BPH

An Overview of BPH (Benign Prostatic Hyperplasia)

What does BPH stand for?

The term “enlarged prostate” is a common term for benign prostatic enlargement (BPE) and benign prostatic hyperplasia (BPH). Hyperplasia refers to an increase in prostate gland cells.

This often results in BPE, the increase in the gland’s size. In most cases, both refer to the same condition.

The prostate gland is a part of the male reproductive system. It is a muscular gland that surrounds the urethra that is beneath the bladder.

It is usually around the same size as a walnut and weighs around 11 grams (range 7 to 16 grams).

The primary function of the prostate gland is to secrete prostate fluid, which also comprises a man’s semen. The muscles of this gland also help to propel seminal fluid into the urethra.

What is BPH?

Benign Prostatic Hyperplasia (BPH) occurs when the prostate, expands to twice or even three times its regular size.

The growing prostate gland gradually presses against the urethra and restricts urinary flow.

As a result, the bladder muscle becomes stronger, thicker, and more sensitive, causing it to contract.

This results in more frequent urination, and as the urethra becomes increasingly narrowed, the urine remains in the bladder, accounting for urinary problems.

As the word, benign suggests, BPH is not indicative of severe diseases like cancer or other malignancies, though it can cause some discomfort as will be explained below.

Hyperplasia is the technical term for the nature of the growth itself, which in the case of BPH is caused either by an increased number of cells growing within the prostate or by a reduction in the number of prostate cells that are dying off.


For more information on the function and purpose of the prostate gland click here.


What causes BPH?

Age

There is no concrete evidence for anyone cause of BPH. However, medical sources agree the condition is most likely linked to aging and the impact the production of testosterone has on older men. In fact, 50% of men over 50 will suffer from the condition, while 90% of men over 80 will develop benign prostatic hyperplasia.

Hormones

As men age, their production of testosterone (male hormones) naturally diminishes, and their production of estrogen (female hormones) increases. In the west, at the age of 55, most men have more estrogens in their bloodstreams then their wives.

The change in the hormonal balance is often noticeable as men start to get middle age spread and lose some of their assertiveness.

Some studies have indicated that the body’s system for working off testosterone slows in middle age. As a result, the body reacts by using this extra testosterone for the production of Dihydrotestosterone (DHT). High levels of DHT is associated with prostate growth.

Diet

Although levels of testosterone naturally decline as men age, certain foods can encourage your body to produce these hormones, ultimately causing damage to your prostate’s health.

Daily consumption of red meat increases the chances of developing an enlarged prostate by 38%. Replace red and processed meats with other forms of protein like fish, chicken, and turkey. You can also get protein from non-meat sources like beans and nuts.

Research has indicated that plant-based diets may reduce the risk of prostate diseases. Fruits and vegetables contain antioxidants, polyphenols, vitamins, minerals, and fibers that reduce may help reduce inflammation in BPH and improve urinary symptoms. For a prostate friendly diet include plant foods such as rice bran, wheat germ, peanuts, corn oil, and soybeans containing beta-sitosterol, which may protect prostate health.

A study examined the relationship between fruit and vegetable intake and urinary symptoms in elderly Chinese men suffering from urinary symptoms. High intakes of fruits and vegetables (at least 300 grams per day) were associated with improved symptoms. At least 50 grams of dark and leafy vegetables and 10 grams of tomatoes per day were strongly linked with improved urinary symptoms over a 4-year period.

Lycopene is an antioxidant that gives tomatoes its red color. A randomized control trial examined the effects of lycopene extract in men with BPH (17). Men were given 15 mg of lycopene per day or a placebo for six months. PSA was significantly reduced in the lycopene group, and prostate volume was unchanged after six months. Prostate volume increased by 24% in the placebo group. However, some studies have reported no effect of lycopene supplementation.

Tomato intake providing about 30 mg of lycopene reduces PSA in men with prostate cancer. These benefits were exerted from lycopene from whole foods rather than as an extract. It is likely that lycopene from whole foods exerts health benefits than do not occur with an extract.

A diet-controlled study examined the effects of a high fiber diet on prostate growth. The diet contained mainly whole grains, fruits, and vegetables. Animal protein was restricted 3.5 oz three times per week, mostly from fish or fowl.

The subjects also carried out physical activity every day. Just two weeks of diet and exercise reduced the growth of prostate epithelial cells by 13%.

Research also suggests that dairy may increase your risk of developing prostate cancer. Cow’s milk is full of female hormones, and as a result, dairy products can further raise estrogen levels, upsetting your hormonal balance and increasing your production of DHT.

DHT is an active form of testosterone and increased production can irriatate your prostate, resulting in an enlarged prostate.

Dairy products such as milk contain a natural growth factor IGF-1, which signals cells to grow, stimulating the growth of calves.

Cancer cells in human beings will accept the IGF-1 as a signal to grow faster, showing that IGF-1 found in milk stimulates cancer growth. A recent study found evidence to support the role of the IGF pathway, in particular, IGF-I in explaining the association between milk and prostate cancer.

Family history and ethnicity

Family history and ethnicity should also be considered, with men of European ancestry being at a slightly increased risk of developing the condition, particularly those from southern Europe.

Still, other studies have drawn a connection between BPH and lifestyle factors such as high cholesterol, excessive weight, poor diet, and immoderate alcohol consumption.

Those with conditions such as diabetes, a lowered immune system, high blood pressure, metabolic syndrome, and atherosclerosis should also practice caution and remain vigilant for the development of BPH symptoms.

The relationship between lifestyle and BPH

The prevalence of metabolic syndrome is due to the western lifestyle (which includes higher intakes of processed food, animal fat, refined carbohydrates, excess calories, and physical inactivity). These health conditions substantially increase the risk of BPH and advanced prostate cancer.

One example is the Baltimore Longitudinal Study of Aging the male participants underwent a number of prostate examinations (MRI, PSA, and DRE) and anthropometric measurements (weight, BMI, waist and hip circumference) between 1992 and 2002.

