Before you start reviewing your will, let me slip you the good news. Though prostate cancer is the most commonly diagnosed cancer in men and the second leading cause of death, only one in six men will have it diagnosed and only one in 32 will die from it.

 

Many men's prostate cancer is so insignificant that it is never diagnosed. When your doctor does find it, you are still more likely to die from some other cause.

 

That doesn't mean you can say, "No worries, mate!" In 2003, 189,000 men will be diagnosed with this disease and 32,000 will die. It is much more common and deadly in African Americans and seems to run in some families.

 

"OK," you say, "How can I prevent it?"

 

Let me give you a quick and dirty primer. The prostate is a chestnut-sized organ (for you non-farm boys, that is a little smaller than a golf ball) that surrounds the urethra (the tube that carries urine through the penis) as it comes out of the bladder. The prostate produces a fluid to nourish sperm that is ejaculated during orgasm. (I told you this was an important topic!)

 

Prostate cancer grows slowly and is usually found in men over the age of 55. What causes it? No one is sure, but it is less common in men who eat low-fat diets or eat lots of tomatoes. Cigarette smoking, high alcohol intake and taking testosterone increases your risk.

 

The problem is that early prostate cancer causes no symptoms. Advanced cancers can cause obstructive urinary symptoms--frequency especially at night, decreased force and size of your urine stream and even painful ejaculation.

 

As with many cancers, the key is early detection. That means that after age 40 you should have an annual digital rectal exam. (I hate it as much as you do, but a minute of discomfort can be life-saving.) Your doctor can feel if the prostate is enlarged or has an abnormal consistency while also screening for colon cancer.

 

The other screening test is the prostate-specific antigen blood test (PSA). It measures a protein produced by the prostate but unfortunately is not a sure-fire test. If your PSA is elevated, there is still a 60 percent chance you don't have cancer, but you will have to have more tests to find out for sure.

 

The other problem is that in five men who do have prostate cancer, one or two of them will have normal PSAs. That is what makes it controversial to use this test routinely. I still recommend that African American men have a physical exam and PSA after 40, and that all other men do so after 50.

 

If your PSA is elevated, what do you do? You will need a transrectal ultrasound-guided biopsy of your prostate to get tissue for accurate diagnosis and prognosis. If cancer cells are found, they are examined to see how aggressive they are.

 

You may need to have your prostate gland removed (one in four men is impotent after surgery). Or, you may be advised to have radiation either from an external source or by implanting radioactive pellets in the prostate gland for a while.

 

If the cancer has metastasized to distant bones or other sites, the doctor will try to eliminate the stimulating effect of testosterone, which fuels its growth. In the past, this was commonly done by orchiectomy (removing the testicles), but today, it's more commonly done with drugs that block testosterone's effect.

 

So here's your game plan: Change your lifestyle and eat less meat and more vegetables. When you reach 40 or 50, have yearly checkups with a rectal exam and a PSA test. Most prostate cancer is not aggressive, but if yours is, catching it early allows curative surgery. Oh, and considering the tomato benefit, use more ketchup. But what do you put it on when you aren't supposed to eat fries?

 

By David Stevens, M.D., executive director of the Christian Medical and Dental Society. For more information, visit www.cmdahome.org.