Woes of a Fun-Loving Organ
CLAUSEN, CHRISTOPHER
Second Thoughts WOES OF A FUN-LOVING ORGAN BY CHRISTOPHER CLAUSEN LATELY PROSTATES have been in the news a lot. Some of them have been political organs—we learn that Bob Dole had his removed, and...
...Life is unfair, as has been noticed before...
...Others are military (Norman Schwarzkopf, like Dole, had a radical prostatectomy for cancer) or literary (Michael Korda just published a book about his cancer operation and has been on all the talk shows...
...Some urologists vehemently disagreed with this negative conclusion, however, and further research continues...
...One reason prostates have been in the news lately, I suspect, is that male baby boomers are beginning to discover they have them...
...It sounds worse than the appendix...
...Benign enlargement, not cancer, is the most common prostate malady...
...The point might not matter so much except for the fact that chronic bacterial prostatitis, unlike the acute kind, is difficult to treat effectively and frequently involves months of antibiotics...
...Unfortunately this fun-loving organ surrounds the urethra, the tube through the penis that transmits not only semen but urine...
...Here the limitationsof medical knowledge and treatment become even more evident than with other conditions of this lamentable gland...
...Prostate cancer could be considered the male equivalent of breast cancer, which kills a roughly equal number of people every year...
...THEN THERE IS the family of diseases known as prostatitis...
...A good many doctors and patients, including the novelist William Styron, swear by it...
...The angels suffer from neither breast cancer nor prostatic enlargement, being without sex...
...In fact there are two, and soon there may be more...
...Its symptoms include: Chills and fever...
...Developed in France, the Prostatron is a machine that uses microwaves to destroy BPH cells with heat and thereby relieve obstruction...
...Urologists are fond of fruit and nut comparisons...
...Disadvantages of the treatment are that it causes swelling and, in a significant number of cases, a temporary inability to urinate...
...The vast majority of patients so treated," continues Dr...
...One urologist calls prostatitis the most imprecise diagnosis in all of medicine," declares Patrick C. Walsh, an eminent surgeon who is chief of urology at Johns Hopkins, in The Prostate: A Guide for Men and the Women Who Love Them (coauthored with Janet F. Worthington...
...The most commonly used diagnostic tool, apart from the time-sanctified digital rectal examination, is the so-called PSA test, which measures prostate-specific antigens in the blood...
...Anyone who has followed this tale so far probably feels horrified fascination that so distressing an organ still exists in the modern American body...
...Furthermore, some of these symptoms (such as frequent or urgent urination) are identical with those of BPH...
...I become distressed when a physician (and this often includes even urologists) performs a digital rectal examination on a patient with some or many of the symptoms already noted and then makes a diagnosis of chronic bacterial 'infection in the prostate,'" writes Stephen N. Rous, another eminent urologist, in The Prostate Book: Sound Advice on Symptoms and Treatment...
...If not, go to a bookstore or, better yet, consult a urologist...
...Why not have it routinely chopped out at birth...
...For another, removing it makes you sterile...
...That would seem to solve the problem, but studies differ as to the effectiveness of this drug, on the market only since 1992...
...A great many doctors dispense with this test and simply put any patient with prostatitis symptoms on antibiotics...
...Some men live for 90 years with prostates that give no trouble at all...
...A controversy about drugs used to treat benign prostatic hyperplasia (ESPH)—the noncancerous enlargement that afflicts most men over the age of 50 —has been the subject of major stories in USA Today and the Wall Street Journal...
...The other drug...
...There is a drug for BPH...
...pain in the lower back and perineum (area between the scrotum and rectum...
...At that stage the historical solution is surgery to remove the excess cells—the kind of operation Governor Reagan underwent in the 1960s and President Reagan had to repeat in the 1980s...
...Its symptoms may include difficult, frequent, urgent, painful, or burning urination...
...as a rule, it responds well...
...Nonbacterial prostatitis is more common than the bacterial kind and has no known cure...
...Proscar makes a small number of patients (about 4 per cent) impotent but otherwise has few side effects...
...If you're lucky, what follows is all you will ever need to know about the subject...
...Walsh, it "hits suddenly, with the impact of freight train, and it's impossible to ignore...
...Supposedly a ""normal" score is a number of four or less, though it is not considered foolproof...
...Acute prostatitis often requires a hospital stay and intravenous antibiotics...
...Why would any sane person want to go through life with such a fount of misery lying in wait between his rectum and his gonads...
...Take chronic bacterial prostatitis...
...The prostate manufactures some of the fluid known as semen and, during ejaculation, propels it on its merry way...
...Then again, it can exist without any symptoms that are evident to the sufferer...
...Another reason is that a number of alternatives to traditional surgery are being tested or, in some cases, have been approved within the last few years...
