Antidepressants Blog

Say you have some of its symptoms and they go away. Everything’s fine, right? Maybe. But you should still have your prostate checked out. Other causes for these symptoms could be serious, and include:

A urinary tract infection that does not involve the prostate;

Benign prostatic hyperplasia (BPH), or enlargement of the prostate;

Urethritis, or inflammation of the urethra, often caused by an infection. Not seeking treatment for this condition could result in a urethral stricture or a nasty infection that progresses back into the vas deferens and involves the epididymis .

In rare instances, urinary problems such as those manifested in prostatitis could indicate something even more serious, such as bladder cancer; they also could mean a stricture or blockage in the urethra, an infected kidney stone or early signs of diabetes.

There are causes of prostatitis other than the ones we’ve covered here; these are not only extremely rare, but they’re secondary to another disease, such as gonorrhea or tuberculosis. In some parts of the world (but hardly ever in the United States), prostatitis can be caused by parasites or fungal infection.

*308\201\8*

This group of procedures can be divided into three categories based on temperature. The normal body temperature, 98.6 degrees Fahrenheit, is 37 degrees centigrade. All of the temperatures discussed below are in centigrade.

Hyperthermia, the mildest approach, uses temperatures that are less than 45 degrees—which probably isn’t hot enough to accomplish major relief of obstruction. In thermotherapy, tissue is heated to temperatures greater than 4s degrees—at which point some cellular protective mechanisms are overwhelmed, and normal cells are destroyed. To make sure only the BPH tissue is destroyed, temperatures in the region are monitored closely during this treatment. Thermal ablation techniques can produce the hottest temperatures of all—above 60 degrees—and are usually performed using high-intensity focused ultrasound, transurethral microwave therapy, interstitial radio frequency waves, and lasers.

An important fact about thermal therapy is that—except for contact laser prostatectomy—the BPH tissue in the targeted area is killed but not removed. One problem with this is that many men experience acute swelling immediately after these procedures and may need a catheter until the dead tissue is re-absorbed by the body, or is sloughed into the urethra and washed away in urine. (Another problem is the lack of tissue samples for pathologists to examine.) This marks a big difference from surgical procedures such as TUR, where the obstructive tissue is extracted, and the patient generally can urinate well immediately afterward.

As noted, temperatures in hyperthermia range from 41 degrees to 45 degrees. As heat treatment goes, these temperatures are rather lukewarm. Hyperthermia is not painful, and it can be performed as an outpatient procedure; it usually involves multiple treatments. It can be done in two ways—trans-rectally, by a probe inserted into the rectum, and transurethrally, by an instrument inserted through the penis into the urethra.

The technique has only recently undergone randomized, placebo-controlled studies, in which patients were treated without knowing whether the heat generator was activated. The largest recent study has demonstrated no significant objective improvement in urinary flow rates.

Why is this? For more than a century, doctors have known that heat can kill cancer cells. Hyperthermia as a treatment for BPH grew out of techniques used to treat malignancies, including prostate cancer. It can be given to cancer patients along with radiation because rapidly multiplying cancer cells in certain phases of division are particularly susceptible to heat.

The basic problem here is that normal cells respond differently than cancer cells; and just because a technique works on cancer cells, it doesn’t necessarily follow that it will work in normal tissue. BPH tissue—though growing—is benign, not cancerous, and it just isn’t that sensitive to these temperatures. Scientists who have looked under the microscope at BPH cells heated to 45 degrees have trouble telling them apart from BPH cells that have not been treated. Hyperthermia isn’t hot enough to kill BPH tissue. The tissue reacts, certainly, but the results are not permanent, and the injured tissue eventually recovers. So at this point, using temperatures less than 4S degrees should be considered an ineffective solution to a long-term BPH problem.

