I still remember the words of one of my medical school professors, “Every man will develop prostate cancer if he lives long enough.” While it was an exaggeration, his fatalistic declaration was based upon autopsy evidence that the incidence of prostate cancer increases as men age.

Studies have shown that the percentage of men having evidence of prostate cancer is roughly the same as the decade of life being examined. In the early 1990s pathologists at Detroit’s Harper Hospital examined the prostate glands of 249 men who had died from various causes. The men ranged from 20 to 69 years of age at the time of death. Their findings, which were reported in 1994, confirmed that prostate cancer is extremely common.

Twenty-nine percent of men dying in their thirties had evidence of prostate cancer. This increased to 55 % of men dying in their fifties and to 64 % of those dying in their sixties. The study did not include men aged seventy or beyond at the time of death, but others have shown that the percentage continues to increase.

The vast majority of these cancers were not found while the men were alive, and most deaths occurred from other causes. This does not mean that the problem can be ignored, however. Current statistics show that 189,000 new cases of prostate cancer will be diagnosed and that approximately 30,200 men will die of the disease each year. Prostate cancer is the most common form of cancer, other than skin cancer, among men in the United States and is second only to lung cancer as a cause of cancer-related death among men.

The severity of the problem may be better appreciated if the statistics are stated in a slightly different manner. The next time you are in a public gathering, look at the men around you. One out of every three in their thirties and forties has prostate cancer. Half of those in their fifties have the disease, and it is present in two out every three who are in their sixties.

Over the years I have found that many people are confused as to what the prostate gland is and does. The prostate gland is a walnut sized organ located at the base of the bladder. It surrounds the urethra, which is the tube through which urine flows out of the bladder, and can be felt through the wall of the rectum. The prostate gland produces the fluid that carries sperm out of the body at the time of ejaculation.

The current methods used to detect prostate cancer include a digital rectal examination feeling for bumps or nodules in the prostate and checking the level of prostate specific antigen (PSA) in the blood. It is currently recommended that PSA testing should begin when a man reaches the age of 50. Levels between 0 and 4 are considered “normal”, those between 4 and 10 “suspicious” and those over 10 highly suggestive of prostate cancer.

If a nodule is felt or the PSA is at a suspicious or suggestive level biopsies of the prostate are obtained and, if positive for cancer, surgery to remove the prostate or radiation of the gland are generally recommended.

The time has come to question this approach has come. We now know that changes begin to occur up to a decade before the first cancer cells appear and that another decade or more will generally pass before a tumor reaches the size at which it is most frequently diagnosed. We also know that the PSA level often reflects the presence of pre-cancerous conditions in the gland long before it rises to a level felt to represent the presence of cancer.

Given this, the practice of allowing the disease to develop over a period of twenty years or longer is unacceptable. It is time that we begin screening men for pre-cancerous changes in their twenties and thirties when they can take steps to reverse the process. Waiting until they are in their fifties or sixties to screen for and treat end stage disease is unconscionable in an enlightened society.

The prostate is subject to three disease entities. Prostatitis is a condition in which the prostate becomes inflamed as a result of infection or injury. Benign prostatic hypertrophy or BPH refers to an enlargement of the gland that can interfere with the free flow of urine out of the bladder. The third is prostate cancer.

Prostatitis, BPH, and prostate cancer have traditionally been thought to be separate and unrelated entities. In the past I have reassured many men with prostatitis that their condition was unrelated to other prostate problems including cancer. Studies over the past decade, however, have shown that it is quite likely that chronic prostatitis, ongoing inflammation of the prostate gland, actually sets in motion the sequence of events that culminates in prostate cancer.

This should not be surprising, for it is known that chronic inflammation is associated with the development of cancers in many sites including the liver, stomach, intestinal tract, skin, lung, and cervix. It may, in fact, be a predisposing factor in all types of cancer.

Johns Hopkins University has been one of the leaders in prostate cancer research, particularly in the sequence of events that occurs as normal prostate cells undergo changes that lead to cancer. A clear pattern has emerged.

