Benign Prostatic Hypertrophy/BPH

Benign Prostatic Hypertrophy/BPH

*This information has not been evaluated by the FDA. This information is provided for educational purposes only and is not intended to cure or treat conditions of the prostate or any other illnesses. If you are experiencing symptoms of prostate hypertrophy or have been told that you have BPH you should immediately contact your Primary Care Doctor or Board Certified Urologist. If you are already being treated by your doctor for this condition you may also receive help from a Naturopathic Physician or Clinical Nutritionist.

Warning: If you think that you might have BPH, do not attempt to treat yourself. It is essential that you visit your doctor so that he/she can determine the appropriate diagnosis and rule out any number of more serious medical conditions. Finally, the inability to urinate or void urine should be treated as a medical emergency and would warrant an immediate visit to the hospital.

The prostate is a male reproductive organ about the size of a walnut that produces up to one third of the seminal fluid during ejaculation. The rest of the fluid originates from the seminal vesicles. The prostate is located in front of the rectum and beneath the urinary bladder. Within the prostate is the urethra which carries urine from the bladder, through the prostate, through the penis and finally outside of the body.

Because the prostate is located in front of the rectum, a digital prostate exam can be performed upon physical examination by a physician. The purpose of the digital exam is to determine if the prostate is normal or perhaps enlarged as in the case of prostate hypertrophy or finally to determine if there are any malignant masses within the prostate. A normal prostate would feel like the tip of ones nose while and enlarged prostate would feel softer like the surface of the cheek. Cancerous masses are firm upon palpation and could be likened to palpating your knuckle.

Another way of determining the health of the prostate is by performing a blood test called the “Prostate Specific Antigen” or PSA. The PSA can detect Benign Prostatic Hypertrophy but more importantly the test is most commonly used to detect prostate cancer in the early stages. Because a prostate with benign prostatic hypertrophy produces far less PSA than a malignant prostate, a doctor can normally differentiate whether a patient has BPH or prostate cancer especially when correlating findings from the digital prostate exam. It should be noted however that the level of PSA alone cannot conclusively differentiate between BPH and prostate cancer. One way to more effectively differentiate the two conditions is to chart the findings of the PSA with future test results. Because BPH does not result in a rapid rise in PSA levels compared to prostate cancer, subsequent testing that determines a steadily rising PSA should serve as a red flag for possible prostate cancer. This is one reason why men especially over the age of 50 should get regular physical exams and PSA’s. There have in fact been cases where men who have had PSA findings at “normal” levels were later found to have had prostate cancer. These malignancies were in fact detected by subsequent PSA’s that showed a steady rise in PSA levels that were still within the “normal range”. These cases would of course serve more as the exception rather than the rule but should nevertheless be as a sobering reminder to men who are lax at following up with their doctors on a regular basis.

Additional diagnostic methods of determining prostate health include ultrasound as well as other imaging procedures and surgical biopsy.

While the prostate grows throughout a man’s life span, symptoms of Benign Prostatic Hypertrophy/BPH generally develop usually after the age of 50. In the case of BPH, the prostate can grow from 2-4 times its normal size and in some cases (albeit less often) even larger. The prostate has receptors for hormones such as dihydrotestosterone (DHT) which contributes to its steadily increasing size since the process of prostatic enlargement is hormonally mediated. Therefore, it would be reasonable to assume that anything that affecting DHT levels should also have a proportional effect on the prostate. Estrogen levels are also known to contribute to BPH.

The Following Signs/Symptoms are Consistent with BPH:

  1. Signs: Signs are objective findings that can be noted or observed by your doctor. A bruise is an example of a sign.
  2. Signs involving urinary stream
  3. Decreased strength and force of the urinary stream

Because the prostate is enlarged, there is increased compression on the urethra which results in a weaker stream.

  1. Difficulty stopping the urinary stream: a man may continue to release urine even after he thinks he is done.
  2. Decreased stream volume: again because the enlarged prostate is compressing the urethra the stream volume is decreased. While the stream volume tends to decrease as a man ages, BPH results in a stream volume that is notably less than what would be expected for a normally healthy man regardless of his age.
  3. Having to wake up more than one time per night to void urine: Also known as nocturia, a man may have to get out of bed several time per night to void urine and as a result doesn’t get much sleep. Nocturia is not an exclusive sign for prostate hypertrophy as it is also seen in other medical conditions such as diabetes. Getting out of bed once a night to urinate is not considered nocturia and is in fact normal.
  4. Hesitancy: While a man may be standing over a toilet or a urinal he may still need several seconds or more before he actually starts to urinate. Some men attest to the fact that sitting rather than standing helps with hesitancy.
  5. Increased Frequency: normal urinary frequency is about every 3-4 hours and should not be under two hours unless the individual is drinking copious amounts of fluids. Men with prostate hypertrophy often need to visit the bathroom in less (sometimes much less) than two hour intervals
  6. Straining during urination: Straining means that more force is required to void urine than normal. It is best to see your doctor and get the appropriate treatment rather than strain for weeks and months at a time as prolonged straining can eventually alter the urinary mechanism rendering it less effective. In this particular instance, we men can learn a valuable lesson from our female counterparts and not procrastinate in the area of going to the doctor.
  7. Total inability to urinate: This is a medical emergency and requires immediate medical attention which means go to the hospital ASAP. This is one instance where scheduling an appointment 3 days from now with your doctor is not a good idea.
  8. Symptoms: Symptoms are subjective in that they are felt by the patient but cannot be observed by your doctor. Pain is an example of a symptom.
  9. Pain upon urination: the pain can be burning or another sensation but pain upon urination is not exclusive for prostate conditions as it is also observed with infections and stones (calculi).
  10. Inability to experience relief from urinary urge following urination: while a man may have just finished urinating he may still feel as though his bladder is full.
  11. Urgency: Urgency is the feeling that you need to urinate immediately