*269\201\8*

Nobody knows what causes BPH; that’s why doctors are unable to prevent it, or even to make it go away completely once the disease process has begun. Briefly, here’s what we do know: Hormones play a major role, but their presence may only be permissive—they may simply provide the necessary soil for the disease to take root and grow. Aging is crucial to the development of BPH; as men age, the prostate becomes more sensitive to hormones. Family history is important, particularly in families where men develop BPH at a relatively young age. The balance between epithelial an A muscle cellsis also important for the development of the disease, as is the role of growth factors, but in what ways? For doctors to fill in these blanks, much more research is needed. Basically, BPH is a different disease in every man. Its many symptoms—and how a man responds to treatment—depend on an intricate interplay of factors, including the site and configuration of the enlarged lobes, the ratio of smooth muscle and glandular tissue involved, and how all these things affect the bladder.

BPH Causes Urinary Trouble.    

Obstructive Symptoms Weak flow

Hesitancy in starting urination; a need to push or strain to get urine to-flow

Intermittent urine stream (starts and stops several times) Difficulty in stopping urination “Dribbling” after urination

A sense of not being able to empty the bladder completely Not being able to urinate at all

Irritative symptoms Frequent urination, especially at night

A strong sense of urgency in urination; inability to postpone urination

Sleep disrupted by the need to urinate Urgency incontinence

*231\201\8*

Currently, researchers are working hard to develop analogs or “cousins” of suramin—to make it more powerful, with fewer side effects. And scientists are investigating whether suramin given in combination with another drug— EMCYT, perhaps—might be more effective.

“We’re talking about the very end of a lifetime of a tumor here,” says the Johns Hopkins oncologist. “By this point, tumors become resistant to drugs in many ways; they express different pathways of resistance. If you treat with Drug A, for instance, this may be effective against a certain portion of the tumor, but probably not all of it—some part of that tumor is probably going to be resistant to that treatment. Therefore, because we’re dealing with a heterogeneous disease, it’s unlikely that any one drug is going to make a significant impact.”

Timing of treatment also may make drugs such as suramin more effective. Some doctors are letting PSA be the guide to beginning additional treatment. “In following men on hormonal therapy,” says the oncologist, “if we see that the PSA is rising—even before patients develop problems—that is probably a better time to start (with other drugs) because the disease is not as extensive as it becomes if you wait until pain, weight loss and other cancer-related symptoms begin.”

*192\201\8*

Treatment planning begins with a series of CT images that give enough cross-section views of the prostate, seminal vesicles, and surrounding terrain (including the bladder wall, rectal wall, small bowel, bony structures and skin) to create a three-dimensional reconstruction. Dosage, and the area over which it will be distributed, can be calculated plane by plane, millimeter by millimeter. Each radiation beam—the 3-D approach allows more segments of treatment than traditional therapy—is automatically shaped by the computer so the energy focuses on the tumor alone (in the prostate as well as in tissue outside the gland where cancer has spread), rather than its entire neighborhood. A special body cast is custom-built for each patient to minimize movement during a treatment session, and also to make sure that a man’s exact position can be reproduced every time. Several quality-control mechanisms are built into this approach; after-the-fact or instantaneous means of verifying that the radiation went to the right spot for the right length of time help guarantee the most successful treatment possible.

Right now, it’s impossible to predict how well these techniques will work. There’s just not enough information yet to give meaningful results on PSA levels after treatment or to predict long-term survival rates; however, this information should be available within a few years. At eighteen months after treatment in one study, only 3 percent of the men had a local recurrence of cancer (two of these were men with stage T2C, or B2, cancer; and five had stage T3 or T4, or C, disease. The best we can say right now is that early results suggest an excellent potential for 3-D conformal therapy.

*154\201\8*

The childhood of the homosexual offender vs. minors was marred by a bad relationship with the father and a poor one with the mother. Lack of affection and open friction seem to have characterized the household.

Perhaps as an escape from the home situation, the future offender socialized very well with other children and had numerous friends of both sexes. This was accompanied by a large amount of prepubertal sex play, somewhat more homosexual than heterosexual, involving a considerable amount of oral and anal activity. The relatively extensive prepubertal sexual behavior of this group included an unusually large number of them having sexual contact with adult males.

After puberty the heterosexual component of the lives of these offenders atrophied and their sexual orientation became increasingly homosexual. Among the single men there was relatively little hetero sexual petting and coitus, and correspondingly more masturbation and homosexuality. Only a relatively few of these offenders married, and extremely few were married at the time of the offense.

