Dear Dr. G,

I am a 52-year-old man who is reasonably fit and healthy.

Like most men approaching their fifties, I have begun to hear more about the prostate.

I have no idea what it is, and how to look after the prostate for the future.

I understand that prostate symptoms will result in dribbling, slow flow and nighttime urination. Thankfully, I have none of these symptoms.

However, I must confess I am somewhat worried about the sexual mischief of my youth, and perhaps over-indulgence in sex which may result in prostate cancer in later years. I am hoping you can clarify a few things for me.

What exactly is the prostate? What does it do?

How do I know whether my prostate is in a good state of health?

Can I self-examine my prostate?

Who exactly is at risk of getting prostate cancer? Any prevention?

Is it true that a sedentary lifestyle can cause prostate cancer?

Is there a link between prostate cancer and sex?

Would too much sex induce cancer in the prostate?

Midlife Michael

The elusive prostate gland is often described as a walnut-shaped organ located within the pelvis of a man. In an anatomical term, this organ is positioned between the bladder and the penis, and surrounding the urethral. The function of the prostate is essential during reproductive years, secreting fluid as nutrients for sperms. The function of prostate is negligible beyond procreation years, however, it continues to grow with advancing age. The enlargement of the prostate can potentially be troublesome as it risks obstructive urinary flow and impairment of sexual dysfunction. In a more serious manner, the ageing process may even result in cancerous changes.

Most men would experience some degree of urinary symptoms by the age of 50, as the occlusion of the urinary flow may cause slowness in urine flow. This can also result in the incomplete voiding, causing frequent urination in the day and night. The enlargement of prostate is also commonly associated with erectile dysfunction. Around 60% of men with urinary symptoms commonly reported erectile dysfunction, and similarly about half of men with erectile dysfunction also complain of obstructive urinary flow.

The symptoms of benign prostate enlargement and cancerous changes are completely undifferentiated. It is also difficult to rely on the symptoms to identify early presentation of cancer. On the other hand, a man is oblivious to the state of his prostate as it is located deep inside the pelvis. The prostate status is usually determined by clinicians, with digital rectal examination (DRE), therefore patient self-examination is completely impossible. The only way to detected malignancy of the prostate is through a blood test called PSA (Prostate Specific Antigen), which may be followed by biopsy through the rectum to definitively determine the presence of the cancerous cells.

It is widely reported that the prevalence of prostate cancer is on the rise throughout the globe. Some clinicians believe this is due to men living longer and more advanced detection technology. Some scientists also highlighted the synthetic man-made chemicals that exist in plastics and pesticides mimicking compounds known as xenoestrogens, interfering with healthy male estrogen-testosterone ratio, leading to undesired prostatic growth. Sedentary lifestyle and animal fat consumption are also associated with prostate cancer. On the other hand, nutritional compounds that are recognised to prevent inflammations of the prostate can help to suppress cancerous changes. Food such as sprouts, broccoli, cabbages and kale are rich in nutrients to support prostatic health.

Many men worry that too much sex may lead to cancerous changes of the prostate. On the contrary, a well-constructed research tracked 32,000 men for 18 years on their sexual activities including masturbation, sexual intercourse and wet dreams identified lower risk of cancer with frequent ejaculation. Research found men with at least 21 ejaculations per month had about 20% lower risk of prostate cancer, compared to men who had sex four to seven times a month.

In the month of November, Men’s Health events raise awareness on the threat of prostate cancer. Although the treatment of prostate cancer has ventured into the robotic technology era, the statistics of men presented with incurable prostate cancer in Malaysia are still leaving our men in the dark ages, as two third of men presented with prostate cancer are in late incurable stages. Taboo, embarrassment, fear and urban myths such as too much sex can cause harm to the body are reasons for men not seeking treatment.

There are many things only men can do, such as shaving a moustache and standing up to pee. More importantly, we need to be aware only men can get prostate cancer and survive the disease if detected early!

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