Although all men have one, the prostate continues to be a puzzling gland, prone to cancer, beset by enlargement, and troubled by infection.
Almost 230,000 men were diagnosed with a form of prostate cancer in 2005, the latest year for federal data. Another 29,000 men died from the disease.
The rate of prostate cancer is eight to 10 times higher in African-American men, who also suffer a higher rate of aggressive tumors and at an earlier age.
Virtually all men who live long enough develop prostate cancer.
Yet relatively few studies have been done on prostate cancer because most patients are reluctant to enter clinical trials.
N’Zinga Shani decided to spread some much needed information about prostate health, on her cable public-access program “21st Century Conversations.” The program will be shown several times on Connecticut cable stations. (Check your local guide for details.)
On the show, Dr. John Colberg (at right in photo), director of urologic oncology at the Yale School of Medicine, and Dr. William Kevin Kelly (at left), associate professor of medicine at Yale, and who concentrates on investigating new therapies for prostate cancer, attempted to dispel the myths and misinformation about the prostate.
Why black men face much higher odds of prostate cancer is not known, they said. The causes of prostate cancer might become clearer if more people entered clinical trials, Kelly said. African American men tend not to trust white scientists for historical reasons, the doctors said.
The Connecticut Department of Public Health and the Connecticut Cancer Partnership awarded the Yale Cancer Center in March with a $745,288 grant to create a clinical trials network in the state to promote research.
Today, most prostate cancer is diagnosed before any symptoms appear, the doctors said, and deciding on a course of treatment can be complicated. Current blood tests for Prostate Specific Antigen, or PSA, require require interpretation, Colberg and Kelly said.
Furthermore, the prostate tends to expand with age, making diagnosis of cancer even trickier.
The prostate is a golf-ball sized gland beneath the bladder, surrounding the urethra. The gland expands during sex and produces a portion of seminal fluid, Colberg said. Seminal vesicles also connect to the urethra within the prostate.
When a man ejaculates the prostate contracts, pushing semen down the urethra and out of the penis.
Sometimes prostates become chronically infected, producing a condition called prostatitis. Prostatitis is usually treated with antibiotics and does not increase the risk of other prostate problems.
Many men over age 50 develop Benign Prostatic Hyperplasia, or BPH, a non-cancerous growth of the prostate that leads to difficulty in urinating, frequent urges to urinate, and inability to completely empty the bladder.
This condition can be treated with alpha-blocking drugs, which relax the muscles inside the prostate, allowing the urethra to expand.
While BPH can be irritating, it rarely interferes with sex, Kelly said, Colberg said. Several medications for other conditions can cause erectile dysfunction. So can stress, depression, and low testosterone levels, Kelly said.
Testosterone is a hormone produced in the testicles that drives sex and also stimulates growth of the prostate, he said.
Most men past age 50, have blood tests for Prostate Specific Antigen. This test was developed in the 1980s to follow men already diagnosed with prostate cancer, and is now used as a screening tool.
The problem is that PSA levels can increase because of BPH or prostate cancer. Some men have naturally high amounts of PSA, and others with prostate cancer do not show increased PSA.
Consequently, a baseline PSA measurement should be taken so that subsequent checks can reveal whether the level is increasing, Collberg and Kelly said.
Drugs used to treat non-cancerous prostate growth may mask prostate cancer.
This is why a digital exam is so important, Colberg said. Most men have an aversion to this test because the only way the physician can feel the prostate is through the rectum with a gloved finger. A healthy prostate feels firm and smooth. A hard, rough prostate may be cancerous and a biopsy should be performed.
A biopsy generally involves inserting 12 extremely narrow tubes into the prostate. The samples are then examined by a pathologist.
Any cancer found is rated on the Gleason scale according to the rate at which it is growing. An older man with a slowly growing cancer might elect to follow active surveillance rather than face the risks of surgery, Collberg said.
Prostate cancer in younger patients is usually more aggressive. About 50 to 60 percent of prostate cancer surgery is now done robotically, meaning that the surgeon’s hand movements are translated to small instruments inserted in the lower abdomen, along with a camera and lights.
The side effects of prostate surgery include incontinence, and erectile dysfunction, both of which can be treated, Kelly said.
Prostate cancer can also be treated with radiation, chemotherapy, hormone therapy, and brachytherapy, in which tiny beads of a radioactive isotope are placed in the prostate.
The age and condition of the patient and the type of prostate cancer all have to be taken into consideration before a course of action is decided upon, the doctors said.
Kelly said the main risk factors for prostate cancer are age and family history.
Some studies suggest that a low-fat diet high in fruits and vegetables can decrease the risk of prostate cancer, he said.
Meanwhile, researchers are developing methods of detecting abnormal prostate cells in the blood. This would be a better screening tool, Kelly said.
Chemotherapy designed for specific patients is also under development.
In May scientists at Yale and the Veterans Affairs Connecticut Healthcare System in West Haven found molecular markers in prostate cancer biopsy samples that are associated with higher death rates.
Would have skipped this article a year ago. as I knew almost nothing about cancer, and wanted to keep it that way.
Jumping PSA led my GP to suggest biopsies and sure as hell I had it,
Now in 3rd week out of nine weeks of daily radiation which hopefully will kill it..
Not bad so far.
Much better than the alternative.
St. Raph's, as well as Yale-NH has well-reputed Cancer Center with all the treatment options.
This year , just in time for me, they opened a Cancer Treatment branch on Whitney Ave. just north of Skiff St. in Hamden.
New, modern place with very pleasant and helpful doctors staff including blood takers and dietician (Same folks as the Hospital facility.)
If the Doc says get biopsies etc. don't, as I did, think he is out of his mind, Get checked and get treatment if needed.
Not bad at all and may save your life.