Maintaining a Healthy Prostate

By Ron Hunninghake, M.D.

The prostate is a single gland, about the size of a chestnut, that lies below the male bladder. The prostate secretes fluids that lubricate the urethra and promote sperm motility. Prostate fluids are 30% of the semen volume.

During the fourth or fifth decade of life, 60% of males will experience enlargement of their prostate.

During the fourth or fifth decade of life, 60% of males will experience enlargement of their prostate. This is called benign prostatic hyperplasia or BPH. The outlet of the bladder is partially blocked causing the following symptoms: frequency (must urinate often); urgency (can’t wait, due to smaller capacity); hesitancy (reduced stream); intermittency (poor force of stream); nocturia (frequent awakening at night); urinary retention (complete blockage). Surgical treatment of this condition costs about one billion dollars annually in the U.S …. and much lost or disrupted sleep.

With aging, male testosterone levels decrease. Simultaneously, several other hormones (estradiol, FSH, prolactin, and leuteinizing hormone) increase. The aging prostate is less capable of breaking down these hormones, which it also takes up more readily.

In an effort to compensate for lower testosterone levels, the prostate will more actively uptake testosterone. This is associated with a higher activity of the testosterone converting enzyme, 5- alpha reductase. 5-alpha-reductase converts testosterone to dihydrotestosterone. It is this increasing presence of dihydrotestosterone in the aging prostate that actually causes the hyperplasia of prostate cells.

Two other forces that drive this process are prolactin and cadmium. Prolactin rises with age and acts to increase testosterone uptake by the prostate. It also stimulates 5-alpha-reductase. Beer and stress increase prolactin levels. (Now we know the real reason certain men get enlarged prostates! So if you are going to be a “real man”, expect to have a real big prostate.) Vitamin B6 and zinc lower prolactin levels and therefore are important for maintaining a healthy prostate.

The second major force at work here is cadmium. This is a toxic mineral, a so-called “heavy metal,” that is preferentially deposited in prostate tissue. Cadmium significantly raises dihydrotestosterone levels in prostate cells. BPH is thus more common in males with cadmium toxicity. And since cigarette paper is quite high in cadmium, smoker’s are commonly afflicted with BPH.

Several non-pharmacologic, nonsurgical therapeutic strategies are available whose effectiveness and safety have been scientifically documented. It is advisable to undertake treatment of BPH under a doctor’s supervision. These symptoms can also involve an undiagnosed prostatic malignancy. Annual digital exams, coupled with the careful use of the PSA test, can help to assure that the prostatic hyperplasia is indeed benign.

Perhaps the most dramatic natural therapy is Serenoa repens. This is the botanical name for saw palmetto berries. The oil extract of this North American plant species is rich in fatty acids and sterols that have been shown to inhibit the conversion of testosterone to dihydrotestosterone, as well as increasing the metabolic breakdown of dihydrotestosterone. Currently, 11 clinical studies demonstrate the effectiveness of saw palmetto to alleviate the symptoms of BPH.

Prostaglandins, whose very name reflects the organ they were first found to be biochemically active in, inhibit testosterone and dihydrotestosterone binding to the prostate. With the aging process, essential fatty acids (the nutritional precursor to prostaglandins) are commonly deficient. In one study, 19 patients were supplemented with 60 mg/d of omega 3 and 6 EFAs. After several weeks of therapy, 19 of 19 of the subjects had a better stream. Twelve of 19 no longer had residual urine, and 13 of 19 had no further nocturia.

The prostate contains the body’s highest zinc concentration. Zinc helps the aging prostate three ways: 1) inhibits prolactin secretion (see above); 2) inhibits 5-alpha-reductase-less formation of dihydrotestosterone; 3) inhibits androgen binding to prostate receptors. Nineteen patients were studied using 150 mg of zinc sulfate for two months. All 19 patients had improved symptoms. Fourteen of 19 were found to have smaller prostates on digital exam. Their serum zinc levels increased.

To briefly wrap up, several additional natural therapies have been studied. Pygeum africanum is a tropical evergreen whose bark extract is effective in treating BPH, as documented in 12 double blind studies. Serenoa repens, in comparison studies, is only slightly better. Neither have side effects. The amino acid combo of L-glutamine, L-alanine, and L-glycine may add further benefits (three studies). Selenium may protect prostate tissue from free radical damage secondary to cadmium toxicity. And two herbal extracts, stinging nettles and flower pollen, may be helpful.

In conclusion, BPH is a common condition, conventionally treated with medication and surgery. Effective nutritional therapies are available with no reported side effects. Whether these more aggressive nutritional interventions will lower the rising incidence of prostate cancer remains to be proven.