hi, everyone. welcome to the "journal" on dw- tv. the top stories, clashes break out in the egyptian capital cairo as the police crackdown and the second day of protests. >> movers and shakers descend on pothos for the economic forum. >> and a scandal in the armed forces. clashes between egyptian demonstrators and security forces have marked a second day of protest against president

hosni mubarak. the police fired rubber bullets to break up rallies and hundreds of people have been detained. these are the biggest protests president mubarak has faced in his 30 years of rule. >> defying a ban on street demonstrations, thousands of protesters took to the streets of cairo for a second day. they returned it to repeat their demands for democracy, social justice, and the president's resignation. the police made good on their threat to crack down on the protests. witnesses say that demonstrators were be down with batons and fired on with teargas. in the face of this unprecedented public outrage, the government has tightened security across the country. curfews are in place and protestors have reported they are not able to access social media sites like twitter and

face book, which had been used to organize demonstrations. the german government has expressed alarm over the crackdown. >> civil rights, freedom of opinion, freedom of assembly, freedom of a lot of the press, egypt must respect these -- freedom of the press, egypt must respect these. >> international support could make it harder for the government to silence the people demanding change. we spoke earlier to our correspondent in cairo and asked for the latest situation. >> thousands of people took to the streets in downtown cairo, 500 reported arrested. it is reported that dozens were taken to a warehouse and beaten by the police, who targeted the

protestors with tear gas, trying to disperse them. there is talk of a curfew for everybody, but that is not confirmed yet. >> tell us more about what the demonstrators are doing and what authorities are doing to stop them. >> atwater has been blocked for 2 days now and -- twitter has been blocked for 2 days now, and facebook has also been blocked. i was told that people are able to circumvent in these block sites by using providers to get around. a>> what are the options for president mubarak and his government? >> the protesters are asking for several things, like raising the minimum wage, dropping prices, and most importantly they want the resignation of the interior minister.

i think that if mubarak acts on these demands, they could restorer a calmer situation. it cannot go on as it did before and things need to change in the country. mubarak must be aware of this. >> thank you for that update from cairo. the interim justice minister of the country of tunisian has asked interpol to arrest the overthrown president, currently in saudi arabia with his wife, wanted on charges of fraud and embezzlement of state funds. hundreds of protesters turned out to demand that all ministers allied to the ousted president be removed.the interior, foreign affairs, and defense are expected to be replaced soon. up to the swiss alps for the

big forum. >> 1 of the most exclusive advance and the world. at this year's world economic forum has kicked off in davos, switzerland, the health of the world economy dominating the meeting. there are still clear race and warnings that the global economic crisis is still far from over -- still clear worries and warnings that the global economic crisis is still far from over. there will be meeting to discuss how to tackle the challenges ahead. >> please pause for a minute of silence. >> dmitri megadeath began his project dmitri megadeath began his -- dmitri medvedev began asking for a moment for silence. >> russia is aware of its place in the world. we are aware of its

responsibilities to its citizens and will fulfill them as low well as its responsibilities to the world community. this is the reason i am on this stage speaking to you today. >> then he used the opportunity to defend russia against criticism that conditions in this country are not ideal for investors. >> we are making progress in moving ahead. in particular in fighting corruption, and modernizing the justice system, and maintaining order. >> he says he thinks those are important steps to improve the security of investments in russia. >> a short time ago i spoke with our reporter at davos and asked how the russian president's comments were received. >> business leaders were not very surprised that he used his platform for his own purposes,

remarking that foreign investment was needed in russia and that russia had a good investment climate. he was prepared for critics and there were criticisms as far as lack of democracy and selective justice is concerned, and he responded his critics, saying that russia had a long way to go, but that russia does not need any teaching but partners. it is interesting to note that before the president's speech, there was a press conference with the russian delegation and bp announcing a new alliance with the big russian oil company, and the message was clear, the investment climate is very good in russia and we need foreign investment. >> tal's, what is the main focus of the world economic forum -- tell us, what is the main focus?

