CHAPTER 4

What Is the Prostate?

“Each ejaculation contains several billion sperm cells—or roughly the same number as there are people in the world—which means that, in himself, each man holds the potential of an entire world . . . As Leibniz put it: ‘Every living substance is a perpetual living mirror of the universe.’”

—Paul Auster, The Invention of Solitude

“Human strength will not endure to dance without cessation; and everyone must reach the point at length of absolute prostration.”

—Lewis Carroll

The prostate: The one unpronounceable word in medical school. Even in the fifth edition of Shearer’s Manual of Human Dissection, a book I used in my first semester human anatomy class, the prostate is listed as the “prostrate” in the index.

Later, when I was practicing internal medicine before moving into psychiatry, I would be asked by male patients after a rectal exam, “How’s my prostrate, doc?” “Your prostrate feels fine,” I would reply, going along with their humble pronunciation, knowing I could pronounce it no better.

The prostate is a chestnut-shaped organ at the base of the penis in the lower pelvis, partly muscular and partly glandular. It secretes a milky fluid that is discharged into the urethra at the time of the emission of semen, the discharge thus mixing with the seminal fluid from the seminal vesicles at the time of ejaculation and orgasm. The bilateral seminal vesicles lie just above the base of the prostate. The fluid from the seminal vesicles and the prostate empty into the vas deferens, filled with sperm cells from the testicles, to form the fertile ejaculant that perpetuates our species. Interestingly, the seminal vesicles are resistant to virtually all of the disease processes that affect the prostate—no inflammations (as in prostatitis), no cancers.

The word “prostate” comes from the Latin “pro” and “stata,” formerly from the Greek “pro” and “statos.” The prostate stands as a “guardian”—something “placed” and “standing.” In other words, if one loses one’s prostate, from cancer and its various treatments, one loses one’s guardian. Indeed one is barely left standing; one’s penis can barely stand up straight. Losing the prostate can lay a man low—well-nigh prostrate.

Only mammals have prostates. As female mammals developed mammary glands to feed their young, the males developed prostate glands at the same time.

Male cats and dogs have prostates; all the male apes and monkeys have prostates, as do bulls and male elephants,

Not all mammals have seminal vesicles. Carnivorous mammals—meat-eaters like lions—do not have seminal vesicles. For some peculiar reason, not having seminal vesicles while being a meat-eater protects an animal from developing prostate cancer. Almost all animals that have both prostates and seminal vesicles are herbivores—vegetable-eating animals like bulls, apes, and elephants.

Human males are the exception to the rule: We are virtually the only mammalian males who have both the prostate and seminal vesicles and who also eat meat. Our closest evolutionary relative—the pygmy chimp or bonobo—has seminal vesicles and a prostate and only eats fruits and vegetables and greens. Bonobos never develop prostate cancer.

We humans are too clever for our own good. We have planted the seeds for our own destruction—if not the destruction of our species, then at least the destruction of our prostates. When our evolutionary predecessors 600,000 years ago developed the capacity to cook, we became committed carnivores. When the earth’s climate and temperatures stabilized 10,000 to 12,000 years ago, we human beings began to domesticate animals. We quit running after animals and instead began to herd them and breed them in captivity. We also became much more sedentary.

The only other animal to develop clinically significant prostate cancer with any regularity is the dog—the pet that eats from our human table, the pet that eats virtually the same food—and meat—as people.

The prostate and its ruination via prostate cancer may truly be the ultimate sentinel, the ultimate tiny chestnut-shaped canary in the human coal mine. This highly vulnerable organ is indeed trying to tell us something essential. We ignore this organ at our own risk.