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Mr. 80 Percent

What is the prostate?

The vast majority of men don’t know the first thing about the walnut-sized gland. But they really should.

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Considering its function and all the trouble it can cause, you might think everyone born with a prostate would know a lot about it. You’d be wrong. The vast majority of men, I’ve learned, don’t know the first thing about the pernicious little gland, including where it’s located or what it does.

I don’t exempt myself. When I was diagnosed with prostate cancer, I didn’t know anything — like, nothing — even though my own father had been treated for the disease. That’s crazy, right? It’s even crazier when you consider that prostate cancer is ubiquitous: 1 in 9 men will be diagnosed with the disease. Nearly 200,000 men in the US are diagnosed with it every year, and about 30,000 die from it, making prostate cancer the second leading cause of cancer death among American men.

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So why do most guys lack even basic knowledge about the prostate and prostate cancer? There’s a stigma about it because prostate cancer can affect sexual function and continence. Unlike women, who’ve spent decades raising awareness about breast cancer — not to mention millions of dollars for research — men remain mostly mum about prostate cancer. Whether it’s because they’re uncomfortable or embarrassed, men don’t like to talk about it, and that’s a big part of the problem.

Here are a few things worth knowing:

> The prostate is about the size of a walnut, and it’s located below the bladder and in front of the rectum — in other words, a busy neighborhood, which makes treatment very challenging.

> What does the prostate do? It produces the components of semen. Not sperm — that’s produced in the testicles — but the fluid that carries sperm. If a man’s prostate is removed, he can still have an orgasm, but no fluid is discharged.

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> The tiny, all-important nerves that control the hydraulics of the penis, enabling a man to get an erection, surround the prostate. Severing or damaging these nerves during surgery can render a man impotent.

> The prostate can cause serious problems even without cancer. For example, many older men suffer from an enlarged prostate, which results in painful urinary issues.

> In its earliest stages, prostate cancer has no symptoms. And typically, by the time there are symptoms — frequent or urgent urination, weak urine flow, less rigid erections, severe back pain — the cancer is advanced and treatment is more difficult.

> There’s no way to predict who’ll get prostate cancer, but there are risk factors. They include:

  • Family history. Men with a close relative who had prostate cancer – say, a father or a brother – are nearly twice as likely to develop prostate cancer than a man with no family history.
  • Age. Two — thirds of men diagnosed with prostate cancer are 65 or older. But men can get it much earlier.
  • Race. Black men are 76 percent more likely to get prostate cancer than white men, and twice as likely to die from it.
  • Diet. Men in Asia, for example, where the diet is light on animal fats and dairy, have a much lower incidence of prostate cancer.

> Researchers believe some men inherit genetic defects that increase their risk of developing prostate cancer. More commonly known for increasing the odds of breast and ovarian cancer in women, BRCA gene defects are also risk factors for aggressive prostate cancer in men.

Can you test for prostate cancer? Not exactly, but the amount of prostate — specific antigen (PSA) in a man’s blood can indicate the presence of cancer. Measuring a man’s PSA level is the first step in diagnosing prostate cancer. Doctors also perform a digital rectal exam with their fingers, which can detect the presence of a tumor.

Opinions vary on when men should start checking their PSA, because screening can lead to treatment of slow — growing tumors that would never become life — threatening. Still, many doctors in the US believe that Black men or men with a family history should begin checking their PSA at 45.

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Prostate cancer is one of the few cancers that doesn’t necessarily require treatment. Active surveillance allows older men with low — risk cancer to be closely monitored, preserving quality of life.



Mark Shanahan can be reached at mark.shanahan@globe.com. Follow him on Twitter @MarkAShanahan.