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state of the prostate

The most common cancer and the No. 2 killer among American men has finally become a hot topic.


Harry Belafonte is coming to Orange County in April. To sing? No, to talk about his prostate cancer.

Michael Milken lectured here in August, but his topic was not junk bonds. He talked about his prostate cancer.

Sen. Barbara Boxer dropped by in January. She doesn't even have a prostate gland, but prostate cancer was what she wanted to talk about.

After generations of being an unfit topic for polite conversation, this disease, the most common cancer and the No. 2 killer among American men, has finally become a hot topic. Now public figures are lining up to give their first-person accounts.

"For 30 years, no one ever called me about this," says Donald F. Coffey, a professor of urology at Johns Hopkins University and one of the world's foremost authorities on the prostate.

"The first major meeting on prostate cancer was held in 1963," Coffey says. "The next one wasn't until 1970. Can you believe that? And now there's meetings every hour on the hour."

Women, complaining that a male-dominated medical establishment had shortchanged them, rallied a decade ago and demanded more research into breast cancer. Now they are reaping the rewards--more sophisticated diagnosis, improved treatment and ongoing research into possible cures.

But if men were in charge all this time, why weren't they funding research into the cancer that half of them have by age 60? It kills as many men as breast cancer kills women, yet until recently research grants were virtually nonexistent.

"Males just didn't like to discuss that they have prostate problems," Coffey says. "I have no idea why, but I think it's for the same reason that males won't stop and get directions when they're lost. It's got something to do with male ego or macho, whatever you want to call it."

We can make some good guesses, however.

Prostate cancer has been diagnosed mainly in the elderly. Therefore, having prostate cancer confirmed you were old.

Treating prostate cancer meant you ran a risk of becoming incontinent. Only babies wet their pants.

And treating prostate cancer often left the man impotent. Enough said.

Beliefs have changed since then. Researchers now think prostate cancer starts early in a man's life, perhaps in the 20s, and usually grows so slowly that many more men die with prostate cancer than die of it.

Improved treatment has greatly reduced incontinence and impotence.

And a blood test, though imperfect, now can warn of prostate cancer much earlier than before.

Now the American Cancer Society in California has enlisted boxer George Foreman to strike a manly pose on posters and proclaim, "Real men get it checked."

But get it checked and what happens? You discover that among reputable physicians and researchers, there is disagreement over virtually everything about prostate cancer.

The blood test gives a lot of false alarms and usually fails to detect the smaller cancers.

If you do have cancer, it may be threatening your life. But it may be growing so slowly you'll die of boredom before you have any cancer symptoms.

Surgery and/or radiation may save your life. Or they may leave you incontinent and impotent when treatment was unnecessary.

There is even disagreement about whether you should be tested at all. Some believe the psychological wear and tear of a prostate cancer diagnosis is worse than the threat from the disease itself.

Patients looking for definitive answers find that there are none. Many physicians instead give a patient an education about alternatives, then hand the decision back to him. You decide what to do.

"The side effects of treatment may be serious--that's the issue," says Dr. Thomas A. Ahlering, a surgeon and chief of urology at the UC Irvine College of Medicine. He has performed about 200 prostate surgeries and is in charge of training resident urologists at UCI.

"You've got this long period before this cancer really becomes a problem to you," says Ahlering. "You have to prioritize. The psychological factor is a very important factor."

Dr. Harmon Eyer, chief medical officer of the American Cancer Society, says he considers prostate cancer "the most complex cancer problem the nation is facing.

"It's a very poorly understood issue of cause, screening, treatment. All of these things the public are poorly informed about."


The cause of all this trouble is a golf ball-size gland in the male abdomen. It lies near the bladder, where urine is stored, and near the seminal vesicles, where semen is stored. The urethra--the tube that carries both urine and semen out of the body--runs right through the prostate.

Until the 1970s, researchers were unsure of the prostate's role. Now it's generally agreed that the prostate is assigned the care and feeding of sperm.

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