The disease is common in men but extremely rare among boys before puberty. How common is it? Statistics are hard to come by, but a National Health Center for Health Statistics study between 1977 and 1978 found 76 annual doctor’s office visits per 1,000 men for genitourinary tract problems. Of these visits, about 19 were for prostatitis.

Prostatitis is an umbrella diagnosis that spreads to encompass three conditions—acute and chronic bacterial, and nonbacterial, prostatitis—although a fourth ailment, called prostatodynia, is often lumped into this category.

Both acute and chronic bacterial prostatitis are associated with urinary tract infections (UTIs), positive cultures that pinpoint the bacteria’s location to the prostate, and an abundance of inflammatory cells in prostatic secretions. Acute bacterial prostatitis comes on suddenly, accompanied by fever and symptoms that demand prompt treatment (see below). Chronic bacterial prostatitis typically manifests itself by repeated urinary tract infections; these keep returning when the culprit—a persistent form of bacteria—defies the antibacterial drugs intended to kill it. The bacteria usually go away for a while after antibiotics, but then they come back. The hallmark of chronic bacterial prostatitis is that, when the infection returns, it’s caused by the same type of bacteria that caused the previous infection. One reason bacterial prostatitis is so closely linked to urinary tract infections is that they often are caused by the same nasty bacteria— most commonly, by varieties of E. coli. (These bacteria also cause urinary tract infections in women.) Also, the bacteria generally are enteric—the kind commonly found in the intestines. In most cases, just one variety of bacteria is involved, but some infections involve two or more types.

In nonbacterial prostatitis, there is a similar excess of inflammatory cells in the prostatic secretions, but no history of urinary tract infections, and negative cultures. Still another ailment, prostatodyniu (which means “painful prostate”) is a good mimic, often manifesting itself by the same symptoms, but patients have no history of urinary tract infections, and they have negative cultures and normal prostatic secretions.

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In this study, the TUR patients were the clear winners in terms of symptom improvement and quality of life. They had “significantly fewer treatment failures, fewer crossovers to alternative treatment, and less bother from urinary symptoms,” the researchers noted. (Some men in the watchful waiting group eventually decided to have a TUR to relieve symptoms.) Men in the TUR group also had a greater improvement in their symptom scores, urinary flow, and quality of life. (Interestingly, spouses or “significant others” were also asked to evaluate their mates’ quality of life, and their reports confirmed the patients’ own assessments.)

The researchers concluded that TUR was safe, that it did not cause incontinence and impotence, and that it was associated with very few short- or long-term complications in men who didn’t have any serious health problems; reoperation rates were also low. Based on these findings, they determined that TUR was superior to watchful waiting in reducing symptoms and improving quality of life in men with moderate to severe BPH. However, they also noted that watchful waiting didn’t cause significant harm to anyone—and therefore, that for men with tolerable symptoms a conservative approach is certainly reasonable.

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BPH is not prostate cancer, and having it doesn’t mean a man is more likely to get prostate cancer. Unlike prostate cancer, which grows outward and invades surrounding tissue, the cell growth in benign enlargement is inward, involving the prostate’s innermost core. The key word here is benign. (In this case, hyperplasia means an increase in the number of cells in the prostate, which causes it to become enlarged.) By itself, an enlarged prostate causes no symptoms and does no harm. If it weren’t for the fact that the prostate encircles the urethra (the tube that carries urine from the bladder through the prostate to the penis), BPH might never require treatment. It takes years to develop; in fact, most men don’t realize they have BPH until the prostate begins to tighten around the urethra and hinder urine flow.

Like wrinkles and gray hair, BPH seems to come with the territory of aging. One exception to this rule seems to be men in Asia; however, BPH—as well as prostate cancer, both of which were once rare in China and Japan—is becoming increasingly common in the Far East. Some scientists believe this is related to increased “Westernization” of the traditional diet, which is low in fat and animal protein.

In this country, studies have found that the incidence of BPH increases every year after age 40; it’s present in 50 percent of men aged 51 to 60, and 80 percent of men who reach age 80. Twenty-five percent of these men—more than 350 thousand a year in this country alone—eventually will require surgery (some of them more than once) to relieve the urinary obstruction BPH causes, making BPH the most common cause of surgery in American men over age 55. The yearly cost of BPH surgery in the United States is well over $3 billion. Clearly, BPH is a significant medical problem in this country, and the numbers will only increase as our lifespans continue to lengthen.

