An examination of expressed prostate fluid by itself is not enough to make a good diagnosis. Comparing the urine samples with the prostatic fluid enables the doctor to determine the site of infection (the urethra, bladder, or prostate), if there indeed is an infection. And cultures of this urine will show the type of bacteria that’s causing it. Then, having pinpointed the bacteria, the doctor can identify the drug that best targets that particular kind of infection.

In chronic bacterial prostatitis, the digital rectal examination may be normal, but white blood cells and bacteria will be spotted in the urine or prostatic fluid. In nonbacterial prostatitis, the expressed prostate fluid contains high levels of white blood cells, and shows other signs of inflammation, but the cultures are negative. In prostatodynia, however, this fluid is normal on microscope examination and culture. Signs of inflammation then, are the litmus test for ruling out prostatitis.

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In one Johns Hopkins investigation, scientists studied men aged 64 and younger with notable prostate enlargement. They also studied their relatives and family histories. (The theory behind the age cut-off here is that early age of onset tends to be a marker for hereditary disease.) They found that the male relatives of these men were four times as likely as other men to require a prostatectomy to treat BPH—in other words, they were more likely to develop BPH that was severe enough to need major treatment. And brothers of these men were six times as likely as other men to need surgery to treat BPH.

*230\201\8*

Then doctors at the National Cancer Institute began wondering whether suramin could cause the same chaos in prostate cancer. They knew suramin was capable of thwarting the activity of such growth factors as basic fibroblast growth factor and epidermal growth factor—both believed to be important to sustaining and promoting the growth of prostate cancer cells. Spurred by such growth factors, these cancer cells somehow revert to a more primitive state, which encourages them to mass-produce.

The scientists also knew that suramin could inhibit growth in specific varieties of prostate cancer cells. And finally—a bonus—suramin also seemed to lower the level of adrenal androgens.

So suramin looked highly promising as the first drug with the potential not only to lower the adrenal androgens but to target the hormone-resistant cells that, so far, have successfully eluded every other attempt to kill them. Could suramin perform as expected—could it interrupt factors that feed cancer cells and make them grow? In other words, could it slow down the proliferation of cancer cells?

The jury is still out on suramin. The bottom line is that it has helped some men; it has not helped other men, and its effects don’t seem to be long-lasting. In one study, suramin caused reduction or “complete disappearance” of cancer metastases in soft tissue—masses in the pelvis, lymph nodes, and even nodules under the skin. However, in only a few men did the improvements last longer than three months. Only a few men showed an improvement in metastases to the bone, and these gains were slow in coming—it took about nine months or longer. In some men, bone metastases got better; in others, they got worse. Some men showed no change at all, and in other men, the cancer continued to progress. PSA levels dropped in some men, but in only a few of these men did this improvement last longer than three months.

A majority of the men in this study who had experienced severe bone pain found significant relief. However, this often happened within the first weeks of treatment and wasn’t accompanied by an obvious shrinking of the cancer. In fact, the doctors weren’t sure this was even due to suramin—it could have been the result of corticosteroid treatments, which are known to ease terrible bone pain.

Side Effects

In addition to inhibiting growth of cancer, suramin can also suppress the body’s immune system. Its side effects can include infection, particularly in the urinary tract; a reversible drop in the number of platelets in the blood; fatigue, decreased appetite; rash; and pain and weakness in the hands and feet.

*191\201\8*

Enter the high-tech advances: Intricate software and imaging systems that allow 3-D treatment planning and computer-controlled radiation delivery systems; elaborate computer programs that can zip through sophisticated mathematical calculations of prostate volume and radiation dose per millimeter (or even smaller) of tissue; amazing technological advances that make it possible for doctors to custom-design a 3-D model and treatment plan, so each patient’s prostate tumor can get the most precise and thorough radiation coverage possible.

*153\201\8*

At one time we thought that the attraction of the boys might lie in their feminine attributes: lack of body hair, softer contours, higher voice, etc. This hypothesis seems to hold true for only a minority of offenders. Most of the men said that they preferred masculine-looking partners.