Natural Recommendations for BPH:

  • Diet, Exercise and Weight Loss: Men who have significant abdominal obesity and who sit for extended periods of time have higher rates of BPH.
  • Limit Dairy Consumption: While this is not conclusive some studies have implicated dairy with increased risk for BPH while other studies have suggested only a minimal risk or none at all. For those who love dairy, moderation is the key.
  • Limit Red Meat Consumption: Men in Japan who consume very little red meat have a much lower rate of prostate conditions such as BPH.
  • Observe Family History: A positive family history of prostate conditions such as BPH and cancer especially with two of more family members should be considered a “red flag” and would warrant earlier and more vigilant observation and diagnostic testing.
  • Raw Juicing: men who consume large amounts of vegetable juices have lower rates of prostate conditions
  • Reduce DHT Levels: DHT or dihydrotestosterone is produced from testosterone by the enzyme 5-alpha reductase. Elevated DHT levels are implicated in BPH. The combined use of the herbs Saw Palmetto, Stinging Nettles and Pygeum have been shown to effectively lower DHT levels and DHT’s effect on the prostate
  • Reduce Estrogen Levels: The hormone testosterone can be converted to estrogen via the enzyme aromatase. Estrogen levels increase in men as they age while levels of free testosterone decrease resulting in an increased estrogen/testosterone ratio which is highly implicated in BPH. In addition to age increasing estrogen levels, increased abdominal fat is also implicated in increased estrogen levels in men thereby subjecting them to greater risk for BPH. Therefore, decreasing abdominal fat may effectively serve in decreasing estrogen levels thereby decreasing the risk for BPH. The most effective aromatase inhibitors are drugs such as Arimidex however natural supplements such as DIM (di-indolemethane) and chrysin may have milder and less effective influence on lowering estrogen levels. The effectiveness of chrysin is not universally accepted and is in fact dismissed by some authorities such as Dr. Ward Dean of “Vitamin Research Products”.
  • Rule Out Cadmium Toxicity: Cadmium interferes with the action of zinc. Zinc has been shown to be helpful in prostate conditions. Cigarette smoke is a source of cadmium. Cadmium may result in BPH.
  • Rule Out Silicon Deficiency: while there is not a strong link between silicon and prostate conditions, eating foods with higher silicon levels such as figs, white onions, cabbage, cucumbers and radishes will certainly not worsen the condition.
  • Sexually Transmitted Diseases: While more research is needed, men with sexually transmitted diseases seem to have a higher rate of BPH than men without such history. Therefore monogamy, abstinence or condom use would all be superior to unprotected sexual activity with multiple partners for this reason and a host of others.
  • Herbs
  1. Flower Pollen: Cernilton is an extract of flower pollen and has been used in Europe for prostate conditions for decades. Cernilton seems to inhibit the growth of prostate cells. It has also been shown to relax the bladder and decrease inflammation.
  2. Pygeum Bark: Pygeum Bark is believed to reduce prostate edema and has been shown to relieve prostate symptoms and signs. It is most effective in the earlier stages of BPH.
  3. Saw Palmetto: Saw palmetto has been shown to lower DHT levels and DHT is implicated with BPH. Saw palmetto also has anti-inflammatory effects and inhibits prostate cell proliferation. Saw palmetto has also been helpful with helping with prostate symptoms.
  4. Stinging Nettle Root: Stinging Nettle blocks DHT from binding to prostate cells. Various studies have shown stinging nettle to be more effective than the control group.
  • Minerals
  1. Selenium: Has anti-cancer properties and may prevent or delay prostate cells from becoming cancerous. Selenium is an antioxidant.
  2. Zinc: Studies have shown that zinc supplementation has a positive effect on prostate health. Zinc decreases DHT production which is also beneficial for prostate health. There is more zinc in the prostate than in any other body organ.
  • Natural Supplements
  • Amino Acids: Particularly glycine, alanine and glutamic acid have been shown to have a positive effect on BPH.
  • Beta Sitosterol: Has been shown to help with urinary flow rate and decreases the amount of urine that is left in the bladder after urination when taken in 20 mg. doses 3 times per day.
  • Lycopene: Seems to have a protective effect against prostate cancer. Lycopene is a carotenoid that is found in tomatoes and watermelon. While it may help in preventing individuals with BPH from developing prostate cancer, its effect on preventing BPH itself is still inconclusive according to some sources. Because it is so easy to obtain lycopene in sources such as low sodium V8 juice, tomato sauce and watermelon it makes most sense to get lycopene from food sources rather than spend money to purchase it in supplements.
  • Omega 3 Fatty Acids: Essential fatty acids such as omega 3’s have an anti-inflammatory effect. Many men with BPH have been shown to have lower levels of omega 3’s and essential fatty acids.