PROSTATE PROBLEMS, Enlarged (BPH), Prostatitis

With age, the prostate gland tends to increase in size for reasons that are poorly understood at present, although it appears that the endocrine system plays a role. The incidence of this disorder, which afflicts only about 1 out of 5 men in their 40s, rises to 1 in 4 men by age 55, 1 in 2 by age 75, and 4 out of every 5 men over the age of 80.

The gland’s location, beneath the bladder and around the urethra, coupled with the fact that benign hypertrophy particularly affects the prostate tissues immediately surrounding the urethra, accounts for the hallmark and often most troubling symptom of the disorder: diminished force and caliber of the urinary stream. The more significant the overgrowth of the tissue becomes, the more difficulty men will have in getting a urine stream started, maintaining a strong and forceful flow, and stopping the flow without dribbles and spurts of urine. With time, the enlarged gland can protrude into the bladder, often partially blocking the opening to the urethra within the bladder and making it difficult for the bladder to completely empty. Urine remaining in the bladder after urination (called post-void residual urine) forms a hospitable environment for bacterial growth as well as for the formation of sediment that could lead to bladder gravel or stones.

Occasionally, the enlarged gland suddenly swells and occludes the outflow of urine. The enlargement of the prostate usually involves both the secretory glands and the muscle of the prostate. Certain antihistamine preparations commonly found in both prescription and over-the-counter cold remedies can cause the muscle of the prostate to contract, resulting in urinary retention.

Prostate problems occur in two principal forms: enlargement of the prostate, called BPH (for benign prostatic hyperplasia); and prostatitis, a bacterial infection, which may be either sudden and severe (acute prostatitis) or milder but persistent or recurrent (chronic prostatitis). A chronic infection may follow an acute one.

Symptoms
For an enlarged prostate:

* Difficulties in urination, including a weak or intermittent stream, unusual frequency (especially at night), straining, dribbling or inability to empty the bladder.

For acute prostatitis:

* Frequent, difficult urination.
* A burning sensation when urinating.
* Sudden fever, chills.
* Pain in the lower back and the area behind the scrotum.
* Blood in the urine.

For chronic prostatitis:

* Frequent, difficult urination.
* Pain in the pelvis and genital area.
* Painful ejaculation or bloody semen.

The signs of prostate enlargement generally appear after the age of 45. Typically, the first indication is a need to urinate at night, with the urge gradually increasing over time. Other urination problems may develop: a difficulty or hesitancy in initiating the urine stream; an inability to empty the bladder completely; and dribbling at the end of urination. These signs all have a common origin — the narrowing of the urethra because of growth of the glandular tissue surrounding it. Although the problem varies in severity, few men escape it altogether: Prostate enlargement affects 50 percent of those over 50 and a somewhat astonishing 90 percent of those over 80.

Enlarged Prostate

Prostatitis is less common and can occur in younger men or without symptoms of enlargement. While some of the signs resemble those of BPH, others are more typical of infection. Acute prostatitis may produce fever, chills and lower back pain. Chronic prostatitis generally brings milder versions of those symptoms and may also cause painful ejaculation and sometimes urethral discharge.

Many men are reluctant to seek treatment for BPH or prostatitis, especially if their discomfort is minor. If either condition progresses toward severe symptoms, the danger can increase sharply. With prostatitis, the infection may reach the testicles and epididymis (a long, coiled tube behind each testicle through which sperm is transported from the testicles), see Epididymitis. With BPH, the bladder may eventually be unable to empty itself, and the lingering pools of urine become sites of infection or stone formation (see Bladder Infection and Bladder Stones). Such urine retention is very painful and should be treated as a medical emergency. If the outflow of urine is blocked, pressure within the bladder may back up to the kidneys, eventually leading to permanent damage.

As the average age of the U.S. population rises, so does the number of men who seek relief from prostate problems. But with BPH, some aspects of the condition, including the chances of its worsening, are still poorly understood. As a result, the field is alive with controversy over when to take medical action and also over the relative merits of standard surgery and newer forms of medical treatment.

What Causes Benign Prostatic Hyperplasia?

The causes of benign prostatic hyperplasia are not fully known. Male hormones (androgens) — and possibly the female hormone estrogen — play a role. The most important androgen is testosterone, which is produced throughout a man’s lifetime. The prostate converts testosterone to a more powerful androgen, dihydrotestosterone (DHT), which stimulates cell growth in the glandular epithelial tissue and is the major cause of the rapid prostate enlargement that occurs between puberty and young adulthood. Many researchers believe that DHT is also the primary stimulant of prostate enlargement later on. Some authorities believe that the female hormone estrogen may play a role; some estrogen is always present in men. As men age, testosterone levels drop and the proportion of estrogen increases, possibly triggering prostate growth. Another theory focuses on cells in a certain section of the gland that may become active late in life, signaling other prostate cells to replicate or causing them to be sensitive to growth-stimulating hormones.

