”I am Your Body”

PROSTATE (for Males)

     I AM ONE OF THE hot spots in your 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 your sleep by requiring several trips to the bathroom each night or kill you with urernic poisoning. If you live 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 your normal sex life. To a great degree, the very existence of the human race depends on me. I am your prostate gland, the principal storage depot for seminal fluid; without me, chances of a pregnancy would be about zero. At each ejaculation, the testicles provide something over 200 million sperm cells. 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 the lower male abdomen, right at the neck of the bladder. Until puberty, I was about the size of an almond. Then, along with the rest of the body, I got the hormonal signal to change the boy to a 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 the 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 of the seminal fluid, and I the rest, for a total of about a teaspoonful. The mixture is projected out through the 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 the 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 and becomes a stagnant pool; bacteria often invade the pool, multiply and 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 capable of bringing a slow death.

As one grows older and production of testicular hormone diminishes, it would be logical 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, you have been fortunate; I am still normal-sized. But soon, almost inevitably, the slow swelling will start. When you reache the age of 50, you 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 your prostate doesn't necessarily mean serious trouble. But should I enlarge enough to put the squeeze on your urethra, your urine stream will decrease in size and force; if infection starts up there will also be a burning sensation. Other symptoms: frequencies of urination and the unpleasant - and accurate - feeling that the reservoir hasn't been completely emptied.

When these things happen, I urge you to see a doctor immediately. The chances that you 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 and 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 the urine 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. One fears these procedures, thinking they spell the end of manhood. Not so. Four out of five men remain sexually capable after prostate surgery for a benign enlargement, though most often they are sterile.

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 one is 50, he will have a five percent chance of having prostatic cancer. By 70, his chances will be 50-50.

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