Prostate Cancer
What's All the Talk About Prostate Cancer?

...by Reynold Mosier, Captain, US Army

There is another set of warning gauges that require a periodic check for your good health, and they monitor a common disorder in middle-aged men, prostate disorder.

The prostate is located next to and under the bladder and completely surrounding the urethra (the tube to drain urine from the bladder). It is about the size of a walnut. The prostate secretes a thin, slightly alkaline fluid that flows through ducts into the urethra. This fluid is secreted continuously, and the excess passes from the body in the urine. The rate of secretion increases greatly during sexual stimulation and the fluid contributes to the bulk of the semen. Enlargement of the prostate is a common complaint in men over age 50. Because of its location around the urethra, enlargement of the prostate quickly interferes with the normal passage of urine from the bladder. Urination becomes increasingly difficult and the bladder never feels completely emptied. Other symptoms may include difficulty starting or stopping the stream of urine, dribbling, and a diminished stream of urine.

Some enlargement of the prostate occurs in over 50% of U.S. males and should be evaluated further, but enlargement by itself does not mean cancer. An evaluation should be done on a yearly basis after the age of 50 by having your health care provider do a digital rectal exam ( a gloved finger is inserted into the rectum to examine the prostate.) There are other tests that will be used if a suspicious area is found on the rectal exam or you have a family history for prostate cancer. These tests may reveal cancers too small to be detected by physical examination.

In the simplest form, cancer is the recurrent injury to the cells in a tissue over a long period of time. The injury causes death of the cells, requires increased cell division, and increases the chance of an error in that cell division so that a malignant (death-causing) cell line is born. With age, the immune surveillance system that usually destroys such malignant cells becomes less effective, allowing the malignant cell line to grow. Cancer accounts for about 20 percent of all deaths in the United States. Prevention and early detection are the key factors related to the likelihood that an individual will get cancer and the outcome of the disease process.

Cancer of the prostate is rare before the age of 50. It is found more frequently with advancing age and has the second highest incidence of cancer in men, next to skin cancer. Dr. Patrick Walsh, a urology surgeon specializing in prostate cancer at Johns Hopkins Hospital, states that mortality from prostate cancer has risen by 3% a year since 1988. According to the American Cancer Society, prostate cancer occurs in more than 240,000 men each year, and an estimated 40,400 men will die of the disease this year. At autopsy, the incidence of asymptomatic cancer of the prostate is as high as 60% in men aged 80-90 and 100% in men over 90. In other words, if a male lives long enough he will have prostate cancer. Prostate cancer is often without symptoms, even when the cancer has extended beyond the prostate.

One of the clinical tests that has been in the news recently is the Prostate Specific Antigen (PSA) test. This blood test measures levels of protein which may be elevated when prostate cancer is present. There are impressive arguments for and against using the PSA blood test as a screening test for prostate cancer. When used it is effective in identifying some cancers at a very early stage. Unfortunately, there is also a relatively high false positive rate associated with this test, resulting in unnecessary follow-up tests and personal concern. This is one instance where it is important for you, if you are a middle-aged or older male, to understand the facts and make choices of your own.

The treatment of the disease depends on the stage of the cancer and the person's age and health at the time of diagnosis. It may vary from surgery, hormone treatments, radiation, anticancer drugs or a combination of more than one of the above. Men diagnosed with localized prostate cancer have a five-year survival rate of 88-90%. The most important consideration in relation to treatment, is that prostate cancer be discovered early. This reinforces the importance of having a yearly prostate/rectal examination if you are middle-aged.

Also on this site: Facts About Prostate Health and Symptoms of Prostate Disease

This article represents a chapter from "Executive Wellness: A Guide for Senior Leaders", an online book written and edited by staff and contributors at the U.S. Army Physical Fitness Research Institute (USAPFRI), U.S. Army War College, Carlisle Barracks, Pennsylvania.