EVERYTHING ABOUT

prostate

Every week I am posting about  everything you need to know about hormones. This weeks topic is about prostate.

Did you know …

  • The prostate is a small, walnut sized, muscular gland located deep inside the groin, between the base of the penis and the rectum, just below the bladder.
  • Surrounds the top portion of the tube that drains urine from the bladder called the urethra.
  • The prostate’s primary function is to produce the alkaline fluid that nourishes and transports sperm (seminal fluid).
  • The muscular action of the prostate helps propel the fluid and semen through the penis during sexual climax.
  • By age 40, the prostate might have gone from the size of a walnut to the size of an apricot.
  • By 60, it might be the size of a lemon.
  • Because it surrounds part of the urethra, an enlarged prostate can squeeze that tube causing peeing problems.
  • Problems are typically not seen before 50, but can start earlier.
  • The prostate is regulated by Testosterone, more so DHT, which is produced from Testosterone in the prostate gland.
  • 50% of men between the ages of 50 and 60 years suffer with benign prostatic hyperplasia, BPH.
  • Up to 90% of men older than 80 years of age suffer with benign prostatic hyperplasia, BPH.
  • Some men experience a sudden onset of the inability to pass urine (known as acute retention).
  • It is estimated that up to 3 million men in the UK have lower urinary tract symptoms associated with BPH.
  • Prostate cancer now accounts for 26% of all new cancers in UK males, making it the most common form of cancer in men.
  • 1 in 4 men of Afro-Caribbean descent get prostate cancer.
  • 1 – 8 white males get prostate cancer.
  • For UK males, prostate cancer accounted for 13% of all cancer deaths in 2018 (11,900 deaths), making prostate cancer the second most common cause of cancer death for males in the UK.
  • More than 47,500 men are diagnosed with prostate cancer every year – that’s 129 men every day.
  • Every 45 minutes one man dies from prostate cancer – that’s more than 11,500 men every year.
  • Around 400,000 men are living with and or after prostate cancer.
  • Statistics from prostatecanceruk.org

Meet Sally and get to know all about prostate

Intro

Prostate 101

Signs & Symptoms of an enlarged prostate

PSA 101

Prostate Cancer

Prostate 101

  • The prostate is a small, walnut sized, muscular gland located deep inside the groin, between the base of the penis and the rectum, just below the bladder.
  • It surrounds the top portion of the tube that drains urine from the bladder called the urethra.
  • The prostate’s primary function is to produce the alkaline fluid that nourishes and transports sperm (seminal fluid).
  • The muscular action of the prostate helps propel the fluid and semen through the penis during sexual climax.
  • By age 40, the prostate might have gone from the size of a walnut to the size of an apricot.
  • By 60, it might be the size of a lemon.
  • Because it surrounds part of the urethra, an enlarged prostate can squeeze that tube causing peeing problems.
  • These problems are typically not seen before 50, but can start earlier.
  • The prostate typically grows during adolescence, under the control of the male hormone testosterone and its by-product dihydrotestosterone (DHT).
  • It is divided into several anatomic regions, or zones.
  • Most prostate cancer starts in the peripheral zone (the back of the prostate), near the rectum.
  • That’s why a digital rectal exam (DRE), in which a doctor examines the prostate by inserting a gloved finger in the rectum, is a common and useful screening test in addition to the PSA blood test.
  • Difficulty with urination is usually not an early or common symptom of prostate cancer.
  • Benign Prostatic Hypertrophy (BPH), which is a non-cancerous prostate condition typically develops from the transition zone that surrounds the urethra closer to the middle of the prostate.
  • Difficulty with urination is usually an early and common symptom BPH
  • The prostate is not essential for life, but is crucial for reproduction.
  • Healthy semen is classified as the perfect consistency and environment for sperm transit and survival, and for fertilization.
  • Semen includes enzymes like PSA and other substances made by the seminal vesicles and prostate, such as zinc, citrate, and fructose, that actually gives sperm energy to make the journey to the egg.
  • Semen also contains substances that may protect the urinary tract and sperm from bacteria and other pathogens.

