Enlarged Prostate

By the age of fifty, about 30% of men will start to experience difficulties with urination related to enlargement of the prostate gland, also known as benign prostatic hypertrophy (BPH). These symptoms often lead to an increased sense of frustration and embarrassment, as well as the disruption of normal activities.

Enlargement of the prostate is usually caused by an abnormal overgrowth and/or swelling of the tissue of the prostate, which then blocks the urethra or opening from the bladder. Problems associated with this condition usually continue to worsen with age, increasing in incidence to about 50% of males by the age of sixty, and up to almost 80% past age seventy. Most physicians consider this to be a normal consequence of aging.

Throughout their lives, men produce both testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies done with animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth.

Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in the prostate, which more actively stimulates prostate growth. Most animals lose their ability to produce DHT as they age. However, some research has indicated that even with a drop in the blood’s testosterone level, older men continue to produce and accumulate high levels of DHT in the prostate. Scientists have also noted that men who do not produce DHT do not develop BPH. 5-alpha reductase is the enzyme which converts testosterone to dihydrotestosterone (DHT) which, besides stimulating prostate growth is the hormone that triggers androgenetic alopecia in individuals who are genetically susceptible.

Some researchers suggest that BPH may develop as a result of “instructions” given to cells early in life. According to this theory, BPH occurs because cells in one section of the gland follow these instructions and “reawaken” later in life. These “reawakened” cells then deliver signals to other cells in the gland, instructing them to grow or making them more sensitive to hormones that influence growth.

There appears to be little or no connection between BPH and prostate cancer development. PSA, a lab test for detecting prostate cancer can occasionally be elevated in BPH also.

Several natural treatments have been found to be very useful in preventing and treating BPH. Some products contain combinations of beneficial agents and as such may be more effective.

 


Signs, symptoms & indicators of Enlarged Prostate

Symptoms - Urinary  

Dribbling during urination



 

(Very) weak urine stream

A reduction in the force and caliber of urination is characteristic of prostatic enlargement.



 

Interrupted urine stream



Counter Indicators
Symptoms - Urinary  

Strong/average urine stream

A reduction in the force and caliber of urination is characteristic of prostatic enlargement.




Conditions that suggest Enlarged Prostate

Symptoms - Reproductive - General  

Absence of enlarged prostate



Tumors, Malignant  


Uro-Genital  


 

Increased Urinary Frequency

Increases in the number of times a man has to visit the bathroom along with a frequent sensation of having to urinate – especially at night – are among some of the early signs. In addition, a reduction in the force and caliber of urination is also characteristic of prostatic enlargement.




Risk factors for Enlarged Prostate

Digestion  

Constipation

Chronic constipation has been implicated as a contributing factor to prostatic discomfort when there is an already enlarged gland. A correction of the constipation will bring some relief of symptoms since the rectum puts pressure on the prostate gland when it is enlarged. In addition, there is a buildup of waste products in the circulation with chronic constipation. This will indirectly have an effect on the function of the prostate.



Hormones  


 


Lab Values - Chemistries  

Normal PSA or elevated PSA



Nutrients  

Antioxidant Need/Oxidative Stress w/ Supplements

A small but direct association was found between BPH and the intake of total energy, protein and long-chain fatty acids, which suggests that oxidative stress may contribute to BPH. Antioxidants may be of value. [ Am J Clin Nutr, 2002; 75: pp.689-697]



 

Antioxidant Need/Oxidative Stress w/o Supplements

A small but direct association was found between BPH and the intake of total energy, protein and long-chain fatty acids, which suggests that oxidative stress may contribute to BPH. Antioxidants may be of value. [ Am J Clin Nutr, 2002; 75: pp.689-697]



Organ Health  

Prostatitis

Prostatitis can cause a tender, swollen / puffy prostate.




Enlarged Prostate suggests the following may be present

Digestion  

Constipation

Chronic constipation has been implicated as a contributing factor to prostatic discomfort when there is an already enlarged gland. A correction of the constipation will bring some relief of symptoms since the rectum puts pressure on the prostate gland when it is enlarged. In addition, there is a buildup of waste products in the circulation with chronic constipation. This will indirectly have an effect on the function of the prostate.




Recommendations for Enlarged Prostate

Botanical  

Saw Palmetto (Serenoa repens)

One of the most well-known and time-honored herbs for prostate problems is saw palmetto. Saw palmetto has been tested in clinical trials and results show that the berries improve signs and symptoms of an enlarged prostate. During the trials, benefits were recorded for symptoms such as difficulty in urination, frequent urination at night, urine flow and size of enlarged prostate.

In all cases, the treatment was free of side effects. Scientists believe the main benefits may be due to the ability of some constituents in saw palmetto to inhibit the enzyme 5-reductase in the body. This enzyme converts the hormone testosterone to DHT. DHT is five times more potent than testosterone in stimulating the enlargement of the prostate.

