I Am Joe’s Prostate
Ramanuj Asawa
I Am Joe’s Prostate
By J.D. Ratcliff
Joe knows— like most men— that I can be a real trouble-maker. Yet like most men he prefers to ignore me. He should know better
I am one of the hot spots in Joe’s body, a design nightmare for which Nature should hang her head.* Red-brown, about the size of an English walnut, I produce a variety of grief. I can disturb Joe’s sleep by requiring several trips to the bathroom each night— or kill him with uremic poisoning. If Joe lives long enough, I will become a cancer site far surpassing the lungs in importance.
Fortunately, I have some good points. I make an important contribution to a normal sex life for Joe. To a great degree, the very existence of the human race depends on me. I am Joe’s prostate gland, the principal depot for his seminal fluid; without me, chances of a pregnancy would be about zero. At each ejaculation, Joe’s testicles provide something like 200 million sperm cells, so minute that the entire number would cover the head of a pin. My task is to produce a fluid that will dilute them thousands for one. And a very special fluid it is, containing proteins, enzymes, fats and sugars to nourish the fragile sperm, alkalinity to overcome the deadly acidity of the female tract, and a watery medium in which the sperm can swim toward the female egg.
I nestle in Joe’s lower abdomen, right at the neck of the bladder. Until Joe reached puberty, I was about the size of an almond. Then, along with the rest of his body, I got the hormonal signal to change Joe from boy to man. I grew to my present size, and my little grape-like clusters of secretory glands began manufacturing seminal fluid for storage in my well-muscled pouch.
In periods of sexual excitement, how do I know when to empty my contents? I don’t. I simply follow orders that come from the lower end of Joe’s spinal cord. Many complex things happen in my area when the signal arrives. The sphincter valve at the bladder neck squeezes tightly shut so there will be no escape of urine. Waves of muscular contractions sweep over me. The same is happening to the two seminal vesicles, the storage depots for sperm, which lie adjacent to me and look something like two linked peanuts. The vesicles contribute about 20 percent ofthe seminal fluid, and I the rest, for a total of about a teaspoonful. The mixture is projected out through Joe’s urethra, or urine tube, to fulfill whatever destiny awaits.
As I said before, I am an architectural nightmare. I have three lobes, or sections, enclosed side-by-side in a capsule. The small urinary tube that empties Joe’s bladder passes over the middle lobe; anything that happens there to swell the prostate— infection, inflammation, cancer— can enlarge these lobes and thus obstruct the flow of urine, causing a wide spectrum of misery. With partial obstruction, urine backs up in the bladder, becomes a stagnant pool; bacteria often invade the pool, multiply, cause serious infection. Worse still is complete blockage. Then urine may back up all the way to the kidneys and spill over into the bloodstream, causing uremic poisoning— an ailment that’s capable of bringing a slow death.
As Joe grows older and production of testicular hormone diminishes, it would be illogical to expect me to shrink back to boy-size. Strangely, however, the exact opposite happens. I grow larger and, in extreme cases, may become as big as a grapefruit. This enlargement can be either cancerous or “benign”— although there is seldom anything very benign about it.
So far, Joe has been fortunate; I am still normal-sized. But soon, almost inevitably, the slow swelling will start. When Joe reaches the age of 50, he will have a 20-percent chance of an enlarged prostate; at 70, it will be 50-percent; and at 80, it goes to 80-percent. What causes the enlargement? I haven’t the slightest idea. But it seems to have something to do with sex hormones since it rarely occurs among eunuchs.
By itself, the enlargement of Joe’s prostate doesn’t necessarily mean serious trouble. But should I enlarge enough to put the squeeze on his urethra, his urine stream will decrease in size and force; if infection starts up there will also be a burning sensation. Other symptoms: frequency of urination and the unpleasant— and accurate— feeling that his reservoir hasn’t been completely emptied.
When these things happen, I urge him to see a doctor immediately. The chances that he will need surgery for my removal are small— about one in 20. The doctor will want to determine whether there is infection present, or inflammation. Almost certainly, he will advise the avoidance of alcohol, pepper, coffee, tea. All these things pass irritating substances along to the urine— and this irritation can close the already constricted urethra.
If closure takes place, a real emergency is at hand. The first problem is to get theurine tube open and establish drainage. This is done by passing a rubber tube through the urethra to the bladder. From here on, the surgeon has several options. He can remove me surgically, if I am too large. Or he may decide that a simpler procedure will solve the problem. In this case he slips an instrument, about the size of a pencil, into the body via the urethra. This lighted tube has a viewing device and a tiny, electrically actuated cutting loop with which to scoop out obstructing tissue. One further option is to freeze blocking tissue with liquid nitrogen. Later, the frozen tissue dies, sloughs off and passes out with the urine. Joe fears these procedures, thinking they spell the end of his manhood. Not so. Four out of five men remain sexually capable after prostate surgery.
Benign enlargement, however, is not my most dangerous problem. Cancer is. My cancers are apt to be particularly nasty, giving no early warning signals. By the time 19 out of 20 men with prostate cancer get to the doctor, it is too late for the cure surgery offers. Nor is the disease a rare one. By the time Joe is 50 he will have a five-percent chance of having prostatic cancer. By 70, his chances will be 50-50.
These figures, however, are not as alarming as they seem. For one thing, my cancers are usually slow-growing— only occasionally are they of the exploding type that can kill in weeks or months. Thus Joe has an excellent chance of going to his grave with an active but nonfatal prostatic cancer, dead from heart disease, artery hardening, diabetes or something else. Another point: even when my cancers are beyond surgerical help, there are nonsurgical treatments that are often lifesaving. For growth, my cancers seem to require the stimulus of male sex hormone. Once this stimulus is removed— by castration or treatment with female sex hormone— pain often disappears, energy returns, normal tasks can be resumed. Radiation shrinks my cancers, too, and combines well with hormone treatment.
Despite all this medical skill, however, 17,000 American men die of prostatic cancer each year. What can Joe do to avoid being in this group? Fortunately, a great deal. When he has a physical examination, he can ask for a serum acid phosphatase test. Normally, the enzyme detected by this test is largely confined to the prostate; if it is found in the blood in any considerable amount, the presumption is that the capsule which contains my three lobes has broken and that my enzyme is escaping into Joe’s bloodstream— which points to the presence of cancer.
Most important, Joe should have a rectal examination once or twice a year. This takes only a minute during a physical and is about the only way to find prostatic cancer early enough for a surgical care. If the doctor’s examining finger discovers a hard, button-size nodule in my otherwise soft, rubbery tissue, he considers it cancer until he has proved otherwise. (Three times out of five, these buttons are cancer.) To be sure, the surgeon obtains a sample of the button tissue by opening Joe up or by withdrawing a small core of tissue with a hollow needle. If I am cancerous, I must be removed in toto.
Is there anything else Joe can do to escape the misery I am capable of causing? I’m afraid not. So perhaps it’s worth repeating myself:
Joe must go to a doctor, preferably a specialist, whenever I announce trouble with my classic symptoms: frequency of urination, a burning sensation, retarded flow. And, of course, he should have that all-important rectal examination at least once— and preferably twice— a year.
*Joe, 47, is a typical American man. A number of his organs have told their stories in previous issues of The Reader’s Digest.
This article is based largely on interviews with Dr. John K. Lattimer, chairman of the department of urology at the Columbia-Presbyterian Medical Center in New York.
Ratcliff, J.D. “I Am Joe’s Prostate.” Reader’s Digest. 99. 596. (1971): 99-102.
December 1971
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CS Ramanuj Asawa
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