A fairly typical example of the hebephile variety was a man who was nearly fifty when we interviewed him, and who had been exclusively homosexual for many years. In childhood he had engaged in both heterosexual and homosexual play, but the former died out while the latter continued without a break into adult life. He seems to have fixated on a particular age of partner, thereby gradually becoming a hebephile as he himself grew older. This is evident in a listing of his “love affairs”—intense homosexual attachments. When he was fifteen he loved a boy of the same age; at seventeen he loved a boy of thirteen; at thirty his affection centered on a youth of fifteen; at forty-four he again fell in love with a thirteen-year-old; and so forth. The man gave the classic reasons for his preference: boys were easier to obtain than adults, they looked up to him, they were easier to dominate, and he felt more at ease with them than with adults.

The second commonest variety of homosexual offender vs. minors is hard to label. It consists of men who are usually primarily homosexual with other adult males, but who sometimes will have sexual activity with boys. These exceptions to the rule in some cases represent lapses of normal judgment and control in the face of temptation, just as a heterosexual man may become an offender vs. minors, while in others the offender is more like the amoral delinquent in his indifference to age.

Perhaps as many as 10 per cent of the cases of homosexual offenders vs. minors may be categorized as of the drunken variety: cases of a homosexual male, when intoxicated and not in control of his impulses, seeking contact with minors whom he would shun when sober.

After subtracting the two major varieties of homosexual offenders vs. minors and also the drunken variety, there remains a few per cent of recognizable varieties: the mental defective, the senile deteriorate, the amoral delinquent, the pedophile, etc.

*197\161\2*

Prior to age twenty small proportions of these offenders had had experience in petting: only 36 per cent by age fourteen (the smallest proportion recorded), 61 per cent by age sixteen (again the smallest), and 80 per cent (a low figure) by age eighteen.

This same delay is also reflected in the age-specific incidence of petting. In the age-period puberty-15 only 35 per cent (the lowest percentage of any group) petted; in the age-period 16-20 they are also relatively low in rank-order, being above only the homosexual offenders and exhibitionists. A similar picture is seen in the age-specific incidence of petting to orgasm. Up to age twenty fewer of these offenders than any others were reaching orgasm in petting: 4 per cent in the puberty-15 age-period (the control group had almost four times that figure) and 8 per cent in age-period 16-20. In the following period, however, the figure increases to a moderate level (20 per cent), which appears to forecast impending marriage. So many of these offenders married in the 21-25 age-period that calculations for the unmarried cannot be carried beyond those years. Since, as we shall see, the incest offenders vs. adults were restrained in their premarital coitus, one has the impression that this increase in petting to orgasm in age-period 21-25 is in large part a substitute for the coitus they would not permit themselves.

The increase in age-specific incidence is related to a similar sudden and marked increase in the accumulative incidence of petting to orgasm. By age twenty the accumulative incidence was 10 per cent, by far the smallest percentage on record, but by age twenty-three (which is as far as calculations can be made) the figure nearly doubled.

It is not worth calculating frequency of petting to orgasm, since so few incest offenders vs. adults had this experience prior to marriage. Indeed, in any five-year age-period (e.g., puberty-15, 16-20, etc.) it is impossible to find in our sample more than three individuals thus experienced.

Their sexual restraint is also evident in a study of the number of females with whom the incest offenders vs. adults petted. Eight per cent had no premarital petting, an extraordinary omission in a group all of whom, by definition, ultimately married. Nine per cent had only one petting partner. The average offender had petted with 12 companions, the third smallest number recorded.

The paucity of petting partners is in keeping with their quite limited social relations with girls at ages sixteen to seventeen, when 28 per cent (the largest percentage) had no female companions whatever.

Their petting techniques were similarly restrained. Only 64 per cent, the lowest percentage and one surpassed even by the homosexual offenders, had engaged in genital manipulation prior to marriage. Consequently it is no surprise to find that they also rank last in premarital cunnilingus with companions (4 per cent) and fellation (8 per cent). The tendency seen among other incest offenders to rank high in mouth-genital contact with their wives is not evident. Like the incest offenders vs. children, they rank high in mouth-genital contact with extramarital and postmarital partners (second in fellation to fourth in cunnilingus— 24 per cent for each).