>> the main focus is clearly emerging markets. emerging markets, there are so many representatives from emerging countries like china and india. india is the partner country here, and india is very, very soft, the debt -- is very self confident. there is a very traditional cafe here which has turned into an indian lounge. there is a big cultural program, and there will be many debates on this shift from the industrialized world to the emerging markets. >> finesse of fisher, thank you. -- vanessa fisher, thank you. sap has revealed its earnings in its fourth quarter profit fell from a year ago. sap did not cheer investors by

forecasting double-digit revenue growth and raising its dividend 20%. >> sap programs can be found everywhere. millions of people's wages are calculated by 1 of their payroll programs. that is just 1 example. lots of companies use the software giant's products. there are even programs to help save energy. they also seem well positioned for the future. >> we see growth in all regions, but brazil, russia, india, and china are growing much faster. we see great opportunities there and we have new categories of software that create growth opportunities, and i would say the small and midsize companies are a huge market for us. >> retailers around the world are especially interested in

sap's accounting programs, but banks are also among their biggest clients. on the downside, a u.s. court recently ordered them to pay american rival or cold billions wrote in damages for copyright infringement -- to the american --oracle billions in damages for copyright infringement. >> they have done well from tee downturn, cutting costs. but its fortunes now depend more heavily on economic performance of developing countries, where the risks are much higher. starting in frankfurt, the blue-chip dax finished 1% higher. the euro stoxx 50 finished the day up. in new york, the dow jones treading 0.2% higher.

over 12,000 points. it and the currency markets, the euro trading at $1.3683. a toyota has announced another recall. this time over concerns about possible fuel leaks. the recall affects 1.2 million toyota cars, including up to 24,000 in germany. japan's transport ministry says bacon develops light truck -- slight cracks that can develop leaks. itoyota has now recalled about 2 million cars since 2009. that is the business update. president hamid cars i opened afghanistan's parliament after they had threatened to start without him. this came 4 months after controversy a parliamentary elections which were racked by

widespread claims of fraud. >> many afghans expressed amazement their parliament had opened. the president swore and 249 members of the lower house of parliament. he also wrote sharply criticized the international committee for meddling in afghanistan's elections. >> we must make government institutions and the elections treat our own. elections controlled by the afghans will be more transparent and less expensive. >> he wanted to delay the opening of the assembly by a month to allow special election court to complete investigations into allegations of fraud and the september poll. but lawmakers threaten to take their seats with or without him, forcing him to agree to agree to the inauguration. >> we are looking ahead. from 2014, we intend to be up to

take care of our security when nato troops leave the country, but the world needs to know that we will need help rebuilding the country. >> but karzai may find governing more difficult. he had been able to rely on the group for support, but no longer. in germany, the defense minister has been testifying to a parliamentary committee over incidents in the armed forces. these include the alleged misconduct on a naval training vessel, the accidental death of a german soldier in afghanistan, and airplanes -- and claims that private mail to soldiers has been open to. i>> the defense ministers day began at a relaxed environment of the weekly cabinet meeting where there was no aggressive questioning about his handling of 3 unrelated cases within the armed forces.

but those incidents made for a stormy session at his next appointment before the defense committee. afterwards, he was clearly irritated by the grilling. >> i have the impression these allegations have collapsed in on themselves like rotten beams. it is all part of the political game. >> he defended his decision to suspend the navy commander, allegations were too serious, but the opposition has called it a knee-jerk reaction. it says he still has questions to answer. >> what new information came to light between forming the defense committee at midday and the dismissal of the capital- letter that evening? this answer was not given. -- and the dismissal of the capt. later that evening? this answer was not given. >> it looks like he will continue to face questions.

