“When I was 54 years old, I started to urinate frequently, sometimes every 30 minutes. This symptom led me to consult a doctor, and I discovered that I would need to have my prostate removed.” Similar stories are common in prostate clinics around the world. What can a man do to prevent prostate diseases? When should he seek medical advice?
THE PROSTATE is a walnut-shaped gland that is located below the bladder and surrounds the urethra. (See the illustration of the male pelvis.) In a normal adult man, it weighs two thirds of an ounce [20g] and measures, at most, 1.6 inches [4cm] along its transverse axis, 1.2 inches [3cm] along its vertical axis, and 0.8 inches [2cm] along its horizontal axis. Its function is to produce a fluid that makes up approximately 30 percent of the volume of semen. This fluid, containing citric acid, calcium, and enzymes, probably improves sperm motility (ability to swim) and fertility. Moreover, the fluid secreted from the prostate includes zinc, which scientists theorize protects against genital-tract infections.
A number of pelvic symptoms in men are related to inflammatory or tumorous prostate disease. Prostatitis—inflammation of the prostate—can cause fever, uncomfortable urination, and sacral or bladder pain. When the prostate is very swollen, it can prevent the patient from urinating. If inflammation is caused by bacteria, the disease is called bacterialprostatitis, and it can be acute or chronic. It is usually associated with urinary tract infection. However, in a greater number of cases, the cause of the inflammation is not detected, and for that reason the disease is called nonbacterialprostatitis.
Common prostate problems are an increase in urinary frequency, urination during the night, a decrease in force of the urinary stream, and the sensation that the bladder is not completely empty. These symptoms usually indicate benignprostatichyperplasia (BPH)—noncancerous prostate enlargement—which can affect men over 40 years of age. The incidence of BPH increases with age. It is present in 25 percent of men aged 55 and in 50 percent aged 75.
The prostate can also be attacked by malignant tumors. Generally, prostate cancer is discovered in a routine examination, even when there are no prostate symptoms. In more advanced cases, there can be urinary retention with swelling of the bladder. When cancer has spread to other organs, there may be backache, neurological symptoms, and swelling in the legs because of obstruction of the lymphatic system. In a recent year, the United States alone reported about 300,000 new cases of prostate cancer and 41,000 deaths caused by it. Scientists believe that 30 percent of men between the ages of 60 and 69 and 67 percent of men between 80 and 89 will develop prostate cancer.
Research reveals that the chances of developing prostate cancer increase rapidly after age 50. In the United States, this cancer is about twice as common among black men as among white men. The incidence of this disease varies around the world, being high in North America and European countries, intermediate in South America, and low in Asia. This suggests that environmental or dietary differences may be important in prostate cancer growth. If a man immigrates to a country with greater incidence, his personal risk can increase.
Men with relatives affected by prostate cancer have a greater probability of developing it. “Having a father or brother with prostate cancer doubles a man’s risk of developing this disease,” explains the American Cancer Society. Some risk factors are age, race, nationality, family history, diet, and physical inactivity. Men who have a diet rich in fat and who are sedentary increase their chances of developing the cancer.
Although scientists still do not know exactly what causes prostate cancer, they believe that genetic and hormonal factors may be involved. Happily, we can control two risk factors—diet and physical inactivity. The American Cancer Society recommends “limiting your intake of high-fat foods from animal sources and choosing most of the foods you eat from plant sources.” It also recommends eating “five or more servings of fruits and vegetables each day” as well as bread, cereals, pasta, other grain products, rice, and beans. Tomatoes, grapefruits, and watermelons are rich in lycopenes—antioxidants that help prevent damage to DNA and may help lower prostate cancer risk. Some experts also claim that certain herbs and minerals may help.
The American Cancer Society and the American Urological Association believe that prostate cancer screening can save lives. Treatment is most likely to be successful when the cancer is detected early. The American Cancer Society recommends that men over 50, or over 45 in the case of those in high-risk groups, undergo an annual medical examination.
