Prostate Problems

Benign Prostatic Hypertrophy

Problems with the prostate are very common in men in western countries and one of the main ways in which they can present is Benign Prostatic Hypertrophy (BPH). The prostate is a walnut-sized gland that is part of the male reproductive system. It is located below the bladder (the organ that stores urine) and surrounds the top portion of the tube that carries urine out of the body (the urethra). The prostate gland makes fluid for semen, which transports sperm during ejaculation.

BPH is abnormal growth of the gland typically seen in aging men and often responsible for various degrees of urinary problems. The condition is not malignant – it won’t invade other tissues – but the gland is becoming larger than normal. The prostate gland surrounds the urethra, which descends from the bladder through the penis, and can block the flow of urine when enlarged. BPH is an almost universal phenomenon in men as they age, beginning at around 45 years old and continuing until, by age 70, 90% of men have an enlarged prostate. Due to this enlargement BPH is the leading cause of urinary outflow obstruction in men.

Some researchers have suggested that BPH typically indicates low levels of male hormones. An abnormally high activity of the enzyme that converts testosterone to dihydrotestosterone (DHT), 5-alpha reductase, is usually seen in BPH. DHT may be more potent stimulator of prostate cell growth than testosterone, and is also considered to be a factor in male pattern baldness. High levels of oestrogen may also factor in the disease progression.

Symptoms of BPH

The primary signs and symptoms are general problems with urination. With a gradual progression, signs usually include: urinary frequency, urinary urgency, nocturia (needing to get up at night to urinate), hesitancy with decreased force of stream, terminal dribbling (the final phase of urination as slow drips), sensation of incomplete emptying, overflow incontinence or total retention, burning on urination, chills and fever which indicate infection has set in (due to the urine staying in the bladder), and possibly a palpable distended bladder. During a digital rectal examination the prostate gland will feel enlarged, rubbery, often with loss of median sulcus. The median sulcus is a vertical groove in the heart-shaped gland which tells the examining doctor that the gland is NOT enlarged or swollen.

Diagnosis and Pharmaceutical Interventions

After the a digital rectal exam, a urinalysis to look for infection and a creatinine test to assess kidney function may be performed. A blood test looking at levels of prostate-specific antigen is usually a good diagnostic clue, as it is elevated in 30-50% of men with BPH. It can also be elevated in other conditions, so important questions to ask your doctor is to include the “rule-outs” which means you want to be sure that the diagnosis is definite and correct. Possible problems that could mimic BPH are: neurogenic bladder, acute prostatitis, chronic prostatitis, cancer and other obstructive pathology.

Pharmaceutical Medications

The most used medication used for PBH is a class called 5-alpha-reductase inhibitors with finasteride (proscar) being the most common. It works by decreasing the endogenous synthesis of DHT by inhibiting 5-alpha-reductase. Finasteride reduces serum DHT levels by 60% – 75%, but it may take six months to a year to see relief. It has the possibility of sexual side effects, namely erectile dysfunction and decreased libido. It may also cause breast swelling and/or tenderness, testicular pain, skin rashes, itchiness, hives or rashes. Finasteride has the possibilities to cause developmental problems in pregnancy, so women who are pregnant or trying to get pregnant should not handle the pills and should avoid exposure to partner’s semen. Another type of medication that may be used for BPH is alpha-1 adrenergic blockers such as tamsulosin (flomax). These cause relaxation of the prostate and bladder and may elevate some urinary symptoms. It should not be used in those with low blood pressure, which is a side effect, as well as dizziness, headaches and fatigue.

Conventional surgical treatment includes removal of all or part of the prostate, called transurethral resection of the prostate (TURP). Most patients improve significantly after treatment but may be rendered impotent. Surgery is not to be taken lightly, as complications include infections, urinary retention and hemorrhage. A complication known as the transurethral resection syndrome, caused by too much fluid being absorbed during the surgery, can cause possible confusion, congestive heart failure, or pulmonary edema.

Lifestyle and Dietary Modifications

When symptoms of BPH are not severe, lifestyle changes will prove helpful. A good place to start is to avoid caffeinated beverages and limit alcohol use. Alcohol increases urine production and may cause congestion in the prostate gland. Caffeine irritates the bladder. The amount of liquids consumed in the evening should be reduced, with 7pm being a cutoff time. Avoid over-the-counter antihistamines and decongestants. These drugs tighten the muscles that control urine flow, making it more difficult to urinate. Another thing that is helpful is too stay warm, as being cold can lead to retention of urine. And each time you urinate, try to empty your bladder completely.

Staying active is important, as urine is retained when you don’t move around. Even a little increase in activity can make a difference. Walking has been shown to be an effective exercise for men with BPH and can help prevent it. Aerobic exercise, a minimum of 3 times weekly for 20 minutes at your target heart rate, will do wonders for not only the prostate gland, but for your heart, lungs, bones and mental well-being. There are some exercises that can improve circulation to the general area as well as tone the bladder. A set of movements commonly called “Kegel” exercises which involve pulling up rhythmically on the pelvic floor (all the muscles around the scrotum and the anus) with the lower abdominal muscles as you exhale, and keep pulling up on the squeeze until you need to take a breath. Repeat 10 times, 5 or 6 times daily. This can be done very discretely — nobody needs to know you’re doing this exercise. It’s perfect for commuting, or while you’re sitting around waiting for someone or something, or in the shower. A change in diet to focus on whole, unprocessed food such as whole grains, legumes, vegetable, fruits, nuts and seeds will add more nutrients and encourage well being. Eating organic food whenever possible is important, as some pesticides can increase the activity of 5-alpha-reductase and stimulate the enlargement of the prostate. Raw pumpkin seeds are high in zinc, a mineral that is paramount to treating BPH, should be consumed, as well as almonds, sesame seeds and tahini.

Nutritional Factors Shown to be Beneficial

Omega 3 Fish Oils

A deficiency of omega 3 fatty acids has been postulated as a possible contributing factor in BPH.
Does: 2-6 grams a day

Vitamin E

Because taking EFAs increases the requirement for vitamin E, most doctors recommend taking a vitamin E supplement along with EFAs.
Dose: 800-1200 IU every day

Calcium d-Glucarate

Calcium d-glucarate (also known as calcium glucarate) is a salt of D-glucaric acid consisting of D-glucaric acid bound to 12.5% calcium. This form aids in the detoxification of steroid hormones.
Dose: 500 mg three times a day

Di-indoly-methane

Di-indoly-methane (DIM) is an indole phytochemical that is a natural metabolite of compounds found in cruciferous vegetables such as broccoli, Brussels sprouts and cabbage. It works to reduce levels of oestrogen metabolites, some of which can contribute to disease.
Does: 100-200 mg a day

Saw Palmetto (Serenoa repens)

The fat soluble Saw palmetto extract can reduce the activity of the 5-alpha reductase enzyme which contributes to BPH. Saw palmetto also blocks DHT from binding in the prostate. This reduces urinary problems and has been shown to improve quality of life.
Dose: 160 mg of the standardized extract twice a day

Pygeum africanum (also know as Prunus africanum)

Pygeum, an extract from the bark of the African tree, has been approved in Germany, France, and Italy as a remedy for BPH. It is an African tree that has been used historically for prostate and urinary conditions. It is especially useful for early cases of BPH conditions.
Dose: 50-100 mg of the standardized extract twice a day