european union's naval mission of the horn of africa has confirmed a german cargo ship was hijacked by pirates over the weekend. the german navy at the vessel as part of the ante. mission was too far away to help. the vessel was seized. it was 800 kilometers north of the area. there has been no word of the fate of the 12 men on board. the crew officially fled to a security room, but the pirates broke in and it is now sailing toward somalia. we will have more on the problems of piracy later on. russia has observed a day of mourning for the 35 people killed in monday's bombing of the airport. flags across the capital were at half mast. at 110 people remained in the hospital. 50 were seriously wounded. authorities suspect islamists

were behind the attack. before he left for the meeting, medvedev fired an official and give them 2 weeks to improve. justin henenen has announced her definitive retirement from the sport. a scan of her elbow revealed too much damage for her to continue playing. she played her last match at the australian open last week. she won 7 grand slam titles during her career. with at least 50 million in prize money, i think she has enough to get by on their retirement. >> too bad for the sport. >> she will definitely be missed. stay tuned for in depth.

the german government has been holding talks with shipping executives to combat piracy on the high seas. this is a growing problem, with the number of attacks going up every year. especially disturbing, the increase and the crew members taken hostage. the horn of africa and the seas off the coastline of the most dangerous for ships. more than 90% in the past year have been hijacked there. >> the pirates boats are small, fast, and highly maneuverable. there is hardly any footage of a pirate attack taking place. bua crew member on an american ship took these images with a mobile phone it in 2009.

it the pirate attack failed on that occasion as the u.s. navy arrived in time. somalia has been without a functioning central government for years. it is a country run by clans and malicious, and poverty is rife, leaving fisherman with little alternative but to become pirates. >> i often don't have enough money for breakfast. that is why i want to be a pirate. at >> the pirates are armed with assault rifles, mortars, and even rocket-propelled grenades. they target cargo ships and crews because kidnapping officers and sailors is lucrative. >> we have another 1. >> ransoms amounting to millions have been paid in the past. the number of pirate attacks around the world has only risen slightly since 1994, but not as fast as the number of. kidnappings. last year set a new record with

over 1000 settlers kidnapped. the european union special naval force active in the gulf of aden and the indian ocean has made scarcely any impact. the area of its responsibility is too large and the somali pirates are operating at ever greater distances out in the indian ocean. they even use of larger vessels suitable for the high seas. at the smaller boats are watched from the mother ships to attack the cargo vessels. there are 2 main areas where the pirates hijacked ships, the gulf of aden and africa's coastline, and in the waters between indonesia and malaysia. the pirates have attacked cargo and container ships and also oil tankers. upon receipt presents a major problem to shipping because without -- piracy represents a major problem to shipping because without safe routes, international trade is in

danger. >> 95% of the world's goods are transported by ship. germany has the largest amount of vessels. but with the dramatic increase in the number of sailors taking hostage, shipping companies are finding it harder to find crews to sell these routes. the captain of 1 ship has so far escaped a pirate attack, but some of his colleagues were not as fortunate. >> this capt. has been a sailor for more than 40 years. though he has never experienced hijacking, he is familiar with the feelings of fear and helplessness when his colleagues are involved, like in october, 2010, when the ship was hijacked by pirates. then, as in the latest incident, the crew members barricaded themselves in it panic room.

the pirates were not able to reach them and the crew was rescued by a naval task force, operation atlanta. after 2 days of fear and worry. >> you don't know what is happening on board the ship. the crew was in a hermetically sealed room. that means they don't know if the pirates had shipped -- set the ship on fire. >> that is why every trip is so risky. this person has just returned from a voyage to africa. there were extra guards on his ship and barbwire and was placed around the edge. security like that is very important as operation atlantic can only provide a limit it help. >> normally the ships come from the suez canal, pass through here, and come together to form a convoy. the naval ships from operation

atlanta accompany them through this region, the g this means that this entire area at that you see here is unprotected. >> that is a very large expanse of ocean. he and his colleagues have been trained how to react to a pirate attack. measures include it spurring the liquid soaps that pirates slipped or disabling the ship's bridge, but that only provides limited security. the over 1000 sailors and over 20 ships that belong to operation atlanta are not capable of providing total protection, as seen with this latest hijacking. he thinks operation and let them must be expanded as soon as possible. the security measures the shipping companies use are no