But if BPH is almost a certainty for most men, its annoying symptoms don’t have to be. Never before have so many good treatment options—medical and surgical—been available for BPH, and never before have so many men sought, and found, relief from their symptoms.

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That is certainly one option, but we doubt that ultimately it will make a difference in prolonging life. Hormone therapy never cures; at best, it palliates cancer. An excellent example of this is a study done by the Veterans Administration Cooperative Urological Research Group, in which 1,764 men received either a placebo, surgical castration, 5 milligrams of DES a day, or the DES plus surgical castration. When prostate cancer began to progress in the men on the placebos—this happened to 70 percent of the men with stage T3 or T4 (C), and to all of the men with stage N+ and M+ (D) cancer—they began hormone therapy. The study, though not originally intended for this purpose, turned into a comparison of early hormone therapy versus delayed treatment. There was no difference in survival between the men who started hormone therapy late and the men who had been on it all along.

So what this means is that whether we treat a man with castration immediately—as soon as the diagnosis of advanced disease is made—or we wait until he has symptoms and then perform the castration, the survival is exactly the same. There is no evidence that any kind of hormone therapy works better earlier than later, when a man begins experiencing symptoms such as urinary obstruction or bone pain. We don’t believe that any man who is asymptomatic—feeling no symptoms—is going to feel any better once he has been deprived of his normal hormones. To repeat a point: The cancer cells that ultimately prove fatal in prostate cancer are the hormone-insensitive cells. They keep right on growing, unfazed by hormone therapy. To these cells, whether hormone therapy comes earlier or later does not matter.

For an asymptomatic man, early hormonal therapy means going from feeling fine and “normal” to experiencing hot flashes, loss of libido and the ability to have an erection, weight gain, changes in muscle mass, skin and hair growth and the subtle changes in personality that accompany the loss of male hormones. The long-term effects of hormone therapy can include osteoporosis— loss of bone density, which leaves bones more brittle and easy to break.

What’s the point of going through this early, when ultimately it’s not going to work any better than if a man waits to start hormone therapy until he develops symptoms of advanced disease?

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(like, “From s’percent to 85 percent of men had . . .”), it’s probably safe to assume that truly accurate results are hard to come by

Having said this, we can also say that there are some complications you can expect from implantation of radioactive seeds. They include the following.

The incidence of death from any of the procedures is extremely low. There is a huge fluctuation in the incidence of late (not immediately after surgery) complications—ranging from zero to 72 percent—depending on which study one chooses to quote; the most common range is from 10 percent to 25 percent.

*147\201\8*

The homosexual offenders vs. minors also rank second in the number who had had more than incidental homosexual activity—80 per cent, a figure far greater than the 59 per cent of the third-ranking homosexual offenders vs. children. Eighty-nine per cent had homosexual activity outside of institutions, clearly indicating a strong motivation rather than merely an adaptive response to imprisonment.

Throughout the age-specific incidence table the single homosexual offenders vs. minors occupy their customary second rank, again by a substantial margin. Beginning with 57 per cent who had homosexual activity between puberty and age fifteen, the proportion rises to 74 per cent in age-period 26-30. In age-period 31-35 the percentage drops only slightly and rises again to 82 per cent between thirty-six and forty. The maintenance of essentially the same high percentages for many years is typical only of the homosexual-offender groups; all other groups display progressively diminishing figures, the reduction usually beginning in age-period 21-25. Baldly stated, the homosexual offenders remain primarily homosexual whereas the other groups, after a teenage burst of activity, give up homosexuality. This is true even among the married homosexual offenders vs. minors, while the separated, divorced, or widowed, though never attaining the levels of premarital activity, have high age-specific incidence figures, nearly half or more of them having been involved in homosexual behavior between twenty-one and fifty. In this respect they are second only to the homosexual offenders vs. adults. The absolute numbers of married or postmarital males, however, in the various age-periods are too small to permit meaningful calculations of frequencies.

