Prostate Health

By Dr Jos Jayarajan

What is the role of the prostate?

The prostate is a walnut sized gland that sits right under the bladder and surrounds the outlet (urethra) through which urine is passed. Its main role is in male fertility by producing fluid that carries sperm. 

The prostate doubles in size during teenage years, then continue to grow after age 25 throughout life. It may progress from the size of a walnut, to that of an apricot once men hit their 50’s and potentially even to the size of a lemon in later life. Various factors including hormones and genetics determines prostate size. 

 
Enlarged Prostate - Benign prostatic hypertrophy (BPH)

As the prostate surrounds the urethra, enlargement over the years can cause pressure on this tube and affect urinary flow. This can affect over 50% of men over 50. Symptoms may include

• Difficulty passing urine 
• Reduced urinary stream or “stop and start” flow 
• More frequent urination including at night
• Feeling some urine is retained after emptying

It’s important to tell your GP if you’re experiencing any of these symptoms at any age. These symptoms are common with “benign” prostatic enlargement, and less common with prostate cancer. Ongoing bothersome urinary symptoms, blood in the urine, urinary tract infections or an abnormal PSA (blood test for the prostate) need review with a urologist

Treatments

Many men have prostate enlargement picked up on ultrasound. Importantly treatment is not recommended unless there are bothersome urinary symptoms or signs that poor bladder emptying is affecting kidney health. 

Medication and Surgery: Initial treatment may involve a single daily tablet, with some relaxing the muscle fibres in the prostate to improve flow (alpha blocker medication) and others also containing a drug that reduces the size of the prostate with prolonged use (5-alpha-reductase inhibitors). Some men may need surgery to clear the blockage within the prostate, which can be done in various minimally invasive ways. This is different to prostate cancer surgery where the whole prostate is often removed. 

Diet, Lifestyle and the Prostate

Following a heart healthy diet and lifestyle is the strongest recommendation for prostate health. Moderating caffeine and alcohol can reduce urinary frequency and urgency. 

A well balanced diet and maintaining a healthy weight with regular exercise is important for reducing both prostate enlargement symptoms and prostate cancer risk. 
 

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Diet, Lifestyle and Prostate Health 

By Dr Jos Jayarajan

Patients often enquire about dietary modifications to benefit prostate health, and the use of prostate targeted supplements are common. 

Diet to treat BPH

The role of diet and relation to BPH symptoms continues to be investigated. 

A four-year study in China reviewing the effect of diet on BPH symptoms found men with diets high in fruits and vegetables — especially leafy, dark vegetables and tomatoes — had less incidence and symptoms of BPH, and less symptom progression. 

The strongest dietary recommendation, also endorsed by the American Urological Association, is to follow a heart-healthy diet and minimise cardiac risk factors as a surrogate for optimising prostate health. 

Exercise 

Questionnaire date from more than 30,000 men in the Health Professionals Follow-up Study, identified even low- to moderate-intensity physical activity, such as walking regularly at a moderate pace, yielded benefits in reducing BPH symptoms.

Supplements

The SELECT (Selenium and Vitamin E Cancer Prevention Trial) study results published in 2011 in JAMA, found that men who took vitamin E supplements had a 17% increased risk of prostate cancer compared with men who took a placebo.

In 2014, review of data from the SELECT study found that high doses of vitamin E (400 international units daily) or selenium (200 micrograms daily) showed no benefit among men at risk for prostate cancer. Those with already high selenium levels at the study's commencement increased their risk of high-grade prostate cancer by 91% after taking the selenium supplements. Vitamin E supplementation increased the total risk of prostate cancer by 63% and increased their risk of high-grade cancer by 111%.

The CAMUS study found that saw palmetto extract used at up to three times the standard daily dose, while safe and with no attributable side effects, did not reduce lower urinary symptoms or other outcomes related to BPH compared to placebo.

 

 

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