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Dealing With Prostate Enlargement

Prostate enlargement is an abnormal enlargement of the prostate gland causing variable degrees of bladder outlet obstruction.

Photo: Health Day

Prostate issues are estimated to affect 50% of men over the age of 50 years

Benign prostate hyperplasia, or BPH, is estimated to affect 50% of men over the age of 50 years. Eighty percent of men 80 years old or older are affected by BPH.

The prostate is a golf ball sized gland located around the urethra at the outlet of the bladder. It produces an alkaline prostatic fluid containing enzymes, minerals and proteins that nourish and protect sperm. It contributes to seminal fluid a secretion containing citric acid, phosphatase and other proteolytic enzymes which accounts for the liquefaction of semen. The rate of production of prostate fluid increases with active relations and stimulation.

Enlargement of the prostate occurs with aging. Hormonal factors, diet, lifestyle factors and genetics are all believed to play an important role.

The major male hormone testosterone is known to decrease with increasing age. A byproduct of testosterone called dihydrotestosterone, or DHT, increases with age. DHT stimulates prostate gland growth. Also, some males are believed to produce higher levels of estrogen which is also believed to stimulate prostate growth.

Poor dietary factors such as increased consumption of alcohol, caffeine, sugar and processed foods are associated with increased prostate size.

Fresh fruits, vegetables, beans and whole grains including all types of dark berries, broccoli family vegetables including broccoli, cabbage. Cauliflower and kale, fish, green tea, plant-based proteins, pumpkin seeds, soybeans and tomatoes are associated with decreased prostate size.

Lifestyle factors, such as obesity, diabetes, erectile dysfunction, heart disease and lack of exercise and lack of healthy relations are associated with an increased risk of prostate enlargement. Genetics and family history are believed to play an important role in the development of prostate enlargement. Having a close family member, like a father or brother, with BPH dramatically increases your risk of developing it. Genetic factors are estimated to influence up to 75% of individuals with prostate enlargement.

Symptoms of BPH include increased frequency of urination, urination at night, incomplete bladder emptying, inability to void, overflow incontinence and terminal dribbling. Hesitancy and intermittency with decreased size and force of urinary stream occur.

BPH is caused by an abnormal enlargement of the prostate gland which irritates the bladder and urethra. Because of its position around the urethra, enlargement of the prostate quickly interferes with the normal passage of urine from the bladder. Urination becomes increasingly difficult and the bladder never feels completely emptied. If left untreated, continued enlargement of the prostate eventually obstructs the bladder completely and emergency measures may become necessary to empty the bladder. If the prostate is markedly enlarged, then chronic obstruction may result.

Diagnosis of benign prostatic hyperplasia by a physician should be based on symptoms, physical exam and laboratory tests. A regular check up and prostate exam is recommended once per year after the age of 50 years. Prostate cancer may initially present with similar symptoms. Prostate cancer is the second leading type of cancer in males.

Conventional medical treatment of BPH is drug therapy. The two most popular drugs in North America for this condition is tamsulosin (Flomax) and dutasteride (Avodart). Tamsulosin belongs to a group of medicines called alpha blockers that relax the muscle of the bladder and prostate and make the passage of urine easier. Dutasteride blocks an enzyme called 5-alpha reductase that decreases production of DHT. It can help to shrink the prostate over time and reduce symptoms associated with it.

If drug treatment does not improve BPH symptoms then a surgical procedure called transurethral resection of the prostate or TURP may be recommended.

Coffee, tea, colas, chocolate and other caffeine containing foods and beverages should be reduced. Caffeine is a natural diuretic that increases urinary excretion. Foods high in added sugar including processed and refined foods should be reduced. Alcohol should be consumed in moderation or none at all. Some men report that spices can irritate the bladder and prostate.

Consuming a diet rich in coloured fresh fruits and vegetables, beans and legumes, nuts and seeds, whole grains and cereals should be emphasized.

Foods rich in zinc including oysters, fish, meats and seafood and nuts and seeds can help to shrink an enlarged prostate.