The causes of urinary symptoms when the prostate is small or normal in size are not yet well understood, and some experts consider this condition something other than the so-called “true” benign prostatic hyperplasia, which is often used to describe typical urinary symptoms only when they accompany an enlarged prostate. (A number of studies report as many elderly women as men showing similar symptoms of urinary distress and discomfort, suggesting that factors other than hormones and prostate enlargement play a role in men who have these symptoms but normal-size prostates.)

Who Gets Benign Prostatic Hyperplasia?

Before age 40, only 10% of men have benign prostatic hyperplasia; by age 80, however, about 80% have signs of the condition. Benign prostatic hyperplasia is the most common noncancerous form of cell growth in men. About 14 million men have BPH, but less than 5% receive treatment for it. The problem appears to be more prevalent in the US and Europe than other regions and more common in married men than single men, but these differences have not been substantiated. A family history of BPH appears to increase a man’s chance of developing the condition, but the increased risk is slight. Other risk factors have not been determined.

How Serious Is Benign Prostatic Hyperplasia?

Problems with urination caused by benign prostatic hyperplasia can be very distressing and severely affect the quality of life. The severity of symptoms is often subjective. Some men can tolerate very uncomfortable sensations of abnormal urination while other men seek relief from mild symptoms. Men are more apt to tolerate obstructive symptoms (intermittent flow, hesitancy before urinating) and seek help for irritative symptoms (urgency, frequency, urination at night). Unfortunately, symptoms that indicate obstruction of the bladder are signs of a potentially more serious condition which, untreated, may sometimes cause damage to the bladder or kidneys. In rare cases, this can cause an emergency requiring immediate surgery. Benign prostatic hyperplasia, however, is rarely life-threatening; the prostate enlarges very slowly and complications are uncommon. BPH does not appear to impair sexual function. A small fraction of men with BPH develop urinary tract infections. Bladder stones have been found in about 1% to 2% of men who have had surgery for BPH; such stones can be the result of infection, bladder outlet obstruction, dietary factors, or foreign objects. Death rates per 100,000 men attributable to complications of BPH vary widely from 0.5 in Singapore to 29.7 in East Germany. The rate reported in the US is 1.8 per 100,000. Because of this wide variation, experts are dubious about the reliability of these statistics. In general, little is known about long-term complications of this condition.

Whether men who have BPH have a greater chance of developing prostate cancer is unknown, but current evidence indicates it has no effect one way or the other. The two conditions develop in different parts of the prostate; BPH occurs in the inner zone of the prostate, while cancer develops in the outer zone. A recent ten-year study found no increased risk. Unsuspected prostate cancer is detected during surgery in about 15% of BPH patients, but the risk of this slow-growing cancer is high in all older men. (Some estimates suggest tha58.5e-third of all men over age 50 have at least microscopic prostate cancers.)

What Tests Will Confirm Benign Prostatic Hyperplasia?

1. Digital Rectal Exam

The digital rectal exam is used for detecting an enlarged prostate; it determines the size of the prostate gland and helps rule out prostate cancer or problems with the muscles in the rectum that might be causing symptoms. The doctor inserts a gloved and lubricated finger into the patient’s rectum and feels the prostate to estimate its size and to detect nodules or tenderness. The exam is quick and painless but embarrassing for some and far from infallible. It is not very accurate for diagnosing prostate cancer and is never the primary diagnostic tool for either BPH or cancer. It is useful, however, for estimating the size of the prostate, which in turn helps the physician determine the best treatment options.

2. AUA Symptom Index

The size of the prostate does not necessarily reflect the severity of BPH symptom. A large prostate may cause few if any symptoms, while a smaller one may be associated with severe symptoms. The American Urological Association (AUA) Symptom Index is a self-assessment test that is used to rank the severity of symptoms. The score on this test gives a highly accurate assessment of the effect on the quality of a man’s life and a reasonable basis from which the patient and physician can discuss treatment options. The index is also often used to gauge treatment outcomes and may be a better indicator than objective tests, such as the measurement of the gland or the rate of urine flow. It should be noted that the AUA Symptoms Index is useful only as a gauge of symptom severity; it is not used as a diagnostic tool for benign prostatic hyperplasia. Other conditions can produce similar scores. The physician will take a detailed medical history to help determine if other abnormalities, diseases, or medications may be causing the symptoms. The physician may also perform additional tests to rule out any other causes of the symptoms, particularly if the AUA score is high.