The study found that for each 1 kg/m-2 increase in BMI, there was a 0.41 cc increase in prostate volume. Elevated fasting blood sugar levels and diagnosed diabetes were also linked with prostate enlargement.

Low HDL cholesterol and insulin resistance have both been suggested as possible reasons explaining the link between metabolic syndrome and BPH. Exercise also improves insulin sensitivity even without weight loss and increase HDL cholesterol.

Furthermore, exercise can also help accelerate weight loss, which may also explain how exercise reduces BPH risk. If you are looking to treat an enlarged prostate making changes to your lifestyle naturally.

Increased inflammation is one of the characteristics of BPH. More prostate inflammation is associated with more severe urinary symptoms and greater prostate volume. Omega-3 fatty acids are known for their potent ability to suppress inflammation.


For more information on how diet impacts on an enlarged prostate, click here.


How is BPH diagnosed?

If you start to experience BPH symptoms, your Doctor will perform a thorough physical examination. He will also consult your medical and familial history. The patient’s lifestyle will also be taken into account with issues like mobility and diet being given particular precedence.

DRE (Digital Rectal Exam)

The physical exam will most likely include a digital rectal examination (DRE). This is one of the simplest and most effective procedures for detecting abnormalities like BPH in the prostate, as well as in the early detection of prostate cancer.

A doctor will insert a gloved finger up the rectum of the patient and will feel the prostate. If they detect any lumps on it, or irregularities, this could be a warning sign of cancer.

PSA Test

Doctors will often order a Prostate Specific Antigen (PSA) test to ascertain the level of antigens in the bloodstream. Recent studies show that the PSA test is not an accurate indicator of prostate cancer. There are cases in which some men who don’t have prostate cancer are diagnosed with it. As a result, they undergo unnecessary and dangerous invasive treatments with many long-term side effects.

Post-void residual

This test the amount of urine left in your bladder after urination. It can be completed either by inserting a catheter through your urethra and into your bladder or by using an ultrasound to show images of your bladder so that your Doctor or urologist can access how much urine is there.

Cystoscopy

A cystoscopy is a visual inspection of the prostate through a thin, lighted tube inserted into the urethra of the penis, is also used, though less often. This is passed into the bladder to allow a Doctor to see inside. In some cases, small surgical instruments can be passed down the cystoscope to treat bladder problems.

Prostate Biopsy

A prostate biopsy is a procedure used to detect prostate cancer. Small samples of the prostate are removed and then observed under the microscope.

Doctors usually recommend a biopsy of your prostate gland based on certain findings. One is when your prostate-specific antigen (PSA) blood test results are higher than normal for your age. Another is when your Doctor detects some signs of a prostate problem during your digital rectal exam (DRE).

However, it should be noted that a biopsy can have a number of risk and life-changing side effects, including infection, sexual incontinence, and even the spreading of prostate cancer cells.

What does BPH feel like?

Enlarged prostate symptoms can be subtle and as a result, remain undetected. Moreover, many men will simply dismiss their symptoms as ‘old age.’ However, by knowing what BPH feels like, you will more closely be able to determine if you are experiencing it.

One of the main symptoms you may experience is difficulty urinating, and you may find that you experience a sudden urge to urinate. When you do go to the toilet, it is difficult to start urinating, and urine flow is weak.

You may also feel that your bladder hasn’t completely emptied and that you experience dribbling after urinating. Patients may also have to use more effort to begin urinating and then “push” with more force than was previously necessary.

What are the warning signs and symptoms of BPH?

Enlarged prostate symptoms usually manifest as problems during and after urination. This is due to the enlarged prostate pressing down on the urinary tract and inhibiting the urine flow.

LUTS (lower urinary tract symptoms) is a common term used to describe a range of urinary symptoms.

Lower Urinary Tract Symptoms related to linked to BPH can fall into two categories; obstructive or irritative.

Obstructive symptoms can cause a delay or straining when starting to urinate and result in dribbling flow of urine.  Irritative symptoms include urgent or frequent urination during the day and night.

Irritative Symptoms of Prostate Enlargement

  • A need to pass to urinate more frequently and urgently. This is as the enlarged prostate gland puts increased pressure on the urethra and bladder, making it increasingly difficult to hold in urine.

  • A need to get up to urinate during the night. This is called “nocturia” and is defined as having to urinate eight or more times per day.

  • Feeling that the bladder can’t be emptied properly.

Obstructive Symptoms of Prostate Enlargement

  • Poor urine stream.

  • Weak urine stream.

  • Difficulty getting started when needing to urinate.

  • Stopping and starting rather than having a steady stream.

  • Dribbling at the end of urination.

  • Pain during urination or ejaculation.

  • Blood in the urine.


For more information on frequent urination in men click here.


What are the complications of Benign Prostatic Hyperplasia?

Despite its prevalence, many cases of an enlarged prostate are left undiagnosed. Many men with an enlarged prostate have no symptoms. For some who have symptoms, they don’t relate it with prostate problems. Rather, they accept it as part of getting older.

Does it bother you that you need to get up several times every night to urinate? If so, see a Doctor. You need to know that the symptoms of an enlarged prostate vary widely. It might not bother some, but might be greatly distressing for others.

It’s best to ask yourself, whether or not, and how much the symptoms of an enlarged prostate are affecting your quality of life.

Don’t take it for granted. If left untreated, an enlarged prostate may lead to the following problems:

Acute Urine Retention. This is a condition where a person is unable to urinate. It needs urgent treatment, as the bladder can possibly tear if it stretches beyond its capacity. The increased pressure in the bladder can also prevent urine from passing through the lower urinary tract. Thus, urine gets back up into the bladder and kidneys, causing tissue damage and kidney failure.

Chronic Urine Retention. Chronic urine retention occurs when the bladder is unable to empty itself of urine over a long period of time. In this case, the bladder may show a massive increase. This condition may require some type of surgical procedure.

Bladder Stones. Bladder stones, like UTIs, can occur if you are unable to empty your bladder. Bladder stones are crystallized minerals in the bladder that form when urine becomes very concentrated. These stones can cause bladder irritation, blood in the urine, severe infections, and blockage of urine flow.

