ALTHOUGH Alfred needed to go to the toilet at least three times each night
and "spent longer in a urinal than younger men," the 50-year-old banker
didn't think this was abnormal for his age.  He laughingly mentioned the
matter to his physician during a routine checkup.  "I suppose it's part of
getting older, isn't it?" he suggested.  The doctor shook his head and
ordered test.

Alfred underwent a digital rectal examination (DRE) and a blood test to
measure PSA (prostate specific antigen).   Something is wrong, the doctor
told him.  A specialist performed a biopsy, which revealed that Alfred has
prostate cancer.

In the Philippines, prostate cancer is the 13th cause of cancer.  Next to
lung and liver cancers, prostate ranks as the third leading cancer site
among men.  The Department of Health reported that 40 out of 100,000
Filipino males die annually of the disease.

"Prostate cancer is a disease of old men," says Dr. William Foo, consultant
in clinical oncology at the Queen Elizabeth Hospital in Hong Kong.  "The
risk increases sharply with age, especially after 60."

French president Francois Mitterrand was 79 when prostate cancer snatched
his life.  American businessman Steve Ross lost the battle at 65.
Hollywood actor Telly Savalas was 70 when the disease took away his life.

Why are there more men being afflicted with prostate cancer now than in the
past? There are two main factors at work, according to Dr. Karol Sikora, of
the Geneva-based World Health Organization (WHO).   The first is the
increasing age of the male population. 

"The majority of prostate cancers occur in men older than 70; therefore, as
more people live longer, they are more likely to get the disease," explains
Dr. Sikora, chief of the WHO Program on Cancer Control.

Dr. William Catalona, an urologist at Washington University in St. Louis,
Missouri, agrees.  "As men live longer and do not succumb to heart disease
and stroke, more will die from prostate cancer," he points out.  In the
United States, where Dr. Catalona lives, there is a 100-percent increase in
prostate cancer over the last decade.

The second factor is the increased availability of a sensitive blood test -
the PSA. Explains Dr. Vineta Bhalla, assistant director (non-communicable
diseases) of the Ministry of Health in Singapore: "The use of PSA has
resulted in the detection of prostate cancer, on average, five years
earlier than would be possible otherwise." The PSA, a glycoprotien (part
carbohydrate, part protein), can be detected in all males. However, its
level is greatly increased in patients who have prostate cancer.
The PSA is far from foolproof.  It misses 20 percent of malignancies and
can often give an indication of cancer where none exists.  Some medical
experts still debate its usefulness.  "The idea that if your PSA is low,
you don't have cancer, is wrong," corrects Dr. Patrick Walsh, an American
doctor who has conducted several studies on prostate cancer at the Johns
Hopkins Hospital.  "But if you have a negative rectal examination and a low
PSA, you probably don't have prostate cancer."

A man's prostate gland is a solid organ found immediately below the
bladder, and it surrounds the "urethra" - which is a tube connecting the
bladder and the penis through which a man urinates.  Prostate has two
important functions: one is to help control urination and the other is to
help sexual activity.  The prostate has a so-called passive role in the
process of urination.  It helps to control the rate at which urine flows
out of the bladder and into the urethra.

The prostate also has an active role in sexual activity.  The prostate
gland makes a whitish glandular secretion, which collects within the
prostate and is fed into the urethra during ejaculation. This glandular
secretion helps the mobility of the sperm in the urethra and makes up about
a third of the seminal fluid, thus giving seminal fluid its whitish
appearance.

According to the Philippine Cancer Society, Inc. (PCSI), symptoms of
prostate trouble may be due to a benign or malignant enlargement of the
prostate or to an infection.  Any of the following symptoms need to be
checked by a physician: decrease in the force and caliber of the urinary
stream; inability to urinate; frequent urination, especially at night;
painful/burning urination; difficulty in starting urination or holding back
urine; incomplete emptying of bladder; blood or pus in the urine; and
continuing pain in the lower back, hips or upper thighs, often times
interpreted as rheumatism or arthritis.

Possible causes

"The causes (of prostate cancer) are still unclear," says Dr. Jason Letran,
whose interest in prostate cancer yielded studies that were able to change
the way urologists think, diagnose and manage prostate cancer.

Although researchers know several risk factors for prostate cancer, they
still are not sure why one man develops the disease and another doesn't.
Some say it may run in the family.  "Patients with first degree relatives
with prostate cancer are more likely to develop it themselves," Dr. Letran
points out.

A study done at the Johns Hopkins University in the United States showed
that if a father or brother has prostate cancer, the risk of developing the
disease is two times greater than the average person.  Families with
prostate cancer in three or more first-degree relatives (father or
brother), or prostate cancer in three generations (grandfather, father,
son) have a hereditary form of the disease.

Medical scientists are also studying the possible role of a high-fat diet
in the development of the disease.  In such countries as China and Japan,
where low-fat diets of vegetables and fish are the norm, the incidence of
prostate cancer has historically been low.  But in recent years, due to an
increasingly "westernized diet," incidence of prostate cancer has surge.

"Japanese are eating more meat these days than in the past," admits Dr.
Keizo Shida, of the Japanese Foundation for Prostate Research, "so the
cases of fat-related diseases, such as breast, colon and prostate cancer
have increased."

