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This next article in our continuing series, “Second Half Comeback”, is about prostrate health and the important facts for men to know. I am sitting with Dr. Oscar Linares, a doctor in Geriatrics, who has written many scientific peer-reviewed articles and received numerous awards and recognition for his excellent care and research. I have known Dr. Linares since we were children, so this will be an easy interview. How well do I know Dr. Linares? Read the following anecdote:
In 1995 Tom Richardson and I sold our IT consulting firm for 30 million dollars. I raced to my mother’s house right after the closing to let her know of this great victory. She heard me out and then simply handed me a health magazine that was on her coffee table with a picture of Dr. Linares on the cover. She then said: “Oscar just won Doctor of the year in Michigan.” I don’t think she ever congratulated me for the sale of the company. Oscar did congratulate me when I called him to tell him the story.
I asked Dr. Linares for an idea of where to start to craft this plan for a “second half comeback”, his answer was quick. “Let’s start with the prostrate. It is an important but troublesome organ that is often misunderstood.” I agreed, even though my PSA is perfect, and here we go, “Locker room questions” on your behalf to Dr. Linares, our coach. Let’s start forming a plan for that “Second Half.”
Question: Dr. Linares, at a high level, what is the function of the prostrate and why is its health so important to a man?
Answer: Anatomically, the prostate is a walnut-sized gland located between the bladder and penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, letting urine flow out of the body. The prostate also secretes fluid that nourishes and protects sperm. The National Institutes of Health, PubMed Health Website provides excellent information on how the prostate works HERE.
Question: Can men experience problems with the prostrate during their youth? (First half)
Answer: Yes, although not as commonly as men over 50. In young men, excessive masturbation or sex can cause enlargement of the prostate (Benign Prostatic Hypertrophy). Sexually transmitted disease can cause bacterial infection of the prostate (Prostatitis). Cancer of the prostate is rare.
Question: At what age should men start to pay attention to the health of their prostrate?
Answer: Young men need to be aware of the potential to acquire sexually transmitted disease (STD) as early as possible because STD can lead to narrowing of the urethra, which will affect the flow of urine as they get older. Otherwise, all men after the age of 50 need to have yearly prostate examination. But, men at high risk, such as African American men or men with a strong family history of prostate cancer should begin testing at age 45.
Question: What are some of the symptoms that a man with a prostate problem might experience?
Answer: Trouble initiating urine flow requiring straining, a weak urine stream, getting up at night to urinate (nocturia), dribbling at end of urination, and urgency to urinate (have to go) are common symptoms of an enlarged prostate. Bladder stones can be a sign of an enlarged prostate. Ultimately, enlarged prostate can lead to kidney failure. Blood in the urine or semen is an ominous sign, which suggests prostate cancer.
Question: Is there an easy test to check the health of the prostrate? If yes, what is it?
Answer: No prostate test is easy, but digital rectal probe of the prostate with the index finger is the first thing to do.
Question: What is a “PSA” test?
Answer: The PSA test is a blood test used to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate. An enlarged prostate can also cause elevation of the PSA.
However, the U.S. Preventative Services Task Force (USPSTF) said healthy men no longer need to get a PSA blood test to screen for prostate cancer. The panel stated the test doesn’t effectively save lives and can lead to needless treatments that can cause pain, impotence (erectile dysfunction) and incontinence (loss of urine control). These recommendation statements contradict advice doctors have issued for years — that men at normal risk for prostate cancer should begin PSA screenings at age 50.
“We recommend that patients speak with their health care providers about the pros and cons of the PSA test,” says Elisabeth Heath, M.D., director of prostate cancer research at the Karmanos Cancer Center in Detroit. “The test isn’t always effective in detecting prostate cancer. But that doesn’t mean patients shouldn’t seek regular medical care.”
Question: Assuming that a man enters middle age with a healthy prostrate, what steps should he take to keep it that way?
Answer: Keep a healthy weight and exercise regularly. Eat fruits and vegetables. Tomatoes, watermelons, pink grapefruits, guava and papaya contain lycopene, a powerful antioxidant. Cruciferous vegetables such as broccoli, cauliflower, cabbage, brussels sprouts, bok choy and kale are also good choices. Let your doctor know if you have a family history of prostate cancer. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. Include more soy in your diet from sources such as tofu, soy nuts or soy flour or powders. Don’t smoke. Eat more selenium-rich foods such as wheat germ, tuna, herring and other seafood and shellfish, beef liver, kidney, eggs, sunflower and sesame seeds, cashews, mushrooms, garlic and onions. Selenium reduces the risk of prostate cancer.
Question: In a worst case scenario that requires the prostrate to be removed, how will this impact a man? What changes? How can this impact be minimized?
Answer: Removal of the prostate is usually associated with loss of urine control and impotence. There is no sure way to minimize this. A skilled prostate surgeon is critical.
Question: Is it true that once cancer is detected in the prostrate, testosterone needs to be kept at low levels?
Answer: The thinking has been yes, but recent evidence by Abraham Morgentaler, M.D., an associate clinical professor of surgery at Harvard Medical School and the director of Men’s Health Boston, is ending that myth. His work indicates testosterone, whether naturally produced by the body or taken as replacement therapy, does not cause prostate cancer or spur increases in prostate-specific antigen (PSA) levels in men. In the lab however, the main androgens in the body, testosterone and dihydrotestosterone (DHT), cause cancer cells to grow.
At this point I would like to thank Dr. Linares for his help in crafting our plan to win during the second half of our life. You will hear more from Dr. Linares, there are a lot of other physical and mental areas that we need to look at, and he is too good a resource to ignore, besides, we are childhood friends!