About half of the men had had extensive homosexual activity, and in the others there was generally a strong homosexual inclination. The great bulk of the homosexual offenders vs. minors appears to be (1) predominantly homosexual men who have retreated from adult homosexual competition and turned to boys, and (2) ordinary homosexuals who, due to situational factors or lapse of judgment, have taken as a sexual partner someone far younger than they ordinarily choose.

*198\161\2*

The number with coital experience by a given age is relatively small in early life. Some 80 per cent ultimately had premarital coitus, but in this instance 80 per cent is a rather low figure, exceeded by all groups except the controls, two of the homosexual-offender groups, and the peepers (the latter being a youthful and restrained group). By age fourteen one fifth (the third smallest percentage recorded) had had premarital coitus; by age sixteen 35 per cent, again the third smallest percentage; and by age twenty the incest offenders vs. adults once more occupy the third lowest position in the rank-order with 65 per cent of their members experienced. The control-group individuals usually surpass them by any given age, and the only less experienced groups are homosexual offenders.

The age-specific incidence of premarital coitus with companions is quite low among these offenders. Between puberty and fifteen they are third from the bottom of the rank-order with about one fifth of their members having such coitus. In the next two age-periods, 16—20 and 21-25, they are second from the bottom with slightly less than half of them involved. In these same age-periods 60 and 73 per cent of the relatively conservative control group had had premarital coitus with companions.

There is nothing unusual in the number of incest offenders vs. adults who had coitus with prostitutes nor in the number whose first coitus was with prostitutes. However, the number who had had such coitus by a given age is always relatively low because of the general restraint exhibited in premarital coitus. The age-specific incidence of premarital coitus with prostitutes is also low to moderate. However, it is noteworthy that in the very age-period, 21-25, in which most were marrying, the age-specific incidence of coitus with prostitutes exceeds that of coitus with companions. We seem to have here die dichotomy between the “good girl” whom you marry and the “bad girl” (or prostitute) with whom you have coitus.

Too few individuals were involved in coitus with prostitutes to permit us to say much regarding the frequencies of such activity within the various age-periods.

In terms of frequency of premarital coitus with companions, the incest offenders vs. adults rank low to intermediate wherever our data permit calculation. Of those who had premarital coitus, the average (median) individual had it about 20 to 25 times a year between age sixteen and twenty-five.

The incest offenders vs. adults reported a total of five premarital companions, the smallest number of any group, but the fourth largest number of prostitutes (16) prior to marriage. Summing up these data, one gains the following impression: these offenders, being traditionalists, subscribed to the standard that nonmarital coitus is a sin to be avoided, but if one cannot avoid it, one should go to prostitutes rather than seduce “good girls.” This philosophy results in less premarital coitus, relatively small numbers of nonprostitute companions, and relatively large numbers of prostitute partners. The proportion of total outlet constituted by premarital coitus with companions is moderate. However, like other incest offenders, the incest offenders vs. adult daughters derived a relatively large proportion of their total sexual outlet from premarital coitus with prostitutes at ages sixteen to twenty, when they are in fourth place, and at ages twenty-one to twenty-five, when they are in second place.

The major reason for their premarital restraint becomes apparent when one examines the various factors that reportedly held them back. The incest offenders vs. adults occupy first place among those who gave moral considerations as a reason (36 per cent), and they also had by far the largest number (24 per cent) who reported that fear of public opinion restrained them. Lastly, they again are first in rank-order (29 per cent) among those strongly desiring to marry virginal women. In brief, the incest offenders vs. adults appear as our most moral, traditional, and conservative group. Only moderate to low numbers of them reported that other factors, such as fear of disease and pregnancy and lack of opportunity, operated as important restraints; the incest offender vs. adults is unabashedly moral. He does not conceal this fact by rationalizing, and the importance he attaches to morality correspondingly reduces the importance of other restraints.

*156\161\2*

The aggressors vs. adults had a rather substantial record of juvenile convictions: 22 per cent, the fourth largest proportion. Five per cent, a moderate figure, had been convicted for juvenile sex offenses.

