by Chris D. Meletis, N.D.
If you’re a man and your prostate isn’t bothering you, chances are good you’re not spending much time thinking about this walnut-sized gland. And if it is bothering you with either painful or just annoying urinary tract symptoms, you’re probably thinking about it a lot, whether you want to or not.
Either way, paying attention to the health of this small gland can have big benefits. That’s because even if you don’t feel as if there’s anything wrong with your prostate, two of the most pressing male prostate health concerns can be symptom-free.
Some men with an enlarged prostate—known as benign prostatic hyperplasia (BPH)—don’t have symptoms. Additionally, early-stage prostate cancer is also often silent. This means that there could be something wrong with your prostate and you wouldn’t even know it without an exam from your doctor.
The prostate gland is an important part of the male reproductive system. It secretes a milky fluid that usually constitutes 20 to 30 percent of the semen, along with spermatozoa and seminal vesicle fluid. The prostate also contains smooth muscles that help expel semen during ejaculation. Furthermore, the urethra runs through the prostate, so changes in prostate structure can impact urinary function.
In this article, I’m going to discuss the three most common prostate challenges—benign prostatic hyperplasia, prostatitis and prostate cancer—what you can do to reduce your risk of developing these conditions and effective approaches to take if you already have these health concerns.
Benign Prostatic Hyperplasia (BPH)
BPH, an enlarged prostate gland, is the most common urologic disease in men over age 50. New evidence indicates that it’s associated with an increased risk of developing prostate cancer. At the European Multidisciplinary Cancer Congress on September 24, 2011, researchers reported that in subjects followed for more than 27 years, clinical benign prostate hyperplasia was associated with a two- to three-fold increased risk of developing prostate cancer. BPH also was associated with a two- to eight-fold increased risk of them dying from prostate cancer.1
BPH symptoms range from non-existent to mild and barely noticeable to more serious. Interestingly, a larger prostate doesn’t necessarily mean more severe symptoms. It’s possible for serious symptoms to occur with a prostate that is only slightly enlarged, while men with a significantly enlarged prostate may experience few if any symptoms.
BPH symptoms include:
- Difficulty urinating (hesitancy and straining)
- Decreased strength of urine stream (weak flow)
- Dribbling upon urination
- Feeling that the bladder is not completely empty
- An urge to urinate again soon after urinating
- Painful urination
- Waking at night to urinate
- A sudden uncontrollable urge to urinate
Some pharmaceutical drugs including over-the-counter cold medicines such as diphenhydramine (Benadryl®), Sudafed® and oxymetazoline spray (Afrin®), as well as antidepressants, diuretics and pain medications can either worsen BPH symptoms or cause urinary tract symptoms not related to BPH. In a study published in 2011, researchers found that common medications contribute to 10 percent of lower urinary tract symptoms among men. In fact, the study subjects who did not have BPH were more likely to be affected by the medications.2
It’s best to work with your doctor to make sure the symptoms you have really are caused by BPH. Other conditions such as urinary tract infections, prostatitis, prostate cancer, diabetes, heart failure and neurologic conditions, including lower back nerve dysfunction, can cause similar symptoms.
Prostate cancer is the most frequently diagnosed cancer in men, aside from skin cancer. The American Cancer Society estimates that more than 241,000 men will be diagnosed with prostate cancer before the end of 2012.3
Prostate cancer has many of the same symptoms as BPH, including difficulty urinating and decreased force in the stream of urine. Other symptoms of prostate cancer include:
- Blood in the urine or semen
- Swelling in the legs
- Discomfort in the pelvic area
- Bone pain (in advanced cases)
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is defined as “urologic pain or discomfort in the pelvic region, associated with urinary symptoms and/or sexual dysfunction, lasting for at least three of the previous six months in the absence of any identifiable pathology such as cancer, a culturable infection or anatomic abnormalities.”4
If you’re a man and suffer from repeated bladder infections, you may have chronic infectious prostatitis. But the most common form is chronic nonbacterial prostatitis/chronic pelvic pain syndrome, which is responsible for 90 percent of the cases.5 If you’ve had urinary and genital pain for at least three of the past six months and there’s no bacteria found in your urine, then you may have this condition.
PSA Generates Controversy
Most men over the age of 50 have likely had a digital rectal exam in which a doctor feels the prostate through the rectum to find hard or lumpy areas known as nodules.
To detect prostate cancer, your doctor also may want to have you take a Prostate Specific Antigen (PSA) test. The test measures the amount of PSA, a protein produced by cells of the prostate gland, in the patient’s blood.
