Dr. Emmanuel L. Sta. Cruz

   I have read once that ancient Chinese doctors were paid keeping their patients healthy, not when they are sick. This truly exemplifies the importance of prevention and promotion of Genitourinary and Prostate Health that I advocate. 

   Why does a problem have to be difficult when it could be easier when addressed early on? Why not focus on prevention by keeping a healthy Prostate?

 

I. Importance of a Healthy Prostate

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   The Prostate is indeed an important gland. Among other things, the Prostate Gland plays a primary role in converting testosterone into 4-Dihydrotestosterone (DHT) which is the potent form of testosterone, about 5 times more powerful, and is essential for a man's libido or sexual drive (Robert Veltri & Ronald Rodriguez, Campbell-Walsh, 2007). DHT is indeed the primary male hormone responsible for a man's Erectile Function rather than raw testosterone.

   DHT likewise increases protein production to build muscles, promotes calcium absorption for increased bone density and performs a major function in fertility. Since a healthy Prostate is a source of DHT,  I have always considered the Prostate as one of the sources of the fountain of youth. I have observed that men aged 45-65 with a diseased Prostate usually look older, while younger men experience diminished muscle mass, decline in sexual function, fatigue, and decreased energy levels. So I believe it is essential to keep the Prostate healthy to promote men's strength and vigor.

 

II. Prostate Disease may start with "Prostatitis"

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   Prostatitis is an infection of the Prostate Gland and may be without symptoms. Prostatitis can affect all adult men from all walks of life, young and old, those in monogamous or polygamous relationships alike and even virgins. It may be acquired early in their teens from organisms found in soiled underwear, previous sexual contact or Urinary Tract Infections (UTI). Almost all men are harboring various organisms inside their Prostate. Definitely an infection of the Prostate is not healthy. Prostatitis can cause Urinary Symptoms, Erectile Dysfunction, Prostate Enlargement, elevated PSA, Prostate Cancer and even Infertility. Ironically the test and means to diagnose Prostatitis is not routinely done.

 

III. How to Keep a Healthy Prostate

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   My experience has taught me that a Periodic Maintenance Prostate Massage allows a man to periodically throw out the garbage accumulating inside the thousands of individual Glands before these Glands are destroyed. Imagine, if we focus our future directions on Prostate Health and in the process, achieve a healthier Prostate, then we may stand a chance in putting a stop to Prostate Disease. Thereby, doctors in the future would be seeing patients for a Preventive Prostate Massage to keep their Prostate Healthy rather than seeing them for treatment of Prostate Disease.

 

IV. Prostatitis Slowly Destroys the Individual Prostate Glands 

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   Prostate Health means preserving the function and integrity of all these thousands of individual glands within the Prostate before they are completely destroyed by an infection.

   When the Prostate Gland starts to become rubbery in consistency and yield less fluid, this could be the start of a critical stage of the Disease Process which could lead to Atrophy wherein the damaged glands lose much of its fluid as well as its function that, if left untreated, may either end up in Fibrosis, that is, losing the glands one after another,  or lead to Prostate Cancer. 

   While Atrophy was typically considered to be a process affecting the elderly, now, it is said to be present in at least 70% of men between 19 and 29 years of age (Magi-Galluzi et al., 2007). This finding should serve as a wake-up call for young men since this may be the last stage to diagnose and treat Prostatitis that caused the Atrophy before Fibrosis or Prostate Cancer sets in.

 

V. How to Diagnose Prostatitis

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   Accordingly, since 1968 the 4-Glass test of Meares-Stamey has been the standard in diagnosing Prostatitis patients today (Nickel, 1999). This entails among others, an examination of the pure Expressed Prostatic Secretion (EPS) or Prostate Fluid by means of Prostate Massage and doing cultures of the said Prostate Fluid. A more complete test should include cultures for Ureaplasma and Mycoplasma bacteria as well as a test for Chlamydia using Direct Fluorescence Antibody (DFA) test by Immunofluorescence microscopy. These tests should be routinely done as these microorganisms have been shown to cause Prostatitis. Otherwise, how would you know whether you have Prostatitis if these tests were never done on you? 

 

VI. Traditional Standard of a Healthy Prostate Gland

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   Generally, the Prostate Gland is deemed healthy when the Prostate is said to be normal in size, smooth, soft and with no palpable mass during a Digital Rectal Examination or DRE.

Prostate ultrasound, either Abdominal or Transrectal, is another popular way to evaluate a patient's Prostate condition. The Prostate is generally said to be normal (by ultrasound) if the size is between 10 to 20 grams and no pertinent findings are seen.

   In the last decade, Prostate Specific Antigen or PSA was being used solely or sometimes in combination with either of the two other tests as a  Prostate Cancer test. But the use of PSA as a screening test for Prostate Cancer has been controversial from the onset, and until just recently the U.S. Preventive Task Force issued a recommendation statement against the routine use of PSA for cancer screening as it has been found to do more harm than good. (Annals of Internal Medicine, July 2012). 

   Unfortunately, the three prevailing diagnostic tests namely, Digital Rectal Examination (DRE), Prostate Ultrasound and PSA test, which are routinely done to assess one's Prostate condition, does not necessarily reflect the true state of one's Prostate Health, as none of these tests can directly diagnose "Prostatitis" which is unhealthy. 

 

VII. A More Comprehensive Standard for a Healthy Prostate Gland

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   The attributes of a healthy physical state of a Prostate should not rely on the size of the Prostate alone, but rather focus on the following:

 

1. The Consistency of the Prostate

2. The Volume of fluid that can be extracted by Prostate Massage as this could be reflective of the number of glands that are still functional and capable of producing fluid. A normal-sized Prostate should yield at least 10 to 20 drops of Prostate fluid, while a larger one should yield more. 

3. The WBC count of the Prostate Fluid as an elevation connotes an infection. A normal WBC count of a Prostate Fluid is 0-5 WBC/hpf or 0-2 WBC/oif.

 

   These last two attributes are important parameters of a Healthy Prostate that have not been given much attention. Then how would you ever know how many drops of Fluid your glands could yield and whether the WBC count of your Prostate Fluid is within normal if these two parameters were never tested.