April 23, 1999 (Ira Pilgrim)

For Men Only

Most men who live to old age are likely to have some kind of prostate problem.

If you don't know much about your prostate gland, just live long enough and you will. Most men who live to old age are likely to have some kind of prostate problem.

The most common problem is called benign prostatic hypertrophy(BPH). The word "benign" means that it is not cancer and the word "hypertrophy" means that it it has grown bigger than it aught to. In other words, it is likely to cause a problem, but is not likely to kill you.

The prostate is a gland that secretes a liquid that makes up part of what a man ejaculates. If you follow the route of urine, it is made by the kidney, flows down the ureters(two thin tubes) to the bladder where it is stored until you pee. From the bladder to the outside is a tube called the urethra, which carries urine to the outside as well as the stuff that is ejaculated. The prostate gland surrounds the urethra where it leaves the bladder. It secretes into the urethra, but only when the muscles contract in orgasm. It is normally the size of a walnut, but in benign prostatic hypertrophy it can sometimes grow to the size of a peach or larger.The main problem with a large prostate is that it can obstruct the flow of urine, which can be serious because it can damage the kidneys, which you need to live. Some men obstruct with a relatively slight enlargement and others don't obstruct until the prostate becomes humongous.

The usual treatment for a prostate that is obstructing urine flow is colloquially called a roto-rooter job or, in medical parlance, a transurethral prostatectomy(TURP). This is done, under anaesthetic of course, by inserting a tube up the urethra and nibbling away with an instrument that nibbles. If the prostate is very large it is often removed as a whole by opening the bladder and taking out the whole damned thing. There are other ways to do this, but the principle is the same. The result of the surgery is that the obstruction is usually removed either permanently or for a long time.

There are drugs which will reduce the size of the prostate and will provide some relief from the symptoms of obstruction. They work for some people, but not for others. Usually the effect is temporary, but for a mild case it might be enough to make surgery unnecessary, or postpone it.

The second problem is prostatic cancer, which can be a killer. It can be diagnosed by a biopsy of the prostate which is done by putting a tube(scope) in the rectum and, with a clever device, taking small samples of the prostate. With the latest equipment, the pain is minimal. I have had two, and one hurt a little and the other was completely painless. If cancer is found it can be treated by surgery or radiation. There is much debate whether it should be treated at all in old people who do not have much of a life expectancy regardless of the prostate cancer.

You might have read that there is a blood test for prostate cancer. This is not so. There is a test for prostate specific antigen(PSA). The amount of this substance in the blood is an indication of the the amount of prostate tissue (cancerous or non-cancerous) that a man has. A man with a very large prostate can have a high PSA and not have cancer. A person with a small cancer can have a normal PSA. Before I had my prostate removed, I had a PSA of 27 (normal is considered as less than 4) and I did not have prostate cancer. My prostate was humongous, but I did not obstruct until a few weeks before I was scheduled for surgery.The PSA test is very useful as a test of whether a prostate cancer has been cured. If it has been cured, the PSA will drop to normal and stay there.

There is no question that a rectal examination should always be part of a routine physical examination. In the process, the prostate is felt and if it is abnormal, then a biopsy can be done to detect or rule out prostate cancer. Aside from that, there is no infalible method of dealing with prostate problems. Having a competent urologist is about the best that you can do.

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