The strong orientation toward males becomes equally clear if one takes the number of homosexual acts since puberty and outside of institutions and divides by the number of postpubertal noninstitutional years of life. The average homosexual offender vs. minors had 45 a year; aside from the homosexual offenders the other most active group had scarcely 9. In frequency of homosexual activity (to orgasm) the unmarried homosexual offenders vs. minors are second only to the homosexual offenders vs. adults, the median being from about 20 to 30 times a year between puberty and age thirty. After thirty still higher frequencies occur. As a rule their frequencies are far in excess of those of the control group.

Not unexpectedly, these unmarried offenders usually rank second in the proportion of total outlet derived from homosexual activity (18-38 per cent). The married also rank second in rank-order confined to the married segments of the comparative groups, but the proportions are much smaller: 0.4 to 7 per cent.

Again excluding any prison experience, the average (median) homosexual offender vs. minors with homosexual experience had 45 male partners—over twice as many as the third-ranking homosexual offenders vs. children (19), almost six times as many as the fourth-ranking prison group (eight partners), and 13 times as many as the control group. The degree of homosexuality among the homosexual offenders vs. minors is also clear from the fact that they had twice as many male as female sexual partners (45 vs. 18); they and the homosexual offenders vs. adults are the only two groups in which male partners outnumber female.

Partly because they began homosexual activity young and continued it, and partly because they preferred quite young males, some 54 per cent of the homosexual offenders vs. minors had sexual contact, when they were aged eighteen or older, with boys aged twelve to fifteen, and an additional 38 per cent with boys under twelve.

This pedophilic tendency is substantiated fully by the age preference for male sexual partners expressed by the homosexual offenders vs. minors. While few of them (9 per cent) desired boys under twelve, 47per cent desired boys aged twelve to fifteen. Somewhat fewer preferred older males: 31 per cent inclined toward males sixteen to seventeen, and 34 per cent toward males eighteen to twenty-four. For still older males the percentages drop sharply—25 per cent preferred males aged twenty-five to thirty-four, and a scant 5 per cent mentioned males of thirty-five and over.

It is most interesting that the homosexual offenders vs. minors stressed youthfulness in their male sexual partners more than in their female partners. Indeed, only 4 per cent preferred girls aged twelve to fifteen, while 49 per cent wanted females from eighteen to twenty-four. Actually this discrepancy in age preference according to gender stems from special attributes possessed only by just-pubescent boys: a vigorous yet naive interest in sex coupled with quick response. Moreover, the homosexual adult is in an ego-satisfying position vis-?-vis such a boy: he is the dominant partner, the admired mentor, the father-surrogate. With progressively older males this position is correspondingly difficult to maintain, and the adult must shift to some other role.

With such a strongly homosexual group it is not surprising to find more of them approving than disapproving of male homosexuality (50 per cent vs. 27 per cent). Only the homosexual offenders vs. minors and adults expressed such preponderant approval. A moderate number (22 per cent) were neutral.

In discussing the heterosexual life of the homosexual offenders vs. minors we pointed out that something disastrous must have occurred between their twelfth and fifteenth year, since earlier good socialization with females deteriorated abruptly and their heterosexuality was nipped in the bud. This “disaster” can now be seen as a sudden and overwhelming incursion of homosexuality that began prior to their initial heterosexual activity and largely smothered it. “Incursion” is perhaps a misleading word; “resurgence” would be preferable since the homosexual offenders vs. minors had a great deal of homosexual behavior before puberty.

One may ask why, if homosexuality did not materially interfere with heterosexuality before puberty, it should displace heterosexuality after puberty. The answer, we fear, is simply that our society inadvertently makes homosexuals by abruptly and powerfully repressing heterosexual behavior (especially in girls) around the age of puberty. Sister can no longer be permitted to play rowdily with the boys nor hide herself with them under the porch or in the attic: society (i.e., the parents, teachers, relatives, etc.) now keeps a vigilant eye on sister. In addition, she is considered too young for dates; she enters a temporary period of asexual isolation. A young boy without a great backlog of homosexual conditioning can wait out this period during which he is robbed of girls and can still emerge primarily heterosexual; a male with much previous homosexual conditioning cannot. In societies where this temporary purdah is not imposed upon girls the incidence of predominantly homosexual males is much less than in ours.