Blood in the Urine. Blood in the urine, or hematuria, occurs when the veins on the surface of an enlarged prostate gland dilate. Gross hematuria occurs when blood in the urine is visible to the naked eye.

Urinary Tract Infections. Urinary retention can cause urine to concentrate. If the bladder can’t empty itself, bacteria will soon grow in it. In this case, urine turns darker and with a strange smell. Note that foul-smelling urine is a sign of a urinary tract infection (UTI). If you have frequent, recurring UTIs, surgery might be needed to remove part of the prostate.

Bladder and kidney damage. Over time, the bladder may stretch and weaken if it cannot empty. The muscular wall of the bladder will be unable to contract normally, making it more difficult to empty itself. Urinary retention due to an enlarged prostate can also put more pressure on the bladder and can damage kidney tissue. In addition, recurring UTIs may spread to your kidneys, causing damage.

If already have these symptoms, it’s more of a reason for you to seek medical help.

If you find that you are experiencing the symptoms discussed above, you may wish to take our *Link to Prostate Health Assessment. Based on the International Prostate Symptom Score (IPSS), this is a test will give you a broad indication of whether you are suffering from the problem and if so, how severe it is likely to be.

It is also important to have your symptoms checked by a doctor, to rule out any underlying prostate conditions, including prostate cancer.

What PSA level indicates BPH?

The PSA test alone can’t diagnose any disease, and high PSA levels do not always mean that you have prostate cancer or any other prostate problem. Many factors can affect your PSA levels so that the Doctor won’t consider your PSA level on its own.

There is no specific normal or abnormal level of PSA. Factors such as age and ethnicity make it hard for researchers to establish a normal range.

However, most doctors consider PSA levels of 4.0 ng/ml as high and would often recommend a prostate biopsy. One study shows that men with this level of PSA often have prostate cancer.

Low PSA levels also don’t always mean that you don’t have prostate cancer. Studies show that some men with a PSA below 4.0 ng/ml do have prostate cancer.

How common is BPH (by age)?

An enlarged prostate is one of the most common health problems for men over the age of 50. Though the actual cause is unknown, it is linked to aging and changes in the cells of the testicles. As you age, you are more likely to develop an enlarged prostate. More than 90% of men over age 80 have this condition.

Often, this condition is not a cause for concern. Not all men with an enlarged prostate experience symptoms.

Only 1 in 3 men over the age of 50 have problems with urination. But as the prostate grows, it’s likely to press against the urethra. This can stop or slow down the flow of urine, resulting in an inability to urinate. The disruption in the urethra may also cause leaking of urine.

Can BPH cause testicular pain?

BPH isn’t usually associated with testicular pain, but it could be if you have inflammation of the prostate, called prostatitis. It’s possible for men to have either BPH or prostatitis, but also possible to have both conditions at the same time.

One of the common symptoms of prostatitis is discomfort, pain, or aching in your testicles or the area between your testicles and back passage.

Do see your Doctor for proper diagnosis of the condition. Once you get a diagnosis, you can then find the solution.


For more information on prostatitis click here.


Can BPH cause hydronephrosis?

Hydronephrosis is a condition which occurs when a kidney swells as a result of urine failing to drain from the kidney to the bladder. If there is an obstruction in the urinary tract, pressure can build up and eventually cause the kidneys to enlarge. In severe cases that are left untreated, you can suffer kidney damage, which could lead to loss of kidney function.

Hydronephrosis is not a primary disease. It is an underlying condition of other health issues. There are many causes of hydronephrosis, with one of the most common being an enlarged prostate.

Benign prostatic hyperplasia (BPH) can compress and obstruct the urethra, resulting in difficulty passing urine.

Can BPH cause incontinence?

There is some evidence for a link between erectile dysfunction (ED) and BPH, although the consensus among medical professionals in this area is far from united on the topic.

However, some of the medical treatments used for BPH can do so. Once diagnosed, doctors usually recommend medication. It is crucial you know that some of the drugs used to treat BPH have known side-effects. Some of these include ED and a diminished sex drive. Other sexual health problems in some cases include retrograde ejaculation, lower sperm count, and low libido.

Men who take alpha-blockers (Flomax, Tamsulosin) and alpha reductase (Finasteride, Dutasteride) are prone to develop erectile dysfunction.

Studies show that approximately 3% of men who took Dutasteride and 6.4% of men who took Finasteride experienced a loss of libido.

The active component of the prostate plays a crucial role in generating libido and sustaining erectile rigidity. Therefore, it is not uncommon for men to experience flagging sexual desire and compromised erectile after initiation of treatment. One example is Finasteride (Proscar), a drug that treats BPH symptoms by blocking testosterone. Studies reveal that 3.7% of men who use it experience erectile dysfunction, and 3.3% experienced decreased libido.

30% of men facing BPH will encounter compromised sexual function, and one-third of men suffering ED have troubling symptoms related to the prostate.

Can BPH cause prostate cancer?

An enlarged prostate does not always mean that you have prostate cancer. It may result from BPH, which is an increased number of non-cancerous prostate cells. BPH doesn’t always develop into cancer.

However, an enlarged prostate could contain areas of cancer cells.

BPH is associated with an increased risk of prostate cancer and bladder cancer. The risk of developing prostate cancer is particularly high in Asian BPH patients, stated Chinese doctors. They went through computer analyses of 16 case-control studies and ten cohort studies with 1.6 million participants to get their final numbers.

Having BPH increased the risk of developing prostate cancer by 2.9 times. It increased the risk of developing bladder cancer 1.7 times.

Yet there are controllable factors. Inflammation can be a cause of prostate cancer as well as BPH. So why not do whatever you can to decrease your inflammation in the body? For example, you can start with making sure your vitamin D, and magnesium levels (red blood cells) are normal. If not, these deficiencies contribute majorly to both illnesses.

Metabolic syndrome is another cause, and it is linked to fast-growing BPH. Yet there are things you can do about it. For example, if your weight is higher than what it should be, drop 10% of your body weight. Then see what happened to your blood sugar, blood fats, and triglyceride levels. You could do intermittent fasting as well since this is a way to reset metabolism.


