The Neglected Sex Gland

Abstract

T ucked away under the bladder in a man's body is the walnut-size prostate gland that often labors away under a cloak of anonymity Many men don't know they have this male sex gland. Others don't know where the prostate is located or what it does. And when something goes wrong with the prostate, even doctors can't always tell whether the condition is a life-threatening cancer or a relatively harmless enlargement. For much of a man's life, the prostate gland produces some of the fluid, or semen, that carries sperm through the urethra during sexual climax. But after age 50, the prostate can begin causing trouble. For reasons not well understood, the prostate gland often gets larger as a man ages. Indeed, more than half of all men in their 60s suffer from an enlarged prostate, a condition called benign prostatic hyperplasia (BPH). If the gland gets too big, it can squeeze the urethra, the tube that also carries urine from the bladder. This pressure can cause a weakened or hesitant urine stream or an increased need to urinate, especially at night. While the symptoms of BPH can be annoying, a second, more serious threat involving the prostate gland plagues older men: cancer. Men with BPH are not at increased risk for prostate cancer; however, symptoms of prostate cancer and BPH are often identical. Even worse, doctors don't have a foolproof diagnostic test to distinguish between BPH and cancer of the prostate, a disease that will kill an estimated 34,000 men in the United States in 1992 alone. Until recently, doctors looking for prostate cancer had to rely on a test known as the digital rectal exam. After pulling on gloves, the physician inserts a finger into the rectum and probes for any hard lumps that may indicate the presence of cancer. While this time-honored test does reveal some malignancies, it misses a large number of prostate tumors. Furthermore, the rectal exam often turns up only advanced cancers those that have spread beyond the prostate wall and thus are more deadly Within the last few years, a protein known as prostate-specific antigen (PSA) has taken center stage in the fight against this potentially lethal cancer. For some time after PSA's discovery more than 20 years ago, the molecule attracted little attention. Then, during the 1980s, a slew of researchers began to take another look at PSA. The scientific community's renewed interest in accelerated about a year ago, when William J. Catalona of the Washington University School of Medicine in St. Louis and his colleagues published a pioneering report on and prostate cancer. By measuring the concentration of in the bloodstream, Catalona's team found they could detect more prostate cancers than they could by relying on the rectal exam alone. We found that was the most powerful test we had, Catalona says about the study, reported in the April 25, 1991 NEW ENGLAND JOURNAL OF MEDICINE. The findings fueled a virtual boom in blood tests ordered by doctors around the country More than a year later, most scientists would agree that, although a powerful predictor of prostate cancer, has shortcomings. Still, PSA may be better than anything we have, even though it's not perfect, Catalona says. His group and several other research teams are now searching for ways to refine PSA's ability to flag prostate cancer and distinguish it from a harmlessly enlarged prostate.