The examination should include a prostate-specific antigen blood test (PSA). This antigen is a protein produced by prostate cells. Its level increases in prostate diseases. “If your PSA test is not normal, ask your doctor to discuss your cancer risk and need for further tests,” says the American Cancer Society. A digital rectal exam (DRE) is also included. Through the patient’s rectum, the doctor can feel any abnormal area in the prostate gland, since this gland is located toward the front of the rectum. (See the illustration of the male pelvis on page 20.) A transrectal ultrasound (TRUS) test is useful “when the PSA or DRE indicates an abnormality” and the doctor needs to decide whether he should recommend a biopsy of the prostate gland. This test takes about 20 minutes.
In addition to detecting prostate cancer, the annual urologic examination can discover BPH, referred to previously, at an early stage, which would permit less aggressive treatment. (See the box “Treatments for BPH.”) Morally clean conduct protects a person from venereal diseases, which can cause prostatitis.
A healthy diet and moderate exercise may help lower the risk of prostate cancer
Certainly your prostate deserves to be protected and cared for. The man mentioned at the beginning of this article related that he has recovered fully from his operation. In his opinion “all men should undergo an annual preventive medical examination,” even if they do not have any symptoms.
If this is your age group, you are invited to consider the box “Symptom Index for Benign Prostatic Hyperplasia (BPH).”
Directions: Answer the questions below by circling the appropriate number.
Questions 1-6 are to be answered:
0—Not at all
1—Less than one time in five
2—Less than half the time
3—About half the time
4—More than half the time
1. During the past month, after you finished urinating, how often did you have the sensation that you had not emptied your bladder completely? 0 1 2 3 4 5
2. During the past month, how often did you have to urinate again within less than two hours after you finished urinating? 0 1 2 3 4 5
3. During the past month, how often did you find that you stopped and started again several times when you urinated? 0 1 2 3 4 5
4. During the past month, how often did you find it difficult to postpone urination? 0 1 2 3 4 5
5. During the past month, how often did you have a weak urinary stream? 0 1 2 3 4 5
6. During the past month, how often did you have to strain to begin urination? 0 1 2 3 4 5
7. During the past month, how many times, on average, did you have to get up to urinate, from the time you went to bed until the time you got up in the morning? (Circle the number of times.) 0 1 2 3 4 5
The sum of the numbers circled is your BPH symptom score. Mild: 0-7, moderate: 8-19, severe: 20-35.
From the American Urological Association
▪ DRUGS: Many different medicines are used, according to the symptoms of each patient. Only your doctor can prescribe them for you.
▪ WATCHFULWAITING: The patient has only periodic medical examinations and does not use drugs.
(a) In transurethralresectionoftheprostate (TURP), the surgeon inserts through the urethra an instrument (resectoscope) that contains an electrical loop that cuts tissue and seals blood vessels. No external incision is needed. It takes about 90 minutes. Transurethral procedures are less traumatic than open forms of surgery.
(b) Transurethralincisionoftheprostate (TUIP) is like TURP. However, this procedure widens the urethra by making a few small cuts in the bladder neck and in the prostate gland itself.
(c) Opensurgery is used when a transurethral procedure cannot be used because the prostate is very enlarged. Open surgery requires an external incision.
(d) Lasersurgery is the use of lasers to vaporize obstructing prostate tissue.
The patient must make the final decision as to which, if any, treatment he will accept. A recent report in TheNewYorkTimes noted that some experts are uncertain about even testing for prostate cancer, especially in older men, in that it “can be an indolent disease unlikely to cause lasting harm to the health, while its treatment can often produce serious side effects.”
1. What operation are you recommending?
2. Why do I need the operation?
3. Are there alternatives to surgery?
4. What are the benefits of having the operation?
5. What are the risks of having the operation? (Hemorrhage or impotence, for example)
6. What if I do not have this operation?
7. Where can I get a second opinion?
8. What experience do you have in performing this operation without blood transfusion?
9. Where will the operation be done? Do the hospital physicians and nurses respect the patient’s rights about blood transfusions?
10. What kind of anesthesia will I need? Does the anesthetist have experience in surgery without blood transfusion?
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