For more information on prostate cancer click here.


Can BPH cause hypertension?

When you look at the numbers, it appears that there’s a connection between BPH and hypertension. Twenty-five to 30% of all men over the age of 60 years old has both of them together.

Doctors say this makes sense because of the influence of stress on the body. You may already know that the nervous system is composed of two primary parts – the sympathetic nervous system and the parasympathetic nervous system. The sympathetic part is related to you reacting properly when you are facing a tiger or a lion-like stressor in your life. It helps you respond so you can survive.

The parasympathetic nervous system tries to help you regain composure after the lion or tiger response. The greater the number of minutes your body spends in the parasympathetic nervous system, the better you will feel. This is the neurological state where you feel peace and contentment.

BPH can be the result of sympathetic nervous system activity and may be related to the development of high blood pressure. Here are four ways:

1. Greater sympathetic (S/) nervous system responses in the body cause both BPH and hypertension.

2. Greater S/ nervous system influence increases as age increases. It gets harder and harder to deal with normal everyday stresses and get the body back to normal homeostasis. (See some of our other articles on the Rubenstein method to reset the stress mechanism via the brain.)

3. When the neurotransmitter norepinephrine is released via the S/ nervous system, blood pressure increases.

4. S/ nervous system activity also causes contraction of the smooth muscles in the prostate and result in enlargement or obstruction of the prostatic secretions.

What’s one of your best strategies to deal with any excess S/ nervous system activity in your body? It’s to relax, to reset your stress reflex mechanism via your brain and don’t give up until you stop reacting to little stresses as if they were major ones. In this way, you can impact not only BPH symptoms but also hypertension.

What are the treatment options for BPH?

There are many treatments for an enlarged prostate. The usefulness of each treatment for BPH depends on the severity of symptoms and whether you have other medical problems. Treatment is also based on your age and overall health condition.

Medications

Drugs are the conventional treatment for an enlarged prostate. Different Types of BPH drugs include:

  • Alpha Blocker
  • Tamsulosin (Flomax)
  • Alfuzosin (Uroxatral)
  • Doxazosin (Cardura)
  • Prazosin (Minipress)
  • Silodosin (Rapaflo)
  • Terazosin (Hytrin)
  • 5-Alpha Reductase Inhibitors
  • Finasteride (Propecia, Proscar)
  • Dutasteride (Avodart)
  • Phosphodiesterase-5 Inhibitors
  • Tadalafil (Cialis)

Alpha blockers are a family of drugs that work to relax the muscles in your body. They also work to prevent the hormone norepinephrine (noradrenaline) from contracting the muscle by attaching to the alpha-adrenergic receptors and stopping receptor from being stimulated by the hormone.

Alpha-blockers like Tamsulosin (Flomax) block the action of the sympathetic nervous system and relax the muscles in the prostate and bladder neck.

This makes it easier to urinate and can mask the symptoms of BPH. The effect is usually temporary and only works until the prostate becomes too enlarged for this “fix” to relieve symptoms of BPH.

Another type of prostate drugs are called 5 alpha-reductase inhibitors, and a popular example is Finasteride (Proscar). Finasteride is also a medication prescribed for male pattern hair loss and androgenetic alopecia. These drugs are used to relieve symptoms such as decreased urine flow, difficulty urinating, and night-time urgency.

Finasteride is most often prescribed for men with substantially enlarged prostates, prostates above 40 or 50 grams. These are men who are at the greatest risk of disease progression, experience moderate-to-severe lower urinary tract symptoms, and acute urinary retention.

However, cases of post-finasteride syndrome depression and sexual side effects have been reported in men.

Unlike natural supplements that help you prevent an enlarged prostate; drugs do not cure the problem. They just relieve the symptoms and are costly. Plus, they come with many negative side effects and cause long-term dependency.


For more information on prostate medication click here.


Minimally Invasive Treatment

Minimally invasive procedures are claimed to work better than drugs in easing the symptoms of an enlarged prostate.

Prostate artery embolization is the only truly minimally invasive procedure which does not damage the prostate. Prostate artery embolization involves inserting a catheter into an artery in the groin or wrist. Using an X-ray, it is passed into the blood vessels, and plastic particles are injected into the vessels to reduce the prostate gland’s blood supply. The aim is to shrink the prostate gland.

The UroLift system is another minimally invasive procedure. It is the first permanent implant for an enlarged prostate and works by pulling back the prostate tissue that is pressing on the urethra.

The Rezūm System uses the stored thermal energy in water vapor (steam) to treat the extra prostate tissue that is causing symptoms.

If you continually experience difficulty urinating, it may be suggested you use a catheter. A catheter is a tube that carries urine out of the body from the bladder; It can either be passed through the penis or insertion made above the pubic bone.

Surgery

Along with drugs, surgical procedures are also performed to treat enlarged prostates. However, the problem with almost all of these invasive procedures used to treat BPH is that they damage the prostate and therefore, cause short or even long-term consequences.

The only difference between them is that they use different technologies, but it doesn’t matter how you damage the prostate, it was damage either way.

Prior to undergoing surgery, carry out extensive research and consult your Doctor on the after effects and impact on the quality of life.

TURP is usually used for enlarged prostates larger than 30 grams and/or your symptoms are severe. It removes the core of the prostate with a resectoscope, an instrument that is passed through the urethra and into the bladder. A wire attached to the resectoscope removes prostate tissue. However, impotence and incontinence occur in 5 to 10% of men after the TURP procedure.

Laser surgery uses concentrated light that heats up and kills prostate tissue. The three types of prostate laser surgeries are photoselective vaporization of the prostate (PVP), holmium laser ablation of the prostate (HoLAP) and holmium laser enucleation of the prostate (HoLEP).  PVP, also known as Green Light laser or the Green Light procedure) is used to remove excess prostate tissue.

Interstitial Laser Therapy (ILT) is a technique that uses image-guided needle probes to deliver laser energy into a tumor to destroy the tumor cells.