longer enough to keep the crew is safe. >> to find out more about what can be done in the battle against piracy, i am joined by my colleague, peter. what new measures could be taken in the battle? >> the united nations has been addressing that and came up with a new report. they say the first thing they're demanding is each and every country around the globe incorporate piracy as a criminal offense in the criminal code, which is not always the case. but they're also asking for a special tribunals to treat and try piracy offenses. that looks like it could happen. they want present capacities to be stepped up in both countries affected by piracy because the prison capacities are not sufficient. what they're also calling for, very important, they want much more robust measures put in place to trace the flow of ill-

gotten gains from piracy on the high seas to find and who is profiting from this network of piracy and to prosecute those people, especially given many experts are beginning to say there is a growing and very worrying overlap between international terrorism and piracy gangs. >> shipping companies say they need more protection. what form could that take? that not many shipping countries -- many shipping companies have been resorting to protection from private security companies. in germany, that is not viewed favorably. a lot of shipping company said that is a step back into the middle ages. the german navy and other international naval forces have not been proved to be very efficient and patrolling the indian ocean. there is a growing debate in germany about using counter- terrorism units by the german police force to intervene and

protect forces in piracy incidents. there are logistic problems and constitutional problems also. >> we have talked about the symptoms, but what about the root cause? >> we're talking about somalia, a failed state that has to be turned around. this is a state that has been ravaged by humanitarian crises and conflict for over 2 decades. it is facing a major doubt -- crack -- drought crisis, has a major displaced population, and does the international committee have its heart in meeting the challenge? i don't know. >> will find out in the coming years, thank you. with that, we wrap up "the journal" at this hour. thank you for joining us. captioned by the national captioning institute --www.ncicap.org--

colonel. >> taboo no more. it's been 20 years since breast cancer ceased to be an unmentional disease. something not to be discussed in polite company. after women stopped talking about breast cancer awareness prevention and research funding all increased dramatically. now men are taking their cue from women and talking openly about silent killers like prostate cancer. will these male cancers have the same impact on society as breast cancers do? we'll ask dr. michael manyak and james anderson.

if. for such a small word it packs a wallop. if i live to a hundred. if social security isn't enough. if my heart gets broken. if she says yes. we believe if should never hold you back. if should be managed with a plan that builds on what you already have. together we can create a personal safety net,

a launching pad, for all those brilliant ifs in the middle of life. you can call on our expertise and get guarantees for the if in life. after all, we're metlife. >> doctor, how common is prostate cancer? >> prostate cancer is actually the most common silent killer in humans. there are estimated to be about 180,000 new cases diagnosed in coming year and 9 million people in the united states that have prostate cancer in various stages. >> does it correlate with age? >> yes, as you get older being even more serious? >> well, yes. the issue is that we cannot -- absolutely prostate cancer is relatively slow growing but sometimes it's very rapidly growing and we cannot always tell which of those -- the particular cancer's going to be. so if, in older men, if this is

diagnosed and there's not a large amount of the cancer or it appears to be an early stage, then i'm sorry you have the option of just observing it or treating it less aggressively than you would if someone were younger. >> what is your professional status at gwu hospital. >> i'm head of the department of urology. >> you're a member of us too, too, correct. >> yes. >> what does that support group do? >> it's to help the men diagnosed with prostate cancer, us too is made up of prostate cancer survivors in total. >> you mean the psychological conditions that occur after surgery or after treatment or even acknowledge that you have prostate cancer? >> what we do primarily is offer counseling to men diagnosed with

it, our case studies if you will, tell them about our situation, what we had. and primarily try to explain to them the various options that they have open for them. we have a very close association with urologists throughout all of our chapters. my own case, for example, i have the chapter and the urology clinic sponsors us at andrews air force base. >> uh-huh. >> they will tell a newly diagnosed patient a group in tandem a list of counselors of men who are survivors and recommend to them they contact one of us and talk to them. >> how withdrawed when you discovered you had prostate cancer. >> 62. >> how long before it took before you you underwent the total removal of the prostate gland, right doctor, and any surrounding tissue? >> there are small glands right behind the prostate gland that are commonly taken. >> we have a graphic that

