A: Your doctor’s advice agrees with the literature I’ve reviewed. What’s most convincing and pleasing to you, no doubt, is your own positive experience.

      The prostate is a small gland in men that encircles the neck of the bladder and the urethra (the tube connecting the bladder to the outside of the body). Just before ejaculation occurs the prostate adds some fluid to the semen, which carries the sperm.

                            

      Prostate disorders are among the most common health problems men encounter. The prostate generally gets larger as men age, particularly after age 55, and this growth can pinch the urethra, making it difficult to empty the bladder. The condition is usually painless, but it can be frustrating to live with. Full-blown prostatitis occurs when the gland gets infected or irritated. The swelling can block the ducts that drain the prostate of fluid. This can further aggravate an infection.
      If the enlargement becomes too great (a normally chestnut-sized gland can become as large as an orange), or if cancer develops, surgery can sometimes interrupt a man's sexual functioning. Radical surgery that involves incisions in the perineum, the area between the anus and the scrotum, frequently results in the loss of erection ability. Minor surgery that leaves most pelvic nerves intact in most cases will not impair erections. Allow for recovery time, sometimes up to nine months, before expecting pre-surgical sexual functioning to return.
      So, as you found out, it's important to maintain the health of your prostate. How often to get a prostate examination depends on several factors. Men over 40 with prostate problems in their family history should get annual exams, as should African American men, who have the highest incidence of prostate cancer in the world for reasons not yet determined. Other men over 40 should be examined every two years, and all men over 50 should have annual prostate examinations. When problems — including cancer — are detected and treated early, chances for recovery are greatly improved.
      As for your doctor's recommendation of saw palmetto, the herb has been catching on in the last few years. It is derived from a palm tree that typically grows in the southeastern United States. The tree produces a dark berry that was used a century ago to treat urinary problems.
      Saw palmetto acts like the prescription medication Proscar (finasteride), which is often prescribed for men in their 50s and older. The hormone dihydrotestosterone, normally present in men, may begin to cause prostate overgrowth in older men. Saw palmetto causes the prostate tissue to shrink, so there is less pinching on the urethra as it goes through the prostate on its way to the penis.
      Saw palmetto had been used as a diuretic by Native Americans and physicians for many years. But during the 1940s and 1950s, the medical establishment in the United States preferred laboratory synthesized drugs over herbal approaches. Most herbs that had any effect on the pelvic area of men and women were perceived as "sex herbs" and came into question in the 1950s. So, saw palmetto was abandoned as a treatment.
      While saw palmetto is growing in popularity again, it pays to keep in mind when using any herb that they are considered nutritional supplements by the Food and Drug Administration and therefore are not tested for safety or effectiveness. And even though herbs are called "natural" products, overdosing is possible.
      You also may have an advantage because of your vegetarian diet. In 1995, Alice Whitemore of Stanford University studied 1,665 men with prostate cancer and an equal number of matched controls, or men without prostate cancer who were similar in most other important ways. Whitemore and her colleagues found that as dietary saturated fat consumption increased, so did the presence of prostate cancer.
      The National Cancer Institute agrees with the findings of this and many other nutritional studies that have pointed to the health benefits of a low-fat, high-fiber diet. The NCI has shown its support by creating the "Strive for Five" program to encourage five servings of fruits and vegetables daily to decrease the rate of nearly all types of cancer.
      Fruits and vegetables help in other ways, too. Normal biological processes produce free radicals — oxygen molecules that have lost an electron and create havoc by snatching electrons from other molecules. Free radicals are also produced by exposure to substances such as cigarette smoke. Vitamins A, C and E, found abundantly in fruits and vegetables, come to the rescue by donating electrons so the free radicals don't have to steal them from the body's cells.
      And here’s a study you may find interesting: In 1986, British urologist Anjan K. Banerjee at the Manchester Royal Infirmary speculated that frequent ejaculations helped to keep the prostate healthy and cancer-free. Dr. Banerjee tested his idea on 423 men who ranged in age from 60 to 80; 274 of the men had prostate cancer and 149 did not. Each man was asked to estimate his ejaculatory frequency per week during the sexually active periods throughout his life. This included ejaculation by any means.
      The men with no prostate cancer reported ejaculating significantly more frequently than those with prostate cancer. Dr. Banerjee could not come to a conclusion about what caused the connection between ejaculation rate and prostate health, but he did suggest that reduced ejaculation frequency appeared to promote the development of the disease.
      This is only one study. But it is a provocative one, and, to my knowledge, no criticisms of its methodology have emerged. Still, it would be a misuse of this research data to insist that your sexual partner have sexual experiences with you when that person isn't willing or interested, just to preserve your prostate. Remember, the study included all ejaculations and that includes those reached through masturbation. Prostate health is always the responsibility of its owner.