Male Trouble

For the middle-aged male, the first signs may be all too apparent. In the dead of night, he must stumble to the bathroom, awakened by an overwhelming urge to urinate. Soon afterward, he is again awake, conscious of great pressure. The same thing happens night after night, and urination--as well as any sexual activity--is often accompanied by a painful burning sensation. Alarmed, the man visits his family doctor or urologist, who confirms his worst suspicions. He is suffering from a disorder of the prostate, a small glandular structure that surrounds the urethra (urinary canal) at the base of the bladder. The condition, which often requires surgery, strikes half of all males, usually in their later years.

Not too long ago, problems of the prostate were a taboo subject; generally they were spoken of only in the locker room, if at all. In a new book titled Male Trouble (Praeger; $6.95), veteran Medical Writer Gilbert Cant has finally done for prostate disease what Happy Rockefeller's and Betty Ford's candor did for the once virtually unmentioned female affliction, breast cancer; he has exposed the myths and misinformation about the prostate to the not-always-harsh light of medical reality.

Contrary to what doctors thought a few decades ago, the prostate is not simply a one-purpose gland that produces lubricating fluid for easing the passage of sperm through the urethra. Recent research indicates that it is an exquisitely complex chemical factory that secretes a rich mix of enzymes and hormones, many of which have functions that are still only partially understood. The prostate is also heir to disorders of varying seriousness, from bacterial infections to a form of swelling dubbed BPH (for benign prostatic hypertrophy) to cancer. The last ailment, in fact, has become so widespread that it is now the second leading cause of cancer deaths among American men (after lung cancer) --largely because it is frequently diagnosed too late.

Cant, who was TIME'S Medicine editor for 21 years, urges all men in their middle years to seek regular prostatic examinations; the doctor's gloved finger can often feel trouble long before the middle-of-the-night trips to the bathroom. Even if removal of part or all of the prostate is indicated, there is no reason for alarm. Contemporary urological surgery is so improved that the mortality rate is less than 1% at good medical centers.

No Incisions At All. In fact, the most sophisticated operation, dubbed the TUR (for transurethral resection), does not require any external incisions at all. The surgeon cuts directly through the urethra with a marvelous combination of scalpel and fiber-optics looking glass called a rectoscope. Unfortunately, Cant adds, progress in drug therapy has not matched that of surgery. He blames this largely on the Food and Drug Administration, which he says has been overly conservative in refusing to sanction certain new drugs for use in treating prostate disorders. These drugs are already used in other countries to shrink swollen prostates.

While impotence can be a byproduct of the 250,000 prostate operations performed annually in the U.S.--crucial muscles and nerves must be cut in the more radical procedures--sexual function is preserved in most cases. Cant cites the encouraging experience of a 62-year-old friend: after his operation he was able not only to urinate easily but his sexual frequency soared from a painful once a month to a highly satisfying two or three times a week.

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