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The Prostate and Its Problems

January 20, 1987|BETTY CUNIBERTI | Times Staff Writer

WASHINGTON — Troubles with the prostate gland--the cause of President Reagan's recent hospitalization--are something that most men over 50 experience in varying degrees.

The small gland is often misunderstood and shrouded in a kind of mythology that discourages many men from having it examined regularly, thus needlessly costing thousands of lives each year, doctors say.

Dr. Patrick C. Walsh, a noted urologist at Johns Hopkins Hospital in Baltimore, said often men don't even know they have this walnut-sized gland, which surrounds the neck of the bladder and the urethra like a doughnut around a tube.

A man can't see or feel his prostate. A secondary sex organ found only in males, its function is to produce fluid for semen, said Dr. Jean de Kernion, chairman of urology at the UCLA school of medicine. "That's it, other than cause problems," he observed.

Minor Size, Major Discomfort

Despite its tiny size and minor duties, the prostate will cause 75% of men over age 50 to experience some discomforting symptoms in their lives, such as difficult, frequent or urgent urination, and 25% of men who reach age 80 will require some form of surgery, according to Walsh. A prostate problem can be mildly annoying, or it can kill, or do many things in between.

There are three basic problems that occur in the prostate:

- Prostatitis, an infection of the gland. This is the most common prostate problem in younger men, sometimes caused by bacteria and treated with antibiotics. Some infections do not respond to antibiotics, and for these people the disease can be a long-term nuisance. Symptoms include fever, chills, painful or difficult urination and pain in the lower back and between the legs.

- Benign prostatic hypertrophy, an enlargement of the prostate, usually in men over 40. This is the most common prostate problem, and the one that President Reagan had surgery for in 1967 and again last Jan. 5. More than 330,000 such operations were performed last year, 260,000 of those on men over 64.

- Prostate cancer. Detected early in a yearly, routine rectal examination by a doctor, prostate cancer can be cured, usually without impairing sexual function. The disease progresses slowly, but later-stage prostate cancer spreads to other tissues and bones, and the prospects of survival and preserving potency become more problematic. While the incidence of prostate cancer is No. 2 among cancers in men, it is the No. 3 cancer-killer, having claimed 26,000 lives in 1986, slightly fewer than rectal and colon cancer, which are usually computed together. (Lung cancer is the No. 1 man-killing cancer, taking 89,000 lives--which constitutes more than one third of all male cancer deaths.)

While much campaigning has succeeded in persuading many women to have regular cervical pap smears and breast exams to detect cancer, there has been no comparable public push for yearly rectal exams for men over 40, even though such examinations are the key to catching prostate cancer in its early, curable stages.

There is "no question" that many thousands of men die of prostate cancer simply because it is not detected early enough, said De Kernion.

Walsh is upset that "ignorance and fear," particularly fear of impotence that may result from treatment, "plus the fact that rectal exams are not comfortable, have been deterrents for men to have early diagnosis," he said. "As a consequence many men present (themselves to a doctor) only when their cancer is far advanced and can no longer be cured.

"Today men should realize that cancer of the prostate can be cured without adversely affecting the quality of life in most patients, but it must be diagnosed early and treated effectively, with surgery or radiation."

Three years ago, Walsh and Dr. Pieter Donker of the Netherlands unveiled a new method of performing the incisions in a cancer operation, sparing the critical nerves that enable a man to achieve sexual function. But the old fears that any sort of prostate problem, if discovered, will lead to surgery and impotency have discouraged men from having this simple, yearly examination, doctors say.

Not As Many Checkups for Men

"Men don't go to doctors as often as women, but we can't blame that on men being less interested," said Walsh. "We (medicine and the media) haven't made the point (of having yearly check-ups) to men as we have to women.

"Part of the problem is that we have men taking care of men. If a doctor knew that he might be sending a patient into a situation that would make him impotent, the natural response is, 'Why make a diagnosis?'

"As more physicians become educated that the gland can be removed without adversely affecting the quality of life, they will start encouraging men to be examined for this."

Doctors stress the importance of catching the tumor early in a yearly exam.

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