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When bigger isn't better: coping with an enlarged prostate.

How can something so small cause such big problems? For some older men, the prostate, which is normally the size of a walnut, can feel as big as a grapefruit as it squeezes the urethra, making urination urgent, painful, and sometimes futile.

Doctors usually prescribe drugs to control the symptoms. But what you eat and how much you move can also help.

"Most men's prostates get bigger as they get older," says urologist J. Kellogg Parsons, an associate professor of surgery at the UC San Diego Moores Cancer Center. The condition is called benign prostatic hyperplasia, or BPH. It's an increase in the number of (non-malignant) prostate cells.

"Some men are on the express and get to an enlarged prostate faster, while others are on the local and get there slower," says Parsons. "But once the prostate has grown larger, it will never go back to its former size by itself." Only certain medications or surgery can make that happen.

While not all men with an enlarged prostate experience urinary problems, most middle-aged and older men eventually feel discomfort.

The lucky ones find it a nuisance, not something that disrupts their lives. For others, however, "an enlarged prostate can have a huge impact on daily activities and the quality of life," says urologist Kevin T. McVary of the Southern Illinois University School of Medicine in Springfield.


Men with BPH may feel an urgency to urinate at any hour of the day or night, then have difficulty actually urinating, only to have the aggravation start all over again a short while later.

"Some men start changing their lives around, depending on their bladder," says McVary. "They pick certain stores to shop in, based on the availability and location of restrooms." Or they avoid going to the movies or the theater or traveling on long plane rides, for fear of not getting to a bathroom quickly enough.

For many men, though, BPH is more than an inconvenience.

"One of the most serious symptoms affecting lifestyle is the repeated getting up at night to urinate, called nocturia, because it so disrupts sleep cycles that folks just have a hard time living their lives the next day," says Parsons.

"And if you're an older man with urinary symptoms who is getting in and out of bed many times a night to go to the bathroom when the room is dark, you may be more likely to fall."

Men with prostate problems are also more likely to face erectile difficulties and suffer depression, Parsons points out. And in a small percent of cases, severe prostate enlargement can lead to infections, bladder failure with the need for a catheter, and even kidney failure.


One thing men with an enlarged prostate don't have to worry about is that it will lead to prostate cancer.

"Scientists have researched the possible link between the two for at least 90 years, and there is no evidence that definitively shows that a man with an enlarged prostate has an increased risk of developing prostate cancer," says Parsons.

In the Prostate Cancer Prevention Trial, for example, over 5,000 men randomly assigned to take a placebo got biopsies to look for prostate cancer, no matter what their PSA scores. (1) (PSA, or prostate-specific antigen, is a protein produced by prostate cells. Blood levels of PSA are often elevated in men with prostate cancer.)

"Those suffering from BPH were no more likely to have prostate cancer than those without BPH," says Alan Kristal, an epidemiologist at the Fred Hutchinson Cancer Research Center and the University of Washington in Seattle.

That's not surprising, he adds. "Prostate cancer and BPH affect different parts of the prostate gland, and the disease process is likely very different for the two."


"Some risk factors you can't do anything about," says McVary. You're more likely to suffer from an enlarged prostate as you get older, for example, or if prostate problems run in your family, or if you're African American or Hispanic.

"But you can make changes in your lifestyle that can lower your risk of suffering from BPH," says Parsons. "And the same changes most likely can also reduce the discomfort if you already have symptoms."

Parsons cautions that those recommendations are based on studies that ask people about their diet and exercise habits and then track who ends up with what health problems in the future. The studies can't prove cause and effect because something else about people who eat a certain way or exercise a certain amount may explain their higher or lower risk.

But even if Parsons' advice turns out not to reduce the risk of BPH, it's worth following. "The advice should sound familiar," he says, "because it's essentially to follow a healthy lifestyle."

Get regular aerobic exercise. "Do at least a moderate amount of aerobic exercise--30 minutes or more a day, five to seven days a week, of brisk walking, jogging, running, or swimming," recommends Parsons.

Three studies have followed a total of more than 37,000 middle-aged and older men for close to a decade to see who reported symptoms of an enlarged prostate and who didn't. In two of the three, regular exercisers had a lower risk.

