Among U. S. males, cancer of the prostate is the second most frequently diagnosed cancer (skin cancer is more common) and is currently the second leading cause of cancer death after lung cancer (R. Hoffman, 2011). An estimated 240,000 men in the United States are diagnosed with prostate cancer each year, and about 34,000 die from the
disease each year (R. Hoffman, 2011). Frequent sexual activity has been reported to reduce the risk of prostrate cancer (Allameh et al., 2011).
Factors known to be associated with the development of prostate cancer include old age, family history of prostate cancer, African American ethnicity, smoking, high fat consumption, and daily intake of 400 or more IUs of vitamin E (Dall’Era et al., 2009; R. Hoffman, 2011; Hoskote et al., 2012). The incidence of prostate cancer is 70% higher among Black men than among White men, and Black men have a lower survival rate than White men for comparable stages of prostate cancer (U. S. Preventive Services Task Force, 2008). The reasons for the increased risk and lower survival rate among Black men are not known, but genetic, hormonal, and nutritional factors have been implicated.
Symptoms of prostate cancer include many of those previously listed for prostatitis, especially pain in the pelvis and lower back and urinary complications. However, prostate cancer often lacks easily detectable symptoms in its early stages. A physical examination and a blood test may be performed in an effort to make an early diagnosis. In the physical examination, a physician inserts a finger into the rectum, a procedure called a digital rectal examination (DRE). Under normal conditions, this exam is only mildly uncomfortable. The discovery of a marker for prostate cancer—prostate-specific antigen (PSA)— detectable by a blood test has added another tool for physicians to use in diagnosing early prostate cancer. A normal PSA level is less than 4 nanograms (ng) PSA per milliliter (mL) of blood (Garnick & Rose, 2008). Efforts to detect prostate cancer using the DRE and PSA level as screening tools are far from precise. Many tumors are not detected by DRE. Both benign and malignant tumors can cause elevations in PSA levels (Garnick & Rose, 2008). Furthermore, even a mildly elevated PSA may lead to a cascade of events (laboratory tests and medical procedures) with "considerable cost implications for the majority of men who will not have a diagnosis of cancer" (Zeliadt et al., 2011, p. e126).
The U. S. government sponsors a task force of medical experts who regularly issue statements that address preventive health services for use in primary care clinical settings, including screening tests, counseling of patients, and treatment strategies. This task force, called the U. S. Preventive Services Task Force (USPSTF), released its latest recommendations for prostate cancer screening in May 2012. The Task Force advised healthy men not to get a PSA test for diagnosis of prostate cancer. This recommendation was based on an exhaustive review of the latest scientific evidence indicating that PSA tests do not save lives and often result in unnecessary patient anxiety, medical tests and biopsies, and serious complications including incontinence and impotence (Colliver, 2011; Stein, 2011).
An evaluation of several large prostate cancer screening trials concluded that more years of harmful side effects (such as erectile dysfunction and urinary incontinence) "will be experienced as a result of treatment than years of life saved by screening and treatment" (Chu and Benoit, 2011, p. e20). Furthermore, no conclusive evidence has emerged that PSA screening reduces the mortality associated with prostate cancer (Slatkoff et al., 2011; Susman, 2011).
Once prostate cancer has been diagnosed, it can be treated in a number of ways, including simply monitoring the cancer to determine whether its rate of progression poses a serious health threat. Among treatment options are radical prostatectomy (removal of the entire prostate gland); cryotherapy, in which the cancerous cells are destroyed by freezing; and two forms of radiation—external-beam radiotherapy and internal radiotherapy by means of implanted radioactive iodine or palladium seeds (O’Shaughnessy et al., 2011). Because growth of prostatic cancer tumors is stimulated by androgen, another treatment option is either orchidectomy (surgical removal of the testes) or the use of androgen-blocking drugs or hormones (Antonarakis & Eisenberger, 2011). Finally, because the dangers or complications of surgery, radiation therapy, or hormone therapy can outweigh potential benefits, especially for older men, an approach
called active surveillance, which involves "watchful waiting" with deferred treatment, is sometimes most appropriate (Eggener et al., 2009; Freedland et al., 2011).