These aggressors came into conflict with society more rapidly than most sex offenders, essentially paralleling the prison group up to age twenty and then outstripping them. By age twenty-six some 87 per cent had been convicted for some crime—a figure exceeded only by the aggressors vs. minors. By age thirty the proportion had risen to 96 per cent—the largest proportion recorded by that age. Compared with other groups, many of these aggressors were convicted of serious crimes; by the time they were twenty-six over two-thirds of them had committed at least one offense that cost them a full year or more of prison time. Again, only the aggressors vs. minors surpass this figure, and no other group comes near equaling it.

Approximately half of the convictions were for sex offenses and slightly fewer were for other offenses; this is a somewhat, though not markedly, low percentage of sex offenses. One third of the men had only sex offense convictions, and again this is a relatively small percentage; the aggressors rank one, two, and three in having fewest “pure” sex offenders.

With this relative stress on nonsex offenses one might expect to find the aggressors vs. adults specializing in some type of antisocial activity, but actually their convictions show no marked concentration. However, they do show, like other aggressors, a predilection for crimes against the person: in these they rank fourth, with 14 per cent of their convictions being for such behavior, and the per capita incidence being 0.27. Again like other aggressors they had few crimes against order.

Considering now the other sex offenses committed by these men, one finds that aside from aggression against adult females the most frequent offenses were against willing or acquiescent females (27 per cent), exhibition (21 per cent), and peeping (19 per cent). Only rarely was there aggression against minors or children; these men were strongly oriented toward adult females. As we mentioned in discussing the aggressors vs. minors, the proclivity to exhibit is not incompatible with aggression, since exhibition may in these cases be a hostile act designed to shock and frighten. Similarly, the stereotype of the timid, harmless peeper need not interfere with our finding that nearly one fifth of these aggressors’ sex-offense convictions were for peeping: after all, a certain amount of reconnaissance is necessary in selecting the object, time, and place for rape.

Concerning recidivism for all types of crime the aggressors vs. adults are remarkable in only one respect: few (17 per cent) were not recidivists. However, they are far less recidivistic than their brothers, the aggressors vs. children, and are more like the aggressors vs. minors.

While the aggressors vs. minors were quite distinctive in the incidence and intensity of response to nonphysical stimuli such as sight and thought, the aggressors vs. adults were undistinguished in all except one of our measurements. This one exception, appropriately enough, was response to pictures or stories of sadomasochistic activity. In the proportion of men reporting sexual arousal from this source (15 per cent), the aggressors vs. adults were second only to the aggressors vs. minors. Similarly a relatively large number (7 per cent, fourth in rank-order) stated that their arousal was strong or frequent.

*114\161\2*

Of all comparative groups, the offenders vs. adults were least responsive to the sight or thought of the opposite sex, a full two fifths reporting little or no sexual arousal from such stimuli. Some of their unresponsiveness may be attributed to the fact that they had, as a group, one of the lowest intelligence records. Only a small number, 17 per cent, reported strong arousal. They rank low again in terms of response to members of the same sex, some 94 per cent claiming they had none. Only one group had fewer men who reported sexual arousal from viewing pornography: three fifths of the offenders vs. adults professed little or no response to this material. Nevertheless, they rank third, with 14 per cent, in proportion of men who were sexually aroused by sadomasochistic pictures or stories—a finding not in agreement with their reported masturbatory fantasy or dream content. Since we usually phrased our question, “Do stories of rape, torture, or violence arouse you sexually?” it may be that the rape portion of the question appealed to some of these offenders, many of whom have a streak of “machismo” in their sexual philosophy anyway. We suspect, but cannot prove, that had we asked solely about torture, whipping, and bondage, we would have received considerably fewer affirmative replies from the members of this group.

