Best Ways to Prevent Prostate Enlargement, Explained by a Urologist

whether you're a man or you have a man in your life I'm certain that you've heard of men having issues with heting when they're older all because of an organ called the prostate well have you ever wondered if you can actually prevent yourself or someone you love from getting prostate issues I'm Dr Reena Malik urologist and pelvic surgeon and today we're going to talk about preventing prostate enlargement what can you do the prostate is a walnut shaped organ that sits underneath the bladder around the urethra which is where you urinate from and as it grows

typically it goes from having normal prostate tissue to having growth of the cells in the prostate called hyperplasia and in a lot of men goes on to develop abnormal cells and sometimes even prostate cancer but can you stop it so when you think of prostate growth in order for the prostate to grow at least through adolescence and to early adulthood you need to have androgens it is very Androgen dependent now what's an androgen that's things like testosterone and in the prostate specifically when testosterone reaches the prostate it's converted by an enzyme called 5 Alpha reductase

to something called DHT or dihydrotestosterone now this is found in the prostate in a very high concentrations and it binds to proteins in the blood at a much higher concentration than that of testosterone because it has a stronger Affinity so dihydrotestosterone is found in the prostate in much higher concentrations in testosterone and this dihydrotestosterone then binds to receptors or Androgen receptors which then causes changes to occur in the prostate causing growth but as you may already know as men age their testosterone tends to decline so while men have declining testosterones as they age their prostate

continues to grow so androgens by themselves are not the cause of the growth that causes BPH or benign Prostatic hyperplasia now if you're wondering more about that check out my video where I talk about everything you need to know about BPH so you can learn more about that condition as well as treatments and options that you have if you are struggling with those symptoms so to understand how to prevent prostate enlargement it's important to understand what happens so BPH or benign prosthetic hyperplasia is due to the increase in number of prostate cells particularly epithelial cells

and stromal cells which are different types of cells located in the prostate basically in the body when any cells are growing or multiplying you're also going to see some death of old cells and so when there's an imbalance particularly in the prostate we're seeing that there's more growth than there is death of prostate cells and so that is typically caused in this case by an increase in certain growth factors like epidermal growth factor insulin like growth factor keratin aite growth factor and transforming growth factor beta or TGF Beta And so what causes this well one

is genetic we know that BPH can be inherited in somewhat of an autosomal dominant fashion what that means is that if your father has BPH it's very likely that you're also going to get it that doesn't mean that everyone's form is inherited but typically when we see people who have enlarged prostates before the age of 60 so bothersome that they need to get surgery for prostate removal this is the kind of person that's more likely to have a genetic component the second cause is inflammation now inflammation is sort of a term that's thrown around all

the time right but what causes inflammation well it can be from bacterial or viral infections it can be through hormone changes which are not necessarily specific to having high levels of testosterone they can be due to autoimmune condition they can be due to urine reflexing back into the prostate duct creating inflammation or even changes in the prostate microbiome now in terms of the prostate microbiome we're still learning a lot about this area but certainly disruptions in the normal prostate microbiome can lead to inflammation so inflammation typically occurs from release of cyto kindes which are chemical

Messengers from te- cells which are from our immune system and these release cyto kindes like il6 which then stimulates certain growth factors like fibroblast growth factor 2 which causes the cells to proliferate now here's where it gets into sort of a vicious cycle after the proliferation this then creates what's called a local hypoxic environment meaning that now this new tissue needs oxygen it's not getting the oxygen it needs and so it releases these inflammatory markers like reactive oxygen species so this then creates more inflammation and subsequently creates more growth and then more inflammation and then

you're in this vicious cycle and lastly symptoms of BPH can be due to increased prostate smooth muscle tone which is regulated by our sympathetic nervous system and certain things can cause upregulation of the sympath itic nervous system and this can include hypoglycemia or hypoglycemia meaning changes in your blood sugar levels dietary factors and obesity so what are things now that you can do to prevent or stop this cycle well number one is you can avoid developing what we call metabolic syndrome metabolic syndrome is essentially a constellation of conditions that's all due to certain metabolic abnormalities

