Trouble below the belt: what your doctor may not tell you about prostate problems

Vegetarian Times, May, 1997 by Luise Light

It may not be macho to talk about it, but four out of five American men can count on developing prostate problems during their lifetime. The prostate, an essential part of the male reproductive system (it produces seminal fluid), is a walnut-size organ, part gland and part muscle, that sits beneath the bladder. Urine passes from the kidneys to the bladder and then flows through the urethra, a tube that passes directly through the prostate to the penis and out of the body.

Estimates b the Baltimore-based, American Foundation for Urologic Disease are that more than half of all American men 50 and older have enlarged prostate glands, a condition known medically as "benign prostatic hypertrophy" (BPH). Men with BPH sometimes have trouble urinating and can develop frequent inflammations and infections of the prostate. Between nine and 12 million men with BPH have urinary symptoms so severe they seek medical treatment and one out of four undergo surgery.

Until recently, surgery was considered the main treatment for BPH. According to Michael Schacter, M.D., author of The Natural Way to a Healthy Prostate (Keats, 1995), when a man came to the office for medical treatment, he would be told that his condition was caused by aging, and there was nothing that could be done about it until the symptoms progressed enough to warrant surgery -- partial or total removal of the prostate to relieve the pressure on the urinary tract. While surgery may have helped many men, at least one-fourth of those who undergo it experience complications such as impotence, urinary tract infections and incontinence, says Schacter, who specializes in adult medicine and lives in Suffern, N.Y.

In recent years, new pharmaceuticals have been approved by the Food and Drug Administration for treating BPH. The best known and most widely used, Finasteride (Proscar), has been shown to be moderately effective in reducing prostate size and improving urinary discomfort, but it has a few downsides. In some men, it decreases libido, causes premature ejaculation and even impotence. Pregnant women are advised to avoid contact with the drug or even the sperm of a man who has taken Proscar apparently because it can damage the male fetus she may be carrying.

Although BPH can be painful, inconvenient and even embarrassing, it is the lesser of two evils. Prostate cancer, the most common cancer found in American men, attacks 19 out of every 100 men. The National Cancer Institute (NCI) based in Bethesda, Md., says an estimated 317,000 new cases of prostate cancer were diagnosed in 1996, and 48,000 men will die of it.

In the last 20 years, the incidence of prostate cancer in the United States has rocketed sky-high, increasing 176 percent from 1973 to the present, according to the NCI. No one knows exactly why the numbers are way up, but some experts believe it's due to better detection methods and not to actual cases. However, there are some puzzling aspects to the statistics that don't quite fit this interpretation.

Katsutoh Shinohara, M.D., a professor of urology at the University of California School of Medicine at San Francisco, notes that screening methods such as serum testing for "prostate-specific antigen (PSA, a factor in the blood that indicates prostate cancer) gives us a more powerful tool to detect prostate cancer." Along with a digital rectal exam, the two tests provide much greater cancer screening power. When one test comes up positive, an ultrasound exam is performed to confirm the diagnosis before a decision about surgery is made.

Shinohara has no explanation for the fact that African-American men have one of the highest incidences of prostate cancer in the world, double that of U.S. whites, while Nigerian blacks have one-sixth that of U.S. blacks. Even worse, U.S. blacks tend to get prostate cancer at a younger age and their cancers tend to be more aggressive than among those of whites, who themselves have a prostate cancer incidence 30 times greater than that in Japan. Japanese men raised in California have rates of prostate disease (and mortality) twice as high as those of men in japan but not quite as high as that of American whites. Epidemiologists who see these contrasting regional trends look for environmental influences to explain them, notably, dietary differences.

Ernst Wynder, M.D., president of the American Health Foundation (AHF) in New York City, says dietary differences are the only way to explain why some countries have higher rates of prostate cancer than others. Scientists suspect that a high level of animal fat in the diet raises the level of testosterone and other male hormones which, hypothetically, could spur the prostate to grow larger -- along with any cancer cells present. According to Wynder, the radical difference in rates of cancer seen in native Japanese men compared to those living in the United States may also be due to the differences in diet. Men who emmigrate from japan to the United States shift from a soy-based, low-fat, high antioxidant diet to a higher fat, more meat-based, typical American menu.