PSA 101

  • Prostate-specific antigen is an enzyme secreted by the epithelial cells of the prostate gland.
  • PSA is produced for the ejaculate, where it liquefies the semen allowing them to swim freely.
  • It is also believed to be instrumental in dissolving cervical mucus, allowing the entry of sperm into the uterus.
  • Is present in small quantities in the blood of men with healthy prostates.
  • Often elevated in the presence of prostate cancer or other prostate disorders.
  • PSA is not uniquely an indicator of prostate cancer, but may also detect prostatitis- prostate inflammation or BPH – benign prostatic hyperplasia, UTI – Urinary tract infections, etc.
  • PSA may produce and immune response.
  • PSA levels under 4 ng/ml are generally considered normal.
  • PSA levels between 4 and 10 ng/ml may indicate a risk of BPH, prostatitis or prostate cancer.
  • PSA level is above 10 ng/ml, higher risk of prostate problems.
  • Low Free PSA levels to Total PSA may indicates prostate cancer.
  • PSA is also expressed in female tissues, such as
  • Breast tissue produces PSA, both normal and abnormal breast tissues, increasing in breast cancer.
  • Breast fluids including milk, nipple aspirate, and cyst fluid.
  • High concentrations found in amniotic fluid, changing with gestational age.
  • Pregnant women have elevated blood PSA.
  • Blood PSA levels also vary during menstrual cycles.
  • PSA levels increase in women with excess androgens.

What can affect PSA levels?

Prostate specific antigen (PSA) is produced by healthy cells in the prostate, so it’s normal to have a small amount of PSA in your blood.

Increased PSA caused by

  • Age as the prostate gets bigger
  • Prostate problems, such as
    – enlarged prostate
    – prostatitis
    – prostate cancer
  • Urine infection
  • Vigorous exercise – wait 48 hours before testing
  • Ejaculation – wait 48 hours before testing
  • Anal sex and prostate stimulation – avoid for a week before testing
  • Prostate biopsy
  • Medicines – such as 5-alpha-reductase inhibitors – finasteride or dutasteride can reduce PSA levels and give a false test result
  • Other bladder or prostate surgery –wait up to 6 weeks before testing
  • Urinary catheters – wait up to 6 weeks after it has been put in before testing
  • Obesity can reduce PSA levels and give a false test result.

Benign Prostatic Hyperplasia (BPH) 101

In many men, the prostate can become enlarged, this is called Benign Prostatic Hyperplasia (BPH) which squeezes the urethra and can cause:

  • incomplete bladder emptying
  • constant sensation of wanting to urinate
  • nocturia, which is the need to urinate two or more times per night
  • dribbling at the end of your urinary stream
  • incontinence, or leakage of urine
  • the need to strain when urinating
  • a weak urinary stream
  • a sudden urge to urinate
  • painful urination
  • blood in the urine
  • UTI’s – urinary tract infections
  • Bladder stones
  • sexual problems, such as, erectile dysfunction, reduced sex drive, decreased sexual satisfaction, pain during ejaculation.

BPH is not the same as prostate cancer and doesn’t increase the risk of cancer, however, it can cause symptoms that can affect the quality of life.

BPH is common in men older than 50 years

Causes

  • unknown
  • could be due to the change in sex hormone production due to andropause
  • could be due to the decrease liver detoxification abilities and thereby the excretion of Testosterone and especially DHT
  • could be gut dysbiosis and an increased reabsorption of DHT
  • a combination of all of the above.

Solutions

Natural

  • Urinate as soon as you feel the urge
  • Try to urinate, even when you don’t feel the urge
  • Avoid alcohol and caffeine, especially in the hours after dinner
  • Reduce stress levels, as nervousness can increase the frequency of urination
  • Regular exercise, lack of exercise can aggravate your symptoms
  • Pelvic floor exercises – yes guys you also have pelvic floor muscles
  • Keep warm, cold can make symptoms worse

Supplements

  • Saw Palmetto – can block DHT production
  • Beta-sitosterol – plant cholesterol – unknown how it works but increases urinary flow
  • Stinging Nettle / Nettle root – can block DHT production
  • Supplement Saw Palmetto + Stinging Nettle Complex – BUY HERE

Medical Interventions

  • The three classes of drugs for an enlarged prostate are:

Alpha blockers
– which relax muscles of the prostate and neck of the bladder to relieve symptoms, such as alfuzosin, doxazosin, tamsulosin, and terazosin

5-alpha reductase inhibitors (5-ARIs)
– which reduce the conversion of Testosterone to DHT helps shrink the prostate and prevent additional growth, such as dutasteride and finasteride

Phosphodiesterase 5 inhibitors (PDE5 inhibitors)
– which have been shown to improve prostate symptoms by increasing flow rate, such as sildenafil, vardenafil, tadalafil and avanafil

Antibiotics
– for bacterial infections

Various Surgeries 
– to remove excess prostate.