Some research suggests that high levels of testosterone (a hormone that
promotes the development and maintenance of male sex characteristics) may
increase a man's risk of prostate cancer.  "Men who are castrated one way
or the other before the age of 40 rarely develop prostate cancer," says Dr.
Foo.

Although a few studies suggested that having a vasectomy might increase a
man's risk for prostate cancer, most studies do not support this finding.
Scientists have studied whether obesity, lack of exercise, smoking,
radiation exposure, or a sexually transmitted virus might increase the risk
for prostate cancer. At this time, there is little evidence that these
factors contribute to an increased risk. 

Early detection

Like any other disease, prostate cancer - if detected early - is often
curable.  British actor Roger Moore, Oscar winner Sidney Poitier, U.S.
businessman Michael Milken, American Senators Bob Dole and Jesse Helms, and
sports star Richard Petty are some of those who have won the battle against
the disease.

"Before, most men were demoralized, thinking that if he has prostate
cancer, it is just a matter of time before they will die, and death is
inevitable," says Dr. Letran.  "But that's not true at all.  It is curable,
especially when diagnosed early."

According to Dr. Eduardo Gatchalian, president of the Philippine Urological
Association, digital rectal exam (DRE) is still the only method to detect
prostate abnormalities.  For this examination, the physician inserts a
gloved, lubricated finger into the rectum to feel for any irregular or
abnormally firm area, which may indicate that a tumor is present.  "Most
prostate cancer begins in the part of the prostate gland that can be
reached by a rectal exam," said Dr. Gatchalian.  "This exam also helps to
detect early rectal tumors. The procedure is uncomfortable, but it takes a
short time."

For men over 50, the American Cancer Society recommends an annual PSA blood
test along with the annual DRE.   "If the results of DRE or a PSA test
suggest the possibility of prostate cancer, your doctor may refer you for
further testing," the society says.

In the Philippines, most males don't undergo these detection processes.
Why?  "For PSA, the reason is mainly financial," explains Dr. Letran.  "The
cheapest test is about P600, which means that a family of a minimum wage
earner will have to starve for two days.  With regards to DRE, most
perceived it as painful, and probably do not like the idea of someone
poking a finger into their rectum."

To treat or not to treat

"For patients with the disease confined to the prostate gland, the biggest
dilemma is whether or not to have treatment," Dr. Sikora says.  "Many are
going to die of something else before any problems arise, especially if
cancer is detected by screening with PSA."

Two features help a doctor determine the likely course of the cancer and
the best treatment:

* How far the cancer has spread.  If the cancer is confined to a small part
of the prostate gland, generally many years will pass before it spreads to
areas around the gland and then to bone and other parts of the body.

* How malignant the cells look.  Prostate cancer cells that are more
distorted under the microscope tend to grow and spread more quickly.

Treatment may serious affect a man's lifestyle, according to 'The Merck
Manual of Medical Information.'  Major surgery, radiation therapy, and
drugs for prostate cancer often cause impotence and may cause incontinence.
  "Treatment provides fewer advantages to men over age 70 than to younger
men because older men are more likely to die of other causes," the manual
points out. 

Many men with prostate cancer, especially older men with early-stage cancer
that's growing slowly, decide that watchful waiting is best.  Researchers
note that treating the disease aggressively with surgery and radiation
therapy might reduce the number of deaths from the disease within ten years
of diagnosis - but only by a small number.  "Aggressive treatment probably
takes a higher toll in quality of life," the researchers claim.

When a man and his doctor decide that treatment is necessary, the type of
therapy depends on the extent of the disease.  Prostate cancer that remains
localized - that is, within the general region of the prostate -can be
removed by surgery.  Several types of operation are feasible, but a common
problem is their potential to interfere with the intricate nerve control
system at the base of the bladder, resulting in incontinence and the
inability to ejaculate sperm.

An alternative to surgery is radiotherapy.  This uses beams of high-energy
radiation, applied over a period of several weeks, to selectively kill the
cancer cells.  The rectum is very sensitive to the effects of radiation, so
diarrhea and sometimes some small ulcers may occur as side effects.  Also,
there is a risk of impotence and some incontinence.

Dr. Sikora says prostate cancer cells need a supply of androgens - the male
sex hormone - to grow.  If the level is reduced, the cells die.  "There are
several strategies to reduce the level of male sex hormone in a patient,"
the WHO official informs. 
"The most radical is simply to castrate the patient surgically, since the
testes are what produce the hormone," she says.  "There are several drugs
that can achieve the same effect, blocking the pituitary gland from
producing stimulating hormones to the testes."

A range of drugs is also available to block the effect of androgens within
cancer cells.  "Such approaches are effective even in patients in whom the
disease has spread, but unfortunately the cancer often becomes
androgen-independent, allowing the cells to grow in the absence of the
hormone," Dr. Sikora says.

Chemotherapy - with a wide range of drugs used successfully for certain
other cancers - has not produced good results against prostate cancer.  In
the United States, the drug finasteride is being studied. 

Again, older men should bear this in mind.  Though prostate cancer is
deadly, it advances slowly.

ooOoo