Listen Up, Guys

New York City Mayor Rudolph Giuliani, Charlton Heston, former Sen. Bob Dole: It seems not a month goes by without news that another famous American has been diagnosed with prostate cancer. The disease kills about 32,000 in the U.S. each year, making it the second most lethal form of cancer in men (after lung cancer). Yet as Dr. Peter T. Scardino points out, if caught early, prostate cancer is highly treatable. A surgeon and the chairman of urology at New York City's Memorial Sloan-Kettering Cancer Center, Scardino, 55, has performed more than 1,800 operations to remove prostate glands. Scardino lives in Manhattan with his wife, Barrie, 55, an author and architectural historian, with whom he has three grown children. Eve Heyn asked him to explain prostate cancer.

What is the prostate gland?

It's an organ in men located between the bladder and the urethra, the channel that allows urine to come out. The prostate secretes fluid, which bathes and nourishes sperm and protects them on their way to their job of fertilizing the egg. Apart from reproduction it serves no useful purpose that we know—just causes a lot of trouble.

Who is most likely to get prostate cancer?

It was long thought of as a cancer of elderly men. But now we find it in men as young as their late 30s, 40s and certainly in their 50s. A family history puts you at increased risk. And African-Americans have the highest incidence of any ethnic group.

What causes it?

We don't know, but diet seems to be a major factor. "We think it's related to dietary fat and possibly calorie intake. A diet that's good for your heart is good for your prostate. We advise people to have a healthy, low-fat diet and maintain appropriate body weight.

What are the signs that you have it?

Unfortunately prostate cancer causes no symptoms until it becomes so advanced that it's basically incurable. Then we find urinary problems—blockage of the urinary stream, blood in the urine and bone pain from spread of the cancer.

How can it be detected earlier?

Beginning at age 50 men should have their doctors administer a blood test called a P.S.A. test and a digital rectal examination of the prostate every year.

Is there a way to check yourself?

Not really.

If it's caught early, what is the likelihood of a cure?

We would expect to cure 9 out of 10 cancers that are caught early.

How do doctors treat the disease?

We have good treatments, ranging from simply watching things very carefully—if the disease isn't threatening yet—to removing the prostate with surgery, called a radical prostatectomy, to various forms of radiation and hormone therapy.

How successful are these treatments?

Depending upon the seriousness of the cancer, three out of four men treated with surgery can be expected to be cured of their cancer. We have been using radiation for less time, but the results are beginning to get close to the results of surgery. Roughly two out of three men who get radiation therapy or seed implants—radioactive pellets implanted with a needle into the prostate—would be cured. Surgery and radiation do put a man at risk for problems with erections. While the fear of loss of erection keeps many men from being tested, these problems are now often treatable with drugs and other techniques.

Aren't there psychological elements at work?

Finding out that you have cancer is a great blow to a man, and then having to cope with the possibility of even temporary altered sexual or urinary function that can come from the disease or from surgery can be a really big blow. Men often need a lot of love and support from their families, and many times professional counseling can be very, very helpful.

Is prostate cancer always life-threatening?

We use the word cancer and it sounds horrible, like you're going to die a terrible death within the next year. But we know that one out of three men over 50 walking around the streets and feeling perfectly healthy actually has cancer cells in his prostate. But only 1 out of 10 will actually die of their cancer.

Is research going on toward a cure?

We're creating prostate cancer in mice so that we can develop new understandings of what causes prostate cancer at the molecular and genetic level and develop new treatments. I hope that by the time my children and certainly my grandchildren get old enough that they're at risk for prostate cancer there will be a simple way to prevent it and treat it.

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