Considerable controversy exists about the optimal approach to treating early — detected prostate cancer. Furthermore, a debate rages over whether the benefits outweigh the health risks of treatment. Medical experts differ widely as to whether treatment should be immediate or deferred. Arguments for immediate treatment, especially for young men, include longer survival time, significantly less pain, and prevention of metastatic disease (the spread of cancer to other areas). Support for active surveillance comes from studies indicating that most men die from unrelated causes before experiencing serious complications from untreated prostate cancer; furthermore, surgical, radiation, or hormonal treatments can result in a variety of complications, including incontinence, bowel problems, erection difficulties, and inability to experience orgasm (Elliott, 2012; Symons et al., 2011; Penson, 2011). Furthermore, active surveillance can lead to a significant cost savings both to the individual and the U. S. health-care system (Corcoran & Benoit, 2011; Keegan et al., 2011).
Prostate cancer specialists are actively seeking biological markers that might distinguish between cancer likely to remain confined to the prostate versus a more aggressive variety likely to progress to metastatic disease. A recent study discovered that sarcosine, an amino acid that can be detected in the urine, increases significantly during prostate cancer progression to metastasis (Sreekumar et al., 2009). Another potentially useful biological marker for aggressive prostate cancer, a protein labeled Cry61, has also been identified (Terada et al., 2011). Two possible genetic markers for aggressive prostate cancer—PCA3 and TMPRSS2:ERG—were indicated by recent research (Salagierski & Schalken, 2012). It is hoped that further research will confirm and clarify the role of viable biological and/or genetic markers for aggressive prostate cancer.
Until well-controlled, long-term studies of treatment outcomes provide clear evidence supporting a specific prostate cancer treatment, both clinicians and patients will continue to struggle with the dilemma of treatment choice. For now, good medical management of prostate cancer involves extensive counseling about treatment options and active involvement of the patient in decisions about treatment. We hope that by the time our young male readers reach middle age, better treatment options and more powerful diagnostic tools will be available.
Male and Female, Masculine and Feminine
What is the difference between sex and gender?
What is the relationship between gender identity and gender role?
Gender-Identity Formation
Is our sense of being male or female based more on biological factors or on social learning?
What is the best treatment strategy for intersexed children who are born with an ambiguous mixture of male and female external genitals?
Gender Role
What are the relative influences of parents, peers, schools, textbooks, television, and religion on the socialization of
‘Hid"l roles?
How do gender-role expectations affect our sexuality?
Transcending Gender Roles: Androgyny
What behavioral traits are expressed by androgynous men and women?
I was taught early on what appropriate gender behavior was. I remember thinking how unfair it was that I had to do weekly cleaning duties while all my brother had to do was take out the garbage. When I asked my mom why, she said, "Because he is a boy and that is man’s work, and you are a girl and you do woman’s work." (Authors’ files)
Among the residents of a small island near New Guinea, awareness of gender-appropriate behavior, as described in the preceding anecdote, is virtually nonexistent. Research by anthropologist Maria Lepowsky (1994) revealed that inhabitants of Vanatinai Island, known locally as "the motherland," behave in a truly gender-egalitarian manner. Men and women are considered equal, and there are no separate gender ideologies in this culture. Women have the same access as men to power and prestige. Both sexes are involved in important decision making, and both appear to enjoy the same freedom to explore their sexuality. Furthermore, the Vanatinai language contains no feminine or masculine pronouns. This pronounced difference between egalitarian roles for men and women in Vanatinai society and gender-based behavior expectations that predominate in American culture raises certain fundamental questions: What constitutes maleness and femaleness? How can the expectations and assumptions for each sex differ so greatly from one society to another? If some gender-related behaviors are learned, do any of the behavioral differences between men and women have a biological basis? How do gender-role expectations affect sexual interactions? These are questions that we will address in this chapter.