Herbal medicines and supplements that can help BPH include bee pollen and rye pollen, beta sitosterol, green tea, lycopene, nettles, pumpkin seed oil, Pygeum africanum and saw palmetto. Beta sitosterol is a plant sterol related to cholesterol. Pygeum africanum or the African cherry tree reduces prostate cell growth and decreases inflammation.

Saw palmetto is a dwarf palm tree that contains lipids, sterols and flavonoids that can help block the conversion of testosterone to dihydrotestosterone or DHT and reduces its effect on enlarging the prostate.

The information provided in this article is not intended to constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) also known as benign prostatic hypertrophy (technically a misnomer), benign enlargement of the prostate (BEP), and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate.

Properly, BPH involves hyperplasia rather than hypertrophy, but the nomenclature is often interchangeable, even amongst urologists. It involves hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra, which interferes with the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, dysuria (painful urination), increased risk of urinary tract infections, and urinary retention. Although prostate specific antigen levels may be elevated in these patients because of increased organ volume and inflammation due to urinary tract infections, BPH is not considered to be a premalignant lesion.

Adenomatous prostatic growth is believed to begin at approximately age 30 years. An estimated 50% of men have histologic evidence of BPH by age 50 years and 75% by age 80 years. In 40-50% of these patients, BPH becomes clinically significant.

Alleviating Urinary Tract Symptoms In BPH: Nutraceutical Shows Promise

Photo Credit: iStock.Com/Olga Arkhipenko

Researchers found that a nutraceutical combining pollen extract and teupolioside effectively alleviated lower urinary tract symptoms in patients with BPH.

A nutraceutical combining pollen extract and teupolioside alleviated lower urinary tract symptoms (LUTS) safely and effectively in men with benign prostatic hyperplasia (BPH), according to a study published online in Archivio Italiano di Urologia e Andrologia.

The product, Xipag (IDI Integratori Dietetici Italiani srl), is designed to target inflammation and reduce dihydrotestosterone production.

"As previously documented in the literature, the effectiveness of teupolioside in addressing prostatic hypertrophy and that of pollen extract in alleviating symptoms such as chronic pelvic pain and irritation are well established, making this product particularly promising for managing moderate LUTS," Study author Mattia Lo Re, MD, of Careggi University Hospital, and coauthors noted.

Testing the Promise

The researchers conducted a single-center observational study assessing its effectiveness in improving urinary function and symptoms in men with mild to moderate LUTS.

Sixty patients with BPH were enrolled and received one tablet of Xipag daily for three months. Participants were evaluated at baseline, one month, and three months using three validated questionnaires: the International Prostate Symptom Score (IPSS), the Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form, and the International Index of Erectile Function. Assessments included blood draws for prostate-specific antigen (PSA) levels and uroflowmetry with post-void residual (PVR) measurement.

Significant Symptom Improvement

Of the 60 patients, 53 completed follow-up assessments. Statistically significant improvements in urinary symptoms were observed: Between baseline and month 3, IPSS scores decreased from 14 to 10, while IPSS QOL scores improved from 3 to 2. Although not statistically significant, objective urinary flow metrics showed favorable trends: maximum flow rate (Qmax) increased from 12 mL/s to 15 mL/s, and PVR volume declined from 50 mL to 35 mL. Sexual function and PSA levels remained largely stable throughout the study. No serious adverse events were reported.

"After 3 months of treatment, 44 patients (83.2%) expressed their willingness to continue. Three patients (5.7%) reported no significant improvement in LUTS and expressed the desire to switch to another therapy," the researchers wrote. Additionally, six patients (11.3%) with mild LUTS discontinued the product but remained open to future use if symptoms progressed.

"The size of our cohort enables a more robust analysis and provides valuable data to the limited existing literature on Xipag," researchers concluded, "and contributes to the growing body of evidence supporting the use of nutraceuticals in managing BPH-related symptoms, particularly in cases where conventional therapies may lead to undesirable side effects."

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