Health News and Information

There’s also medical therapy—new drugs designed to attack the problems of BPH in a couple of ways. One strategy is targeted at shrinking the enlarged prostate; the other is aimed at keeping smooth muscle tissue in the prostate from tightening around the urethra.

A drug called finasteride shrinks the prostate by blocking the formation of a powerful hormone called DHT. Because finasteride doesn’t affect the body’s production of the male hormone testosterone, impotence is a rare complication. About one-third of men taking finasteride have a significant improvement in symptoms, but this doesn’t happen right away; it generally takes six months to a year for the drug to reach its maximal effect.

Drugs called alpha blockers relax the smooth muscle tissue within the prostate. For many men, they can provide immediate relief. Because these drugs can also lower blood pressure, the dose needs to be increased gradually, and these medications are best taken at night.

The degree of improvement in symptoms is similar to the results achieved with finasteride.

Which BPH treatment is right for you? Be your own advocate; learn as much as you can about the disease itself, and about the pros and cons of each treatment. Before committing to any treatment, you owe it to yourself to find answers to some basic questions, including: What are the odds that my symptoms will improve? How long will the effects of the treatment last? And, what are the risks of complications?

*299\201\8*

It’s important to understand that no form of prostatectomy stops BPH; these procedures only treat the disease that’s present. It’s a bit like mowing the lawn, in that, depending on how fast the prostate grows back, the procedure may have to be performed again.

In a recent study of more than 400 men who had the TUR procedure, symptoms improved markedly in 93 percent of those with severe manifestations of BPH, and in 79 percent of those with moderate problems. None of the men died as a result of the procedure, none had a heart attack, and only 5 percent reported impotence. In other research on men who’ve undergone the TUR, the improvement in urinary flow has been shown to last longer than seven years after surgery in most men.

Despite generally excellent results, TURhas come under fire recently. Some research has suggested that it’s less effective, in the long run, in fighting urinary obstruction than open prostatectomy. One such study examined the long-term progress of men in Denmark, England, and Canada, who underwent either open prostatectomy or TUR: 13 percent of those who had TUR needed a second procedure, as opposed to 3.5 percent of men who’d had open prostatectomy. (The proportion of men having had a TUR who need a repeat TUR amounts to about 1 percent to 2 percent a year.) However, from this and other studies, it’s clear that, given the choice, many men would rather have two TURs over ten years than one open prostatectomy.

In the same controversial study, investigators raised another issue: The statistics suggested that, four or five years after surgery, TUR might be associated with a higher likelihood of death from heart attacks than open prostatectomy. (The likelihood of a man dying from a TUR itself is almost nonexistent—less than 0.5 percent.) Further research, however, brought an explanation—that men undergoing open prostatectomy were healthier to start with. Men with heart disease and a large prostate were excluded from undergoing open prostatectomies; the more complicated nature of this procedure demanded healthier patients. With the simpler TUR procedure, however, nearly all men—including those with heart disease—were still considered eligible for surgery. Thus, the increased number of deaths from heart disease four or five years after surgery can be fully explained by the fact that more men with heart disease underwent a TUR than underwent open prostatectomy.

*260\201\8*

Libido is stimulated by the male hormone, testosterone, which is produced mainly by the testicles. When testosterone levels drop, the sex drive is diminished.

Erections are controlled by nerves that lead to and from the penis; particularly important are the nerves in two bundles that sit on either side of the prostate. In normal erection, sexual stimulation causes these nerves to release chemicals that increase blood flow into the penis. As the penis becomes engorged with blood, veins clamp down—shutting themselves off, so the blood can’t leave the penis. This keeps the penis erect during sexual activity. But sometimes these nerves are damaged—during a surgical procedure, for instance. Sometimes the arteries that pump blood into the penis are injured—after radiation therapy, perhaps. Or sometimes, for various reasons, the veins that are supposed to keep blood trapped inside the penis just don’t do their job. When a man has trouble with an erection, doctors call this “erectile dysfunction.”

Ejaculation involves powerful muscle contractions in the epididymis, vas deferens, prostate and seminal vesicles. During orgasm, a muscular valve in the bladder neck slams shut, forcing semen out the only possible exit—through the urethra and penis to the outside world, rather than backward into the bladder. But certain prostate treatments can result in the loss of this fluid. In a TUR procedure to treat BPH, for instance, the valve in the bladder neck is sometimes destroyed—so, because there’s no barrier to keep sperm from going back into the bladder, it isn’t forced out the urethra. After radical prostatectomy, there’s usually no emission of fluid because the prostate and seminal vesicles, which make most of it, are gone and the vas deferens has been shut off. After radiation therapy, many men also have a loss of ejaculate fluid because the glands responsible for making it are “dried up.”