*191\161\2*

The aggressors vs. adults share with the aggressors vs. minors the characteristic of having had a large number of petting partners. They are fourth in a rank-order of those with 31-50 partners, second in the 51-100 category, and fourth in the 101+ category (20 per cent). This sexual success is in keeping with their records of excellent socialization with females of sixteen and seventeen; over half (the second largest percentage) reported having had numerous girl companions (not necessarily sexual partners) at that age, and only 13 per cent (the second smallest percentage) reported having had none.

While not equal to the aggressors vs. minors, a large proportion of the aggressors vs. adults had petted to orgasm. By the time they were sixteen, a quarter (the second largest proportion) were thus experienced; two fifths (again second in rank) by the time they were twenty; and 46 per cent (third largest) by twenty-three.

The age-specific incidence of petting to orgasm is high for these aggressors until after age twenty-five. From puberty to fifteen they rank fourth with a figure of 17 per cent, and from sixteen to twenty they rank second with 38 per cent, just below the control group. In age-period 21-25 they drop just below the control group with 28 per cent involved, and thereafter they fall to an intermediate or low-intermediate status in the rank-orders. In brief, there was a marked youthful outburst of petting to orgasm that dwindled with age after the early twenties.

The aggressors vs. adults who did pet to orgasm tended to reach orgasm more often in their premarital petting than did the members of other groups; this is seen particularly in the frequency of such orgasms between puberty and fifteen and to a lesser degree in age-period 16-20. While the average (median) aggressor vs. adults was at those ages petting to orgasm 4 or 5 times a year, there were enough others with higher frequencies to raise the average (mean) frequency to once in two weeks between puberty and fifteen, and to a bit over once a month between sixteen and twenty, both of these frequencies being the highest recorded. However, the aggressors vs. adults owe their first rank to some insignificant, tiny differences.

Again like the other aggressors, they are particularly given to mouth-genital contact: about 41 per cent had performed cunnilingus and 66 per cent had experienced fellation by females at some point in their lives. These figures are nearly double those of the control group. In comparison to other groups, this oral activity was concentrated in premarital life and in prostitute relationships. One fourth had cunnilingus with companions before marriage (a percentage exceeded only by the aggressors vs. minors); and 34 per cent had experienced fellation prior to marriage (the highest percentage, just above that of the aggressors vs. minors). In mouth-genital contact of both sorts with prostitutes the offenders vs. adults also rank high: 6 per cent (third in rank) with cunnilingus and 59 per cent (first in rank-order) with fellation. This stress on mouth-genital contact is evident in their marital sex lives as well, the aggressors vs. adults ranking third in cunnilingus (46 per cent) and third in fellation (49 per cent). The control-group individuals rank eighth or lower in both respects.

We have previously mentioned that an unusually large number of aggressors vs. adults had sadistic dreams and masturbatory fantasies. In this connection it is worth noting that a rather large proportion of them (15 per cent, the fourth largest percentage) frequently bit or nibbled their sexual partners.

*107\161\2*

In age-specific incidence, the offenders vs. adults display in general the highest figures. In age-period puberty-15 they rank second with slightly over half of their number involved in premarital coitus with companions. In the next age-period, 16-20, they again rank second with 88 per cent. In the successive periods they rank first in period 21-25 (89 per cent), third in period 26-30 (89 per cent), and second once more in period 31-35 (93 per cent). In age-specific incidence the importance of premarital commercial sexual relationships to these offenders is rather clear. In age-period 16-20 half of them had coitus with prostitutes; in age-period 21-25 this figure increased to two thirds (fourth in rank-order); in age-period 26-30 it increased to nearly three quarters (second in rank-order); and in the following period it dropped back to two thirds (again fourth place).

The heterosexual offenders vs. adults had premarital coitus more frequently than did the members of any other group. In total median frequencies of coitus combining experience with both companions and prostitutes they lead by unequivocal margins. Between puberty and age fifteen the average offender vs. adults had coitus 1.3 times per week; this frequency increased with age, ultimately to 2.1 per week between ages thirty-one to thirty-five. In contrast, the average control-group individual began with a frequency of 0.29 (i.e., once a week less than the offender vs. adults) and never exceeded 0.75 (3 times a month) at any age. In terms of mean frequency the offenders vs. adults make a less dramatic showing but are still clearly the most active insofar as premarital coitus is concerned.

