Considering it's only about the size of a walnut, the prostate gland seems disproportionate to the epic life-and-death scenarios to which it plays host. Situated at the base of the bladder, the prostate's secretions are the main component in seminal fluid and are necessary for ejaculation and reproduction. The source of these life-giving secretions, though, is prone to infection, benign enlargement and, for more than 200,000 men a year, cancer.
"I call it the gland of pleasure and enjoyment and also the gland of pain and discomfort," says Dr. Neil Baum, urologist and associate clinical professor of urology at Tulane University and Louisiana State University's medical schools. "Prostate cancer is the most common noncutaneous (not of the skin) cancer in men. ... It causes the death of 26,000 people annually and is the second leading cause of death in men following lung cancer."
Prostate cancer most commonly afflicts men older than 50, but males of all ages should cultivate an awareness of prostate health. Prostate problems may begin to develop as early as the 20s and 30s. "Younger and middle-aged guys get a lot of prostate infections," says Dr. Robert Ryan, urologist at East Jefferson Family Medical Clinic.
Prostatitis (inflammation of the prostate gland) causes symptoms such as burning and pain during urination, pelvic pain, frequent urination and blood in the urine, Baum says. The cause usually is bacterial — bacteria transported in the urine may get into the prostate and cause infection, or sexually transmitted diseases may be the culprit.
"[Bacterial prostatitis] is usually successfully treated with antibiotics," Baum says. "Between 5 and 10 percent (of the male population) develops it." However, incidents of bacterial prostate infection do not have any correlation with future cases of prostate cancer, Ryan says.
As men enter their 40s and 50s, they may experience symptoms such as frequent urination, dribbling after urination, a weakened urine stream and an inability to sleep through the night without getting up to urinate, says Dr. Raju Thomas, professor and chairman of urology at Tulane University Health Sciences Center.
"As men age, the prostate becomes a problem area," he says. "Most men will have what is considered a benign enlargement of the prostate [and] as the prostate enlarges, it can block the urine stream."
Benign enlargement has hormonal causes and can interfere with quality of life. A number of treatment options exist, however, including prescription medications such as finasteride and dutasteride, which shrink the prostate, reducing its pressure on the urethra and relieving symptoms, Baum says. Alpha-blockers work by relaxing the muscles in the prostate, making urination easier. Though alpha-blockers may affect a man's fertility by decreasing the volume of ejaculate, he will still be able to get an erection and have intercourse. Most patients' symptoms respond to these medications; however, if the problem persists, a minimally invasive office procedure called microwave treatment can shrink the prostate with an application of heat. Performed with the patient under sedation and local anesthetic, the treatment lasts 30 minutes, and Baum says significant improvement can be seen after six to eight weeks.
Prostate cancer is symptomless in its early stages, which is why annual blood tests and digital rectal exams (DREs) are imperative for men over age 50. (For African-American men and males with a family history of prostate cancer, annual tests after age 40 are recommended.)
If the DRE is normal and the prostate specific antigen (PSA) levels in the blood are low, patients can wait two to three years before being screened again. Thomas says that during the course of his 33 years at Tulane, he has seen a marked decrease in the morbidity of prostate cancer since the introduction of PSA screening.
"[P]rior to the introduction of PSA screening, a huge percentage of men were diagnosed too late, and the cancer had spread to the bones, which is a very painful existence," Thomas says. "We do not see that scenario today. There is no question that screening has ... decreased the pain and suffering that many men had to go through prior to the introduction of PSA."
Four options exist for men diagnosed with prostate cancer, Baum and Thomas say, and the appropriate course of action depends on the patient's age, medical status and biopsy results. First, men with less than 10 years life expectancy or cancer that is not very malignant may opt to monitor the growth of their prostate cancer with periodic PSA screenings. Second, the prostate gland may be surgically removed. Third, radiation can be applied externally or internally via placement of tiny, radioactive "seeds" on the prostate. Fourth, hormonal treatment to decrease the amount of testosterone is one of the choices for men whose cancer has spread beyond the prostate, since testosterone "is like fertilizer for prostate cancer cells," Thomas says.
Like many therapies, prostate cancer screening and treatment is not without controversy. "There's no consensus on screening," Ryan says. "When you ask the American Cancer Society whether there is any proven benefit from it, the answer is no. [Screening] is one of these things that there is a lot of talk about in the press, but when you get down to it, there is no consensus on whether it makes a difference."
The questions surrounding prostate cancer screening and treatment are complicated by the fact that prostate cancer may not be just one cancer, but many different kinds with varying degrees of aggression.
"Prostate cancer ... is probably a hodgepodge of several kinds of prostate cancers with different characteristics lumped into one heading," Ryan says. "Some cancers are very aggressive in the prostate, some are very slow-growing. It doesn't always manifest itself as something significant."
Mounting evidence suggests that a diet rich in fruits and vegetables and low in red meat and animal fat can ward off prostate cancer.
"This is not scientifically proven," Baum says, "but it is strongly suggested that a healthy diet that is low in red meat — particularly meat with a high fat content — and high in lycopene found in cooked tomatoes, as well as vitamin E, zinc and selenium, seems to be associated with a decreased risk of prostate cancer. Consumption of highly processed or charcoaled meats, dairy products and fats seems to be associated with prostate cancer."
Thomas would like to see men improve awareness of prostate cancer the same way women have increased awareness of breast cancer: by talking about it, going in for regular screenings and promoting the message through political activism.
"Unfortunately, we still see a lot of men diagnosed too late, even in the year 2010, and I think we can do better than that," Thomas says. "Any battle begins with awareness."