The prostate is a gland between the bladder base and male urethra. Its primary role is fertility, as it is the site of ejaculate formation. Unfortunately, it is also the site of potential problems as a male
matures. In the young, sexually active male, pelvic discomfort and urinary symptoms are often attributed to the prostate. A urinary infection and venereal disease can be the cause of the discomfort. However, often no infection is found and the cause of prostatic inflammation (prostatitis) remains unclear. Some specialists are convinced that pelvic floor spasm is an alternative explanation for these symptoms. Contributing
factors seem to be diet (spicy and acidic foods), stress, inadequate fluid intake, guilt (sexual relations beyond one’s primary partner and/or unsafe sex) and pelvic irritation (prolonged cycling or sitting for extended periods of time). Consequently, the combination of these activities would seem to promote a young man’s prostatic health. Fortunately, the above problems seem to bear no relationship to either future prostatic enlargement or the incidence of prostate cancer. As a male matures, change in voiding pattern occurs (day and nighttime frequency, hesitancy and urgency). Aging of the bladder and tightening of the bladder neck can be contributing factors, but it is often prostatic enlargement that obstructs the flow of urine from the bladder. This benign prostatic growth seems to be a consequence of genetically driven hormonal changes. There do not appear to be any well-defined dietary changes or physical activities that can prevent this process.
Since the changes are often slowly progressive, many men simply live with the symptoms and never seek medical attention. However, 30 percent of males undergo some form of treatment to improve their quality of life. These treatments can be divided into three categories: medications, minimally invasive options and surgery. Medications are designed either to reduce prostatic size or relax the bladder neck. Their intent is to reduce bladder obstruction, allowing easier
urinary flow. Two types of medications are commonly prescribed: Alpha-blockers (Hytrin, Cardura, Flomax or Uraxatrol act on the bladder neck. They work quickly and approximately 60 to 80 percent of men find some benefit. Five
alpha-reductase inhibitors such as (Proscar and Avodart) affect hormone metabolism and decrease prostatic size. They work slowly (one to four years) and approximately 40 percent of men find some benefit. The combination of both classes of medication is being tried and may have added benefit. Side effects are usually mild and reversible. Finally, herbal preparations (that is, saw palmetto) are also available and have a somewhat positive effect. When medications are ineffective or side effects are problematic, minimally invasive options are a reasonable alternative. These are usually in-office procedures to essentially warm the prostate (“cook it”) to decrease bladder obstruction. These procedures include microwave hyperthermia, transurethral needle ablation and interstitial laser. Approximately 50 percent of patients find improvement with these procedures. The final alternative is surgery to remove obstructing prostatic tissue. Using a telescope via the urethra, either high-energy laser or electrocautery is employed. They require at most a short hospitalization and while more invasive than the warming procedures, they are usually well tolerated with 80 to 90 percent effectiveness and long-term durability. It is important to mention that prostate cancer and benign growth occur at the same time. Unfortunately, prostate cancer has no symptoms in its early stages and therefore, requires patient and physician diligence to diagnosis when curable. Prostate cancer is the most commonly diagnosed malignancy and second most common cause of death in men. Its cause has yet to be determined. However, high-risk groups and behaviors do exist. African-Americans and patients with a family history of prostate cancer are both at higher risk. Suggestive risks include sexual promiscuity and dietary choices. Prostate cancer is screened with a digital rectal exam to rule out an irregularity and a PSA (prostate-specific antigen) blood test. Usually, early detection begins at age 50, but should be performed earlier in high-risk groups. Having an abnormality in either test does not guarantee a malignancy, but does raise a statistical suspicion. The degree of suspicion, plus the age and health of the patient, dictate whether a biopsy is performed. If diagnosed early, prostate cancer may be cured by one or more therapies including radiation and/or surgery. Major side effects of these therapies include impotence and incontinence. Can prostate cancer be prevented or its progression delayed? A recent study suggested that five alpha-reductase inhibitors decreased prostate cancer incidence by 26 percent. However, a significant percentage
of those who developed the disease in spite of taking the medication, had a more aggressive form. Consequently, many urologists are reluctant to consider this approach at present. Diet may also play a role. Studies have concluded that a low-fat intake, at least three portions of tomato products (lycopene) per week, daily soy protein, green tea, increased fiber intake, vitamin E and selenium may promote prostate health. There are changes involving the prostate that are often beyond a male’s control. However, with routine medical attention, a healthy diet and common sense, the negative effects of these changes can be favorably modified.