Focal Laser Ablation (FLA) is a type of treatment often used for early-stage prostate cancer. It uses lasers to target tumors to prevent damaging surrounding tissue. However, further research is needed to determine which cancers it’s most suited to and the long-term side effects.

Open prostatectomy surgery is the choice for very large prostates. A suprapubic prostatectomy involves opening the bladder and removing the enlarged prostate through it. In a retropubic prostatectomy, the bladder is pushed upward, and the prostate is removed without entering the bladder.

High-Intensity Focused Ultrasound (HIFU) uses high-frequency ultrasound energy to heat and destroy cancer cells in the prostate.

Transurethral Needle Ablation (TUNA) involves a heated needle being inserted into the prostate through the urethra. Like TUMT, this is done to destroy extra prostate tissue.

Transurethral Microwave Thermotherapy (TUMT) is when a microwave antenna is attached to a flexible tube and is inserted into your bladder. The heat from microwaves kills the excess prostate tissue.

Prostatic urethral lift (PUL) implants are when a surgeon inserts implants that hold the prostate away from the urethra. This prevents it from being blocked and helps to relieve symptoms such as painful urination.

TUIP is typically recommended for men whose prostate is only slightly enlarged (less than 30 g). It is executed with an instrument that is passed through the urethra. But instead of removing excess prostate tissue, the doctor only makes one or two small cuts in the prostate with an electrical knife or laser. These cuts relieve pressure on the urethra. While it is a much easier procedure, TUIP can only be performed on men with smaller prostates.

Transurethral Vaporization of the Prostate (TVP) is usually reserved for men whose prostate is 30 grams or less. TVP involves a tiny electrified cylindrical roller or loop electrode.

Water ablation is a new treatment for prostate enlargement. The pressure of the water is then used to destroy some of the prostate tissue, making it smaller.


For more information on prostate surgery click here.


Active Surveillance vs, Watchful Waiting

When searching for information about active surveillance, you may have come across the term watchful waiting. The two are very different and should not be confused with one another. Although both are used as a way to avoid unnecessary treatment, they have their differences.

Active Surveillance

Active surveillance monitors prostate cancer more closely, involving a range of periodic tests. It is generally recommended for men with low-risk prostate cancer and never for those diagnosed with high-risk cancer.

If your results change, your Doctor will then proceed to discuss treatment options. It is suitable for men with low-risk prostate cancer, which has a low risk of spreading (localized prostate cancer). Active surveillance includes grade group 1 or Gleason 6, a PSA level <10, cancer that is confined to the prostate.

While it has been ingrained in us by doctors to treat a problem with drugs and surgery immediately, alpha blocker drugs, surgery, and radiation can have side effects that lessen a person’s quality of life.

A benefit of monitoring low-risk cancer is that you might avoid having unnecessary surgery. In fact, one study of men undergoing active surveillance found that, 15 years later, less than 1% of men developed metastatic disease.

Watchful Waiting

Watchful waiting is usually used by men experiencing other health problems, who may be unable to handle surgery or radiotherapy. It can be used in men with both low-risk cancer or men whose cancer has spread (advanced cancer).

It involves fewer tests than active surveillance and is less intensive, more often than not taking place at the GP surgery than a hospital. If you do have treatment in the future, it will aim to control cancer and manage any symptoms, rather than to cure it.


For more information on active surveillance click here.


How can you reduce your prostate naturally?

Diet

As discussed above, diet can be a contributing factor of an enlarged prostate. Certain foods can affect your hormonal balance, resulting in increased levels of DHT. However, while some risk factors, such as family history may be out of your hands, the good news is that diet can be modified.

The phrase ‘you are what you eat’ remains distinctly true, and some studies have identified foods that help or hinder your prostate health.  Therefore, all men should consider consuming a prostate friendly diet, including fruit and vegetables, legumes, nuts and seeds, healthy sources of fat, and remove in particular red meat and dairy.

A study published by John Hopkins researchers evaluated the intake of fruit, vegetables, and antioxidants among men with BPH. The results found that vegetable consumption, especially vegetables rich in beta-carotene, lutein, and vitamin C, was associated with a reduced risk of BPH.  To find out more about the relation between diet and an enlarged prostate click here.

Exercise

According to the American Cancer Society, not being active is a key factor that can increase a person’s risk of cancer risk.

Countless studies have shown that exercise can prevent prostate enlargement and help to manage BPH symptoms.

A meta-analysis involving 43,083 men looked at the relationship between physical activity and benign prostatic hyperplasia (BPH). The results suggested that men undertaking moderate or vigorous physical activity were less likely to develop BPH compared with prolonged sedentary time.

This was further examined in a study published in the International Journal of Obesity. Italian researchers reviewed occupational and recreational activity levels of 1,369 men with BPH and 1,451 men without it.

The results showed that men who had physically active jobs were 30% to 40% less likely to develop BPH. These studies suggest that physical activity could play a crucial role in the prevention and management of BPH. To find out more about the relationship between exercise and an enlarged prostate click here.


For more information on the benefits of exercise on prostate health click here.


Pelvic Floor Training

Pelvic floor training, commonly referred to as Kegel exercises, have been shown to help strengthen pelvic muscles. These muscles make sure that the bladder, rectum, as well as the small intestines, are all in place.

When these muscles are weak due to prostate cancer surgery, for example, incontinence from urine and feces may increase. This is also a non-invasive treatment for health problems in men with impotence or erectile dysfunction.

Stress

It is well known that stress has a significant effect on your overall health and wellbeing. However, the effects of stress on your prostate health tend to be underestimated.

High levels of stress and anxiety impair the body’s immune system, leaving you vulnerable and hindering your ability to fight off diseases and illness. When a man receives any type of diagnosis, his stress levels rise. It is natural to feel anxious and worried when faced with the unknown.

This can result in a vicious cycle, whereby stressing about your prostate health can actually worsen it. A research team at Ohio State University discovered a link between stress and the spread of cancer cells. Their research showed that stress triggers a ‘master switch’ gene known as ATF3. This gene is expressed in all types of cells as a response to stressful situations.