Orgasm doesn’t really have much to do with the prostate. Orgasm happens primarily in the brain; as long as sensation is intact, orgasm can occur even in the absence of an erection and ejaculation. This is the key reason why normal sexual function can be restored to most men who are impotent after prostate treatment. (The one exception here is men receiving hormone therapy; because this causes a loss of libido, there is a general lack of interest in sexual activity.)

The most common sexual problem that troubles men after prostate treatment is the loss of erection, and there are several good ways to restore this, including vacuum erection devices, penile injections (injecting tiny amounts of erection-producing drugs into the penis), and penile prostheses.

The take-home message here is that after treatment for prostate disease (except for men treated with hormone therapy), recovery of sexual function is almost certain. Take heart!

*223\201\8*

This varies from man to man. Ten percent of men with M+ (D2) disease— metastatic prostate cancer—live less than six months. Ten percent live longer than ten years. The rest fall somewhere in the middle; statistics show that half of these men live three years or less, and only 25 percent are alive after five years. What accounts for the extreme disparity in these numbers? It all has to do with the ratio of hormone-sensitive cells to hormone-insensitive cells, and how fast the cancer grows. In some men, nearly every cell is responsive to hormones; in other men, very few cells are hormone-sensitive. Some cancers take hundreds of days to double in size; others double every few weeks.

There is a mathematical model of how these cancer cells grow, called tumor kinetics. A tumor must double in size thirty times before a doctor can even feel it—before there’s a centimeter of cancer. This growth is logarithmic—two cells, then four, then eight, etc. Say a tumor is at its tenth doubling; it has 1,024 cells. And say that three-fourths of these cells are responsive to hormones. The patient is castrated, and all the hormone-responsive cells drop out of the picture, leaving only 256 cells. What happens? These cells aren’t affected by the hormones; they continue to grow. The now-smaller tumor doubles. There are 512 cells. It doubles again—1,024 cells. It’s back to where it started. And when it doubles again, there will be twice as many cells as before.

Now say only 1 percent of this cancer is not responsive to hormones. It’s going to take many more doublings before this tumor becomes dangerous. So how long hormones work depends on two things: The ratio of hormone-resistant cells to hormone-dependent cells, and how long it takes for the cancer to double in size. Relapse will come a lot sooner in a man whose cancer doubles every 30 days, for example, than in a man whose cancer takes 100 days to double.

*184\201\8*

Several transperineal procedures don’t require open surgery at all. One is done just with fluoroscopy (an X-ray image that appears live on a TV screen instead of as a still photograph). Another involves a perineal template like the one described above, and uses CT scanning for extra precision in placing the needles. Over the course of several CT scans, doctors are able to create a three-dimensional image of the prostate. A computerized guidance system helps determine where the seeds should go, how deeply they should be inserted, and how strong their radiation should be.

Many doctors are encouraged by new techniques that use transrectal ultrasound and a sophisticated grid to guide placement of the implants. Like the CT scanner, the transrectal ultrasound enables doctors to develop beforehand a three-dimensional map of the prostate; this guarantees a much more even distribution of radiation throughout the gland. During the procedure, a Foley catheter is inserted through the urethra into the bladder, an ultrasound probe is inserted in the rectum, and needles are placed according to the electronic grid. In this approach, long stabilizing needles are used that don’t have anything to do with placement of the seeds. Because there’s no abdominal incision here, and therefore doctors don’t have full access to all sides of the prostate, they use these needles basically to skewer the prostate and move it around so the seeds can be placed in the appropriate spots. Doctors also use fluoroscopy and ultrasound to double-check the position of the seeds. In some studies, this has been shown to ensure a more accurate, even distribution of the seeds.

