Enlarged prostate: natural prevention and treatment strategies | UroChannel
If you are a man, over 30 years old and you ve never thought about your prostate, then you should watch this video and pay attention closely because this gland can cause you a lot of trouble. In the 4th decade of life as many as 30 to 40 % of all men start to develop a benign enlargement of their prostate. In this video, I am going to explain natural strategies for prevention and treatment of this common problem in men. But first, listen to what I have to say about the development and symptoms of an enlarged prostate. If you are an expert already, you may skip to the end of the video, I divided it into chapters. Welcome to UroChannel! My name is Stefan Buntrock, I am a urologist and on UroChannel, I am giving you medical information on urological conditions from the point of view of the professional. Now, let s talk about the prostate. Only one out of four men above age 50 knows what the prostate does and roughly one out of five men isn t aware they even have a prostate. So just in case, I better give you a short introduction. The prostate is a gland that s positioned below the bladder. Alongside with the seminal vesicles, it produces most of the ejaculate. If you have thought, that the fluid is build in the testicles then you were actually mistaken, because the testicles only contribute with the sperm, mixed in a small amount of the ejaculate. This means that the prostate plays a central role in human reproduction. Without the prostatic fluid, the sperm cells wouldn t be able to survive. As you can see, the urethra runs through the prostate, or better, the inner part of this gland forms parts of the urethra. The actual size of a normal prostate comes quite close to a chestnut. In millilitres this is around 20 ml. What happens, when men get older is, that the prostate will start to grow. Well, strictly speaking, not all of it, but the inner parts. Why this is happening, is still not quite clear. There are two established factors that lead to the enlargement: aging and fully functioning testicles. Because the male sex hormone testosterone is needed for prostate integrity and prostatic function. In men with androgen deficiency, like after castration or problems with the androgen receptor, the prostate will not enlarge. There are clearly other factors that are linked to prostatic growth but they are less well defined. Before I go on, it is important to point out that benign prostatic enlargement, or BPE, has nothing to do with cancer. I am telling you this because many of my patients believe that an enlarged prostate equals prostate cancer. Good news! This is not the case! And good news are meant to celebrate! Push the uro-like button now to express your relief, that BPE is not cancer! And if you like good news and urologic topics, consider subscribing to my channel! Now for the other triggers of prostatic enlargement. Inflammation could be one factor as the prostate has a connection to the outer world through the urethra. Bacteria and viruses have a chance to enter the organ via that pathway and cause infection and inflammation. As a matter of fact, prostatic infection as in prostatitis, is a fairly common urological condition. But, as I pointed out, there is still much research to be done to really make sure, this is a definitive factor. Obesity seems to be another point. At least, we know that obesity goes along with a 3.5-fold increased risk as compared to the non-obese. Obesity in itself is the starting point for the so called metabolic syndrome. Within the metabolic syndrome the following changes typically take place: hypertension, diabetes, gout, arteriosclerosis. The body gets into a generalized inflammatory state. This can also be measured in the lab by a slight elevation in CRP levels in the blood which is a marker for inflammation. Increased body fat changes the ratio between testosterone and the female sex hormone oestradiol in a disadvantageous way. Because body fat is able to take testosterone and turn it into oestradiol. These might be some of the reasons why obesitiy is linked to prostatic enlargement. Anyway, the prostate will grow in most men. Between 30 and 40, BPE can be found in 30-40% of all men and in men older than 80 years, 70-80% have it. Of course, there are variations. Starting out at about 20 ml, most men will go up to 40 ml while some might even progress further. Over 300 ml is possible which is comparable to the size of an orange. Why this is happening in some men, is not understood. Does an enlarged prostate cause problems? Another thing that is not quite clear. In the old days urologists believed that prostatic growth compresses the urethra thus resulting in symptoms which we nowadays summarize as LUTS. Lower Urinary Tract Symptoms that is. It s a whole bunch of annoying stuff that includes urinary frequency, urgency, having to go to the bathroom frequently at night, weak stream, feeling of not adequately emptying the bladder and more. With time it became clear that the enlarged prostate is responsible for these symptoms in some men, but not all. Even with quite a large prostate, there might