Protect your prostate; keeping this walnut-sized sex gland healthy is a breeze—once you find it. Here's how to be proactive - Health

Men's Fitness, Sept, 2002 by Robrt L. Pela

It's 10 o'clock. Do you know where your prostate is? Despite the vital role this particular gland plays in male sexual function, 89 percent of us aren't sure where to find it, according to a recent survey, while 69 percent don't have a clue to its purpose or importance. Even more embarrassing: Women interviewed for the same study knew more about the prostate than men did--and they don't even have one.

So in case some pollster corners you, here are the basics:

* The prostate gland lies between the penis and rectum at the base of the bladder.

* The prostate's function is to secrete a fluid that lubricates the urethra (the canal that carries urine and semen) and protects sperm as it exits.

* From the onset of puberty until adulthood, the prostate enlarges from the size of a grain of wheat to that of a walnut.

* Trouble usually begins when midlife hormonal changes cause the gland to grow significantly, but prostate problems--from inflammation to cancer--can afflict a man at any age.

* Measures taken now may dramatically decrease your risk of serious illness in the future.

IS IT CANCER?

When the prostate becomes enlarged because of infection or spasm, it squeezes on the urethra or presses against the neck of the bladder, causing urinary problems and sometimes sexual dysfunction. An inflamed prostate is a nuisance, but it's relatively easy to treat with antibiotics, urinary antiseptics, muscle relaxants and/or rest.

Things get more complex when swelling indicates benign prostatic hypertrophy or cancer. BPH, a nonmalignant growth that afflicts one-third of all men over age 50, can be treated noninvasively if symptoms aren't severe. Otherwise, laser, microwave or traditional surgery is used to remove part of the gland, making it possible to urinate normally again. Usually, neither libido nor sexual ability are affected, notes Mitchell Kaye, M.D., a urologist in Scottsdale, Ariz., though "retrograde ejaculation," the failure to ejaculate--which can reduce fertility--may result.

Like BPH, prostate cancer is more common in--but not exclusive to--older patients. It's the second-leading cause of cancer death in men, after lung cancer. "We're expecting 189,000 new cases of prostate cancer among American men this year," says Judd W. Moul, M.D., director of the Department of Defense Center for Prostate Disease Research in Rockville, Md. "One in six of us is at risk for the disease, and 30,000 men will die from it in the next 12 months alone."

There's no apparent cause for prostate cancer, though more and more evidence traces increased risk to both heredity and a diet laden with fatty foods. Unfortunately, when the disease is in its earliest, most curable stage, it shows no symptoms. "If a man waits for signs like blood in his urine or back pain to develop," says Moul, "the cancer has likely advanced to a stage where it's less treatable." Care options include hormones, radiation, and partial or radical surgery.

THE YOUNG MAN'S PROSTATE

Moul recommends annual rectal exams beginning at age 40. (You know, that 60 seconds of bending over during your checkup that you try not to think about during the rest of the year.) "But young men, too, should familiarize themselves with the signs of prostate trouble," he cautions, "because it's likely to affect them as they get older. Pay particular attention to prostate health if other men in your family have had a history of problems."

It's never too early to request a prostate specific antigen test, which measures the levels of gamma seminoprotein in the blood, a substance released only by prostate cells--and in much higher quantities by prostate-cancer cells.

"It's the greatest screening test for any type of cancer ever," says Moul, "but it's not infallible. People with prostate inflammation can test positive for cancer on a PSA. [So can recent ejaculators, so abstain for 48 hours before having the test.] Further testing will determine which condition you have, and--in either case--the sooner you know, the better."

A recent federal study suggested that men with very low PSA results can take an extra year between tests, but don't do so without your doctor's approval.

HAIRY DRUGS AND PALM TREES

The most popular drug for prostate enlargement is finasteride, which goes by the brand name Proscar (and moonlights as the baldness drug Propecia). It can have unfortunate side effects, however, such as diminished libido. It can also cause birth defects in male infants; therefore a pregnant woman should never touch a crushed Proscar tablet, and any sexual partner taking the drug should wear a condom to protect her from small amounts of medication in his semen.

A new study presented at this year's meeting of the American Urological Association found that combining finasteride with doxazosin (brand name Cardura) can improve finasteride's performance significantly.

Clinical studies have also shown that herbal treatments are. helpful for prostatitis. The best known is saw palmetto, extracted from a palm tree rich in fatty acids and plant sterols that may reduce swelling by blocking cholesterol. The primary ingredient in supplement products such as Prostate Plus is nearly always saw palmetto.