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Prostate Health
 

Prostate Health Introduction

:prostate-exam-sm.jpg Only found in males, the prostate is a chestnut shaped gland that surrounds the beginning of the urethra in the urogenital system. Its main functions are to produce a component of semen, to help eject semen during ejaculation, and to help prevent the backflow of urine from the urethra. The prostate can only be felt by rectal examination; also known as a digital rectal examination, or DRE.

In the U.S., a DRE is considered standard within the complete physical examinations performed on every man over the age of 50, as well as in higher risk populations. Prostate health is an important component in all wellness examinations and should be monitored.

Prostate disease is multi-factorial and many disorders of the gland are still unknown. Acute and chronic prostatitis, benign prostatic hypertrophy, and prostate cancer are the most common conditions seen in men.

  • Prostatitis is one type of lower urinary tract infection, which can become chronic over time.
  • Acute prostatitis is usually spread via sexual activity and is more commonly seen in younger men.
  • Chronic prostatitis is usually associated with a western lifestyle, in which the patient is inactive, obese, or eats a low nutrient diet. It has been estimated that half of all men will have symptoms of chronic prostatitis at some point in their lives. [1]

One of the most common issues in the development of benign prostate hypertrophy (BPH) and cancer is hormone dysfunction. Estrogens and dihydrotestosterone (DHT) accumulate and inhibit the normal cell death in the prostate, causing cell accumulation and increasing the size of the gland. It is common in men past the fifth decade to have a gradual decline in testosterone and a rise in estrogen. However, these normal characteristics also support higher than normal levels of estrogen and promote prostate disease. [2] Evaluating and treating the endocrine (hormonal) component of both conditions is imperative to a healthy outcome.

BPH is a condition in which there is an excessive growth of prostatic cells. It is a benign process and may be a normal part of aging. [3] Recent studies have suggested that 80% of men over the age of 80 will develop BPH. [4] Most men with BPH are asymptomatic, but some will develop symptoms that affect urination and sexual function.

BPH can be diagnosis by DRE. The gland will be boggy and enlarged. Symptom evaluation is usually done with a questionnaire that evaluates the frequency and discomfort with urination. Prostate specific antigen (PSA), a blood serum test used to measure the inflammatory markers, should be measured before a digital examination, as this may increase levels that were previously normal.

Prostatitis Symptoms

  • Acute Prostatitis: fever, pain on urination, low back pain, urinary urgency and frequency
  • Chronic Prostatitis: fatigue, chronic pain (perineal, testicular, penile), sexual dysfunction, sense of rectal fullness
  • BPH: urinary frequency, nocturia (urination at night), urgency, hesitancy, weak stream, straining to void, incomplete sensation at voiding [11]
  • Prostate Cancer: usually asymptomatic but may include all urinary symptoms seen in benign prostatic hypertrophy

Prostate Cancer Statistics

  • Prostate cancer is the second most common cancer in men in the United States. [5]
  • It is estimated to affect approximately 1 in 6 men, but diagnosis is uncommon before the age of 50. Approximately 70% of cancers are now diagnosed with the monitoring of PSA (prostate specific antigen) levels. [6] However, PSA levels can be falsely elevated and should not be considered the only parameter when making a diagnosis. [7] PSA levels between 4-10 ng/ml are considered to be more treatable than levels above 10ng/ml. [8]
  • In 2003, 220,900 men were diagnosed with prostate cancer. 28,900 died from the disease.
  • Autopsy studies show that 30% of men over the age of 50 have evidence of prostate cancer at death, even though it was not the direct cause of death. [9]
  • Chinese men at autopsy have the same rates of prostate cancer as American men but do not have the same mortality rates. [10] It can be hypothesized then that cancer is common to many, but only clinically evident and aggressive in some populations, perhaps due to certain dietary and lifestyle choices.

Prostate (Prostatitis) Treatment

Acute and Chronic Prostatitis Antibiotics are the common choice for conventional treatments of prostatitis. Acute prostatitis responds well to antibiotic treatment, however, antibiotics should not be applied for the treatment of chronic prostatitis. There is a growing concern that certain antibiotic medications may actually worsen a chronic case. This classification of drugs is, largely, inefficient at penetrating into the prostate fluid. Due to this characteristic, it is theorized that antibiotic therapy may actually cause a rebound effect in chronic prostatitis. [12] Acute prostatitis can lead to cystitis, orchitis (infection of the testes) or infertility.

Benign Prostatic Hypertrophy Finasteride (Proscar) can slowly induce an 80-90% reduction in serum dihydrotestosterone. Prostatic volume, on average, decreases by about 20% in 3-6 months. [13] Side effects include impotence, ejaculatory dysfunction, and decreased PSA levels, a situation that may lead to false negatives for cancer screening.

Surgical options for BPH are now common practice, and this form treatment is growing in popularity. Many of the techniques are, however, quite invasive and can cause long term damage to the gland, resulting in sexual dysfunction and urinary incontinence. Some treatments are less invasive and involve the use of radiofrequencies and microwaves to destroy the hypertrophied tissue.

Prostate Cancer For highly malignant cancers, radical prostatectomy is often performed. This is the complete removal of the prostate gland. Radiation therapy may be performed and entails the insertion of tiny radioactive metal seeds being implanted into the prostate. Chemotherapy is of limited use in prostate cancer. Hormone therapies, like anti-androgen therapy, are used that help to reduce the hormonal influence on the prostate. However, men can begin to experience hot flashes, impotence, anemia, and weakness with these drug therapies.