Elevated PSA levels can be caused by many factors, including benign prostate enlargement or inflammation of the urinary tract, particularly the prostate. This is why additional tests are used with the PSA test. If the PSA test reveals anything suspicious, physicians will order a biopsy of prostate cells to confirm the diagnosis.
However, there is controversy revolving around the PSA test, namely because it’s uncertain whether the benefits of screening ultimately outweigh the risks of overdiagnosis.6 The U.S. Preventive Services Task Force in December 2011 reported that the test may not save lives, and after three or four screening rounds, 12 to 13 percent of screened men had false-positive results.7 It’s also well known that PSA can be elevated in men without prostate cancer, while men with prostate cancer may have normal levels of PSA.
However, in a Mayo Clinic study published in September 2012, researchers concluded that the PSA test is valuable in predicting which men should have biopsies and which are likely to be diagnosed with low-risk prostate cancer.8
Researchers are working on developing other screening methods. In May 2012, scientists reported that they had developed a genetic test that outperformed the PSA test.9 For now though, the PSA test and digital rectal exams are the recommended screening options.
Possible Causes of Prostate Problems
A number of factors could be affecting the health of your prostate gland. One of those factors is environmental toxins. In rodents, exposure to methylmercury resulted in changes to the prostate, including hyperplasia and inflammation.10
Bisphenol A (BPA) is another environmental toxin that may harm the prostate gland. BPA is found in liners of metal cans, plastics and even cash register receipts. Evidence indicates that nearly everyone in the United States has BPA in his or her body. This affects nearly every aspect of bodily health—and the prostate is no exception. Researchers have shown that BPA disrupts prostate development in male mice at doses equivalent to human exposures.11
In a study published in October 2011, researchers have shown that even low-dose BPA increased the prostate weight and volume in rats. BPA also decreased testosterone levels and increased prostate-specific antigen levels.12
In humans, epidemiological studies also have linked specific pesticides, PCBs and inorganic arsenic exposures to elevated prostate cancer risk.13
Additionally, use of the contraceptive pill in the population as a whole was significantly associated with both the number of new cases of prostate cancer and deaths from the disease in individual countries around the world. Researchers linked this association to the estrogenic metabolites of birth control pills that end up in the water supply and food chain in areas where oral contraceptive use is common.14
The Viral Link
Certain viral infections also are linked to the development of prostate cancer. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are both present in most prostate cancers and may even team up with each other to promote the survival and proliferation of cancer cells. Researchers have found a high-risk strain known as HPV 18—which is associated with other human cancers—in prostate samples.15
Viruses may also be the reason why some men with BPH experience symptoms while others do not. According to a study published online in September 2012, scientists found that there is a greater anti-viral immune response in tissues from patients undergoing surgery to alleviate symptoms of BPH compared to tissue from BPH patients with no symptoms.16
A possible viral component to prostate concerns also explains why circumcision before a male’s first sexual intercourse may help protect against prostate cancer. This is because circumcision can prevent infections linked to the development of prostate cancer.17
Another important factor regulating prostate health is insulin and blood sugar control. A study published in September 2012 showed that 166 Korean patients with the highest insulin had more than a 5.6 fold risk of advanced prostate cancer compared to those with the lowest levels.
The patients who scored highest on the insulin resistance index also had an increased risk of advanced prostate cancer compared to the group with the lowest scores on the index.18
The researchers concluded that elevated insulin and insulin resistance are associated with the advanced pathological stage of prostate cancer in Korean patients.18
Sliding Down a Sedentary Slope
Sedentary behavior is associated with an increased risk of prostate cancer. Studies have shown that sitting for long periods is associated with increased risk of cancers, including prostate cancer. One study published in December 2009 showed that, compared to men who mostly sit during their main work or occupation, men who sit half of the time experienced a 20 percent lower risk.19 Researchers believe this increased risk in sedentary people could be due to either weight gain due to lack of exercise or the insulin resistance that occurs in many sedentary people.20
In my practice, I recommend the “G Seat®” to patients who have to sit for extended periods. The G Seat® is a lightweight cushion from Gelco Products that is ergonomically engineered to enhance comfort while seated. It has a five-degree forward slope to help return the pelvis to its proper position and disperse pressure at the point of contact to reduce low-back pain and help maintain proper lumbar curvature. This may also help to take pressure off of the prostate. (G Seat® may be purchased at www.gelcoproducts.com.)