displays it. as we see on the screen this is peroneal surgery and the incision is made under the terre haute tim, between the scrotum and the anus? did you have that? >> i had a radical operation with the incision made just below the navel to the pubic bone. >> we have that available, too, as a graphic, retro pubic surgery, is that what we see there? does that pretty much describe what the location was? >> yes, it does, john. >> it's from the navel down to the top of the where the penis joins the anatomy. >> that's correct. >> what was that like? >> well, it's major surgery. i was diagnosed in february of '93 and i had my surgery on may 20th of '93. i was out of the hospital in four days. i was up and walking the day after the surgery and what have you. i was back running three miles a

day a month after the surgery. >> did you have full energy? >> oh, yes. i -- i won't kid you, it's a major surgery and it takes a full six weeks before you're back to what i call 100%. >> if you had been seven years younger would you have recovered your full quotient of energy earlier? >> i don't think so. i was very -- i ran for 15-20 years before it so i was in pretty good shape so i don't think being a little younger would have made any difference in my recovery. >> what's the age at which prostate cancer's found? >> there's an autopsy series from out of detroit that demonstrates that men that died of violent causes, there is actually about a 10% incidence of a tiny focus of prostate cancer in in men between 20-29. this really raises the question about how long those cancers are there. the youngest i've ever heard of being actually diagnosed with prostate cancer was a

29-year-old male in the u.s. army. >> is testicular cancer more common in younger men than is prostate cancer? >> well, yes, certainly that's the most common tumor in young men. men between the ages of 15-35. however, you know, we don't know what the incidence of very tiny cancers are in other organs of the body. >> is that a neglected disease? or condition? meaning that not enough attention is paid to it whether by budgetary funding as a matter of public policy or the recognition of its existence and the continued enhanced treatment of it? >> prostate cancer? >> no. >> testicular cancer? no there are only 3 to 4,000 cases of it in the united states. >> how many prostate cancer? >> 180,000 per year. >> what are the lifetime odds of getting it for prostate cancer for a male, of course? >> it's about one in six. i mean, to put it in perspective, a man who is diagnosed with prostate cancer

about every three minutes in the united states. >> and if a man it going to die of cancer after the age of 50 or in mid life, this is the cancer that is most likely to kill him, correct? >> actually i think lung cancer's a little higher numbers but prostate cancer is certainly one of the top ones. >> should we also take note of the fact that if it's one in six lifetime risk of getting prostate cancer, it's one in eight of getting ma'am mary cancer, breast cancer, correct? >> yes. >> so the odds are slightly enhanced meanwhile that there's slightly lower level at risk for ma'am mary cancer. does it seem to you odd then that the funding for, we're getting a little ahead of ourselves but we'll turn to more fundamentals but while we're on subject does it occur to you that it is odd that the funding for, annual funding for breast cancer is 600, what, $98,000, million dollars.

and for prostate cancer it's 100, and, what, 38? >> i believe that's correct, john. >> so that's a factor of more than about three to one favoring breast cancer even though there's a higher risk. what about the incidence of breast cancer, 180,000 for prostate cancer, what is it for women? >> i believe it's slightly less than prostate cancer. is slightly high incidence of less than that. >> i believe with all due respect -- does sexual activity correlate with a healthy prostate? we'll put that question to our guests but first, here are their distinguished profiles. born, flint, michigan, 49 years of age, wife, rebecca, three children. roman catholic, republican, university of notre dame, b.a. university of the east, the flu vaccines, doctor of -- philippines, biotech knowledge fellow, george washington university seven years, george washington chief of urology five

years. men's health magazine, contributor. hobbies: explorers club, a national exploration society. chairman of expeditions. michael john manyak.born, jersef age. wife, mary. seven children. roman catholic. republican. st. peter's college, b.a. auburn university m.a., public administration. united states air force, colonel, 31 years. chrysler technology's electrospace technology nine years. us cancer support group regional director two years and currently. hobbies working in his yard, photography. james robert anderson. couple anderson, what symptoms did you experience that helped you detect that you had cancer of the prostate? >> that's what's so alarming about this john, i had no