Typical Symptoms of Enlarged Prostate – BPH

  • A weak or slow urinary stream.
  • A feeling of incomplete bladder emptying.
  • Difficulty starting urination.
  • Needing to pee urgently and or more frequently
  • Getting up frequently at night to urinate.
  • A urinary stream that starts and stops.
  • Straining to urinate
  • Continued dribbling of urine.
  • Returning to urinate again minutes after finishing.
  • Accidentally leaking urine (urinary incontinence).

Minimally Invasive Treatments for BPH

When medications don’t help the BPH, several procedures can relieve symptoms – without surgery and can be performed in a doctor’s office.

 

Prostate Steam Therapy – Rezūm Therapy

  • Uses water vapor therapy
  • Injections of steam induces cell death
  • Removes the obstructive prostate tissue from the inside of the organ without injuring the prostatic part of the urinary tube.

 

Prostate Artery Embolization – PAE

  • Performed by an interventional radiologist (IR).
  • A small catheter is inserted into an artery in the wrist or groin and guided into the blood vessels that supply blood to your prostate.
  • An arteriogram is done to map the blood vessels feeding your prostate.
  • Tiny round microspheres (particles) are injected through the catheter and into the blood vessels that feed your prostate to reduce its blood supply.
  • Following this procedure the prostate will begin to shrink, relieving and improving symptoms usually within days of the procedure.
  • A high rate of success – over 90% of men experiencing relief in the first year.
  • PAE does not affect sexual performance.

 

Water-induced thermotherapy – WIT

  • An experimental procedure that involves destroying excess prostate tissue utilizing heated water and an air-filled balloon, which protects normal prostate tissue.
  • The procedure is performed with only local anaesthesia. Results may not be fully apparent for three to four months.
  • However, preliminary studies examining WIT have shown positive results, with a near doubling in urine flow.
  • Water, heated to 60 degrees C, is continuously circulated through the catheter to a treatment balloon, which conducts thermal energy to targeted prostatic tissue.
  • The combination of heat and compression reduces the heat sink effect of the circulating blood, thus enhancing the thermal energy transfer to the compressed tissue.
  • WIT treatment is performed using only topical urethral anaesthetic, in a single 45-minute session.
  • The 2-year follow-up data from a European multicenter study consisting of 125 patients showed an improvement in peak urine flow of 87.4%.
  • Patient tolerance of WIT was rated as “excellent” or “good” in 91.8% of the procedures.
  • WIT is efficacious, simple, and inexpensive, has few side effects, and does not need special probes to monitor prostate or rectum temperature; thus, it can be used in hospitals, outpatient clinics, and doctors’ offices.

 

TUMT – Transurethral Microwave Thermotherapy

  • This therapy for mild to moderate blockage reduces urinary frequency, urgency, straining, and intermittent flow.
  • Does not correct any bladder-emptying problems.
  • In this procedure, computer-regulated microwaves are used to heat portions within the prostate to destroy select tissue.
  • A cooling system protects the wall of the urethra during the procedure.
  • TUMT is performed in a doctor’s office and requires only topical anaesthesia and pain medications.
  • Possible side effects include:

– painful urination for several weeks

– temporary urgency and frequency of urination

– May be less semen ejaculated

– Many need to repeat the procedure, either because symptoms return or do not improve.

 

TUNA – Transurethral Radio Frequency Needle Ablation

  • Destroys prostate tissue to improve urine flow and relieve symptoms.
  • Involves heating the tissue with high-frequency radio-waves transmitted by needles inserted directly into the prostate.
  • Some anaesthesia is used.
  • The procedure does not require a hospital stay.
  • Possible side effects:

– painful, urgent, or frequent urination for a few weeks.