Some people have expressed concern that bicycle saddles (seats) may contribute to pain and numbness in the groin and prostate as well as to erectile dysfunction. However, a review of the literature on bicycling and genitourinary disorders did not commonly find elevated PSA levels in bicyclists.21
For my patients who spend a lot of time on a bicycle, I recommend using a different type of saddle that is gentler on the prostate.22 Some available choices include:
- A noseless saddle (reduces saddle contact pressure in the perineal region)
- A recumbent seat made of nylon webbing (allows better air circulation around the buttocks and back)
- The split, dual-padded Easy Seat, or moon-shaped and horseshoe-shaped seats
Testosterone: Good Guy or Bad Guy?
In the past, men with prostate cancer or BPH were always warned to avoid anything that would increase testosterone levels. Even now, a standard form of conventional therapy for prostate cancer is androgen deprivation therapy, which reduces the amount of male sex hormones (including testosterone) in a man’s body.
The reason why testosterone has been blamed as the bad guy in regards to prostate health is because researchers thought that high testosterone levels could fuel prostate growth, inducing prostate cancer development or leading to a poor prognosis in prostate cancer. However, based on mounting evidence in the medical literature, scientists are beginning to realize that it’s actually low testosterone levels that are related to features of poor prostate health, such as higher PSA levels.23
In one study of 137 men with prostate cancer published in 2012, the higher the testosterone level, the smaller the tumor in the biopsy. The study authors found high testosterone levels in patients who had low risk of cancer progression.23
As mentioned on page 4, environmental toxins can destroy prostate health. So your first step is to consume a good detoxification product. It’s also helpful to wash your hands after touching cash register receipts and avoid eating canned food or food stored in non-clear plastic.
Second, balance your insulin levels by consuming a diet low in white starches and sugars and high in vegetables, healthy protein and fiber.
Exercise is another essential component of an effective prostate-protecting program. Studies have shown that exercise can help prevent prostate cancer. A 10-year study published in 2009 found that, of 45,887 men aged 45 to 79 years, standing for most of the time during work or occupational activity and walking or bicycling more than 30 minutes per day during adult life was associated with reduced incidence of prostate cancer.24
When most people think about natural solutions for prostate health, the conversation almost always starts with saw palmetto, especially when it comes to BPH. However, there has been some controversy around the effectiveness of this herb. Given this, we suggest looking into a few other botanicals and nutrients to promote prostate health, including beta sitosterol, stinging nettle, pygeum, cranberry and vitamin D.
Many studies have shown that beta sitosterol can help men with prostate concerns. In two randomized, placebo-controlled, clinical studies conducted on 350 men diagnosed with benign prostatic hypertrophy, 60 to 130 mg beta-sitosterol taken daily for six months resulted in improved peak urinary flow rate, as well as an improvement in subjective symptoms of BPH.25-27
Researchers have studied stinging nettle (Urtica dioica) for its ability to support prostate health. It’s been shown to improve lower urinary tract symptoms, reduce the international prostate symptom score and improve the maximum urinary flow rate.28
Pygeum africanum supplementation has resulted in a moderately large improvement in the combined outcome of urologic symptoms and flow measures, an improvement in overall symptoms, reduced nocturia (urination in the middle of the night) and an increase in peak urine flow.29
Cranberry, long known for its ability to prevent urinary tract infections, is emerging as another prostate-protecting nutrient. Cranberries contain components that inhibit prostate cancer. Additionally, research shows that men who consumed cranberries for six months had a statistically significant improvement in International Prostate Symptom Score, Quality of Life, urination parameters such as voiding parameters (rate of urine flow, average flow, total volume and post-void residual urine volume) and lower total PSA level.30-31
Studies are beginning to show that this vitamin plays a starring role in prostate health. In a study published in July 2012, 44 subjects who had low-risk prostate cancer took 4,000 IU of vitamin D3 per day for one year. At the study’s end, there was a decrease in the Gleason score, which measures the severity of prostate cancer. Cancers with a higher Gleason score are more aggressive and have a worse prognosis. After vitamin D3 supplementation, subjects also had a decrease in the number of positive biopsies.32
Another study reported at the AACR Annual Meeting March 31 to April 4, 2012 indicated that vitamin D may slow prostate cancer cell growth as well.33
In my clinical practice, my motto is “test, don’t guess,” so I recommend that you get your vitamin D levels tested to determine the exact amount of supplementation necessary. For anyone who tests below 55 ng/ml, it usually takes anywhere from 2,000 to 6,000 IU per day to bring your levels up to normal.
Protect Your Quality of Life
A prostate gland that’s not working optimally can impair your quality of life, from having to get up in the middle of night to go to the bathroom to more painful symptoms that affect your emotional well-being. Even if you’re not feeling any outright symptoms, your prostate could be suffering in silence. Beginning a regimen to protect the prostate can relieve any existing symptoms or stop them from developing in the first place.
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