be no symptoms and bladder emptying is working well. There are other factors: the natural aging process which also comprises aging of the bladder. And there might be pelvic floor issues which also may be responsible for these symptoms. And of course, urinary tract infections, bladder emptying issues, prostate cancer, bladder cancer and so on. Now I am going to talk about natural prevention strategies and treatment possibilities and welcome to those viewers who skipped the first part of the video! The foundation to prostatic health is a healthy lifestyle! This means a diet low on saturated fat, lots of vegetables, some fruit, if you are unable to avoid meat, try to stay away from red meat, especially if it has been barbecued. But you know: since we don t know anything specific as pointed out earlier, it is kind of difficult to say: do this and don t do that. However, there is scientific evidence that lifestyle is indeed a factor. Like in the Prostate Cancer Prevention Trial some years ago where they evaluated the efficacy of Finasteride for the prevention of prostate cancer. And this was a huge study that included nearly 19,000 men. They did a subanalysis of 4,770 participants in the placebo arm who were free of BPE when they entered the trial. During the seven-year follow-up, 876 men developed BPE, or BPH which stands for benign prostatic hyperplasia. They changed the terminology some years back and reserved BPH for histologically proven prostatic enlargement only. In practice it s kind of the same. Bottomline for this study was a significant risk reduction for those who consumed more than 4 servings of vegetables a day and gosh I hate this! But it would be unfair to hide it from you alcohol. In the Prostate Cancer Prevention Trial, regular consumption of alcoholic beverages, two or more per day, turned out to be protective. However, I don t encourage you to start drinking alcohol, absolutely not! There are lots of disadvantageous effects, so I don t think it is wise to drink on a regular basis! On the downside, they found that daily consumption of red meat increased the likelihood of BPE significantly. There is also evidence that a diet high on bread and cereal might be a risk factor. Lycopene from cooked tomato products, zinc, vitamin D might be protective but it depends which study you are looking at. Obesity with the metabolic syndrome puts the body into a permanent inflammatory state. And we know that inflammation is not good for the prostate. The finding that fatty liver disease which is linked to the metabolic syndrome, is associated with intraprostatic inflammation, thus causing BPE is something that goes into the same direction. In other words: fight inflammation! Besides body weight, the natural aging process puts the body more and more into an inflammatory state as we get older. So becoming obese aggravates this development. What about sports? Definitely something to consider! Check out my video on this topic! For the sake of time, let s turn to natural treatment strategies once you ve caught symptomatic BPE and suffer from LUTS. First of all, you will indeed need a baseline urologic examination to make sure, you empty your bladder completely without residual urine, that there are no bladder stones, no infections, no cancer that might cause your problems. Natural remedies and behavioural exercises are something for the early stages. When it comes to chronic or acute urinary retention and severe symptoms paired with a large prostate, a red line is crossed and you will seriously have to think about proper medication and surgery is just around the corner. O.k. behavioral interventions, some baseline tips: plan you fluid intake ahead of activities. Reduce it at times when it would be very inconvenient to go to the bathroom. Don t drink coffee, tea or alcohol as it might have an irritant effect on your bladder. If the voided volume is low, try bladder retraining and resist the first urge to go to increase the capacity of your bladder. Review your medication. Some tablets will have a diuretic effect which means, they will increase urine production. Talk to your doctor whether modifications are possible. And finally: think about constipation. If you have difficulties in this area, use strategies to ameliorate your bowel movements, that ll help the bladder, too. How this is done, is not within the scope of this video. Post a comment if you want me to do a video about this topic. When it comes to drugs, I will skip the usual stuff I prescribe and talk a bit about herbal remedies. Are there any? Yes, there are and the most effective of them would be saw palmetto which has an established effect. However: don t expect too much as the efficacy might only be modest. In Germany, pumpkin seed is used a lot and even phytosterol. Plant extracts work anti-inflammatory and have a more estrogenic effect and as I said earlier, inflammation and androgens play an established role in the development of BPE. This is it for now, a video about the traditional treatment of BPE is on the way. Check out my playlist of videos in English, if you want me to speak exotic languages, have a look at my other videos. Bye-bye!