The Whole Life Prostate Book

Everything That Every Man-at Every Age-Needs to Know About Maintaining Optimal Prostate Health

H. Ballentine Carter, Gerald Secor Couzens

• Publisher: Free Press
• Year: 2012
• ISBN:
  9781451621235
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

MEN TODAY face a growing health crisis. More than twenty million nationwide are affected by a prostate health issue, and more than two hundred thousand are diagnosed with prostate cancer every year. Many of these problems are preventable because they are related to the chronic diseases of age associated with poor health choices. Dr. H. Ballentine Carter is a preeminent expert in the diagnosis and management of prostate disease, and he believes that it's never too late—or too early—to make important changes to improve and maintain overall prostate health. Dr. Carter provides men of all ages the one resource that details what needs to be done when in crisis, but more important, he supplies crucial advice about how to prevent a prostate crisis from ever occurring. Whether a man is in his twenties, thirties, or sixties, he is one day closer to being told he has a prostate problem. But positive lifestyle changes that incorporate diet, exercise, and health maintenance can significantly lower those odds. Dr. Carter shows you how in this comprehensive and authoritative guide, The Whole Life Prostate Book. With wisdom gleaned from his many years in the field, Dr. Carter cuts through the overwhelming amount of information—and misinformation—on the topic, arming men with the knowledge they need to make the best decisions about prevention, testing, and treatment. In clear language, he explains how to read test results and outlines the management options available for lower urinary tract symptoms; inflammation of the prostate; and management strategies for prostate cancer, including no immediate treatment—an approach pioneered by Dr. Carter himself that's designed to preserve quality of life. Filled with simple and nutritious recipes, easy-to-follow workout routines, and a straightforward approach to demystifying the complex medical jargon of prostate disease, The Whole Life Prostate Book is an empowering manual for maintaining optimal health throughout a man's life.

PART ONE

YOUR HEALTHY PROSTATE

Life is not merely to be alive, but to be well.

—Marcus Valerius Martial

CHAPTER ONE

PROSTATE 101: THE BASICS

For a considerable part of a man’s life, the lowly prostate gland is taken for granted all too often. Unless it is acting up and forcing him to acknowledge it, the prostate flies under the radar, unnoticed and unappreciated. In my experience, it’s the rare man who thinks about the health of his prostate, let alone knows where it is or what it actually does. Astoundingly, I even come across the occasional patient who doesn’t even know he has a prostate!

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MYTH BUSTER

Females do not have prostates! Only men and other male mammals do. However, women have Skene’s glands around the urethra (the conduit for urine) that produce fluid similar to the prostate.

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Yes, some men have heard of prostate-specific antigen or PSA—an enzyme produced by the prostate; elevated amounts detected in the blood can signal prostate cancer—but only because they may have had a PSA test by the age of fifty to check for the possible presence of prostate cancer and because, in recent years, this test has become the center of an international debate about its benefits and harms. An elevated PSA can often be a tipoff to prostate cancer, but other noncancerous conditions such as benign prostatic enlargement can also cause PSA elevations. Oftentimes a man will have the PSA test coupled with a doctor’s digital rectal exam (DRE) to feel the prostate for any suspicious lumps, which can indicate cancer. With a normal PSA report and no sign of prostate cancer, any interest in the prostate often ends right there in the doctor’s office—typically with no desire for more probing by the doctor.

All male mammals have some variant of the prostate; it’s the way that we have all evolved over many millennia. Like the mysterious appendix, the prostate is a gland that you can live without, although minus its production of seminal fluid, reproduction through sexual intercourse isn’t possible. Mammals differ widely in the amount of ejaculate volume they produce, from 1 milliliter (0.03 ounces) for a randy ram, to 250 milliliters (8 ounces) for a boar—the hairy animal, not the guy who always seems to buttonhole you in the corner at a cocktail party; that’s a bore. That guy will produce about 3 milliliters, or 0.1 ounces, on a good day.