When prostate cells become inflamed they release highly reactive substances like hydrogen peroxide and nitric oxide, which are capable of damaging neighboring cells. The outer zone of the prostate, where the vast majority of cancers develop, contains two types of cells. These are referred to as basal cells and secretory cells. Prostate cancer appears to arise from mutations in secretory cells. Researchers believe they know why.

Basal cells have the ability to release an enzyme called GSTP1 to protect their DNA from damage. Some, but not all, secretory cells can also produce GSTP1. It appears that inflammatory substances damage the DNA of unprotected secretory cells triggering a condition called proliferative inflammatory atrophy (PIA).

With continued exposure to inflammatory substances proliferative inflammatory atrophy progresses either to a precancerous condition called high grade prostatic intraepithelial neoplasia (PIN) or directly to invasive cancer.

The progression of inflammation to PIA may take a decade or longer. Another decade may pass before PIA changes to PIN or before prostate cancer develops. That means that it is theoretically possible for a man to know that he is developing prostate cancer as much as 10 or 20 years in advance. Armed with that knowledge he could institute changes in his lifestyle or take other steps to interrupt the process.

Earlier in this article I mentioned that it is currently recommended that PSA testing begin when a man reaches the age of 50 and that levels between 0 and 4 are considered normal. In reality, approximately twenty percent of prostate cancers are discovered in men whose PSAs are below 4. Retired General Norman Swartzkopf, for example, was found to have prostate cancer with a PSA of only 1.2.

It is no longer necessary to take a “watch and wait for cancer to appear” approach. One urologist, Ronald E. Wheeler, M.D., has demonstrated that a PSA of 1 or greater is indicative of prostatitis in virtually every instance. Another urologist, Dr. Balantine Carter of Johns Hopkins Medical School, has reported that a man in his 40s or 50s who has a PSA greater than 0.7 has a much as a fourfold increased risk of prostate cancer over the next 20 years.

Knowing that the true normal level of PSA is less that 1 and probably less than 0.7 we have the ability to interrupt the development of prostate cancer years before a tumor develops and grows to a detectable size. Rather than waiting until age 50, PSA testing should begin in the thirties. Since inflammation progresses to cancer very slowly the test need not be done annually. A five-year interval would catch nearly all cases in time to take steps to reverse the process.

Perhaps early prostate screening is not performed because a system geared to treating rather than preventing disease has no answers when faced with the indication that the progression of inflammation to cancer has begun. Answers do exist, however.

The most obvious is to identify and treat the cause of the inflammation. Prostatitis is generally assumed to be due to a low-grade bacterial infection, but I have seen several instances when prostatitis resistant to antibiotic treatment responded to antifungal treatment.

When inflammation persists despite treatment for infection other measures can be taken. Simply decreasing the amount of animal fat in the diet may be enough to reverse the inflammatory cycle.

Essential fatty acids, which are found in fish oils or vegetable oils such as flax oil, help the body produce anti-inflammatory substances. It is estimated that the average person in the United States receives only 10 % of the necessary levels of these fats in the diet each day. Therefore supplementation with fish oils (commonly referred to as marine lipids) or flax, borage, or primrose oils is recommended.

Bioflavanoids, which are a family of plant chemicals, can be extremely effective in combating chronic inflammation. The most effective are oligo proanthocyanidins (OPCs), which are found in sources such as grape seeds and pine bark. Another bioflavanoid, resveratrol, which is extracted from the skins of red grapes, has not only been shown to reduce inflammation but to protect cell membranes and DNA from damage.

Systemic enzymes, the repair workers of the body, are also available as nutritional supplements. They are highly effective in reversing inflammation and have virtually no risks associated with their use.

The time has come to aggressively attack the challenge of prostate cancer. We know a least one mechanism, inflammation, by which cancer develops and we have the ability to detect that process as much as twenty years in advance of an identifiable cancer. It is no longer necessary to accept the fatalistic viewpoint that, “Every man will develop prostate cancer if he lives long enough.” It is time to begin saying, “Every man can prevent prostate cancer if he starts soon enough.”