The incidence of prostate diseases is on the increase in the West. The reason for this is complex and may be due to longer male life expectancy and increased public awareness of the problem. In the US, screening for prostate cancer has led to a dramatic increase in the detection of this cancer at a stage when it can be treated with a high probability of cure. In Ireland, which has no screening program, most patients are diagnosed at a late stage. The debate, concerning the screening and treatment of prostate cancers, remains one of the most controversial subjects in Medicine.

Since the 1980s a blood test which detects a protein produced in the prostate gland has been used to diagnose prostate disease. High concentrations of this protein indicate inflammation of the prostate. Scientists were so sure of its specificity that they called the protein Prostate Specific Antigen (PSA). Like so many certainties, this has proven to be wrong, but the name PSA has persisted.

The gene that codes for PSA in the prostate is located on chromosome 19, which is also present in women. PSA has been detected in tumours unconnected with the prostate, including female breast tumours. Hence this protein, which was originally thought to be valuable only in the male, is now under examination in female breast tumours.

In Ireland, prostate cancer is the most common internal cancer in men. It represents 11% of all cancers, and 16% of non-skin cancers in men. There are about 1,000 new cases diagnosed each year. Although the statistics for this disease are similar to those of female breast cancer, it receives considerably less publicity or health resources.

Risk factors for developing prostate cancer are complex - but include family history, increasing age, racial origin and dietary intake. As this cancer is a very slow growing tumour, many men who develop the disease die from other causes. This fact has generated an oft-quoted truism that "prostate cancer is a disease that older men die with rather than of". Prostate cancer detected while still within the confines of the gland has a good prognosis. Modern X-ray, ultrasound and biopsy techniques have improved the ability to diagnose tumours. Early detection is essential for successful treatment.

Frequent urination, inability to urinate or a burning sensation when urinating are the symptoms which indicate it is time to seek medical help. These symptoms are due to an enlarged prostate gland but are coincidentally associated with prostate cancer only if the tumour is large. Most cancers of the prostate are initially too small to cause any symptoms.

Other diseases of the prostate can cause the same symptoms. The more common prostate disease is Benign Prostatic Hyperplasia (BPH) and has nothing to do with cancer. Over half of men in their sixties and over 90% in their seventies or older will have symptoms from the prostate gland enlarging as men grow old. This enlargement is as much a part of ageing as grey hair. The prostate gland, which is part of the male reproductive system, is doughnut shaped and is wrapped around the urethra. As the prostate enlarges, it constricts the urethra, thereby impeding the flow of urine. This is successfully treated by surgery, drug or laser therapy.

The introduction of the PSA assay has had a stimulating effect both on the public and on health care workers. Even as the shortcomings of the test became apparent, more effort was put into its improvement. PSA is a serine protease belonging to the kallikrein family. In the circulation it is bound to protease inhibitors. This has contributed to some methodological problems associated with this assay. Other blood tests, either alone or in combination, are being investigated. The concentration of Insulin-like Growth Factor in blood was found to be an effective indicator. Proteins, similar to PSA but under separate genetic control, are now being evaluated for the diagnosis of prostate disease. Methods of measuring the amounts, ratios and absolute production of these proteins are the subject of current research.

The discovery of PSA in the female has renewed interest in this protein. PSA is normally produced in some women during pregnancy and in breast milk. Not all breast tumours produce PSA, but those that do seem to have a favourable outcome. At present, it is not known if the PSA produced in females is identical to that produced in males. In Ireland there is little fundamental research being carried out in prostate disease despite its increasing incidence.

Some workers in this field have described prostatic disease as "the male epidemic". Last October the theme for Europe Against Cancer Week was "Men and Cancer". This raised public awareness of prostate cancer. Every effort must be made to encourage men with symptoms to seek medical advice. This is the single most effective action that can be taken. Ideally men above the age of 50, or younger if symptomatic, should have an annual prostate evaluation as part of a health check-up. Other issues raised include the cost of maintaining funds for research into cancer, and the ever-increasing costs of financing a health service.

Surely there should be more effort put into the research and management of prostatic disease in Ireland? A chauvinistic view? Hardly, since the author is female but her husband, father, brother and half her friends are males and they all deserve the best!