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The prostate is a male gland about the size of a walnut located just behind the bladder and is part of the reproductive system.
The prostate is a chestnut-shaped organ that surrounds the beginning of the urethra in men. It produces a milky fluid that is part of the seminal fluid discharged during ejaculation. Male hormones (androgens) make the prostate grow. The testicles are the main source of male hormones, including testosterone. The adrenal gland also makes testosterone, but in small amounts. If the prostate grows too large, it squeezes the urethra. This may slow or stop the flow of urine from the bladder to the penis. The common term for an enlarged prostate is BPH, which stands for benign (non-cancerous) prostatic hyperplasia or hypertrophy. Hyperplasia means that the prostate cells are dividing too rapidly, increasing the total number of cells and therefore the size of the organ itself. Hypertrophy simply means enlargement.
There is some research that suggests a diet rich in soy products, berries, sunflower seeds, and peanuts can contribute to prostate health, according to the American Cancer Society. The mineral zinc has also shown beneficial properties for the prostate. Natural sources of zinc include pumpkin, sesame, and sunflower seeds, some nuts (almonds, cashews, Brazil, and walnuts), leafy lettuce, and whole oats, and onions. Zinc supplements are also available in health food stores, pharmacies, and some supermarkets.
Prostate cancer is the most common cancer among men in the United States, and is the second leading cause of cancer deaths. The National Cancer Institute estimates that in 2007, 218,890 new cases of prostate cancer will be diagnosed, and it will cause 27,050 deaths. One in six men in the United States will be diagnosed with prostate cancer. Age is the main risk factor for prostate cancer. It is rarely seen in men younger than 45. The chance of getting it increases as a man ages. Most men diagnosed with prostate cancer are older than 65. A man’s risk is higher if his father or brother had prostate cancer. Prostate cancer affects African American men about twice as often as it does Caucasian men, and the mortality rate among African Americans is also higher. African Americans have the highest rate of prostate cancer in the world.
BPH is often part of the aging process. The actual changes in the prostate may start as early as the 30s but take place very gradually, so that significant enlargement and symptoms usually do not appear until after age 50. Past this age the chances of the prostate enlarging and causing urinary symptoms become progressively greater. More than 40% of men in their 70s have an enlarged prostate. Symptoms generally appear between the ages of 55 and 75. About 10% of all men eventually will require treatment for BPH. The condition is viewed as rare in African Americans, but this finding may partly be due to the fact that black patients may have less access to medical care. The
condition also seems to be uncommon in Chinese and other Asians, for reasons that are not clear.
The precise cause of prostate cancer is not known. However, there are several known risk factors for disease including being over the age of 55, African American heritage, a family history of the disease, occupational exposure to cadmium or rubber, and a high-fat diet. Studies suggest that men who eat a diet high in animal fat or meat may be at increased risk for prostate cancer, whereas men who eat a diet rich in fruits and vegetables may have a lower risk. Men with high plasma (blood) testosterone levels may also have an increased risk for developing prostate cancer. Frequently, prostate cancer has no symptoms and the disease is diagnosed when the patient goes for a routine screening examination. However, when the tumor is big or the cancer has spread to the nearby tissues, the following symptoms may be seen:
- Weak or interrupted flow of urine
- Frequent urination, especially at night
- Difficulty starting urination
- Inability to urinate
- Pain or a burning sensation when urinating
- Blood in the urine
- Persistent pain in the lower back, thighs, or hips
- Painful ejaculation
The cause of BPH is a mystery to medical researchers, but age-related changes in hormone levels in the blood may be a factor. Whatever the cause, an enlarging prostate gradually narrows the urethra and obstructs the flow of urine. Even though the muscle in the bladder wall becomes stronger in an attempt to push urine through the smaller urethra, in time, the bladder fails to empty completely at each urination. When the enlarging prostate gland narrows the urethra, a man will have increasing trouble starting the urine stream. Because some urine remains behind in the bladder, he will have to urinate more often, perhaps two or three times at night. The need to urinate can become very urgent and, in time, urine may dribble out to stain a man’s clothing. Other symptoms of BPH are a weak and sometimes a split stream, and general aching or pain in the perineum (the area between the scrotum and anus). Some men may have considerable enlargement of the prostate before even mild symptoms develop.