In a 2001 study of 85 men (aged 45 years or older) with lower urinary tract symptoms, treatment for 6 months with a saw palmetto product improved urinary symptoms, but had no effect on urinary flow rates. [Urology 2001;58(6): pp.960-963]



 

Pygeum (Pygeum africanum)

The literature on P. africanum for the treatment of benign prostatic hyperplasia is limited by the short duration of studies and the variability in study design, the use of phytotherapeutic preparations, and the types of reported outcomes. However, the evidence suggests that P. africanum modestly, but significantly, improves urologic symptoms and flow measures. Further research is needed using standardized preparations of P. africanum to determine its longterm effectiveness and ability to prevent complications associated with benign prostatic hyperplasia. [Am J Med. 2000 Dec 1;109(8):654-64]



 

Nettle (Urtica urens)

Reports claim that as many as 80% of European men with BPH are given the option of herbal remedies for their symptoms, including saw palmetto and stinging nettle roots, rather than medication or surgery. Studies in people suggest that the root of the stinging nettle, in combination with other herbs especially saw palmetto, may be an effective treatment for BPH, relieving urinary symptoms such as reduced urinary flow, incomplete emptying of the bladder, post urination dripping, and the constant urge to urinate. These symptoms are due to the enlarged prostate gland pressing on the urethra (the tube that empties urine from the bladder). Laboratory studies have shown stinging nettle to be comparable to finasteride (a medication commonly prescribed for BPH) in slowing the growth of certain prostate cells. However, unlike finasteride, the herb does not decrease prostate size.

A metabolite of testosterone called dihydrotestosterone (DHT) stimulates prostate growth, leading to enlargement. Nettle root inhibits the binding of DHT to attachment sites on the prostate membrane.



 


 

Radix Urticae

Radix urticae is another plant investigated for its beneficial properties in treating benign prostate hyperplasia. Much less information is available on radix urticae compared to saw palmetto and what little there is comes from eastern Europe, but there are a few reports that suggest radix urticae extracts may help improve symptoms. [Romics 1987]



Diet  

Pumpkin Seeds

Pumpkin seeds have long been used by naturopathic physicians in treating prostate disorders. The efficacy of pumpkin seeds is thought to be due to their high content of essential fatty acids, zinc and plant sterols. Men with BPH have used 160mg tid with meals of a standardized pumpkin seed oil extract in trials to examine its usefulness. Animal studies have shown that pumpkin seed extracts can improve the function of the bladder and urethra also.



 

Caffeine/Coffee Avoidance

Coffee consumption was found associated with an increased risk of BPH in a study of 882 randomly selected men 65-80 years old. [BJU Int 2002;90(7): pp.649-54]



 

Alcohol Consumption

Moderate alcohol consumption was associated with a reduced risk of BPH. [BJU Int 2002;90(7): pp.649-54]



Drug  

Conventional Drugs / Information

Finasteride (Proscar or Propecia) is a medication that helps shrink the prostate in many men. This can lead to improvement of symptoms.



Hormone  

Progesterone

Males also produce progesterone, although only about half as much as females do. Progesterone prevents the body from converting testosterone to di-hydro testosterone. It does this by inhibiting the enzyme 5-alpha reductase. Progesterone inhibits 5 alpha reductase more effectively than Proscar and saw palmetto which are the more standard agents employed in traditional and natural treatments for BPH. The dose of natural progesterone for men is 10-12mg per day (5-6mg bid) applied topically. Men do NOT need to cycle like premenopausal women and can safely take the progesterone daily.



Mineral  

Zinc

Zinc supplementation has a clearly documented usefulness in shrinking an enlarged prostate. Research has shown that zinc and essential fatty acids are important to help prevent prostate problems that affect men as they grow older. Many studies confirm that a lack of these two nutrients in the diet could be associated with prostate enlargement.

Zinc has been found to inhibit the activity of 5-alpha reductase, the enzyme that irreversibly converts testosterone to dihydrotestosterone, a form which binds more avidly to the prostrate and stimulates greater growth. It also decreases prolactin secretion by the pituitary gland, thus decreasing its binding to the prostate, both of which prevent prostatic enlargement.



 


Nutrient  

Essential Fatty Acids

The administration of an essential fatty acid (EFA) complex containing linoleic, linolenic and arachidonic acids has resulted in significant improvement for many patients. All 19 subjects in an uncontrolled study showed diminution of residual urine, with 12 of the 19 having no residual urine by the end of several weeks of treatment. These effects appear to be due to the correction of an underlying EFA deficiency, since these patients prostatic and seminal lipid levels and ratios are often abnormal. Gamma-linolenic acid (GLA), which is derived from evening primrose oil and borage oil, appears to be a powerful 5 alpha-reductase inhibitor.



Key

Weak or unproven link
Strong or generally accepted link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended

Glossary

Prostate

The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.

Benign

Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.

Hypertrophy

Increase in the size of an organ due to enlargement of its cells; frequently with a corresponding increase in functional capacity.

Testosterone

The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.

Hormones

Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Estrogen

One of the female sex hormones produced by the ovaries.

DHT

Dihydrotestosterone - a highly active form of testosterone, which influences many aspects of manly behavior, from sex drive to aggression. The conversion from testosterone to DHT is driven by an enzyme called 5-alpha reductase, which is produced in the prostate, various adrenal glands, and the scalp.

Enzymes

Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.

Alopecia

Loss of hair.

Cancer

Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Chronic

Usually Chronic illness: Illness extending over a long period of time.

Constipation

Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.

Protein

Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Fatty Acids

Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.

Antioxidant

A chemical compound that slows or prevents oxygen from reacting with other compounds. Some antioxidants have been shown to have cancer-protecting potential because they neutralize free radicals. Examples include vitamins C and E, alpha lipoic acid, beta carotene, the minerals selenium, zinc, and germanium, superoxide dismutase (SOD), coenzyme Q10, catalase, and some amino acids, like cystiene. Other nutrient sources include grape seed extract, curcumin, gingko, green tea, olive leaf, policosanol and pycnogenol.

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