*146\201\8*

A study of the age of the first coital companions of these homosexual offenders vs. minors reveals that almost 5 per cent (the largest number recorded) had partners under age twelve; a moderate number (11 per cent) had partners aged twelve to thirteen; a large number (30 per cent) had their first coitus with girls of fourteen to fifteen; relatively few (16 per cent) with girls sixteen to seventeen; and moderate numbers with females of eighteen or over. This abrupt shifting in rank-order, which we also saw in the homosexual offenders vs. children, is something of a puzzle. The considerable number who had their first coitus with girls under twelve may be explained by the fact that at ages ten to eleven these future offenders had an excellent socialization with girls which resulted in abundant prepubertal sex play, and a carry-over of this situation into early postpubertal life would account for the relatively high percentage of youthful coital partners. The sudden drop from second place in rank-order with respect to initial coital partners aged fourteen to fifteen to next to last place with respect to partners aged sixteen to seventeen agrees with what we saw in the homosexual offender’s vs. minors history of socialization with females; an excellent socialization at ten to eleven and a poor socialization at ages sixteen to seventeen. Something disastrous to their heterosexual ability must have taken place between their twelfth and fifteenth years of life; this is the puzzle that only an examination of their homosexual activity can explain. It is noteworthy that the homosexual offenders vs. children and adults also socialized well with girls at ages ten to eleven, but by ages sixteen to seventeen had a mediocre social life with females.

When asked how old a female they would prefer for coitus, only a moderate number (about 4 per cent) of the homosexual offenders vs.

minors said twelve to fifteen, but about one quarter chose girls of sixteen to seventeen. Except for the heterosexual aggressors vs. minors, who exceed this figure, this is by far the largest percentage of any group who specified this particular age. The choice of age sixteen to seventeen is most curious, for when the offenders were at that age they had a poor socialization with females and, moreover, very few of them had their first coitus with girls of that age. It is almost as though one quarter of the homosexual offenders vs. minors looked back with regret at the rather dismal picture of their heterosexual lives in their mid- and late teens and wished to remedy it by a post-factum preference for females of that particular age.

*190\161\2*

These incest offenders vs. minors, like the incest offenders vs. adults, appear to be singularly unresponsive to psychological sexual stimuli. While the majority of both groups (three quarters) responded to the sight or thought of females, very few (about one seventh) responded strongly or frequently. The equivalent control-group figures are 90 per cent and 37 per cent. None responded to males. None reported any sexual arousal from sadomasochistic pictures or stories, and the response to pornography was weak or infrequent. Some of their unresponsiveness to visual and fantasy stimuli is due to their age.

These incest offenders had the third largest proportion of alcoholics: 20 per cent. It will be recalled that the incest offenders vs. children ranked second in this respect. When the alcoholics committed their incest offenses they were drunk in nine out of ten instances. Aside from the large number of alcoholics, the remainder of the proportion of frequent drinkers among the incest offenders vs. minors is modest and quite a few did not drink at all.

The incest offenders vs. minors were, as a group, not gamblers: some 53 per cent, the third largest proportion recorded, had never gambled and very few (8 per cent) had ever gambled seriously.

*148\161\2*

There are three salient points concerning the nocturnal emissions and dreams of the heterosexual aggressors vs. adults: first, a relatively large percentage had heterosexual dreams (a trait of aggressors), and second, the highest percentage of any group (4 per cent) had sadomasochistic dreams. This latter phenomenon, as we have said, coincides with the relatively large percentage of aggressors vs. adults who had sadistic fantasies during masturbation, and is in keeping with the overt behavior that resulted in their conviction. No such coincidence was observed in the other aggressors. The third notable feature is that the proportion of total outlet (total orgasms) constituted by emissions is always very small for both the single and married aggressors vs. adults.

The quantitative unimportance of nocturnal emissions to these aggressors is also visible in the age-specific incidence figures. Among the single males they have the smallest proportion of men with nocturnal emissions in age-periods 26-30 (43 per cent) and 31-35 ( 40 per cent). Among the married men, they show a low percentage in age-period 16-20 and the lowest percentages of all in age-periods 26-30 (33 per cent) and 31-35 (17 per cent).

*106\161\2*

All our sample of heterosexual offenders vs. adults had petted before marriage. By age twelve a considerable proportion (46 per cent, third in rank-order) had petted; by age fourteen they are sixth; by age sixteen they are again sixth; but by age eighteen they are second with 95 per cent.

The median individual began petting shortly after his fifteenth birthday (as also did the median control-group individual), and in the span of time from puberty to just before the sixteenth birthday some 69 per cent had petted—a moderately high percentage. Between sixteen and twenty, 95 per cent (the fifth largest percentage among all groups) petted. The petting proclivity of the offenders vs. adults is best seen in the number of their partners (including coital partners): relatively few had only a small number; large numbers were the rule. The average offender had petted with 36 partners before marriage. In the category of over 100 partners the offenders vs. adults rank second with 29 per cent, surpassed only by the prison group. This “record,” so to speak, was foreshadowed by the unusually good social adjustment that the offenders vs. adults had between ages sixteen to seventeen with their female contemporaries in which they ranked fourth, 11 per cent above the control group.