 

Prostatic stents

  • A tiny metal coil called a stent can be inserted in the urethra to widen it and keep it open.
  • Stenting is done on an outpatient basis under local or spinal anaesthesia.
  • Usually for men who are unwilling or unable to take medications, or are reluctant or unable to have surgery.
  • The majority of doctors don’t consider stents a good option for most men.
  • Can be serious side effects, such as

– painful urination

– frequent urinary tract infections.

  • Some men find that stents don’t improve their symptoms.
  • Sometimes a stent shifts position, which can worsen the symptoms..
  • Stents are expensive, and can be difficult to remove.

Surgeries for BPH

For most men with very enlarged prostates, surgery can relieve symptoms – but there are both risks and benefits with each type of operation.

TURP (transurethral resection of the prostate)

  • The most common surgery for an enlarged prostate.
  • Brings the greatest reduction in symptoms.
  • Only the tissue growth pressing against the urethra is removed to allow urine to flow easily.
  • The procedure involves an electrical loop that cuts tissue and seals blood vessels.
  • Most doctors suggest using TURP whenever surgery is required, as it is less traumatic than open surgery and requires shorter recovery time.
  • Can cause retrograde or dry ejaculation, where semen travel backwards into the bladder instead of through the urethra, which is only an issue if fertility is a concern.
  • Other possible side effects:

– blood loss requiring transfusion (rare).

– painful urination.

– recurring urinary tract infections.

– bladder neck narrowing.

– blood in the urine.

– erection problems range from 5% to 35% – often temporary, the ability to have an erection and an orgasm returns after a few months.

 

TUIP (transurethral incision of the prostate)

  • Involves making cuts in the prostate instead of removing prostate tissue.
  • The cuts reduce pressure on the urethra, making urination easier.
  • Patients go home the same day wearing a catheter for a day or two.
  • Symptom relief is slower compared with TURP.
  • Though most men are satisfied with their ultimate symptom
  • Retrograde ejaculation is less common and less severe than after TURP.
  • Risk of erection problems is similar to TURP.

 

Laser Surgery

  • This procedure uses a high energy vaporizing laser to destroy prostate tissue.
  • Done under general anaesthesia
  • May require an overnight stay at the hospital.
  • Provides immediate relief of symptoms, yet men may suffer from painful urination for a few weeks.
  • In general this procedure causes less blood loss.
  • Can include retrograde ejaculation into the bladder instead of down the penis.

Various laser treatments

  • Transurethral holmium laser ablation of the prostate (HoLAP).
  • Transurethral holmium laser enucleation of the prostate (HoLEP).
  • Holmium laser resection of the prostate (HoLRP).
  • Photoselective vaporization of the prostate (PVP).

 

Open Prostate Surgery (Prostatectomy)

  • When a transurethral procedures cannot be used, open surgery may be necessary.
  • Allows the surgeon to remove tissue in the prostate.
  • Open prostatectomy is typically done when

– the prostate gland is greatly enlarged

– the bladder is damage

– when there are bladder stones

– when the urethra is narrowed.

  • The inner part of the prostate is removed under general or spinal anaesthesia.
  • Recovery can take a few weeks to several months.
  • Side effects are similar to TURP.

– blood loss requiring transfusion

– urinary incontinence

– erection problems

– retrograde ejaculation.

Herbal Therapies for BPH

  • Several herbal supplements are marketed for enlarged prostates.
  • NB! like any drug, a herbal remedy can affect how other medications or treatments work, or interact dangerously with your other medications. They can also have side effects.
  • Before trying any alternative treatment, learn as much as you can about it

Saw palmetto

  • From ripened berries of the saw palmetto shrub.
  • Extracts are thought to prevent testosterone from breaking down to DHT, similar to the 5-alpha reductase inhibitor medications.
  • Studies of this supplement have had varied results.
  • One of the most popular herbal supplements taken for BPH. BUY YOURS HERE.

Beta-sitosterol

  • Extracted from pollen of rye grass.
  • Some evidence that it provides relief from urinary symptoms.

Pygeum

  • Extract comes from the bark of the African plum tree.
  • Numerous studies have found positive results for pygeum.
  • In 18 studies, this extract relieved BPH symptoms twice as often as the placebo; it also increased urinary flow by nearly 25%.