Restraint is to be seen in yet another oral technique. A fairly large proportion (75 per cent) had never nibbled or bitten their sexual partners in loveplay or in the abandon of extreme arousal; some reticence about biting is clearly demonstrated in a rank-order of those who frequently employed this technique: the incest offenders vs. adults are at the bottom of the list with only one of their members having reported frequent activity. The other incest offenders also rank low in this list.

*155\161\2*

The age-specific incidence figures are moderate: 7 per cent had animal contacts betwen puberty and fifteen, 5 per cent between sixteen and twenty, 2 per cent between twenty-one and twenty-five, and none thereafter.

As in the case of aggressors vs. minors, this activity is not reflected in their dream content (not one reported dreams of animal contact) or in their masturbation fantasy. The sexual contact with animals was confined in every case except one to the years between puberty and twenty, and seems to have been, as usual, a seldom-repeated experiment, devoid of much emotional content. The quantitative unimportance of animal contact is seen in the proportion of total sexual outlet, where it never constitutes as much as 1 per cent of the total orgasms experienced in a given age-period.

*113\161\2*

The only other outstanding point is the fact that the proportions of nonsex offenses and sex offenses are equal (51 and 49 per cent). These offenders are as much general offenders as they are sex offenders. They display a rather varied and nonprofessional criminality centering mainly on crimes against property (theft) but with much vagrancy, disorderly conduct, and similar troublemaking. While other groups consist predominantly of sex offenders, most of whom have statistically atypical sexual behavior, the offenders vs. adults appear to be a fairly delinquent but not seriously criminal group whose sex offenses do not depart much from the statistical norm.

*71\161\2*

Despite their unobtrusive early percentages regarding coitus with prostitutes, a rather large proportion (27 per cent) had their first coitus with a prostitute rather than with a companion. This may be a simple function of age; coitus with prostitutes was more common in the past than it has been recently, and the offenders vs. children are our third oldest group of offenders. In contrast, relatively few of our younger groups (e.g., aggressors vs. minors, peepers, prison group, and offenders vs. minors) had their first coital experience with prostitutes.

There is nothing unusual in the frequency with which the offenders vs. children had premarital coitus. The average (median) individual had a rather uniform frequency of 0.4 to 0.5 per week from puberty onward, about equal to that of the control group. The bulk of the coitus was with companions rather than with prostitutes, and after age twenty-five the offenders vs. children exhibit relatively high mean frequencies of premarital coitus with companions. The frequency of premarital coitus with prostitutes is in no way remarkable.

In terms of numbers of premarital coital partners, the average offender vs. children who had premarital coitus had it with ten companions and 15 prostitutes. The number of companions is moderate in comparison with other offender groups, but well above the average control-group individual’s eight. In premarital experience with prostitutes, the offender vs. children ranks sixth.

The proportion of total outlet consisting of premarital coitus with companions is moderate, increasing from 13 per cent to 37 per cent by age thirty. In age-period 31-35, however, the unmarried offenders vs. children rank third with 48 per cent of their orgasms derived from such coitus.

The proportion of total outlet constituted by premarital coitus with prostitutes increased from a moderate level to 25 per cent in age-period 36-40, winning these offenders vs. children first rank in this respect. In the following age-period, 41-45, they rank third, but still derived nearly one quarter of their outlet from this source.

As for the factors that restrain premarital coitus, nearly one third of the offenders vs. children, the third largest proportion recorded (just below the 34 per cent of the control group), reported strong moral inhibitions. Slightly over one fifth (the largest proportion of any group) were strongly restrained by fear of impregnating their partners. Nineteen per cent (the fourth largest percentage) were often held back by fear of venereal disease, and 14 per cent (the second largest percentage) were quite concerned over public opinion. Relatively few refrained from lack of desire, and a rather large proportion (60 per cent) reported lack of opportunity as a major factor. Rating in first to fourth place in four of the six categories of restraint that we established makes the offender vs. children a singularly inhibited offender psychologically if not behaviorally. To have maintained an average sort of premarital coital record (average in terms of other offenders) must have cost the offenders vs. children dearly in terms of worry and/or guilt

*28\161\2*