symptoms. >> no symptoms, zero. had you been getting your p.s.a. annually? >> i get one annually with my physical. >> let's talk about psa, a blood test, stands for what. >> prostate specific antigen which means there's a protein released. >> and the protein determines what your level is. and when you get up to, what, four or five, then you have to proceed with caution but don't get unduly alarmed, is that right? >> well, there are some people that are starting to feel that even at those levels it should be investigated more closely such as biopsies. most important thing about the psa is the rate of change of the psa. you can't just take it as one particular test but rather as a series. >> he means, i believe to say it's constant at year to year. if you come in at a four one year, you should come in at a four the next year or drop, if -- or drop, if you go up you've got a problem. did you get the psas every year. >> i did. the doctor who did this for me,

god bless him, he gave me my physical in '91 and my bsa was 9.2 and he called me up at work and said, "get your butt out to the urology cling we're goinged to do a sonogram on you." they did and they found nothing. >> there are three tests for -- maybe there's more but there are three tests that i know of, that's the psa, that's the blood test, the sonogram, which is the introduction of a scope rectally to examine the outer layer of the prostate to the extent they can get to it, two-thirds of the prostate? >> actually it images the entire prostate so you can look at the internal structures as well. >> can you see much with it? >> you can see the prostate. the problem is you can't really detect cancer that often because cancer frequently looks the same as normal tissue. >> you can see texture? >> yes. >> if you can improve the image would you be able to tell more?

>> yes, there's a lot of research going on in that arena now to increase not only the resolution of the ultrasound but also to add things that might be able to be detected in cancer as opposed to normal -- >> the third thing that mention to have is the digital examination, the digital probe, the doctor's finger. what is he looking for with that probe? >> well, the actual digit tal rectal exam, prostate cancer arises 70-80% of the time in the outer portion of the prostate so the closerrest thing you can get to is your finger -- >> softness or hardness, is that the key, if it's hard you're in trouble, soft you're ok? >> that's one of them. and also if there's an irregularity. >> what does that mean? >> a bump, a nodule. >> there are presumably an experienced doctor who has conducted many rectal, digital rectal exams has a greater -- it's like the doctor's hands on the body, some of them are

terrific at that, diagnosticians, is that right. >> that's right. >> so there is the development over time of making that skill and making that determination whether we should be concerned, right? >> most people can feel a nodule but the subtleties is where the experience comes in. >> what i'm getting at is that there is the possibility that we're getting hyperconscious of the -- of this disease and it's ok to take note that there are 180,000 cases a year and there's one chance out of six but not every single symptom, like a certain hardness at a certain part of the gland, necessarily means that you have cancer and you don't have to get alarmed by it. now, do you run into people that think that there is just too much high per bowly or exaggeration and that it breeds suspicion where there ought not be that? >> yes, you're on to something for that. there are men, for example, think the psa is overused, it

puts men at unnecessary risk for biopsies and what have you but i don't agree with that, john. i had, as i mentioned to you, i was diagnosed in '81 with a 9.2, no cancer, though. i did biopsies and came back negative. the following year my psa jumped to 17.2 and found four hits on the left side. if it hadn't been for that psa and it hadn't been for the pier sis tense of my doctor and my urologists i would have never caught that and i know that from the pathology report after they took the thing out that i had a serious prostate cancer problem. >> did you experience any period of incontinence? >> no. >> any impotence? >> in the beginning there was certainly a problem with that. >> are you helped by viagra? >> i can't really say i am. >> you can't say because you'd prefer not to say? >> oh, no, no, no. well, i've used it but -- and i -- it hasn't helped me that much. >> has not?

