After twenty years, what began as a hunch about prostate cancer has turned into a remarkable breakthrough.
News this week that billionaire investor Warren Buffett intends to undergo radiation therapy for early-stage prostate cancer has refocused the nation's attention on a curious and perplexing disease. At 80, Buffett's chance of dying from prostate cancer as opposed to something else is fairly low -- prompting some to wonder if he'd be better off avoiding treatment altogether.
The uncertainty surrounding Buffett's diagnosis is a perfect example of how little we still understand the prostate. Back in 1993, Charles Mann penned a lengthy story for The Atlantic called "The Prostate-Cancer Dilemma," in which he explained how scientists came to understand the causes behind prostate enlargement, a related but benign condition:
[Benign prostate hyperplasia, or BPH] is linked to the presence of male hormones, especially testosterone, and male hormones are necessary to maintain interest in sex. Past efforts to treat the condition without surgery involved blocking the effects of testosterone, which risked eliminating a man's libido.
That was before researchers discovered that prostate enlargement -- an affliction that puts pressure on the bladder and makes it hard for men to urinate -- was due to a very specific kind of testosterone called dihydrotestosterone, which itself was the product of a prostate secretion known as 5-alpha-reductase. Treating BPH medicinally, then, meant blocking the effects of 5-alpha-reductase -- and soon, the pharma company Merck was selling a drug called finasteride that could do it. (Incidentally, finasteride is sold under two brand names. Proscar is the one that targets BPH. The other comes in the form of a little hair-loss remedy called Propecia.)