Green Tea

  • Catechin epigallocatechin gallate (EGCG) act as potent 5 alpha-reductase inhibitorsBUY YOURS HERE

Prostate Cancer 101

  • Is one of the most prevalent cancers in men.
  • Known as a “silent killer” for its ability to go undetected for several years.
  • Cause not known
  • Risk factors

– Age

– Family history

– Genetic factors

– Race – African-Americans have a 75% increased risk

– Lifestyle – smoking, inactivity, obesity

– Dietary habits – high omega 6 fatty acids and sugars, processed foods, charred (BBQ) meats, excess alcohol

– High calcium intake

  • Prostate cancer occurs when normal prostate cell begin to grow out of control.
  • Once a prostate cancer forms, it feeds on androgens and uses them as fuel for growth.
  • Therefore the cancer is treated with anti-androgen drugs
  • In many cases, prostate cancer is relatively slow-growing, and can take years to become large enough to be detectable

Signs of Prostate Cancer

Early Signs of Prostate Cancer

No warning signs

  • Can’t feel the growing tumour pushing against anything else, so there’s no pain.
  • Can have the disease for years and not know it.
  • That makes regular prostate cancer screenings very important.

Symptoms of Prostate Cancer

Once a tumour causes your prostate gland to swell, or once cancer spreads beyond your prostate, you may have symptoms. The following aren’t symptoms of the cancer itself.

They happen because the cancer growth is blocking your prostate, just as with BPH.

  • The need to pee often, especially at night
  • Trouble starting or stopping a stream of urine
  • A weak stream or one that starts and stops
  • Leaking pee when you laugh or cough
  • Not being able to pee standing up
  • Pain or burning when you pee
  • Pain or burning when you ejaculate
  • Less fluid when you ejaculate
  • Blood in your pee or semen
  • Pressure or pain in your rectum
  • Pain or stiffness in your lower back, hips, pelvis, or thighs
  • Trouble getting an erection

Symptoms of Advanced Prostate Cancer

  • Dull, deep pain or stiffness in your pelvis, hips, lower back, ribs, or upper thighs
  • Pain in the bones of the above areas
  • Loss of weight and appetite
  • Fatigue, nausea, and or vomiting
  • Swelling of your lower limbs
  • Weakness or paralysis in your lower limbs, often with constipation
  • Bowel problems.

Prostate Cancer Treatments

Depending on each case, treatment options for prostate cancer might include:

  • Observation or Active Surveillance.
  • Surgery – Open or laparoscopic radical prostatectomy, done less often than previously.
  • Radiation Therapy – uses high-energy rays or particles to kill cancer cells.
  • Cryotherapy – use of very cold temperatures to freeze and kill prostate cancer cells as well as most of the prostate.
  • Hormone Therapy – also called androgen suppression therapy, the goal of which is to reduce levels of male hormones, called androgens, in the body to stop them from fuelling prostate cancer cells.
  • Chemotherapy – uses anti-cancer drugs injected into a vein or given by mouth.
  • Immunotherapy – uses medication to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively.
  • Targeted therapy – uses drugs to identify and attack cancer cells while doing little damage to normal cells.

Love your Prostate

  • A prostate-healthy diet – antioxidant-rich foods, such as deep coloured fruits, organ meats, avoid charred meats, such as BBQ, avoid sugars and excess omega 6 fatty acids.
  • Focus on liver supporting nutrients – see the blog about liver health
  • Consume more green tea – see product here 
  • Get more omega 3 fatty acids – see product here  – login with 4265940
  • Cut back on alcohol and or caffeinated drinks, such as sodas.
  • Optimise vitamin D levels – get some sun.
  • Staying active – minimum 30 minutes’ walk every day.
  • Frequent ejaculation – studies show that frequent ejaculation may have a positive effect on the prostate. Men in their 40s who ejaculate 21 or more times in a month on average are 32% less likely to develop prostate cancer than those who only do it for 7.
  • Manage stress.
  • Quit smoking.
  • Get regular prostate check-ups – digital rectal exam (DRE) and a PSA prostate-specific antigen test.
  • Maintain a healthy weight.

Questions? Please don't hesitate to contact me

Sign up