WASHINGTON -- The mere thought of a cancerous or infected prostate can be a nightmare to a man, but it's also a distress to a woman: his wife, mother, sister or daughter who loves him and often takes on the nagging role of urging him to face facts -- and a doctor.
Many men would rather not think about facts such as possible cancer of the prostate, or enlargement, or infection. Nor do they want to make a doctor's appointment. They'd rather ignore the whole unpleasant business.
But problems of prostate just don't ''go away,'' it's often up to a woman in a man's life to help educate him and request some action. That's why Patrick C. Walsh, urologist-in-chief at Johns Hopkins Hospital, and Janet Farrar Worthington, award-winning medical writer, chose the title for their book: ''The Prostate: a Guide for Men and the Women Who Love Them'' (The Johns Hopkins University Press).
Cancer of the prostate is the second-leading kind of cancer (skin cancer is first). In the past two years, some 200,000 men in the United States were diagnosed with prostate cancer each year, and about one out of every five died. The encouraging news is that if caught early enough, all prostate problems can be cured. And that can happen if a doctor can made periodic screening and diagnosis early enough.
Don't wait for any ''symptoms'' -- for prostate cancer has no clear-cut tell-tale warnings. Once the cancer has advanced, there are late symptoms such as trouble urinating, ''interrupted or weakened flow, hesitancy, dribbling.'' Or blood in the urine. Or severe pain in the back, pelvis, hips or thighs. But, as the authors bluntly point out, by the time a man has such symptoms, it's probably too late for a cure.
How can the cancer be caught early enough? A urologist has several methods of detecting the problem. One -- by a method men wish they could avoid -- is a digital rectal exam, which is uncomfortable but is brief and can provide vital information that simply cannot be gathered any other way. Another test is a simple blood analysis to check out the level of PSA -- the prostate-specific antigen, or enzyme, made by the prostate. High amounts of PSA can signal prostate cancer.
No one method
This blood test can also indicate a benign enlargement or possibly an infection. The authors repeat, however, that there is no one way to diagnose problems of the prostate -- it takes a complex combination of a qualified doctor and various sequences of tests and observations.
So, too, with treatment, which depends on the stage of the cancer, the age of the patient, his genes, his diet and his health. Various kinds of surgery, performed early, may treat the cancer; or radiation or cryoablation -- a process of killing prostate cancer cells by freezing them. Watchful waiting is another treatment. But there is no magic solution, and it's up to the patient himself to assess the alternatives and consider what he wants done.
This simple review is only the tip of the iceberg of information contained in this clearly written, no-nonsense book. A wealth of knowledge, data, observations and advice is given by the authors, fully illustrated with explicit and delicate line drawings by Leon Schlossberg.
A detailed index is presented at the end of the book, and a glossary provides straight-forward definitions when your journey through the book gets dense and complex.
A quick sense of humor lightens the text, and the imagery used by the authors is delightful: ''The mutations that lead to the development of prostate cancer may involve a process in which the accelerator [of a car] is stuck and the brakes have been removed, and cell growth is out of control.'' Or: ''The prostate encircles the urethra like a fist holding a straw.''
This is not easy or fascinating reading for the layman. but if the man is wise about his health, he'll use this Michelin Guide as a gentle but forceful manual of information about what the prostate is, where it is, how it functions and its vulnerability to cancer and infection.
And take the authors' advice: Get a doctor's check-up before you become one of the 38,000 men diagnosed each year with prostate cancer that cannot be cured.
Barbara Tufty is a natural-science writer.