The general lack of response to anything save physical contact is to be expected in a group with high frequencies of sociosexual activity (i.e., they tend to be satiated), limited intelligence, and little education (i.e., they tend to be unimaginative and direct in their outlook). We have found that males of the lowest socioeconomic level generally require rather concrete stimuli with the prospect of immediate reward in order to evoke a sexual response. Pictures, stories, or even the sight of an unavailable living female mean little to these men, who are empirical in the extreme. Our offenders vs. adults and, to a somewhat lesser degree, the offenders vs. minors, contain a large proportion of individuals from this stratum of society.

The offenders vs. adults tie with the control group in having the smallest number (6 per cent) of alcoholics. They were not against alcohol, for we find that in both groups only about one sixth of them abstained from its use. This is not an unusual proportion of teetotalers.

There were also very few drug users in the group. Only 9 per cent, the third smallest percentage of any of our comparative groups, had used any drug for euphoric purposes.

Neither were they, as a group, gamblers: 56 per cent, the second largest percentage, had never gambled and very few (25 per cent) had what we call social gambling in their histories. However, a moderate proportion, about one sixth, had gambled seriously in the sense of deriving an appreciable part of their income in this way.

*72\161\2*

Two thirds of our sample of heterosexual offenders vs. children had married; however, the accumulative incidence data show that ultimately at least 81 per cent married. The average married offender vs. children was twenty-three at the time of his first marriage and had lived 41 per cent of his life between puberty and time of interview as a married man. None of the foregoing figures is unusual. However, number of marriages is a different story: of all groups, the offenders vs. children had next to the fewest who married once; they rank fourth in those married twice; and third in those married three times or more. The broken marriages were not of particularly short duration—the offenders vs. children are intermediate when one calculates the number of marriages that lasted two years or less and ended in separation or divorce. On the other hand, they were prone to rush into marriage: the average offender vs. children had known his wife somewhat less than four months before marrying her. This is the third briefest courtship record, and may explain in part the high divorce and separation rates. At this point it should be noted that the average control male had known his wife nearly 17 months prior to marriage.

Not quite half of the heterosexual offenders vs. children had coitus with the women who became their first wives; this is a low proportion —probably the result not only of brief courtship but also of the strong moral restraint regarding premarital coitus that these offenders reported. This abstention resulted, naturally, in relatively few of the brides being pregnant at marriage or unwed mothers.

In regard to fertility in marriage, about 19 children were produced per ten married offenders vs. children, and while this is neither few nor many in comparison with other sex offenders it is below par considering the age of the group, and below the control group.

Turning now to the specifically sexual aspects of marriage, we find

that the offenders vs. children were somewhat inclined to precede their

marital coitus by only brief foreplay. Some 41 per cent (the fourth

largest proportion) averaged less than three minutes of foreplay, while

about half that number indulged in protracted (30 minutes plus) pet-

ting. Fellation and cunnilingus occurred in a moderate percentage of

cases.

While the frequency of premarital coitus among the offenders vs. children was in no way unusual, they had the highest over-all frequency of marital coitus of any group. True, in their earlier years the frequencies are not exceptional, but from twenty-six to thirty the median individual ranks third; from thirty-one to thirty-five, second; and in subsequent periods, first. Calculation of mean frequencies does not reveal so marked a trend, but the offenders vs. children are always high, ranking fourth from age twenty-six on. A similar situation is seen when one examines the proportion of total sexual outlet derived from marital coitus: it is usually moderate up to age forty, but thereafter the offenders vs. children rank first or second, with over 90 per cent of their orgasms derived from coitus with their wives.

According to the husbands, in about 55 per cent of their years of married life their wives experienced orgasm in 90 per cent or more of their marital coitus; in 17 per cent of their married years their orgasms ranged from none at all to 10 per cent. This report is somewhat on the low side when compared to the estimates of other sex offenders. Possibly this tendency toward fewer orgasms stems in part from the rather high frequency of coitus coupled with the somewhat brief foreplay.

Despite the divorces, separations, and numerous marriages, these offenders had the second largest proportion of members who reported very happy marriages. Only the control group were more fortunate. Conversely, rather few offenders vs. children reported unhappy marriages.

The abundance of marital coitus and the high degree of happiness in marriage did not, however, prevent some 31 per cent of the offenses vs. children being committed by married men.

*29\161\2*