A research team at Ohio State University found a link between stress and the spread of cancer cells in many types of cancer. This includes prostate cancer. Their research shows that stress triggers a “master switch” gene in the body known as ATF3, which is expressed in all types of cells as a response to stressful conditions.

This gene usually causes normal and benign cells to self-destruct if they have been irrevocably damaged. But the research suggests that cancer cells coax the immune system to release ATF3 in order for them to travel around the body and infect other areas.

With stressful conditions being the most likely trigger for the release of this gene, the research shows that stress causes cancer to worsen and spread.

Do supplements help with BPH?

The world is over-medicated, and people spend billions of dollars on prescription drugs each year. However, several studies have already established the effectiveness of drugs as questionable. Many drugs often only mask the symptoms, without fixing the root cause of the disease.

Many prostate medications can result in adverse effects, such as sexual dysfunction, severe allergic reactions, and changes in blood pressure.

The truth is that prevention is way much better than cure, and supplements are a better option. They are natural therapies that are much safer and more effective.

Rye grass pollen

Multiple clinical studies support its effectiveness in the treatment of an enlarged prostate. One 2017 meta-analysis consisting of 10 clinical studies actually revealed an 83% positive response rate from patients, with no side effects reported.

Beta Sitosterol (Saw Palmetto)

Beta-sitosterol is a sterol, similar to cholesterol, found in plant foods. It has been shown to help reduce the symptoms of BPH, including improving urination flow and prostatitis. Many studies have been conducted, reviewing the effectiveness of beta-sitosterol as a natural treatment for an enlarged prostate.

French researchers say this well-known herb is a suitable replacement for Flomax plus it decreases 65% of biomarkers for chronic prostate inflammation. That’s a good amount since the drug only decreased the biomarkers 46%.

Saw palmetto berry also decreased 80% of the genes most frequently expressed for prostate enlargement while the drug came in with a pale 33% reduction.

Patients who had the MIF protein overexpressed because of the disorder showed a higher response to the International Prostate Symptom Score when they took the hexane extract of the herb as well. The scientists stated that their study showed for the first time that saw palmetto has distinct clinical level anti-inflammatory properties for men with prostate enlargement.


For more information on prostate supplements click here.


Boron

In recent years, there have been many studies that demonstrate that boron can kill prostate cancer cells while leaving healthy cells unharmed selectively. In addition, boron has been found to lower PSA—which was previously believed to be only a marker for prostate cancer. More recent research shows that elevated PSA is actually a causal factor in prostate cancer progression.

Adequate boron levels are associated with a 64% reduced risk of prostate cancer but obtaining protective levels of boron from food alone is difficult. Very little boron is to be found in food, especially if such food is not produced organically.

Pygeum Africanum

Pygeum Africanum is a cherry tree found in Africa. Pygeum contains a wide variety of active components including the phytosterols beta-sitosterol. Phytosterols found in plants produce an anti-inflammatory effect, helping to relieve the uncomfortable symptoms of BPH.

One study reviewing the benefits of pygeum africanum found that men using the herb were more than twice as likely to report an improvement in overall symptoms. Getting up to go to urinate in the middle of the night was also reduced by 19%. Residual urine volume was decreased by 24%, and peak urine flow was increased by 23%.

Curcumin

Curcumin is a powerful weapon against inflammation, even matching the effectiveness of some anti-inflammatory drugs such as ibuprofen, aspirin, tamoxifen, sulindac, and naproxen, but without the negative side effects.

Ellagic Acid

Ellagic acid is an antioxidant naturally found in 46 different types of fruit. Studies carried out by The Hollings Cancer Institute found that ellagic acid can cause apoptosis (death of cancer cells) for prostate cancer cells within 72 hours.

Japanese Sophora (Flower Buds) Quercetin

Quercetin is a flavonol, derived from plants. Many studies have shown it to be an effective anti-inflammatory, helping to reduce prostate-related pain and swelling. Quercetin has been labeled a Tier 1 Supplement. That means that quercetin has many successful clinical studies and research that support its effectiveness.

Sources

BPH –  Causes, Diagnosis, Symptoms

  1. Wein AJ, et al., eds. Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. In: Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016.
  2. Management of benign prostatic hyperplasia (BPH). American Urological Association. http://www.auanet.org/guidelines/benign-prostatic-hyperplasia-(2010-reviewed-and-validity-confirmed-2014). Accessed April. 15, 2019.

Can BPH cause hydronephrosis?

  1. Riyach O, Ahsaini M, Kharbach Y, et al. Bilateral ureteral obstruction revealing a benign prostatic hypertrophy: a case report and review of the literature. J Med Case Rep. 2014;8:42. Published 2014 Feb 11. doi:10.1186/1752-1947-8-42

Can BPH cause prostate cancer?

  1. Chang RT, Kirby R, Challacombe BJ. (2012). Is there a link between BPH and prostate cancer?. Practitioner. 2 (1750), p13-6.
  2. Dai, X., et al. Benign prostatic hyperplasia and the risk of prostate cancer and bladder cancer: A meta-analysis of observational studies. Medicine (Baltimore). 2016 May;95(18):e3493. https://www.ncbi.nlm.nih.gov/pubmed/27149447
  3. Liu ZM, Wong CK, Chan D, Tse LA, Yip B, Wong SY. Fruit and vegetable intake in relation to lower urinary tract symptoms and erectile dysfunction among Southern Chinese elderly men: a 4-year prospective study of Mr OS Hong Kong. Medicine. 2016 Jan;95(4).
  4. Schwarz S, Obermuller-Jevic UC, Hellmis E, Koch W, Jacobi G, Biesalski HK. Lycopene inhibits disease progression in patients with benign prostate hyperplasia. The Journal of nutrition. 2008 Jan 1;138(1):49-53.
  5. van Breemen RB, Sharifi R, Viana M, Pajkovic N, Zhu D, Yuan L, Yang Y, Bowen PE, Stacewicz-Sapuntzakis M. Antioxidant effects of lycopene in African American men with prostate cancer or benign prostate hyperplasia: a randomized, controlled trial. Cancer prevention research. 2011 May 1;4(5):711-8
  6. Chen L, Stacewicz-Sapuntzakis M, Duncan C, Sharifi R, Ghosh L, Breemen RV, Ashton D, Bowen PE. Oxidative DNA damage in prostate cancer patients consuming tomato sauce-based entrees as a whole-food intervention. Journal of the National Cancer Institute. 2001 Dec 19;93(24):1872-9.
  7. Paur I, Lilleby W, Bøhn SK, Hulander E, Klein W, Vlatkovic L, Axcrona K, Bolstad N, Bjøro T, Laake P, Taskén KA. Tomato-based randomized controlled trial in prostate cancer patients: effect on PSA. Clinical nutrition. 2017 Jun 1;36(3):672-9
  8. Barnard RJ, Kobayashi N, Aronson WJ. Effect of diet and exercise intervention on the growth of prostate epithelial cells. Prostate Cancer and Prostatic Diseases. 2008 Dec;11(4):362.