Pre-Disposing Factors:

a. Food allergy/sensitivity (dairy products most frequently).

b. Non-specific urinary tract infection.

c. History of venereal disease.

d. Obesity.

e. Infrequent sexual activity.

f. Lack of exercise.

g. Normal hypertrophy of aging or genetic predisposition to hypertrophy.

h. Especially, Low testosterone levels and high estradiol levels. Get blood tests to check these hormone levels and if there are abnormal levels, then talk to your doctor about how to correct them.

General Considerations

Over fifty percent of men will develop an enlarged prostate in their lifetime.

BPH is largely the result of hormonal changes associated with aging.

The PSA test can help distinguish BPH from prostate cancer.

Paramount to an effective BPH treatment plan is adequate ZINC intake and absorption.

Cholesterol damaged by free radicals is particularly toxic and carcinogenic to the prostate.

In Europe, plant-based medicines are the most popular prescriptions for BPH.

Saw palmetto extract and other herbal approaches to BPH are most effective in mild to moderate cases.

Roughly ninety percent of men with mild-to-moderate BPH experience some improvement in symptoms during the first four to six weeks after beginning to take saw palmetto extract.

Severe BPH, resulting in significant acute urinary retention, may require catheterization for relief; a sufficiently advanced case may not respond to therapy rapidly enough and may require the short-term use of an alpha-1 antagonist drug (e.g., Hytrin or Cordura) or surgical intervention, but this is not too common.

Therapeutic goals for BPH are to normalize prostate nutrient levels, inhibit excessive conversion of testosterone to DHT, inhibit DHT receptor binding, and limit prolactin, which promotes prostate cell growth.

General Recommendations

Since there have been no clinical trials on the use of diet in the treatment of BPH, the following recommendations are somewhat speculative, although we get excellent results.

The diet should be high in protein, low in carbohydrates, low in animal fats, and high in essential fatty acids.

Focus on whole, unprocessed foods (whole grains, legumes, vegetables, fruits, nuts, and seeds).

Include lots of fresh fruits, vegetables and juices in the diet. These foods have a cleansing effect on the urinary tract as well as the rest of the body.

Eat a quarter-cup of raw sunflower seeds or especially pumpkin seeds several times weekly. Eliminate intake of alcohol (especially beer), caffeine, and sugar as much as possible.

A diet rich in meats (either beef or poultry) can cause problems. Many of the hormones used in cattle production have been outlawed; however, many poultry producers still feed hormones to chickens and turkeys to speed their growth period and get them to market sooner. These hormones can be found later in your grocery store meats and cause havoc with your system. The hormone testosterone has the ability to awaken dormant cancer in the prostate! (This is the reason the male source of testosterone, the testicles, are removed by castration after prostatic cancer has been diagnosed.)

Drink 2 to 3 ounces of filtered or distilled water every 30 minutes while awake (more if you are sweating) with no well water or water containing fluoride or chlorine.

Eliminate all dairy products, gluten containing grains, alcohol, refined carbohydrates, processed foods and caffeine containing foods such as cola, tea, coffee and chocolate.

Eliminate hydrogenated fats and oils. Use fish oils, coconut oil and extra virgin olive oil as your only dietary source of oil.

Increase raw foods and quality protein especially fish and sea vegetables.

NOTE: Insure that you have been checked by a qualified doctor to insure problem is benign and not neoplastic.

Nutritional Supplements

Primary Nutrients:
1. BIO-MULTI PLUS — 1 tablet, 3 times daily after meals.

2. BIO-C PLUS 1000 — 1 tablet, 3 times daily after meals.

3. M S M POWDER — 1/2 teaspoonful 2 to 4 times daily depending on the severity of symptoms. NOTE: Always take MSM with your Vitamin C.

4. BIOMEGA-3 — 2 to 3 capsules, once daily after meals.

5. BIO-D-MULSION FORTE (2000IU) — 4 to 5 drops on tongue orally once daily after a meal.

Specific Nutrients: When symptoms or condition begins to subside, gradually, as needed, wean yourself from the Specific Nutrients & stay on the Primary Nutrients. If any symptoms re-occur resume taking Specific Nutrients.
6. PALMETTO PLUS — 3 capsules, 3 times daily with meals.