They also rank high (first to sixth) in frequency of premarital coitus with prostitutes during various age-periods from puberty on, the average offender having such coitus 4 to 5 times a year prior to age twenty and 10 to 15 times a year up to age thirty. Nevertheless, the great emphasis was upon companions rather than prostitutes; relatively few (17 per cent) had their first coitus with a paid partner.

The average (median) offender had premarital coitus with 19 companions—the largest number recorded. He also purchased coitus from 11 prostitutes, a moderate number.

Naturally, the proportion of total outlet provided by premarital coitus with companions is correspondingly great. These offenders display the largest proportions in every age-period save one (when they ranked fourth), deriving from 46 to 67 per cent of their orgasms in this way. They are the only group with percentages in the 60s, and even the lower figure of their early teens surpasses that for the adults of most groups. Until twenty-five, the proportion of total outlet derived from premarital coitus with prostitutes was moderate, but thereafter the offenders vs. adults rank first in this respect. The increasing dependency upon commercial relationships with increasing age is a trend common to most groups; it occurs too early in life to be the result of deterioration in physical appearance. It seems to be simply a manifestation of the gradually increasing dislike that older males develop for having to go through a fairly lengthy and often expensive courtship ritual in order to obtain coitus.

Only an average or below-average number of offenders vs. adults reported that their premarital coitus had been substantially inhibited by various moral and social considerations. In fact, for nearly half of them the most common restraining factor seems to have been satiation: 48 per cent gave lack of interest as a prime reason for not having had more premarital coitus. The second most common (32 per cent) factor was, naturally, lack of opportunity; however, 32 per cent is the smallest proportion reported by any group. A rather large number cited fear of venereal disease as a retarding factor, but it is obvious that this was more a source of worry than an effective deterrent. The offenders vs. adults clearly illustrate a paradoxical sexual attitude that was common in our society and that is still common in Latin American culture: they had few moral scruples about having premarital coitus (only a little over a tenth of them reported substantial moral restraint), yet close to one fifth of them demanded that their future wives be virgins. They do not usually recognize their inconsistency.

*65\161\2*

The control-group members earned their livelihood chiefly as semiskilled laborers (40 per cent), lower white-collar workers (32 per cent), and skilled laborers (24 per cent). The prison group presents a different picture of employment; about half of them were semiskilled, two fifths unskilled, and one fifth lower white collar. More significantly, a full quarter of the prison group had at least at one time derived their living from illegal activity. The sex offenders, taken as a whole, are like the prison group minus much of the element of professional crime

Most of the sex-offender groups consist chiefly of unskilled and semiskilled laborers; the proportion of white-collar workers exceeds one fifth only among the homosexual-offender groups, and the incest offenders alone have more than one fifth of their members who held skilled jobs. The amount of illicit employment varies from zero up to a figure exceeding that of the prison group. Aside from the homosexuals, much of whose “criminal activity” consisted only of selling their sexual services, in only three groups had over 10 per cent supported themselves through illegality. These were the aggressor groups, the aggressors vs. children with 24 per cent, those vs. minors with nearly 30 per cent (well above the figure for the prison group), and those vs. adults with 16 per cent.

We also recorded the occupational status of the parents of each individual. When the subjects are compared with their parents some interesting trends are revealed. With regard to the control group, the differences are inconsequential: more of the men move up into white-collar jobs, but other shifts involve only a few percentage points (see Table 8). Among the prison group and sex offenders, however, one sees a definite downward trend; members of these groups often move down into jobs of lesser status than those of their parents. In the prison group the per cent of unskilled labor among the sons is twice that of their fathers, and the figure for skilled labor is halved. Of course the greatest change lies in the proportion who supported themselves by crime: this is scarcely 2 per cent in the parental generation and over ten times that among the sons. The sex offenders as a whole show a rather similar downward mobility. There is little change in the white-collar picture, but in the blue-collar area there is a shift from skilled to unskilled labor like that noted in the prison group. Again, as in the prison group, the proportion of illegal employment rises markedly (from 1 to 10 per cent).

Certain sex-offender groups do not fit the above general picture. The incest offenders tend to improve upon their fathers’ records, substantially increasing the proportions of semiskilled and skilled job. Aside from the incest offenders, every offender group reveals a marked reduction in the category of skilled labor, usually accompanied by an increase in unskilled labor—this disinclination to develop a skill through hard work and patience appears, in hindsight, a bad omen

*22\161\2*