Daskivich said. He and his team have proposed a “trifecta” method for communicating cancer prognosis to the patient. This method involves the physician discussing the likelihood of dying from the cancer with treatment versus without treatment at the endpoint of the patient’s life expectancy. This approach personalizes the risk of the cancer that is relevant to each patient.

“Our goal is to encourage clinicians to make longevity part of the discussion about the best treatment options so that prostate cancer patients with limited life expectancies can make educated choices,” Daskivich said. “A patient may be given this data and choose to pursue surgery or radiation treatments regardless of a limited probability of benefit.  Another patient may take a different course.”

“Every individual is different, and statistical averages for lifespan, treatment effectiveness and cancer risk cannot predict outcomes with certainty,” Daskivich added. “But patients should be given the opportunity to make informed decisions with the best possible information.”

Hyung L. Kim, MD, chair of the Department of Urology at Cedars-Sinai, said the JAMA Internal Medicine study reflects a signature strength of Cedars-Sinai: the close cooperation among researchers and clinicians. “Many of our investigators are themselves clinicians, which ensures that their research addresses real-life problems in healthcare with an emphasis on finding solutions,” he said.

Other Cedars-Sinai authors include Michael Luu and John R. Heard. Other authors include I-Chun Thomas from Stanford University and senior author John T. Leppert from Stanford University in Stanford, California, and the VA Palo Alto Health Care System in Palo Alto, California.

This work was supported in part by VA Merit Review (I01 HX0021261 to JL). The Department of Veterans Affairs Health Services Research and Development Service work was supported using resources and facilities at the VA Informatics and Computing Infrastructure (VINCI), VA HSR RES 13-457. The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government.

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Neither option was appealing.

Luckily, Gold’s urologist recommended a different treatment option: prostate artery embolization. The urologist referred Gold to H. Gabriel Lipshutz, MD, a Cedars-Sinai interventional radiologist who specializes in the minimally invasive, low-risk procedure that uses tiny beads to block blood flow to the prostate, allowing it to shrink.

“Prostate artery embolization offers a dramatic improvement in quality of life for men whose symptoms are severe enough to affect their lives and the medication they’ve been using is not effective or causes unwanted side effects, or surgery is not an option for them,” Lipshutz said.

Gold was a good candidate for the outpatient procedure, which took about two hours and left him “exuberant” about being free of symptoms, side effects—and the catheter.

“Ten days after the procedure, there was definite improvement,” Gold said. “Three weeks later, I was a very happy camper. And today, my symptoms are completely gone.”

A Common Health Concern

June is Men’s Health Month, a time to raise awareness about men's health concerns and ways they can be proactive about their health.

Enlarged prostate, or benign prostatic hyperplasia (BPH), is common in men as they get older. About 50% of men have the condition at age 50, and the percentage increases with age. Most men have an enlarged prostate by the time they’re 80, according to the National Institutes of Health.

As the prostate gland grows, it presses on the urethra—the tube that carries urine from the bladder and out of the body. The result is often a weak urine stream, difficulty emptying the bladder completely, and difficulty urinating despite feeling an urgent need. Some men do not experience symptoms bothersome enough to seek treatment. But for others, like Gold, the symptoms become detrimental to their quality of life.

“You can either live with your symptoms, or you can’t,” Lipshutz said. “Men who can’t live with their symptoms seek treatment.”

It had been more than two decades since Gold, 68, had a normal urine flow. Medication helped for a while, but over time it became less effective.

Then one day late last year, Gold rushed to the hospital.

“My symptoms were as extreme as you can get—I was not able to urinate at all,” Gold said. “The suffering was unreal.”

Imaging revealed that his prostate was extremely large—too large, in fact, for some treatments. So a catheter was inserted, which Gold lived with for three months until the successful prostate artery embolization.

A Dramatically Improved Quality of Life

Prostate artery embolization is a complex procedure performed by highly trained specialists like Lipshutz. He makes a small incision in the wrist and a mini-catheter is inserted into the radial artery and then guided, using X-ray technology, through the body to the arteries that feed blood to the prostate. Microscopic beads are then injected into those arteries from the catheter to block the flow of blood.  

Because prostate artery embolization is a relatively new treatment for BPH, long-term research data is not yet available. However, clinical trials have shown the procedure to be highly effective. Patients’ urinary symptoms can continue to improve for up to six months afterward.

Complications are rare, there is virtually no risk of the incontinence or impotence that can accompany traditional surgery, and recovery time is minimal, Lipshutz said.

“Some of my patients are almost in tears because they are so happy with the results,” Lipshutz said. “These are people who were severely affected by their symptoms—not being able to sleep at night because they wake up several times to go to the bathroom, for example.

“They can’t believe how their lives have changed. Many ask, ‘Why didn’t I do this sooner?’ or [say], ‘I wish I had been aware of this procedure sooner.’”

Lipshutz partners with urologists to ensure that patients with enlarged prostate are informed of all treatment options and are treated optimally, based on each person’s individual needs.

Gold is grateful his urologist referred him to Lipshutz.

“This procedure was a godsend,” he said. “I’m back to where I was over 20 years ago. It’s changed my life.”

Read more on the Cedars-Sinai Blog: Why You May Have Trouble Peeing, Plus Solutions to Help