Ambiguous Gland

The enemy that made General Douglas MacArthur a bedfast hospital casualty last week is as common as it is mysterious. Every man is born with a prostate gland --it is one of the clear, anatomical distinctions between the sexes. In childhood it serves no known purpose. In life's prime its role is obscure and minor: it secretes a fluid which mixes with the output of the testicles, apparently helps to increase the mobility of spermatozoa. In old age, when again it appears to be useless, the prostate is the site of ailments ranging from the trivial to cancer which may prove fatal.

More Cells. In most men, long before they reach MacArthur's age (80), the prostate has undergone some enlargement. Why this is, medical science has no clear idea. Researchers are not even agreed as to the nature of the enlargement. They used to call it hypertrophy, meaning that they thought the cells within the gland were enlarged. Now they usually call it hyperplasia, meaning an increase in the number of normal-size cells.

In some cases, enlargement is the result of infection (usually in the bladder, which rests like an upside-down flask with its neck in the upper part of the prostate). These infections cause acute urinary difficulties, which subside when the infection yields to sulfa drugs or antibiotics.

In other cases, where there is no detectable cause such as infection, the prostate may become gradually enlarged--from a little more than an inch long by i% in. broad to double or triple its normal size. A year may elapse before painful or difficult urination, backache, testicular pain or sexual impotence sends the victim to his doctor. At this stage, the already enlarged prostate is especially vulnerable to secondary infection. Once this infection has been cleared, surgery is the usual answer--and mandatory in the 10% to 15% of cases where cancer has developed.

Less Pressure. Operations are of several types and designed to remove varying amounts of prostate tissue. Invariably their purpose is to relieve the pressure of the swollen gland on the urethra, which passes through it, to permit easy urination. In cancerous cases the entire gland is sometimes removed. The gland's response to the sex-hormone balance is shown by the fact that many prostate cancer patients apparently live longer if they are castrated. And female sex hormones are sometimes used instead of surgical castration. But this still does not prove that the hormone changes of advancing years cause either the hyperplasia or the cancer.

This week General MacArthur's surgeons had to wait for an infection to clear before they could operate. There was no immediate indication of cancer. But cancer of this ambiguous gland strikes 24,000 U.S. men each year, kills about 16,000, thus ranks second only to lung cancer (30,000 deaths) as the most commonly fatal cancer in males.

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