For President or Plain Citizen, Prostate Problems Come with Age, Says Surgeon Haakon Ragde
A large part of the problem, says Dr. Haakon Ragde, 59, a prominent urological surgeon in Seattle, lies in the fact that prostate malignancy is so difficult to detect through traditional diagnostic techniques. Ragde, born in Norway and trained at the University of Virginia Medical School, is a pioneer in bringing to the U.S. a Danish-developed ultrasonic method for early detection of prostate cancer. He explained to correspondent Russell Sackett how such techniques are bringing new hopes for curbing a killer disease.
What is the purpose of the prostate?
It is normally the size of a walnut, inconveniently located between the rectum and the bladder, where it encircles the urethra, the duct through which urine passes from the bladder through the penis. The prostate's chief function is to provide part of the fluid that nourishes and transports sperm during ejaculation. Surgically removing the prostate, however, need not leave the patient impotent, so its value is very debatable. Most males who have had some prostatic ailment probably would not grieve if the prostate were suddenly to become extinct.
Why does the prostate malfunction?
It is vulnerable to infections that can occur at any age beginning with puberty. In a man's later years, it is subject to enlargement, and this can squeeze the urethra partially or completely shut. This condition can result in urine backing up, distending the bladder and, in severe cases damaging the kidneys. The condition can be caused by an inflammation and swelling called benign prostatic hypertrophy; it can also be caused by malignancy.
How common is prostate cancer?
If a man lives long enough, he will almost certainly get it. By age 80, about two-thirds of all males have it. Cancer of the prostate is the second most common cancer found in males, after lung cancer. It is the third highest cause of cancer deaths, after lung and bowel cancer, among males between the ages of 55 and 74.
Why this high death rate?
The chief reason is the difficulty of early diagnosis. Because of the prostate's inconvenient location, physicians throughout history have checked its health and contours by feeling it with a finger inserted in the patient's rectum. By this means contact was possible only with the back side of the gland; if the prostate seemed reasonably symmetrical and "springy" and the patient had no other symptoms or difficulty, it was presumed to be free of tumors. The trouble has been that of the cancers we were discovering by touch, about four out of five were already in advanced stages. Those are not statistics to be proud of.
How much has the new ultrasound method improved diagnosis?
With it, I say with no hesitancy that we are going to be right 95 percent of the time in determining the extent of the tumor once we know it is there. The accuracy by conventional methods is about 50 percent.
How does that diagnosis work?
Basically the machine involves an electronic probe tipped with a revolving ultrasound scanner. This sends out impulses that are reflected and projected on a screen—much the same as a 360-degree radar scan on a TV weather report. As the probe moves through the rectum, each rotation produces a sectional view of the prostate, rather like looking at sausage slices end on. But there is no prodding, and compared to the digital probe, the ultrasonic method is painless.
How many ultrasound scanners are there in the U.S.?
There are now about 200, each costing from $35,000 to $70,000.
How is cancer detected on the ultrasonic scan?
Cancers usually occur in certain portions of the gland. Advanced cancers are pretty much unmistakable—they are black, irregular and evil-looking, frequently with crablike tentacles reaching out in the direction of their growth. Early cancers are not as easy to detect. Inflammatory conditions may give much the same picture. If the inflammation is treated but does not fade, you do a biopsy.
How great are the possibilities that the President's prostate may prove to be cancerous?
Of course, I am not his physician. Hypothetically, if I had a 75-year-old patient, such as President Reagan, with a history of a transurethral resection of the prostate 20 years ago, I would definitely prescribe an ultrasonic scan before surgery. If there were already reasons to suspect cancer, the scan would tell me how advanced it is.
How is prostate cancer treated?
There are three courses open to the patient: radical surgery to remove the prostate, a series of external beam radiations by cobalt or internal radiation, which is the implantation of radioactive iodine "seeds" in the prostate itself. Now if you have an early cancer, I think you are going to get good results with any of the three methods. But while these treatments are all available, the most important point remains early diagnosis.