Lifestyle and metabolic

  1.       Barnard RJ, Kobayashi N, Aronson WJ. Effect of diet and exercise intervention on the growth of prostate epithelial cells. Prostate Cancer and Prostatic Diseases. 2008 Dec;11(4):362.
  2.       Yong L, Jin-Lian L, Yan-Lin W, Shu-Guang P, Su H, et al. (2012) The Effect of Weight Losing to Benign Prostate Hyperplasia Patients with Metabolic Syndrome. J Obes Wt Loss Ther 2:151.
  3.       Muller RL, Gerber L, Moreira DM, Andriole G, Hamilton RJ, Fleshner N, Parsons JK, Freedland SJ. Obesity is associated with increased prostate growth and attenuated prostate volume reduction by dutasteride. European urology. 2013 Jun 1;63(6):1115-21.
  4.       Barter PJ. The causes and consequences of low levels of high density lipoproteins in patients with diabetes. Diabetes & metabolism journal. 2011 Apr 1;35(2):101-6.
  5.       Parsons JK, Kashefi C. Physical activity, benign prostatic hyperplasia, and lower urinary tract symptoms. european urology. 2008 Jun 1;53(6):1228-35.
  6.       Raheem OA, Parsons JK. Associations of obesity, physical activity and diet with benign prostatic hyperplasia and lower urinary tract symptoms. Current opinion in urology. 2014 Jan 1;24(1):10-4.
  7.       Liu ZM, Wong CK, Chan D, Tse LA, Yip B, Wong SY. Fruit and vegetable intake in relation to lower urinary tract symptoms and erectile dysfunction among Southern Chinese elderly men: a 4-year prospective study of Mr OS Hong Kong. Medicine. 2016 Jan;95(4).
  8.       Schwarz S, Obermuller-Jevic UC, Hellmis E, Koch W, Jacobi G, Biesalski HK. Lycopene inhibits disease progression in patients with benign prostate hyperplasia. The Journal of nutrition. 2008 Jan 1;138(1):49-53.
  9.       van Breemen RB, Sharifi R, Viana M, Pajkovic N, Zhu D, Yuan L, Yang Y, Bowen PE, Stacewicz-Sapuntzakis M. Antioxidant effects of lycopene in African American men with prostate cancer or benign prostate hyperplasia: a randomized, controlled trial. Cancer prevention research. 2011 May 1;4(5):711-8.
  10.   Chen L, Stacewicz-Sapuntzakis M, Duncan C, Sharifi R, Ghosh L, Breemen RV, Ashton D, Bowen PE. Oxidative DNA damage in prostate cancer patients consuming tomato sauce-based entrees as a whole-food intervention. Journal of the National Cancer Institute. 2001 Dec 19;93(24):1872-9.
  11.   Paur I, Lilleby W, Bøhn SK, Hulander E, Klein W, Vlatkovic L, Axcrona K, Bolstad N, Bjøro T, Laake P, Taskén KA. Tomato-based randomized controlled trial in prostate cancer patients: effect on PSA. Clinical nutrition. 2017 Jun 1;36(3):672-9.
  12.   Barnard RJ, Kobayashi N, Aronson WJ. Effect of diet and exercise intervention on the growth of prostate epithelial cells. Prostate Cancer and Prostatic Diseases. 2008 Dec;11(4):362.

Can BPH cause hypertension?

  1. Kopp, W. (2018). Diet-Induced Hyperinsulinemia as a Key Factor in the Etiology of Both Benign Prostatic Hyperplasia and Essential Hypertension? Nutrition and Metabolic Insights.
  2. White, William B. and Moon, Timothy. Treatment of benign prostatic hyperplasia in hypertensive men. Journal of Clinical Hypertension, April 2005, 7;(4):212-217.

What are the treatment options for BPH?