including things like diabetes high cholesterol high blood blood pressure and they often occur together these are particularly due to our Western diet which is high in fat high in red meat high in simple carbohydrates and sugar and physical inactivity and they've actually looked at some of these factors to see what percentage increase of risk are you to getting BPH if you have some of these factors first off diabetes diabetes increases your risk of having benign prostatic enlargement by 125 5% that is really remarkable now having a large prostate doesn't always mean you have symptoms so

when they looked at the correlation with lower urinary tract symptoms or symptoms that are usually caused due to an enlarged prostate like weak stream stopping and starting your urine having to wait a long time before your urine starts and sometimes having to go often at night or during the day or having a lot of urge to go to the bathroom they found that having diabetes increased the risk of lots by 95% so diabetes certainly is a very problematic condition now what about BMI or body mass index now I know it's not a perfect indicator of

health because some people can have a high BMI and have a lot of muscle mass and they're actually not unhealthy but generally speaking a BMI of greater than 35 compared to people who had a BMI of less than 25 had an increase in benign prosthetic enlargement by over 200% so so being overweight is actually a strong indicator of risk of getting BPH so having a waste circumference of 109 CM or 42 in increases your risk of getting BPH by 138% now 42 in is quite large now with about 102 cm or about 40 in that

increases your risk by about 48% so regardless of how you look at it having a being obese having a large waist circumference and having diabetes is going to put you at risk for BPH number two now moving on to the second way you can reduce your risk of BPH is by increasing your physical activity so in a literature review they compiled eight studies with over 355,000 men and with all the data on the different types of activity they decided they categorize the activity as light moderate or heavy exercise and they found that even light exercise

decreased the risk of BPH by 30% and if you increased that it went up to 36% reduction and specifically in terms of what types of exercises there was one study that looked at walking for greater than 2 hours a week versus walking less than that and they found that that reduced the risk of BPH by about 27% now 2 hours a week is really not that much There's 7 days in a week and you can do the math right that's less than 20 minutes a day if you do it every day and so it's really

not a huge amount of activity that you need to see an improvement so doing physical activity to the tune of 862 kilo calories per day in the men's Massachusetts aging study saw a reduction in about 50% in terms of risk of BPH now what about doing physical activity regularly if you do it about six times a day based on large populationbased study using the Nan's data they saw a reduction of of again nearly 5050 51% number three avoid certain medications so over-the-counter medications can worsen your BPH symptoms and potentially if you're starting to have some

symptoms it's important to realize that certain things can make it worse now this is not preventative but I think it's important to discuss because if you're having any symptoms at all this can make it significantly worse and sometimes it can make it difficult to urinate so one is antihistamines a side effect of antihistamines is that they can relax the bladder so that the bladder can't squeeze as hard as it normally does to help pass urine past and enlarge prostate the second one is decongestion like pseudophed or pseudophedrine we as urologists use alpha blockers to help

improve the symptoms of BPH these are things like Flomax or tamsulosin and these work by relaxing the bladder neck and relaxing the prostate to allow urine to flow and things like Su of fedrin actually do the opposite they tighten up these smooth muscles so it makes it more difficult to urinate also things like anti-depressants anti-depressants specifically tricyclic anti-depressants can also worsen symptoms because of their negative effect on the bladder number four is Diet now the best data we have on diet and as you if you've been here before you know that learning about diet and

how it affects our bodies is actually very challenging in research settings because you have to control everything that goes into someone's mouth in order to ensure that they're going to follow the exact plan that you're prescribing for them compared to a general control and that can be very difficult and costly so they're very difficult to do but the best data we have is from something called the prostate cancer prevention trial which was done to look at the effects of a medication called dutasteride on prevention for BPH but within that study one they recruit a ton

of patients over 18,000 patients they also included data with food frequency questionnaires this was a pretty rigorous questionnaire that looked at 99 different food groups six different beverage groups as well as different preparations of food to see what types of foods people are eating regularly and how much of it so and they followed these men for seven years so we have long-term data so these people when they started the study couldn't have BPH but they could have developed it during that 7-year period so in terms of fat intake they looked at quartiles so they looked

at how much of their total diet was coming from fat now the highest quartile took in about 38% of their total consumption or total energy from fat and the lowest quti was less than 26% those people who had a more high fat diet had about a 31% increase in risk of developing BPH and then was it a specific type of fat so we looked at polysaturated unsaturated saturated fat and they really didn't find a difference in terms of the type of fat you're consuming compared to the risk of developing BPH now they also looked at

