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Friday, December 27 2019

New Ideas about Prostate Health

According to the World Health Organization, prostate cancer is the second most common cancer in men and the sixth most frequent cause of death among males worldwide. Prostate cancer affects mostly patients above 50 years of age and most commonly targets the prostate’s peripheral zone. The mortality rate is relatively low, especially if it is diagnosed early. Statistically, fifteen percent of men have prostate cancer during their life, but only 3% die from it.   Another prostate problem that is common in men is BPH or benign prostatic hyperplasia.

BPH is not a precursor to prostate cancer but every man should be aware of symptoms related to prostate problems, which would include:

             -needing to urinate more frequently, often during the night

            -needing to rush to the toilet

            -difficulty in starting to pee (hesitancy)

            -straining or taking a long time while peeing

            -weak flow

            -feeling that your bladder has not emptied fully

            -blood in urine or blood in semen

            -having low testosterone


Diagnosing the prostate

Historically, digital rectal examination and serum prostate-specific antigen (PSA) testing are the most utilized methods of prostate cancer screening along with BPH. However, both have their own limitations. Digital rectal examination presents limitations for nonpalpable prostatic lesion (early stages), and the differentiation between malignant and benign lesions is difficult. Serum PSA testing, in clinical use since 1986, is the most frequently utilized tumor marker for the screening of prostate cancer. PSA is produced in the prostate gland.  Increased PSA numbers could be from prostatitis (most often caused by infection), benign prostatic hyperplasia, and prostate cancer. A PSA score above 4 ng/mL on a blood test will cause concern with any doctor, and historically could trigger recommendations for a biopsy of the prostate tissue and using the Gleason scoring test to determine whether cancer was present. However, since a biopsy is invasive, and because 75% of prostate biopsies are negative for tumors, a need for methods to evaluate prostate health without using a biopsy so quickly in the diagnostic process is important.


Another measurement of importance is prostate volume.  This is done by ultrasound and the procedure is called TRUS, which stands for transrectal ultrasound.  This is done by measuring the height, width, and length of the prostate and multiplying it by .523.  The normal volume of a prostate is usually between 25-30 mL. A larger volume would indicate hypertrophy of the gland.


One method is determining the Percent Free PSA.  This is calculated by obtaining a serum test of the free PSA (unbound by any protein) and total PSA, and creating a ratio of the free-to-total PSA.  Generally, a score of 25% or higher would indicate a lower likelihood of prostate cancer and conversely a score of under 25% would indicate a higher likelihood of prostate cancer.  For example, in two men with total PSA levels of 6 ng/mL, the man who has 10% free PSA has about a 50% chance of having cancer, and the man with 30% free PSA has a 10% chance of having cancer.  Testing total estrogens and DHT (dihydrotestosterone) in the blood is also useful.  Testosterone is converted to estrogen in the fatty tissue by an enzyme called aromatase so increased estrogens in males could indicate a need to reduce body fat.  Testosterone is converted to DHT by an enzyme in the prostate called 5 alpha- reductase so a high DHT would indicate a need in blocking the 5 alpha-reductase enzyme


Are there natural courses of action for BPH?

There are multiple supplemental strategies to consider with prostate hypertrophy.  Most commonly we hear about two categories of supplementation.  One that reduces the aromatase conversion of testosterone to estrogen and the other which is to block the 5 alpha reductase conversion of testosterone to DHT.   Of the aromatase inhibitors the most common supplements are herbs such as Nettle root, Chrysin, Maca, grape seed, and DIM (diindolylmethane) which is found in cruciferous vegetables such as broccoli and cauliflower.  In the 5 alpha reductase category, Saw Palmetto, Pygeum, Pumpkin seed oil, green tea, and an Indian herb Giant Dodder.


Medicines do the above too.  5 alpha reductase blockers such as Proscar and Avodart have side effects such as low blood pressure, dizziness, nausea and headaches.  Alpha blockers to improve urine flow such as Flomax also can cause nausea and headaches.  To improve testosterone, PDE-5 inhibitor drugs like Viagra and Cialis also have side effects of headaches, nausea, and muscle and joint pain and they cannot be taken with alpha blockers!  


Other considerations:

Vitamin D may slow the growth of low-grade prostate cancer.   Zinc, Omega 3 fatty acids from plant and fish sources. The herb Boswellia inhibits (5-LOX), 5 LOX metabolizes arachidonic acid to (5-HETE), and to leukotriene B4 which prostate cancer cells use to escape destruction.  The lethal 5-LOX cascade is provoked by a diet that is heavy in refined carbohydrates and arachidonic acids such as meat. Beta Sitosterol a plant sterol which seems to reduce swelling of the prostate.


New Treatment

A new medical advancement in prostate care got FDA approval in August.  A procedure called TULSA-Pro from a company Profound Medical Corp. uses robotically guided transurethral thermal ultrasound while getting a real time MRI to ablate the cancerous tissue while a patient is anesthetized with hardly any disturbance to the sensitive nerve endings and surrounding tissue. 


Final thoughts

50% of men in their 50’s has some prostate enlargement, 60% of the men of their 60’s, 70% of men in their 70’s and so on.  Although a flawed study published in JAMA in December 2008 about vitamin E and selenium having no effect on prostate cancer survival, it used a synthetic form of vitamin E called alpha tocopherol instead of a mixed tocopherol containing the helpful gamma tocopherol. Other studies had mixed results regarding Saw Palmetto, but it appears that dosage, and quality of the supplements needs to be considered. 

Prostate health for men over the age of 50 can benefit from regular exercise. Just this month the World Cancer Research Fund said exercise can reduce the risk of prostate cancer by 50%!  Natural methods to lower inflammation, reduce estrogen, and block the 5 alpha reductase enzymes can have positive results.  It is useful and important that if more serious prostate issues develop that there are new techniques available that spare biopsies and spare complete removal of the prostate gland and the consequences that can arise from transecting the nerves that affect sexual health. 

Posted by: Dr. Goldstein AT 10:55 am   |  Permalink   |  0 Comments  |  Email

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