  1. Bird ST, Delaney JA, Brophy JM, Etminan M, Skeldon SC, Hartzema AG. Tamsulosin treatment for benign prostatic hyperplasia and risk of severe hypotension in men aged 40-85 years in the United States: risk window analyses using between and within patient methodology. BMJ. 2013 Nov 5. 347:6320.
  2. Brigantia, A, Fossatia, N, Cattob, J, Cornfordc, P, Montorsia, F. (2018). Active Surveillance for Low-risk Prostate Cancer: The European Association of Urology Position in 2018. European Urology . 74 (3), p357–368.
  3. Christidis, C, McGrath, S, Perera, m. ( 2). Minimally invasive surgical therapies for benign prostatic hypertrophy: The rise in minimally invasive surgical therapies. Prostate International. 5 (2017), p41-46
  4. Elzayat EA, Habib EI, Elhilali MM. Holmium laser enucleation of the prostate: a size-independent new “gold standard”. Urology. 2005 Nov. 66(5 Suppl):108-13.
  5. Foster HE, Barry MJ, Dahm P, Gandhi MC, Kaplan SA, Kohler TS, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline. J Urol. 2018 Jun 11.
  6. Gupta N, Rogers T, Holland B, Helo S, Dynda D, McVary KT. Three-Year Treatment Outcomes of Water Vapor Thermal Therapy Compared to Doxazosin, Finasteride and Combination Drug Therapy in Men with Benign Prostatic Hyperplasia: Cohort Data from the MTOPS Trial. J Urol. 2018 Aug. 200 (2):405-413.
  7. Mahal BA, Butler S, Franco I, et al. Use of Active Surveillance or Watchful Waiting for Low-Risk Prostate Cancer and Management Trends Across Risk Groups in the United States, 2010-2015. JAMA.2019;321(7):704–706.
  8. Mulhall JP, Guhring P, Parker M, Hopps C. Assessment of the impact of sildenafil citrate on lower urinary tract symptoms in men with erectile dysfunction. J Sex Med. 2006 Jul. 3(4):662-7.
  9. McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med. 1998 Feb 26. 338(9):557-63.
  10. Nimeh T, Magnan B, Almallah YZ. Benign Prostatic Hyperplasia: Review of Modern Minimally Invasive Surgical Treatments. Semin Intervent Radiol. 2016 Sep. 33 (3):244-50.
  11. Shim SR, Kanhai K, Ko YM, Kim JH. Efficacy and safety of prostatic arterial embolization: Systematic review with meta-analysis and meta-regression. J Urol. 2016 Aug 31.
  12. Tosoian,  J ,Mamawala, M, Epstein, J, Landis, P, Wolf, S, Trock, B, Carter, B. (2015). Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer. Journal of Clinical Oncology . 1 (30), p3379-3385.

Do Natural Treatments Work For BPH?

  1. Azimi, H., et al. A review of animal and human studies for management of benign prostatic hyperplasia with natural products: perspective of new pharmacological agents. Inflamm Allergy Drug Targets 2012 Jun;11(3):207-21.
  2. Barlet, A, Albrecht , J, et al. (1990). [Efficacy of Pygeum africanum extract in the medical therapy of urination disorders due to benign prostatic hyperplasia: evaluation of objective and subjective parameters. A placebo-controlled double-. S National Library of Medicine National Institutes of Health. 102 (22), p667-673.
  3. Cai, T, Verze, P, et al. (2017). The role of flower pollen extract in managing patients affected by chronic prostatitis/chronic pelvic pain syndrome: a comprehensive analysis of all published clinical trials.. BMC Urology. 17 (1), p120-130.
  4. Cui, Y, Winton, M, et al. (2011). Dietary boron intake and prostate cancer risk.. Oncology Reports. 4 (1), p887-892.
  5. Chen Y, Yu W, Zhou L, et alRelationship among diet habit and lower urinary tract symptoms and sexual function in outpatient-based males with LUTS/BPH: a multiregional and cross-sectional study in ChinaBMJ Open 2016;6:e010863. doi:10.1136/bmjopen-2015-010863
  6. Dal Maso L, Zucchetto A, Tavani A, et al. Lifetime Occupational and Recreational Physical Activity and Risk of Benign Prostatic Hyperplasia. International Journal of Cancer2006;118:2632–35. PMID: 16380994
  7. Demaagd GA, Davenport TC. (2012). Management of Urinary Incontinence. Pharmacy and Therapeutics. 37 (6), p345-361.
  8. Espinosa, G. (2013). Nutrition and benign prostatic hyperplasia.. Current Opinion in Urology. 23 (1), p 38–41.
  9. Favilla V1, Cimino S, Salamone C, Fragalà E, Madonia M,et al. (2013). Risk factors of sexual dysfunction after transurethral resection of the prostate (TURP): a 12 months follow-up.. Journal of Endocrinological Investigation. 36 (11), p1094-8.
  10. Garcia, C, Chin,P, Woo, H. (2015). Prostatic urethral lift: A minimally invasive treatment for benign prostatic hyperplasia. Prostate International . 3 (1), p1-5.
  11. Gonzalez A, Peters U, Lampe JW, White E. Boron intake and prostate cancer risk. Cancer Causes Control. 2007;18(10):1131–1140.
  12. Gallardo-Williams MT1, Chapin RE, King PE, Moser GJ, Goldsworthy TL, Morrison JP, Maronpot RR.. (2004). Boron supplementation inhibits the growth and local expression of IGF-1 in human prostate adenocarcinoma (LNCaP) tumors in nude mice.. Toxicologic Pathology. 32 (1), p73-78.
  13. Harrison S, Lennon R, Holly J, et al. Does milk intake promote prostate cancer initiation or progression via effects on insulin-like growth factors (IGFs)? A systematic review and meta-analysis. Cancer Causes Control. 2017;28(6):497–528. doi:10.1007/s10552-017-0883-1
  14. Ishani, A, MacDonald, R, et al. (2000). Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. The American Journal of Medicine Home. 109 (8), p654–664.
  15. Lee HW, Kim SA, Nam JW, Kim MK, Choi BY, Moon HS. The study about physical activity for subjects with prevention of benign prostate hyperplasia. Int Neurourol J. 2014;18(3):155–162. doi:10.5213/inj.2014.18.3.155
  16. LeBeau, A, Kostova ,M, et al . (2010). Prostate-specific antigen: an overlooked candidate for the targeted treatment and selective imaging of prostate cancer. Biological Chemistry . 391 (4), p333-343.
  17. Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G.. (2010). Efficacy and Safety of Finasteride Therapy for Androgenetic Alopecia. JAMA Dermatology. 146 (10), p1141–1150.
  18. Michel, M, et al. (2004). Association of Hypertension with Symptoms of Benign Prostatic Hyperplasia . The Journal of Urology . 172 (1), p1390 –1393.
  19. Platz EA, Kawachi I, Rimm EB, et al. Physical Activity and Benign Prostatic Hyperplasia. Archives of Internal Medicine 1998;158:2349–56. PMID: 9827786.
  20. Rohrmann S et al. Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men. American Journal of Clinical Nutrition2007 Feb; 85(2): 523-29
  21. Taktak,S, Jones, P, Haq, A, et al. (2018). Aquablation: a novel and minimally invasive surgery for benign prostate enlargement. Sage Journal. 10 (1), p183-188.
  22. Wilt, T., et al. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002;(1):CD001044.

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