* In the Health Professionals Follow-Up Study, Harvard researchers monitored more than 30,000 men for eight years. The more physically active the men reported being at the start of the study, the lower their risk of surgery or symptoms of BPH later on. (2) And that was true at any age.

Those who walked at least two hours a week for exercise, for example, had about a 25 percent lower risk than those who didn't walk for exercise. And men who watched TV or videos for more than 10 hours a week were about 30 percent more likely to need prostate surgery or to have symptoms than men who watched for less than six hours a week.

* Among 1,700 men living in the Boston area, those who were the most physically active over an eight-year period had a lower risk of prostate surgery or of having the symptoms of an enlarged prostate than those who were the least active. But the risk was no lower for men who were moderately active. (3)

* In contrast, among 5,667 men in the seven-year Prostate Cancer Prevention Trial, those who were the most physically active were just as likely as those who were the least active to report urinary tract symptoms from an enlarged prostate. (4)

However, "we really didn't measure exercise that well in this study," admits the University of Washington's Alan Kristal, who says he believes that exercise does matter, "because pretty much every other study has found that."

Why would exercise help the prostate? Although researchers aren't certain, says Parsons, exercise increases blood flow to the pelvic area, which is good for the prostate. Also, an enlarged prostate is associated with inflammation, and exercise lessens inflammation in the body. (5)

Another possible mechanism: physical activity decreases the body's sympathetic nervous system "tone."

The sympathetic nervous system is in touch with every organ and muscle, ready to mobilize the body's fight-or-flight response to stress.

"Increased activity of the sympathetic nervous system goes hand in hand with prostate growth and its symptoms," explains McVary.

"And we know that physical inactivity causes your sympathetic tone to increase dramatically, while exercise can actually lower it."

Maintain a healthy weight and avoid a big belly. "Overweight men are more likely to suffer prostate symptoms, especially if they're carrying extra fat in their bellies," says McVary.

Among the men in the Health Professionals Follow-Up Study, for example, those with waists greater than 42 inches were twice as likely as those with waists less than 35 inches to have their prostates removed or to report frequent symptoms over an eight-year period. (6)

And in the Prostate Cancer Prevention Trial, "we found that being overweight or obese increased the chances of suffering from an enlarged prostate by about 30 percent," says Kristal. (4) "The relationship was even stronger for abdominal obesity," he adds.

"What that tells you is that beyond being overweight, it's where you're overweight that matters most."

That's not surprising, notes Kristal. "Abdominal obesity is an inflammatory disease and raises the levels of inflammatory compounds in the blood. The higher the level of these compounds, the more likely a man is to suffer from BPH."

Insulin levels are also higher in people with abdominal obesity, McVary points out. High insulin triggers more insulin receptors to appear on cells, a process that requires insulin growth factor.

"And insulin growth factor can cause the prostate to enlarge," says McVary.

Eat plenty of vegetables. In the Health Professionals Follow-Up Study, men who reported eating six servings of vegetables a day had an 11 percent lower risk of prostate symptoms than men who said they ate no more than 1 1/2 servings a day.7 Those who got the most lutein (from green vegetables like spinach, broccoli, and peas) and beta-carotene (from orange or dark-green vegetables like carrots, sweet potatoes, and spinach) had half the risk of those who got the least.

And in the Prostate Cancer Prevention Trial, men who said they ate at least four servings of vegetables a day had a 32 percent lower risk of BPH than men who averaged less than one serving a day. (8)

"Of course, instead of the vegetables, the lower risk of BPH symptoms might be due to the fact that men who eat lots of vegetables are likely to follow a healthy lifestyle," Kristal points out.

If vegetables do help, adds Parsons, "one possible reason is that there are compounds in vegetables that tend to be anti-inflammatory."

(1) Am. J. Epidemiol. 173: 1419, 2011.

(2) Arch. Intern. Med. 158: 2349, 1998.

(3) J. Clin. Epidemiol. 54: 935, 2001.

(4) J. Urol. 177: 1395, 2007.

(5) Mediators Inflamm. 2008: 109502, 2008.

(6) Am. J. Epidemiol. 140: 989, 1994.

(7) Am. J. Clin. Nutr. 85: 523, 2007.

(8) Am. J. Epidemiol. 167: 925, 2008.
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Title Annotation:SPECIAL FEATURE
Author:Schardt, David
Publication:Nutrition Action Healthletter
Date:Jan 1, 2013
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