Alternative Treatments for Prostate Health

Nutrition for Prostate Health:

A diet low in saturated fats should be encouraged in all patients with prostate health issues. Foods that are high in saturated fats can cause hormonal fluctuations in the estrogen levels in men. These types of foods can also increase the incidence of conditions like BPH and prostate cancer. Men who eat a lot of high fat foods also tend to be obese, which puts them at an increased risk for cancers in general. Saturated fats are also high in arachidonic acid, a precursor to the body’s many inflammatory pathways. [14]

Omega-3 fatty acids should also be consumed to help with inflammation and the balancing of hormones. Fish, such as salmon and mackerel, nuts, and seeds are all high in omega-3s and should be included in one’s dietary regiment.

Supplements for Prostate Health:

Vitamin E

Vitamin E has been shown to reduce the incidence of prostate cancer. Supplementing with just 40 IU/day has reduced the incidence of prostate cancer by approximately 33%, and associated death rates by as much as 40%. [15] D-a-tocopherol is recommended for dietary supplementation until further studies are conducted on synthetic and blended versions.

Zinc

Zinc is highest in the prostate gland and may help protect the gland from infections. Zinc levels are often low in prostate cancer and chronic prostatitis. When zinc levels are declined, there is a high probability that infections will occur. Supplementing with 50-100 mg/day is a standard dose in maintaining prostate health.

Selenium

Selenium has been shown to be extremely effective in preventing prostate cancer. A daily intake of 200mcg/day resulted in a 50% decline in death in patients with prostate cancer compared to control groups. [16] Yeast-based selenium has been extensively studied in regards to prostate health and appears to be the best source of selenium.

Lycopene

Lycopene is derived from fruits and vegetables that have a rosy color. Tomatoes are the most abundant, natural source of this potent antioxidant. A dose of 15 mg twice a day has been shown to help control cancer growth. It is best absorbed when taken with a fatty food such as olive oil.

Vitamin D

Vitamin D has also been used in prostate cancer. It has been shown to assist in the inhibition of cancer cell growth. Vitamin D is, largely, synthesized within the body from exposure to UV light. Interestingly, in northern latitudes that have less sun than other parts of the world, prostate cancer rates are much higher. [17] 2,000 IUs of Vitamin D, in conjunction with 500 mg of calcium daily, has been shown to help with side effects in patients with prostate cancer.

Botanical Medicine for Prostate Health:

Saw palmetto

Saw palmetto (Serenoa repens) is able to inhibit the enzyme that stimulates prostate growth. It has been shown to help improve urinary symptoms in BPH. Saw Palmetto is considered as effective as finasteride, but does not have the side effects. [18] The standard dose is 160 mg twice a day.

Pygeum

Pygeum helps to inhibit prostatic inflammation. Pygeum is over harvested and should be avoided due to it being a threatened species. Only products from cultivated sources should be used at a doses of 100 mg/day.

Stinging nettles

Stinging nettles (Urtica dioica) is often used in combination with saw palmetto to help prevent the over stimulation of the prostate by specialized hormones. The standard dose is 400 mg three times a day.

PC-SPES

PC-SPES was developed in 1990 to treat prostate cancer and was formulated based on an ancient Chinese formula. It contains a variety of herbs that appear to stop cancer growth and stimulate the immune system. PC-SPES has been effective at lowering PSA levels and has also been shown to have long term benefits in treating both BPH and cancer.

References

[1] Stewart C. Prostatitis. Emerg Med Clin N Amer 1988; 6: 391-402.

[2] Rakel D. Prostate Health. Clinics in Family Practice 2002; 4(4): 967-980.

[3] Kirby R, McConnell J et al. Textbook of Benign Prostatic Hyperplasia. Oxford: Isis Medical Media, 1996

[4] Austin O, Rice RE. Prostate cancer screen: an appraisal of the PSA test. Fam Pract Recent 1996:18: 81-91

[5] American Cancer Society. Cancer-Cancer facts and figures 2003. Atlanta, GA. American Cancer Society, 2003.

[6] Remzi Mesut et al. Prostate cancer in the aging male. The Journal of Men’s Health and Gender 2004. May 1(1).

[7] Frankel S, Smith GD, Donovan J, Neal D. Screening for prostate cancer. Lancet 2003; 361(9363);1122-8

[8] Noble. Textbook of Primary Care Medicine, 3rd edition. Mosby 2001: 32.

[9] Scardino FT. Early detection of prostate cancer. Urol Clin North Am 1989; 16(4):635-55.

[10] Carter HB, Piantadosi S, Isaacs JT. Clinical evidence for the implications of multistep development of prostate cancer. J Urology 1990; 143: 742-6.

[11] Barry et al. The American Urological Association symptom index for benign prostatic hypertrophy. The Measurement Committee of the American Urological Association. J Urol 1992; 148: 1549-57.

[12] Stamey TA. Prostatitis. J R Soc Med 1981; 74: 22-40.

[13] Dull, Pamela. Managing benign prostatic hypertrophy. Am Fam Physician 2002; 66(1): 77-84.

[14] Myers CE, Sgarlat Steck S, Sgarlat Myers R. Eating your way to better health: the prostate forum nutrition guide. Charlottesville, VA. Rivanna Health Publications, Inc.; 2000. p15-16.

[15] Heinonen OP et al. Prostate cancer and supplementation with alpha-tocopherol and beta-carotene: incidence and mortality in a controlled trial. J Natl Cancer Inst 1998; 90(6); 440-6.

[16] Clark LC, Combs GF, Turnbull BW, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. JAMA 1996; 276: 1957-63.

[17] Hanchette CL, Schwartz GG. Geographic patterns of prostate cancer mortality: evidence for a protective effect of ultraviolet radiation. Cancer 1992; 70: 2861-9.

[18] Carraro JC, et al. Comparison of phytotherapy with finasteride in the treatment of benign prostatic hyperplasic: a randomized international study of 1098 patients. Prostate 1996; 29: 231.