The prostate is, very loosely speaking, the closest thing men have to a womb - hidden, crucial to reproduction, and not much worried about it until it packs up. Except of course that women tend to know a great deal more about their wombs than men know about their prostates.
In a profoundly unscientific poll, male colleagues reveal that the prostate lies "in the bowels", "somewhere behind you-know-where", "under the bladder, although I'm not really sure where my bladder is now that I think about it" and "at the back of your penis". There is some consensus on its uses ("it makes the watery bit of sperm" and "you can ejaculate spontaneously if it's rubbed") but little on how to safeguard its health, beyond "eating lots of tomatoes". "I do know that you mustn't drink cold coffee," one says.
For all those who aren't quite sure, the prostate is about the size and shape of a walnut, weighs about an ounce, and sits just below your bladder and not far in from the front-facing side of your rectum wall. It's quite firm to the touch: about a third of it is muscle, the rest glandular tissue. It produces the liquid that carries your sperm out of your body. And, most important of all, your urethra runs through it. Anything that's going to come out of your penis - a list which you would probably hope to confine to urine and semen - has to get past your prostate. So if anything happens to your prostate, it causes problems with urination and with sex.
Losing it altogether is no small deal: it means you can't have babies without hi-tech medical help, and it's probably not good news for your recreational sex life. That's presumably why when Nelson Mandela first had problems with his prostate in 1986 (although the growth was later found to be benign), surgeons removed only part of the organ - the more limited the operation, the more limited the chances of your surgeon severing any vital nerves.
As for the chances of something happening to your prostate - they're pretty high. If you're lucky, you'll only get benign growths of some kind or inflammation problems that will make peeing and ejaculating a pain but won't kill you. But you've got a fairly good chance of getting the cancer. The statistic most often used is that one in 10 men over the age of 40 will get it. Recent reports have suggested that by 2020, prostate cancer will be the most common form of the disease in the developed world, eclipsing cancers of the lung, bowel and breast (cases are also on the rise in developing countries, but it is far less common there). More than 400,000 new cases are diagnosed around the world each year, with about 20,000 recorded in Britain. The number of cases here is predicted to double over the next 20 years.
The three main things to know about prostate cancer are that it runs in families, you're more likely to get it if you're of Afro-Caribbean descent, and it is, generally speaking, an old person's disease. Mandela, at 83, is a prime candidate. The adage that's always trotted out is that you're more likely to die with it than of it. In this country more than 70% of 70-year-old men will have a "touch" of prostate cancer, according to Sanjiv Agarwal, a consultant urologist at Hammersmith hospital in west London.
Often there are no early warning signs, but the symptoms, when they come, include difficulty peeing and pain in the hips, thighs and lower back. These are also symptoms of benign growths or inflammation, so don't panic, but do go to your doctor. In fact, if you've got any worries about your prostate, it's well worthwhile asking your doctor for a blood test, because if detected early enough, your chances of survival are excellent: around 96%. And if it's not cancer, your doctor may well be able to help you with whatever problems you do have - you don't have to accept problems peeing as a natural part of old age.
The treatment you're offered for cancer depends on you. If you're older, or the disease has spread beyond your prostate, then surgery or radiotherapy are probably going to do you more harm than good, but anyway, hormone treatment could control the disease for many years.
For younger men, or for those where there is a risk that the cancer may spread, treatment is more radical. The main options are surgical removal of all or part of the prostate (risking incontinence and no more erections), radiotherapy (with the same kind of complications, although perhaps to a lesser extent) or brachytherapy, which involves inserting radioactive "seeds" into the organ to kill off the cancerous cells at close range. "It's very difficult to prove which treatment is less complicated," says Agarwal.
Alleged breakthroughs in treatment are two a penny - in America, for example, they now have fancy procedures which involve freezing the prostate - but basically it comes down to which is the bigger risk: living with or without your prostate. If you decide to do without, then find a surgeon who has handled his or her fair share of them.
So what to do to avoid prostate problems? Agarwal says no controlled randomised trials have been done to test whether tomatoes are a good thing, say, or cold coffee is bad. That isn't exactly surprising: controlled randomised trials tend to be restricted to the testing of potentially lucrative drugs.
He says there is mounting evidence, however, that diet and lifestyle are factors - too much fat, not good, fibre, good, vitamin C, very good - and the lower levels of prostate cancer in the developing world may back this up. "I think healthy living in general is a good idea to prevent any disease and prostate cancer is no exception," says Agarwal. Yep, same old story.