red meat intake and they found that men who ate red meat less than once per week versus eating it the ones who ate it daily had a 30% increased risk of developing BPH and similarly they looked at vegetables so people taking vegetables less than one serving per day compared to four servings per day they saw a 38% increase in risk of BPH so from this we can take away that high fat diet high red meat intake and low vegetable intake puts you at higher risk of developing BPH now lastly in terms of diet everybody wants

to know is there a certain food I should eat to reduce my risk that brings me to something that's actually been studied quite a lot which is called lycopene lycopene is a keratinoid it's the most powerful keratinoid in terms of reducing inflammation and it's the primary component in tomatoes tomatoes are basically the source of about 80 5% of our dietary lycopene intake now you can take lycopene as a supplement but we're going to talk about food right now and in my next video I'm going to talk about the data on supplements for improving symptoms related

to BPH and now how these are anti-inflammatories essentially they're like an antioxidant now in that same pcpt trial or the prostate cancer prevention trial they did see an 18% reduction in risk of developing BPH in those who had lycopene in their diet it and there's been a lot of studies that have sort of shown mixed results some show a benefit whereas some do not in terms of improving symptoms related to BPH again in terms of prevention there's not a ton of data and the best one we have is that prostate cancer prevention trial but there

are some questions in what makes lycopene more effective so one is there's definitely genetic variability in how our bodies process lycopene and make it bioavailable so some people may do better and some not at this point we don't know who's the do better with lycopene intake the other thing is that actually cooking the Tomato May in some ways be better so cooking the tomatoes actually creates a reaction called the malard reaction and what happens is when you cook an amino acid attaches to a sugar and that's why certain things will brown or their flavors will

change when cooked and so particularly when you cook Tomatoes you get what's called a fru his reaction the fructose attaches to the histadine molecule and this in addition addtion to the lycopene also has antioxidant properties and has been shown at least in one study to improve the effect of lycopene by itself now how much tomato product do you need to eat well there's no really perfect amount but the studies have looked at anywhere from 6 Mig all the way to 21 milligrams per day and just for set for context a four a cup of tomato

paste which you probably use in your food very often has about 19 milligram eating a slice of watermelon gives you 13 Mig and eating one cup of cherry tomatoes gives you about 3.8 Mig so getting that amount is not really too difficult and in terms of what's necessary would say anything above 6 Mig is probably sufficient based on the studies that we've seen however again I would not say this is a mandatory must do but if you like tomatoes by all means eat them because they may be helpful or other lopine containing products and there's

quite a bit so just Google it you'll see a whole list of different foods that have lopine in them but Tomatoes is usually the easiest one for people to eat you do have to be thoughtful about eating too many tomatoes it can cause other side effects so some people can develop irritable bowel syndrome some people can get bladder overactivity because tomato based products can be a bladder irritant you can also get gird or reflux and that can be quite uncomfortable in rare cases it can cause kidney problems body aches or arthritis or even in some

cases cause discoloration of the skin it can turn sort of a orangish Hue if you're eating too much so eat within reason there's no no strong evidence at this point that that will prevent BPH the strongest evidence we have is through exercise and eating mostly a Mediterranean like diet which is high in vegetables and small amounts of meat small amounts of fish some small amounts of healthy fats and that has been kind of shown overall to to show the most benefit in terms of reducing your risk avoiding the development of other conditions like diabetes high

blood pressure high cholesterol which as we know are sort of a direct reflection of of our diet and exercise I hope you guys found this helpful if you are enjoying my content please check out our premium membership where you will get Early Access and add free access to all of our podcasts which are released on Fridays as well as the ability to ask me anything and a monthly AMA episode that is just for you only premium members will have access also if you're having issues with bladder condition sexual dysfunction hormone problems with testosterone for men

or going through menopause for women or if you're having pelvic pain we'd be happy to see you at our practice at Reena Malik MD we're currently running a special we're offering $1,000 off of Shockwave therapy treatments in our office if you book an appointment before January 26 2024 in my practice I spent an entire hour with all of our new patients making sure that we address all of your issues and concerns and I'm easily accessible between visits so I'd love to see you there and as always remember to take care of yourself because you're worth

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