The prostate is diminutive compared with the kidneys, the liver, and other vital organs such as the heart and the lungs. Yet it’s important that you know all about the gland: its primary functions, what can go wrong with it as you age, and how to lessen the chances of prostate disease—because the odds are very high that, with each passing day, you will get one step closer to either developing or being labeled as having a prostate disease.

My entire professional life, all thirty-plus years of it, has been spent investigating and treating all issues associated with this complex little powerhouse of a gland, and I still don’t know what makes it so vulnerable. I think, however, that it really comes down to a combination of genetic propensity and the lifestyle choices that men make. The primary issues related to the prostate are problems caused by benign prostatic enlargement, which may result in lower urinary tract symptoms (a “going” problem), prostate inflammation, and prostate cancer. Each of these conditions, which are covered in great detail later in the book, is a disorder that can bring a man to his knees, to a hospital, or, in the case of advanced prostate cancer, to a medical oncologist who will help him decide which drug regimen he will follow to keep his cancer in check.

S-E-X: IT GETS MEN’S ATTENTION

When I was first speaking with publishers about writing this book, the one question that came up consistently was why I thought a healthy young man in his twenties or thirties would want to read this book and become proactive about his prostate health.

My answer was twofold: virtually every man, as he ages, will have to deal with issues involving urination, pelvic pain, or sexual dysfunction either caused by, related to, or blamed on the prostate. I went on to say that if proper steps were taken—mainly, steps having to do with awareness and lifestyle modification—these issues could be greatly reduced or, in some instances, prevented altogether.

The second part of my answer had to do with sex, plain and simple. I don’t know any young man—or older man, for that matter—who is not interested in sex. Prostate issues vary in severity, but even the slightest problem with the prostate can have some impact on sexual function. The more serious conditions go hand in hand with significantly reduced sexual performance and, in some cases, the complete inability to have an erection ever again!

TAKING CARE OF YOUR PROSTATE

Let’s start with proper pronunciation and spelling. The name of this gland is the prostate, not prostrate, as some men are wont to call it. But this gland, its name derived from the Greek word for “guardian,” does anything but prostrate, or lie down, on the job. It’s working all the time as a participant in urination and in helping to create a fulfilling sex life.

While the prostate is your guardian, you also have to be the guardian of your prostate. Changes in urinary habits or ejaculation, pelvic pain, and abnormal PSA results need attention before a treatable condition becomes more difficult—or impossible—to address effectively. Because the prostate is prone to microscopic malignant tumors, an inevitable part of aging for so many men, vigilance along with periodic testing after the age of forty is right for some men to ensure that they don’t ever become a prostate cancer statistic.

All the while I’ve been describing the prostate, you’ve probably been wondering what it looks like. I want you to imagine a crabapple, stem side up. The prostate is typically about an inch and a half wide at the base, a little narrower in its vertical dimension, and weighs about 20 grams, or 0.7 ounces. Think of the protective skin of the apple as a stand-in for the outer portion of the prostate. The inner, fleshy fruit of the apple represents the prostate gland. The apple core, running from top to bottom, represents the urethra, the flexible tube that is buried within the prostate and transports urine and semen.

IMPORTANT MESSAGE FOR CONCERNED WOMEN

Since men of all ages typically don’t know all the complex workings of their bodies and are often hesitant to respond to medical issues, you may find this prostate information invaluable as you try to help the various men in your life maintain optimal health and well-being. Helping your partner, father, brother, or son cope with prostate problems should include far more than just comforting. I’ve come to realize that a concerned woman acting as another guardian of a man’s health—by offering daily encouragement or brushing up on prostate facts—can improve the quality of her man’s life beyond measure.

HOW THE PROSTATE DEVELOPS

While tucked away in the womb, you and your grandmother, mother, sister, aunt, and wife were all indistinguishable from one another for the first two months of gestation: you all had the X (female) chromosome. But at the end of this time, you started to become male, thanks to the influence of your Y (male) chromosome. It’s the presence of the Y chromosome that sets in motion the development of the testes, or testicles; without the Y chromosome, ovaries will develop. At about seven to eight weeks, the testes produce an inhibiting substance that prevents the development of female anatomy, and shortly thereafter, at around nine weeks, production of the male hormone testosterone (and its reduced counterpart, dihydrotestosterone, or DHT) leads to the development of the male anatomy, including the penis and the prostate.