>> no. >> what's the percentage of help? >> estimated 25-30% of men helped by viagra. >> what's coming on stream? >> there are other drugs looked at. one in particular that will be released later this year, i believe, we tested in clinical trials and that acts centrally in the nervous system in the brain. and this would be additive we believe -- >> let me get this straight now. this is not physiological so it's not we'll peyton i'll oriented it's cerebral, is that correct. >> that's correct. >> it affects something in the brain. >> that's correct. >> and the brain sends a message. >> that's correct. >> and if everything else is functioning, if the plumbing is good then the message gets through and you're in business. >> that's the theory, that's correct. and so these -- >> what is the -- what is this brain situation? >> well, i think everybody understands that erectile dysfunction is complex. there's a psychological component to it as well. >> do you believe that?

>> yeah, i do. >> no question about that. >> no question. >> people were -- in the early stages of viagra would give us believe automatic, almost a pneumatic -- >> that's a good word. >> function, right? >> that's not true. >> not true. what else is coming on stream? what about a salve applied externally? >> there are medications that increase blood flow into the penis that are administered through creams and salves like that and there are devices that are being looked at to help drive those medications in through the skin at a greater rate. >> is the farm's company that's producing viagra coming out with a quicker effect producing viagra. >> there are several pharmaceutical companies looking at that issue, you're exactly right, anything to improve that, rather -- because it's usually about a one-hour wait time from the time you take the medication until the effects can be noted.

>> before you had your real bout with serious cancer, did you experience knock turnal urination of a higher frequency? or any kind of -- >> no, no. >> you did not not? >> no. >> did you have an enlarged prostate. >> yes, i did. >> did the doctor tell you there was no relation between an enlarged prostate and a cancerous prostate? >> enlarged prostate can cause a rise in psa and my father had an enlarged prostate before me so i was not at all alarmed by the fact that several doctors had told me my prostate was enlarged over the years. >> what do you conclude when you see an enlarged prostate, doctor? >> several things, first of all, the size of the prostate gland doesn't necessarily correlate with the symptoms a patient may have. we know prostate cancer frequently does not have symptoms. so -- >> doesn't an enlarged prostate cause frequent urination? >> it can, it can be one of the things that leads to the frequency of your own nation.

>> the most serious thing you can say about enlarged prostate is you have to go to the bathroom more often and particularly at might and that's unpleasant? >> not really. if the prostate gets large enough it can completely block the urinary stream and that's an emergency. >> you're still not in the cancer zone. >> no, you're not. >> there's no diagnostic value to enlarged prostate cancer as to determining if a cancer exists. >> i wouldn't say that, if you have greater amount of tissue there's more likelihood there would be small focus of cancer in there at least. >> is it fair to say what you look for in these three fundamental diagnostics that is the digital, the rectal, the sonar, and the -- what's the third -- the psa, that you look for a confluence of those, they all have to work together for you to determine probability of cancer? >> yes, that's correct. >> and then you cross the line and you say, ok, now is the time to have a what? >> well, the first thing is you have the blood test and the

digital exam. >> right. >> and if either one of those are abnormal that raises suspicious. if they're both abnormal there's a much higher likelihood of cancer then the next step you go to is an ultrasound with a biopsy. the ultrasound is not good just to look for cancer alone but it's very good to get little samples of tissue, the systematic areas of the prostate that may cause cancer. >> i am familiar with a radiologist and all he does is sonar in this sector and he can make a determination of, for example, the accumulation of white deposits on the surface of the gland and he can guess or conjecture as to whether it's calcium or whether it's cancer. but if he sees that, he then looks at the other testing, the other diagnostics, but i'm -- i was given to believe that a biopsy requires a threshold beyond that which you have described, that a biopsy doesn't always go hand in hand with any

usage of sonar. >> well, i think that's a fallacy that needs to be straightened out because i would take exception to the radiologist you mentioned being aircraft diagnose cancer on the basis of a ultrasound. >> i didn't go that far. i used the word conjecture. sonar is a limited instrument. they're all limited are they not that's why you need all three together. >> that's correct. >> we crave for better diagnostic tools in the world of prostate cancer. >> are we getting them? >> yes, i think we are. we have new blood tests becoming available, we're learning much more about prostate cancer and the steps for development of cancer and then the spread of cancer. we have new imaging techniques that are used, such as the body scans used for soft tissues, lymph nodes, there are a variety of things that are on the horizon. >> another way of treating prostate cancer is radiation and we have on the screen there a -- an image of radiation treatments. what do we see there,