7. FLAXSEED OIL LIQUID — 2 tablespoonsful, 2 times daily with meals.

ADDENDUM

1. Exercise! Walking is especially beneficial to the prostate. The movement of muscles and organs in the pelvic cavity during walking help circulation to and from the gland. Constant sitting during most of your childhood and adult life only adds to your chances of having prostate problems.

2. Avoid intense sexual excitement without a natural conclusion of ejaculation. Continued excitement without ejaculation causes engorgement of the gland and if this continues it can lead to structural and functional damage. Develop regularity in sexual habits if possible.
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Prostate Problems

Introduction & Symptoms — Causes & Treatments

Although the molecular mechanisms underlying prostate enlargement remain uncertain, the condition seems to stem from age-related changes in hormone balance that begin when a man is in his 40s. Testosterone levels in the blood decrease, while other hormone levels rise; the net effect is the increase of a testosterone derivative that stimulates cell growth in the prostate. This results in enlargement and consequent stricture of the urethra within the gland. Prostatitis is usually the result of a urinary tract or bladder infection that has spread into the prostate gland. Rarely, the infection can be sexually transmitted.

Diagnostic and Test Procedures

If symptoms indicate prostate enlargement, a physician will want to determine whether the growth of the gland is benign (BPH) or malignant (prostate cancer). The physician will insert a gloved finger into the rectum to feel the prostate for hardness or nodules, which can indicate malignancy. A urine sample is taken to detect infection and/or chemical indicators of cancer cells. (In 10 percent to 20 percent of benign cases, the prostate also harbors such cells.) Ultrasound imaging of the bladder and prostate is usually performed, and the bladder may be examined with a cystoscope. If symptoms suggest prostatitis, a urine test may identify the infectious agents. A rectal exam will find the prostate to be very tender and sensitive and will provide a check for coexisting conditions.

Treatment
For prostate enlargement, be sure that you and your doctor consider the whole range of treatment options. Just a few years ago, many physicians felt that surgery was the only solution; today, researchers are proposing an array of new treatment choices, from hormone-blocking drugs to lasers that can remove prostatic tissue without hospitalization.

Conventional Medicine

Enlarged prostate: When BPH symptoms are mild to moderate, medication may be the appropriate therapy. Drugs called alpha blockers (such as doxazosin, terazosin and prazosin) relax the smooth muscles at the bladder neck and urethra, easing urination. Another new medication, finasteride, has shown some ability to gradually reduce prostate size and symptoms, though noticeable improvement may take three to six months.

When symptoms are severe or there is evidence of cancer, surgery is usually recommended. About 85 percent of patients experience marked relief of symptoms. In the most common surgery, the patient is placed under anesthesia, but no incision is needed. A small cutting instrument called a resectoscope (resect means to remove part of an organ) is passed through the penis and into the prostate by way of the urethra. Using an electrical apparatus at the end of the scope, the surgeon carves away the inner prostate, leaving a hollow shell through which the urine can flow. This procedure is known as TUR, or transurethral resection.

In about 15 percent of cases, TUR can have complications, including possible impotence and urinary incontinence; some patients experience infection or bleeding, and others require a second operation to reopen the urinary tract. For these reasons, and because of the desire of patients to avoid surgery, there is much enthusiasm for nonsurgical resectioning methods. Several kinds of laser resecters, which can be used for outpatients, have shown good results. The instrument is passed through the urethra, as in TUR; the laser is then fired, and the heat quickly coagulates and vaporizes excessive prostate tissue.

Microwave devices, similarly inserted, have been widely employed in Europe and Canada for nearly a decade; in the U.S., however, they have not yet been approved by the FDA and are available only at selected centers. Like laser resections, they can be done in an outpatient setting.

If the prostate is too large for TUR or other methods, the surgeon may recommend open prostatectomy, the removal of the prostate gland via surgical incision.

Prostatitis: A prolonged course of antibiotics is usually successful in eliminating the infection. Stool softeners, sitz baths, and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for discomfort. If an infection is neglected too long, antibiotics may not be effective — and it may be difficult to remove the infection even by surgery without causing further complications.

Prevention

To prevent a recurrence of chronic prostatitis and promote prostate health:

* Take warm sitz baths.
* Drink more water; dehydration stresses the prostate.
* Avoid prolonged bicycle riding, horseback riding or other exercises that irritate the region below the prostate.

Call Your Doctor If:

* Your symptoms lead you to suspect an enlarged or infected prostate. If allowed to progress, prostate problems can lead to bladder stones, generalized infection or kidney failure.

In addition, an enlarged prostate can be a sign of cancer.

LINKS:

Prostatitis Foundation

The Prostate Dictionary