Prostate cancer is curable when detected early. Yet there are often no symptoms during the early stages of prostate cancer, so the disease often goes undetected until the patient has a routine physical examination. Diagnosis of prostate cancer can be made using some or all of the following tests: a digital rectal examination, blood tests, ultrasound, a needle biopsy, x rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI).
When a man’s symptoms point to BPH, a physician will usually do a digital rectal examination, inserting a finger into the anus to feel whether—and how much—the prostate is enlarged. A smooth prostate surface suggests BPH, whereas a distinct lump in the gland might mean prostate cancer. The next step is a blood test for a substance called prostate-specific antigen (PSA). Between 30-50% of men with BPH have an elevated PSA level. Studies indicate that the PSA level can be used as a predictor of a man’s long-term risk of developing BPH.
A class of drugs called alpha-adrenergic blockers, which includes phenoxybenzamine and doxazosin, relax the muscle tissue surrounding the bladder outlet and lining the wall of the urethra to permit urine to flow more freely. These drugs improve obstructive symptoms, but do not keep the prostate from enlarging. Other drugs, such as finasteride (Proscar) and dutasteride (Avodart) may stop prostate enlargement or even shrink the prostate. Symptoms may not, however, improve until the drug has been used for three months or longer. Another class of drugs, called alpha-blockers, such as terazosin (Hytrin) and tamsu-losin (Flomax), relax the muscles in the prostate and may relieve symptoms. However, they do not shrink the prostate. When drugs fail to control the symptoms of BPH, surgery may be required.
There are no known nutritional or dietetic concerns that play a role in prostate health or prostate conditions, such as cancer or BPH. In alternative medicine, saw palmetto, a dietary supplement usually sole in capsule form, is used to promote prostate health and to treat BPH.
A diet low in fat may slow the progression of prostate cancer. Hence, in order to reduce the risk of prostrate cancer, the American Cancer Society recommends a diet rich in fruits, vegetables, and dietary fiber, and low in red meat and saturated fats. Intake of lyco-pene, which is found in cooked tomatoes or tomato sauce, is also thought to help reduce the risk of prostate cancer. There is no known therapy for BPH.
According to the American Cancer Society, the survival rate for all stages of prostate cancer combined has increased from 50% to 87% over the last 30 years. Due to early detection and better screening methods, nearly 60% of the tumors are diagnosed while they are still confined to the prostate gland. The five-year survival rate for early stage cancers is almost 99 percent. Sixty-three percent of the patients survive 10 years, and 51% survive 15 years after initial diagnosis.
In a man without symptoms whose prostate is enlarged, it is hard to predict when urinary symptoms will develop and how rapidly they will progress. For this reasons some specialists (urologists) advise a period of “watchful waiting.” When BPH is treated by medication, symptoms are usually relieved and the man’s quality of life will be enhanced.
Because the cause of the cancer is not known, there is no definite way to prevent prostate cancer. However, the American Cancer Society recommends that all men over age 40 have an annual rectal exam and that men have an annual PSA test beginning at age 50. Those who have a higher than average risk, including African American men and men with a family history of prostate cancer, should begin annual PSA testing even earlier, starting at age 45.
Whether or not BPH is caused by hormonal changes in aging men, there is no known way of preventing it. Once it does develop and symptoms are present that interfere seriously with the patient’s life, timely medical or surgical treatment will reliably prevent symptoms from getting worse. Also, if the condition is treated before the prostate has become grossly enlarged, the risk of complications is minimal. One of the potentially most serious complications of BPH, urinary infection (and possible infection of the kidneys), can be prevented by using a catheter to drain excess urine out of the bladder so that it does not collect, stagnate, and become infected.
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American Cancer Society. P.O. Box 73123, Oklahoma City, OK 73123. Telephone: (800) 227-2345. Website: http://www.cancer.org.
Canadian Cancer Society. 10 Alcorn Ave., Suite 200, Toronto, ON M4V 3B1 Canada. Telephone: (416) 961-7223. Website: http://www.cancer.ca.
National Cancer Institute. P.O. Box 24128, Baltimore, MD 21227. Telephone: (800) 422-6237. Website: http://www.cancer.gov.
National Institute of Diabetes, & Digestive, & Kidney Diseases. Building 31, Room 9A06, 31 Center Drive, MSC 2560, Bethesda, MD 20892. Telephone: (800) 891-5390. Website: http://www.niddk.nih.gov.
Ken R. Wells