...Partly for this reason, health-food stores sell a variety of expensive dietary supplements that contain zinc, pollen extracts, melatonin, saw palmetto, and so forth—all supposed by their enthusiasts to alleviate prostate difficulties...
...One of the existing drugs, Proscar (chemical name finasteride), shrinks the prostate...
...The remaining varieties are less satisfactory to the logical mind...
...A Japanese study, not much publicized in this country, suggests that heavy smoking retards prostate growth...
...Women, of course, have no prostates but plenty of comparable distresses peculiar to their sex...
...About the same number also succumb annually to aids...
...Every disease has its day in the sun, and the season of the prostate gland has evidently arrived...
...So the male half of the race will continue to go through life with this thoroughly troublesome gland...
...The expansion usually leads to frequent and urgent urination, lots of getting up in the night, a weak or interrupted stream...
...The Food and Drug Administration has just approved another alternative to surgery call the Prostatron...
...and usually an accompanying urinary tract infection...
...At the recent annual convention of the American Urological Association, a new study sponsored in part by the Department of Veterans Affairs belittled the effectiveness of Proscar...
...The procedure has been used in Europe for several years, and initial test results in this country have been encouraging...
...The most serious and unambiguous form is appropriately known as acute bacterial prostatitis...
...pain in the lower back or elsewhere in the general vicinity of the genitals...
...A great deal of research is going on, but at the moment you pay your money—sometimes lots of money—and take your choice...
...When it grows larger, as it almost inevitably does in middle age, it is likely to compress the urethra, slowing the rate of urination, a situation that can lead to serious problems of the bladder and kidneys...
...Unfortunately, matters are not simple at all...
...Ideally, the adult organ should be about the size of a walnut, but in nearly all men it grows...
...Although its symptoms are similar to those of nonbacterial prostatitis, it is thought to originate somewhere outside the prostate itself, in the surrounding pelvis...
...This is far less severe than the acute form...
...When the prostate gets infected or inflamed, as in prostatitis, it usually (not always) makes urination difficult or painful...
...Rous, "will not show any improvement in their symptoms because there is no infection and no bacteria present...
...Some men in the their 50s and 60s have prostates the size of a grapefruit or even a cantaloupe...
...On the other hand, cancer that begins in the prostate can spread...
...While the size does not directly determine the degree of urinary obstruction, the tendency is for a large prostate to strangle the urethra progressively, sometimes to the point where large quantities of urine are retained in the bladder...
...The only certain way to distinguish between bacterial and nonbacterial prostatitis is through a complicated process known as the three-glass test: three urine samples given in a way that carefully indicates where each comes from in the system...
...According to Dr...
...Some of them have been political organs—we learn that Bob Dole had his removed, and Ronald Reagan had two less drastic operations while he was governor and President...
...Walsh has invented a procedure for removing the prostate while preserving potency...
...As if that were not confusion enough, there is in addition a nonbacterial prostatitis that has the same symptoms but whose causes are wholly mysterious...
...Others have problems that start in their 20s...
...extreme pain, burning, urgency, or difficulty urinating, which can lead to urinary retention...
...Its causes too are obscure, and its cure is to date nonexistent...
...But diseases of the prostate are not restricted to cancer...
...New books on the subject have been piling up on the shelves of our local Encore outlet and selling almost as fast as ghostwritten sagas of the Simpson case...
...And grows...
...Hytrin was originally marketed as a medicine to reduce blood pressure...
...But it offers an attractive alternative to conventional surgery, at least to those patients who live near hospitals that can afford to buy the expensive machinery involved...
...blood in the urine...
...Finally, there is a fourth category of disease known by the half-facetious name of prostatodynia, which means simply "painful prostate...
...The classification scheme now in common use has prostatitis coming in three varieties, with a fourth sometimes thrown in as what my high school biology teacher used to call a garbage-can category...
...A nice simple drug would answer many prayers...
...One lives with it, takes palliatives, and hopes it will someday go away...
...and, usually, repeated urinary-tract infections...
...in many patients it causes dizziness, lassitude and other unpleasant but not life-threatening side effects...
...For a third, it usually, though not always, makes you impotent...
...Hytrin (chemical name terazosin), has no effect on the prostate's size or growth but relaxes the muscle of which it is partly composed, thereby easing the flow of urine...
...Still, neither it nor Hytrin is a universal solution to BPH problems...
...Often it is slow-growing and appears in older men who will die of other causes before it becomes fatal...
...The damned thing doesn't stop growing...
...If it gets cancer, that may or may not prove life-threatening...
...For one thing, removal of a gland wholly surrounded by some of the most sensitive parts of the body is no easy matter...
...There are other reasons, but you get the idea...
...a cliche of urologists is that more men die with prostate cancer than of'rt...
Vol. 79 • May 1996 • No. 2