The situation as described above does not seem mirrored in the frequency with which the offenders vs. adults reached orgasm in petting: whether median or mean is used, they ordinarily reveal neither a high nor low frequency, the median frequency among those who had orgasms being 3 to 4 a year. Their moderation in petting to orgasm is not the result of any restraint—it is simply the result of their going ahead and reaching their orgasms in coitus rather than in petting. Aside from the period of juvenile experimentation (where, it should be noted, the offenders vs. adults do rank third), and aside from some orgasms resulting from mouth-genital contact, petting to orgasm is chiefly a substitute for coitus. Such a substitute will naturally be employed more frequently by those who are somewhat sexually restrained or who for various reasons have difficulty in obtaining coitus. Those who are definitely restrained sexually avoid even petting to orgasm.

The age-specific incidence of petting to orgasm is moderate up to age twenty-five, a bit low (14 per cent) between twenty-six to thirty, and lowest of all (7 per cent) between thirty-one and thirty-five. In brief, these older males were strongly inclined to have either coitus or nothing in their sexual relationships with women.

Nearly all (96 per cent, the second highest percentage among the groups) included genital manipulation as a part of their petting, but, like the offenders vs. minors, they nevertheless were averse to mouth-genital contact. Eighty-eight per cent, the largest percentage among the comparative groups and one shared with the offenders vs. minors, never placed their mouths on female genitalia. Sixty-seven per cent, again the largest percentage, never had a female place her mouth on their genitalia. The minority who had experienced fellation had experienced it primarily with prostitutes, and very few of the ever-married males had been fellated by their wives. This is in keeping with the fact that males who desire some taboo sexual activity but who are, nevertheless, quite inhibited about it, seek it with prostitutes rather than with friends or wives.

The avoidance of mouth-genital contact is particularly interesting in that the offenders vs. adults also avoided another oral activity: nibbling or biting the sexual partner’s body. Such biting is commonplace in mammalian sexual behavior and among various human societies. Thirty-two per cent of the control group had engaged in biting. Nevertheless, 86 per cent of the offenders vs. adults had never so much as nibbled an ear lobe. This is the largest percentage of “nonbiters” in any group, and it is significant that the offenders vs. minors rank second with 79 per cent. In our culture biting is always construed as an aggressive act, and biting others is so taboo that even in barroom brawls it is regarded as being not quite ethical. Consequently, many individuals find it difficult to reconcile what they have always regarded as a hostile oral act with sexual activity between two people reasonably well-disposed toward one another.

*64\161\2*

At the time they were interviewed, about two fifths of the control group had never married, half were married, and the remainder were separated, widowed, or divorced. The prison group and the sex offenders taken as a whole were similar to one another but quite different from the control group: only one fifth to one quarter were currently married, and slightly more than one third were separated, widowed, or divorced. This high latter figure reflects both a style of life and the consequence of imprisonment. Of the various sex-offender groups, not one can match the control group in marital stability: the percentage separated, divorced, or widowed ranges from 17 to 60 per cent. In terms of currently married, only the incest offenders (all of whom by definition must have married) equal or surpass the control group; most other sex-offender groups had but a sixth to one third of their members married at the time of interview.

Marital status is partly related to age; note that our youngest groups —the peepers and the aggressors vs. minors—have the highest proportions of never-married individuals except for the homosexual offenders. Among the latter, the homosexual offenders vs. minors and vs. adults, two thirds and three quarters of their members, respectively, never married. However, while marital status is obviously influenced strongly by one’s age and degree of heterosexuality, we shall subsequently see that there are other important operant factors.

In a study of sexual behavior that includes persons confined in institutions, one must take such social isolation into account. Consequently, to put it simply, we took all the men who had ever been married, omitted prison time, and calculated the percentage of years since puberty that a man was a bachelor, a husband, and an ex-husband. The variation, as one can see from Table 6, is considerable. Again, some of this variation is based upon age—note that the youthful peepers have the largest proportion of their adult nonprison years spent as bachelors or divorced, and next to the smallest proportion spent as married men. With this sort of demographic information, proper allowance can be made for the amount of time spent behind bars.

*21\161\2*