Prostate Health
Robert A. Wascher, MD, FACS
PROSTATE HEALTH:
MEET YOUR PROSTATE GLAND:
The prostate gland is a walnut-sized glad that is attached to the bottom of the bladder. The prostate gland wraps around the male urethra as it arises from the bladder, and multiple ducts that connect the prostate gland to the urethra allow the prostatic secretions to be expelled into the urethra at the time of ejaculation. These prostatic secretions, which constitute about 20 percent of the volume of semen, help to create the optimal chemical environment for sperm to thrive and migrate within the female genital tract, thereby enhancing sperm function.
BENIGN PROSTATIC HYPERTROPHY (BPH):
BPH is a very common condition that affects essentially all men as they age. The prostate gland continues to slowly enlarge throughout a man’s life. In many men, as they reach their fourth or fifth decades of life, the enlarging prostate begins to interfere with the flow of urine through the portion of the urethra that is surrounded by the prostate gland. The onset of these obstructive voiding symptoms may be gradual, or they may arise relatively suddenly.
The typical symptoms associated with BPH include a delay in the start of the urinary stream, decreased force of the urinary stream or dribbling (especially at the end of urination), a feeling of inadequate bladder emptying after urination, and increased frequency of having the urge to urinate (especially at night). In severe cases of BPH, urinary tract infections, kidney damage, and a complete inability to urinate may occur (these complications of BPH are urgent medical problems that require prompt intervention by a physician).
There is no known effective method of preventing BPH, although some large public health studies have suggested that moderate alcohol intake (which, ironically, increases the risk of certain types of cancer), a diet low in meat products (and, especially, red meat), and a diet high in fresh vegetables and non-meat protein, may be associated with a reduced risk of BPH during middle age.
There are a variety of treatments available for men with BPH, including medication (alpha-blockers, and hormonal agents such as Proscar and Avodart, are the most commonly prescribed medications for BPH). There are also an increasing number of surgical options available to men with severe symptomatic BPH, including newer procedures that are less invasive, and that are associated with fewer long-term complications, than the “gold standard” TURP procedure (transurethral resection of the prostate gland).
As a cautionary note, middle-aged or elderly men who develop the new onset of obstructive voiding symptoms must also be carefully evaluated to rule-out prostate cancer, in addition to BPH.
PROSTATE CANCER:
In many respects, prostate cancer is the male counterpart of breast cancer in women. As is also true with regards to breast cancer in women, prostate cancer is the most common cancer that occurs in men (excluding minor skin cancers), and the second most common cause of cancer death in men. In 2009, an estimated 192,000 new cases of prostate cancer will be diagnosed, and approximately 27,000 men will die of this disease. Prostate cancer accounts for 25 percent of all cancer diagnoses in men (similar to the percentage of breast cancer cases among all cancer cases diagnosed in women). As with the great majority of breast cancer cases, most prostate cancers appear to be stimulated to grow and spread by sex hormones produced by the gonads (and, specifically, by testosterone and other androgens, produced by the testes and other tissues in the body).
Not surprisingly, prostate cancer occurs only in men. As with most types of cancer, prostate cancer becomes more common with advancing age. The average age at diagnosis with prostate cancer is 70 years, and two-thirds of all prostate cancer cases occur in men over the age of 65 years. Autopsy studies have demonstrated that approximately 80 percent of men over the age of 70 have identifiable prostate cancer in their prostate glands at the time of their death.
There is a great deal of ongoing debate regarding the optimal method of screening men for prostate cancers. That being said, most experts, including the American Cancer Society, still recommend that otherwise healthy men begin to undergo annual prostate cancer screening when they reach the age of 50, to include a digital rectal examination (DRE) and prostate-specific antigen (PSA) blood testing. Some experts also recommend that annual DRE and PSA testing begin at age 45 for men with a significant family history of prostate cancer, and in African-American men (prostate cancer is more common in African-American men than in Caucasian and Asian men).
The currently accepted methods of treating prostate cancer include surgery (prostatectomy), various forms of radiation therapy, and medical therapy with hormone blocking drugs and other types of drug therapy. Each of these approaches to prostate cancer treatment has its own unique risk-to-benefit profile, and so men with prostate cancer need to have a thorough and frank discussion with their urologist and medical oncologist regarding the optimal treatment of their disease. (A more recent method of prostate cancer treatment, referred to as cryosurgery or cryotherapy, is still being studied, and has not yet been embraced by most mainstream prostate cancer experts.) The optimal treatment for elderly men with early stage prostate cancer is also the topic of considerable debate, with some prostate cancer experts advising that men who are 75 years old and older consider “watchful waiting” instead of undergoing active prostate cancer treatment (other cancer experts recommend that any man, irrespective of age, consider treatment if it is likely that he will live at least another 10 years). There is also some experimental evidence, as I have reported on www.doctorwascher.com, that exercise, dieting, and the loss of excessive weight may improved one’s chances of surviving prostate cancer.
Recent clinical studies looking at various dietary supplements and vitamins as possible prostate cancer prevention aids have been mostly disappointing, particularly with respect to selenium, Vitamin E, and Vitamin D. However, other dietary compounds may still play a potentially useful role in prostate cancer prevention, including broccoli sprout extract (sulforaphane) and pomegranate juice extract (ellagitannins). There is also some clinical research data suggesting that frequent ejaculation may be associated with a mild decrease in the risk of developing prostate cancer. (Look for additional details regarding current approaches to prostate cancer prevention in my columns on www.doctorwascher.com, and in my forthcoming book, “A Cancer Prevention Guide for the Human Race,” which will be published in early 2010.)
Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and the Physician-in-Chief for Surgical Oncology at the Kaiser Permanente healthcare system in Orange County, California. Doctor Wascher writes a weekly global health update column, which can be viewed at www.doctorwascher.com. Doctor Wascher is also the author of the much awaited forthcoming book on cancer prevention, “A Cancer Prevention Guide for the Human Race.”
Cancer surgeon, professor of surgery & author. Webmaster: http://doctorwascher.com | More from Robert A. Wascher, MD, FACS
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