Most men over the age of 50 suffer with some degree of enlargement of the prostate gland, a gland that only men have, and yet a survey in The Times found that 89% of men did not know where their prostate is located.
The prostate gland is shaped like a ring-doughnut, and is about the size of walnut. It surrounds the top of the urethra (the urine duct), just under the bladder. Its job is to secrete a slightly acidic fluid which contributes to seminal fluid and improves the viability of sperm. When the prostate becomes enlarged it can mean trouble.
Benign prostate enlargement, where it is not cancerous, is where the tissue has increased in volume sufficiently to cause problems, usually 2-4 times its original size, though it can be much more. This is called benign prostate hyperplasia, or BHP. Enlargement can also be due to infection or inflammation (prostatitis), and of course it can also be the result of cancer of the prostate.
Signs of prostate problems usually come about as the urine flow is constricted through the urethra because the enlarged prostate is pinching it off. There is usually an increased urgency to have a pee, but often there is reduced flow, dribbling, and a feeling of not having finished. If the blockage is prolonged or total, then this can mean urgent surgical attention. Serious blockage can also lead to infections, kidney damage, bladder stones or retention of urine in the blood.
Prostate cancer has a low profile, and for every £17 spent on breast cancer only £1 is spent on prostate cancer. Prostate problems often go unchecked for quite a long time as many men are embarrassed to report problems to their GP, and may even believe that they have some sort of venereal disease. Investigation involves a rectal examination, and while the majority of problems turn out to be BHP, the delay in diagnosis means that cases that turn out to be cancer are frequently diagnosed at a later stage than they could have been.
Prostate cancer is one of the cancers which is increasing at the fastest rates, and it is set to overtake lung cancer as the main cancer to affect men, in the next six years. At the moment there are around 19,000 cases each year with a 50% mortality rate the numbers have doubled in the last 20 years, and are likely to triple in the next two decades.
Diet is key
What has led to this massive increase in the number of cases? Johnathan Waxman, cancer specialist at Hammersmith Hospital, and chair of the Prostate Cancer Charity was recently quoted as saying “We know that family history has got very little to do with it. The main environmental factor has to be diet, which has dramatically changed in the last century. For example, we know that vegetarians get prostate cancer at half the rate of meat-eaters and that soya beans and tomato products can be protective”. This is an unusually strong statement from an expert in the field on the effects of our lifestyle on the incidence of a cancer.
We also know that other cultures do not have the same rate of prostate problems either benign or cancer. Notably the Japanese, who have a similar level of industrialisation as in the West, have a considerably lower incidence of BHP and prostate cancer. This has been attributed to their diet and the high levels of soya foods which they consume. Soya has been shown to mildly mimic the female hormone oestrogen, with compounds called phytoestrogens, which have a beneficial effect on the prostate.
The hormone connection
Testosterone, the male hormone, is broken down into DHT (dihydrotestosterone) and it is DHT which is the main hormonal culprit with enlarged prostate problems. In the meantime it has been suggested that we are living in a sea of man-made oestrogens called xenoestrogens. These man-made oestrogens result from obvious sources such as the Pill and HRT being excreted into the water, but also from less obvious sources including farming chemicals and plastics. These chemical xenoestrogens are thought increase the amount of testosterone which is converted into DHT, and is a factor in both BHP and prostate cancer. Conversely soya foods, as eaten by Eastern cultures, interfere with this process by virtue of their milder, beneficial phytoestrogens.
Prostate health solutions
Conventional treatment for prostate problems usually have radical side effects. The main treatments are surgery or hormonal and in both cases there is a high risk of impotence, and incontinence with surgery. Because of this, it can be more appealing to many men to consider possible preventative measures. These are the main ones to consider:
These fruits are the richest source of a powerful antioxidant called lycopene. The higher your intake of this member of the carotene family, the lower your risk of prostate cancer. Ten portions weekly of tomatoes and tomato products is the recommended amount. Interestingly, cooked and processed tomato products are considerably richer sources of lycopene than fresh tomatoes. This is because it is liberated from the bonds in which it is held and is then more available. Ideas for getting your weekly quota include:
- tomato soup
- tomato sauce on pasta
- tomato salad
- tomato juice
- tomato salsa dip
- stuffed tomatoes.
- chopped sun-dried tomatoes on toast
- canned tomatoes in stews or chillis
- tomato topping on pizzas
- ketchup (sugar and sweetener-free is best)
As already mentioned Eastern men who consume soya regularly have a much lower incidence of prostate cancer (this changes when they adopt a Western diet). Eating soya five times a week is not difficult when you think about the possibilities:
- soya beans cooked and added to stews
- mashed tofu added to mashed potato or other root vegetables
- marinated tofu, chicken and vegetable kebabs
- soya milk used in cooking and on cereals
- soya yoghurt is indistinguishable from ordinary yoghurt and makes a delicious dessert with chopped fruit.