In the developing female (with XX chromosomes), because of the absence of the inhibiting substance and male hormones from the testicles, tissues that would have become part of the male internal anatomy (prostate, seminal vesicles) wither away, and in their place, female structures (uterus, fallopian tubes, vagina) develop. Part of the vagina arises from tissues that would have formed the prostate had genetic shuffling not resulted in two X chromosomes.

By three months, the male anatomy is formed with ductwork intact, and in the last trimester, the testicles descend into the scrotum, and the penis starts to grow. Once you’re born, the prostate lies relatively quiet for the next ten-plus years, until puberty, when a metamorphosis takes place. As testosterone levels begin to rise again, your voice deepens, hair begins to sprout in unfamiliar places, and the prostate begins to grow, eventually giving rise to the complex, mature prostate gland.

Prostatic hyperplasia, or benign prostatic hyperplasia (BPH), as pathologists like to call growth of the prostate gland that is not related to cancer, does not occur in men younger than age thirty. But after age forty, when most body functions are declining with concurrent drops in testosterone production, the prostate may start to grow in some men. The reasons for this growth are not clear but may be related to testosterone levels during fetal development in the womb, inherited genes, and lifestyle choices that lead to inflammation and alterations in growth factors, the protein molecules that regulate cell division and survival. Whatever the cause, prostates come in all sizes (much like breasts) and, after age forty, can enlarge from the size of that crabapple to a large orange or grapefruit over the decades.

As the prostate continues to enlarge in some men, it may begin to squeeze the urethra, pinching off urine flow. When severe cases of obstruction are ignored and left untreated, this problem can sometimes escalate to damage the bladder and kidneys or else cause other problems such as infections and stones within the bladder.

Although I have many patients who worry initially that this benign prostatic enlargement, or BPE, causes prostate cancer, they are greatly relieved to find that the two ailments are separate, apparently unrelated disorders that just happen to occur in the prostate. While prostate cancer is typically found in the gland’s peripheral zone next to the rectum, prostatic enlargement that comes with aging begins in the inner transition zone of the prostate, compressing the urethra and causing bothersome urination issues.

ARE YOU A BOY OR ARE YOU A GIRL?

Shortly after a baby’s birth, the doctor checks the status of the genitalia and reports the sex to the parents. In rare cases, a condition called ambiguous genitalia, in which the penis, scrotum, vagina, and clitoris are not distinct, makes it difficult to tell the sex of the baby.

What does this have to do with the prostate? The male hormone testosterone gets converted to a more potent hormone called dihydrotestosterone (DHT) in the tissues that before birth give rise to the prostate and male external genitalia. Without this conversion, the prostate and genitalia don’t develop normally. In fact, the discovery that chromosomally normal males (XY) with an inability to convert testosterone to DHT had ambiguous genitalia and no development of a prostate eventually led to the formulation of the drugs you see advertised on TV for “shrinking” the prostate. These drugs inhibit the conversion of testosterone to DHT.

Of course, these medications wouldn’t be very marketable if they also shrank the penis. That situation does not occur, thankfully, since the penis, unlike the prostate, is not sensitive to male hormones (androgens) such as testosterone later in life after it has developed fully.

WHAT THE PROSTATE DOES

The prostate is a mixture of dozens of microscopic, spongy, fluid-producing glands, ducts, and muscle all wrapped up in a neat, paper-thin wrapper of sturdy fibrous tissue, encased...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Note to Readers
• Introduction
• Part One: Your Healthy Prostate
• Part Two: Waterworks
• Part Three: Inflammation of the Prostate
• Part Four: Cancer
• Glossary
• Prostate Disorders Resources
• Acknowledgments
• Index
• About the Authors