A gland that doesn't age well; Prostate: Swelling, inflammation and cancer loom large when a man meets middle years.


As we all know, women are more evolved and mature than men, especially when it comes to taking care of their health. We manly men, by and large, would rather do anything, including go to the opera or watch a subtitled movie, than get a digital rectal exam.

But life is cruel, and along with all the other delights of middle age, like getting fat, bald, and weak, the prostate begins misbehaving. This can have some dire consequences, ranging from not being able to urinate to contracting cancer.

Unfortunately, the dreaded digital rectal exam is a sure-fire way to assess the state of the prostate. You can view this philosophically (every man, no matter how lofty, must eventually prostrate himself before his prostate) or pragmatically (it's another inevitable unpleasantness, along with telemarketers and capital-gains taxes).

Even though it seems every man I know over age 60 has prostate problems, I've tried to remain blithely ignorant, in keeping with my general denial of middle age. But now, on the verge of the half-century mark, I realize that my prostate is not something I can afford to ignore. That's why I turned to Tom Sansone, a Philadelphia urologist, to enlighten me.

Q. What is the prostate?

A. It's a gland about the size and shape of a walnut that surrounds a man's urethra, sort of like a doughnut right below the bladder.

Q. What does it do?

A. It enables men to make babies. It provides about half the fluid in semen. Not only that, but it helps keep sperm alive during the great salmon swim to the egg. How? By providing a protective alkaline escort through the acidic regions of the vagina and cervix.

Q. Why does it act up?

A. After age 40 or so, the prostate begins to grow bigger in just about every male. It's God's way of saying, "Your studly days are over, big fella." Sometimes this enlargement is benign. Sometimes it's a sign of cancer. In either case, the jumbo prostate may press against the neck of the bladder or urethra, squeezing the pipe shut. Result: It's hard to urinate (and may hurt).

Q. What are the signs?

A. A need to urinate frequently, urgently or several times a night. When the urine stream starts and stops, is hesitant or weak. When urinating is painful or burning and it feels like the tank is never empty.

Q. Does an enlarged prostate mean cancer?

A. No. On the other hand, prostate cancer is prevalent among men, and the incidence rises with age. Autopsies of 40-year-old men, says Sansone, show that a fifth have signs of cancer. By age 70, about 65 percent of men have cancerous cells in their prostate glands.

Q. How can a guy tell?

A. Get tested. There's a blood test that measures your PSA. That stands for prostate specific antigen. PSA, an ingredient of semen, is made by the prostate. Some PSA naturally leaks from the prostate into the bloodstream. Problems with the prostate -- such as enlargement or cancer -- may cause extra PSA to enter the blood.

Another screening technique: that old favorite, the digital rectal exam.

During a rectal exam, the doctor feels for several things: nodules, areas of hardness, changes of consistency and symmetry. A normal prostate should have two symmetrical lobes and the consistency of a rubber ball. If it's so hard the doctor can't indent it with his thumb, well then, as they say in space, "Houston, we have a problem."

By the way, for a really vigorous exam, go to a urologist, suggests Sansone, who says he manipulates the gland for a full minute and does "a lot of pressing." Family docs, he says, tend to be more "gentle and superficial."

Q. Does prostate cancer mean I'm a goner?

A. There are different kinds of prostate cancer, says Sansone. Clinical cancer, characterized by a mass of cancer cells, can overrun and incapacitate the prostate and spread to other parts of the body. It's lethal stuff. But incidental cancer, which is more common, is slow-growing and may not cause symptoms or health problems. That's why the best approach often is watchful waiting.

Q. How big a threat is prostate cancer?

A. An estimated 184,500 new cases of prostate cancer will be diagnosed this year, and about 40,000 men will die from it, according to the American Urological Association. But it's all relative, says Sansone. Heart disease, in all its various forms, annually kills about 455,000 American men.

Q. What causes prostate cancer?

A.Genes play a role. If the disease runs in your family, you have a one-in-four chance of developing it yourself. But diet and environment are also factors.

Q. Does sex cause prostate cancer?

A. No. There's no evidence that it makes it more likely and worse or less likely and better. However, regular ejaculation is beneficial for prostatitis (it gets the juices flowing and clears out the ducts).

Q.What is prostatitis?

A. Inflammation or infection of the prostate. It comes in three kinds: nonbacterial, acute bacterial and chronic. The symptoms: frequent and painful urination, pain in the lower abdomen or lower back, and, with acute prostatitis, fever and chills. Some causes: stress, bacteria or viruses, sexually transmitted diseases, and not having regular sexual activity.

Q.How can I avoid it?

A. Some don'ts: sitting for long periods; sitting on a hard chair; riding a bike. Says Sansone: "You want to stay away from any activity where you're likely to be sitting on the prostate and crushing it."

Q.How can I cure prostatitis?

A. Medications such as antibiotics, anti-inflammatories and muscle relaxants often help. Also, taking hot baths, drinking more fluids, and ejaculating frequently (at least a couple times a week or so).

Q.Does prostatitis raise the risk of prostate cancer?

A. No.

Q. What about vasectomies?

A. Links to cancer have been studied extensively. The result: no conclusive evidence that a vasectomy either hurts or helps.

Q.Who is high-risk?

A. Hairy-chested he-men with tons of testosterone. Testosterone feeds prostate cancer.

Q. Is there a cure for prostate cancer?

A. No guaranteed permanent cure, but there are several effective treatments that can relieve discomfort and prolong life. A cancerous prostate can be knifed (a prostatectomy), zapped (with via radioactive beams), poisoned (by implantation of radioactive "seeds" or pellets), frozen, or carefully bird-dogged through watchful waiting.

Q.What should men do?

A. From age 50 on, get yearly checkups, including a PSA test and digital rectal exam. Men who are African-American or who have family history of prostate cancer should begin at age 40.

Q. Anything else?

A. Cut down on red meat and red-meat fats, Sansone recommends. Make sure you get plenty of vitamin D and E. Eat tomatoes (which are possibly protective) and soy products.

Pub Date: 01/31/99

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