- add soya flakes to mueslie in the morning
- make milk shakes using soya milk and silken tofu mixed with soft fruit
- soya baked beans.
There is a link between high meat and animal fat consumption and the development of prostate cancer. Switching from the typical Western level of 40% of calories from fat, to 30% of calories from fat has been shown to lower levels of troublesome male androgen hormones, as well as oestrogens. To cut back on fat levels favour lean meats such as skinless chicken and game over other cuts, eat more fish, eat low fat dairy products (or use soya alternatives which have healthy fats) and reduce your reliance on processed foods, especially convenience snacks.
Healthy snack options include home made popcorn, fruit and raw nuts and seeds. Evening primrose oil (EPO) which is rich in a compound called GLA seems to reduce the risk of BHP and prostate cancer. It may do this by stopping testosterone from actually adhering to prostate cells, and by stopping the conversion of testosterone into DHT. Cold pressed flax oil is rich in a type of fat called omega-3 and this may also be helpful. Two grams of EPO or a tablespoon of flax oil daily could be a wise investment. You can even get delicious garlic and chilli flavoured flax oil now. Oily fish, such as mackerel, sardines, tuna and salmon, are also rich sources of the omega-3 fats.
Studies of Seventh-Day Adventist men have shown that the more fibre consumed, the greater the amount of troublesome testosterone and oestrogens are excreted. Seventh-Day Adventists eat high quantities of beans, lentils, peas and dried fruit, all of which are rich sources of fibre. It is easy to incorporate more beans and pulses into your diet, in familiar and tasty ways:
- chunky lentil soup
- baked beans on wholemeal toast
- hummus, and other, bean dips
- Tex-Mex refried beans with tortillas
- chick pea curry, green peas
- red kidney beans in chilli
- butter beans as a side vegetable
- flageolet beans added to salads.
The prostate gland is the tissue with the highest concentration of zinc in the human body. Each ejaculation uses up about two or three mg of zinc, and the portion of seminal fluid contributed by the prostate gland is the source of this mineral. Zinc is required for producing male sex hormones and low levels may have a part to play in the change in ratio of testosterone to female sex hormones in men after the age of about 40. Men with BHP and prostate cancer routinely have lower levels of zinc than men who do not have these problems.
Zinc rich foods include most nuts (unroasted and unsalted are best), sunflower and pumpkin seeds, turkey, crab meat, soya beans and eggs. (One to two oz daily of pumpkin seeds, as snacks or sprinkled on dishes either whole or ground, are favoured for prostate health because they also contain the healthy fats and lots of fibre in addition to the zinc). A supplement of 15 mg daily may be a wise investment for prevention, but 50 mg daily, over several months, has been shown to return enlarged prostates to normal in 70% of cases in trials.
This is one of the most important antioxidant minerals which helps to fight most cancers. It also seems to protect against the toxic heavy metal cadmium (which we get mainly from cigarette smoke and cookware) which appears to stimulate prostatic tissue in BHP. Selenium rich foods include wheatgerm and bran, tuna, rice, tomatoes, broccoli and nuts. Two Brazil nuts daily should provide the daily amount needed, or alternatively, you can take 100-200 mcg daily in supplement form. Smokers have a higher incidence of prostate cancer, especially if they also have low blood levels of vitamin E, which works alongside selnium.
(Serenoa repens) One of the main uses of this herb is in the prevention of BHP as it interferes with the conversion of testosterone to the troublesome DHT. Studies directly comparing the herb with one of the main drugs used, Proscar (finasteride) have shown that it works better at shrinking the prostate, but does not have the possible side effects of the drug including impotence, decreased libido, ejaculation disorders, and breast enlargement and tenderness.
About 300 mg of standardised extract in supplement form daily is the suggested dose and is the amount that has been used successfully in several trials. There are several products which combine Saw Palmetto with zinc and EPO. Some products also contain Beta-sitosterol which is found in plant oils, and is also rich in Saw Palmetto. Other helpful herbs which may be included in prostate-specific supplements include stinging nettle extract and pygeum africanum extract.
Sunshine and water
Two of the basics of life are also essential for prostate health. In areas of the world where people get more sun exposure there are also lower prostate cancer levels, due to the vitamin D that we manufacture in our skin. Supplementing with vitamin D may not necessarily have the same effect. This does not mean baking yourself in the sun sporadically on holiday, but regularly getting half-an-hour sun exposure at times of the day when you are unlikely to burn, and even weak winter sun can be beneficial. Water is always important for keeping the whole urinary tract healthy, and the temptation to cut back if you are experiencing difficulty urinating is a false economy.