dr. manyak? >> well, you see a schematic representation of what would be termed external beam radiation therapy which is an outside -- a source outside of the body directing the beam towards the prostate area. >> yeah, what are the risks and what are the unfortunate negative side effects? >> well, radiation has similar risks to surgical approach in this area, you can have both incontinence and erectile dysfunction. >> was radiation considered to you rather than the radical surgery? is there i considered all of it. >> did he give you that option? >> yes, i had that option. >> did you rule that out? >> i did personally. >> you wanted to make sure you had gotten rid of the cancer? >> that's right. what was available in the i used the john hopkins medical library as my source, and from my reading, it was very clear to me that in 1993 the survival rate, long-term survival rate for men was highest with surgery if they could handle the surgery so i

opted for surgery. >> yeah, but then you went to the zone of real risk, you got the incontinence and impotence risks, what other risks -- what are the negative -- what's the negative downside of radical surgery? >> i think you covered the two that are of most concern. there's always a chance you might lose some blood during surgery although we've been able to decrease that significantly over the years. >> in connection with radiation, besides radiation, you can also treat it by internal insertions into the gland itself. what do you put in the gland to help control the spread of cancer? >> well, there are radioactive seeds that are placed. >> seeds, right? >> yes, tiny pellets. >> what else besides seeds, what are those radioactive? >> they're radioactive. so it's a similar -- >> how is a cure effected through nuclear energy? >> it kills the cell. >> what happens after the cells are killed, the seeds are

removed? >> they stay there. what's coming down the road is something more interesting, also very small inserted pellets that are actually -- create heat, thermal energy and you can place a patient into a magnetic field afterwards and treat them and then retreat them again at another time. >> colonel anderson, did you contemplate that or was that offered to you? you put these -- are they pellets or rods? >> tiny pellets. >> pellets, like a bb. >> yeah. >> a little bigger. >> cylindrical. >> cylindrical pellets inserted. >> 20 to 40. >> you get those. and they function on a heat principle and you get additional heat if you sit. and if you sit x number of minutes it can drive up the body temperature. >> you need to drive it well beyond body temperature to cause the death of the sell. >> you don't have to get to a boiling level, do you? >> well, you can do that.

that may not be necessary. >> well, that sounds like a dream therapy 'cause you can go in and do it on monday and two weeks later you go back and there's no side effects and the heat will do it? >> that's right. there are clinical trials ongoing right now in chile and the data looks very interesting. >> so this is brand new. >> brand new. >> is there anything else that's brand new by way of treatment? >> well, there are a variety of people that are looking at vaccines and different types of intervention from the medical tan point. >> what's the relationship between sexual activity and a healthy prostate? >> i think if you have an unhealthy prostate such that you have an infection or something that will affect your desire. >> how about the other way? namely that if you give your prostate a real workout, a lot, which means considerable sexual activity, a lot, are you better off physically? from a prostate point of view? >> no relationship between development of cancer with either underor overactivity in

the sexual arena. >> did your support group get into any questions we discussed here and what do you focus on? we've only got a few seconds and i'm sorry for that. >> i think the bad effects from prostate cancer, the one that causes the most grief is incontinence. the men, they don't -- impotence is not that big a problem, incontinence is. >> because of the level of frequency or because it can be handled psychologically and emotionally better. >> handled emotionally better. >> thank you, dr. michael manyak and colonel if. for such a small word it packs a wallop. if i live to a hundred. if social security isn't enough. if my heart gets broken. if she says yes. we believe if should never hold you back. if should be managed with a plan that builds on what you already have. together we can create a personal safety net, a launching pad, for all those brilliant ifs in the middle of life.

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