he prostate gland completely surrounds the urethra, making it the single most troublesome gland of the male reproductive system. When the prostate becomes enlarged, as it tends to do as early as age 30, it presses on the urethra, causing obstruction of flow of urine, diminished urinary stream, and sometimes complete urinary obstruction.
Obstruction may well eventually require insertion of a catheter to allow the urine to drain, and sometimes even a surgical operation which, while it relieves the symptoms of prostatic hypertrophy, may also relieve the symptoms of erection by destroying the nerve supply – a not uncommon complication of surgery.
By the age of 80, approximately 85% of men have so-called BPH, benign prostatic hypertrophy – enlargement of the prostate without any evidence of cancer.1
The only requirement for developing BPH is age and functioning testes. There may be a genetic form of BPH also, but it accounts for less than 10% of BPH.
So, what’s a guy to do? He can’t help getting older. He finds himself getting up two or three times during the night to urinate, he feels as though his bladder does not empty completely, perhaps he gets a bladder infection which requires treatment with antibiotic. His doctor starts talking about urologists…
So your prostate is enlarging. Now, how do you tell if the situation is benign or cancerous?
UNRELIABLE PSA TESTS
Cancer screening is controversial. Diagnostic tests to differentiate BPH from cancer of the prostate can be unreliable. The PSA test measures the prostate specific antigen, or PSA. This antigen is elevated with any enlargement of the prostate – be it benign or cancerous. If this level goes up rapidly, over the space of a few months, this may be more suggestive of rapidly growing prostate, hence more suggestive of cancer. About 50% of men with a PSA over 10 have cancer when their prostates are biopsied, and about 25% of those whose PSA is over 4.
Even when screening does detect a cancer, it is hard to know how dangerous the cancer is. Doctors can’t be sure which men need treatment and which would be fine without any. And men who are told they have prostate cancer may have a hard time just doing nothing, even if the cancer is unlikely to cause them harm.
The American Cancer Society revised the PSA screening guidelines in 2010 because of too many false positives – about 30 percent of patients are misdiagnosed as having an aggressive form of cancer. And many prostate cancers develop so slowly that they never cause problems during the man’s lifetime. Better to leave them alone than to engage in invasive procedures that detract from quality of life.
The new guidelines stress that men should talk to their doctors about taking the test instead of automatically taking it:1a
• The discussion should begin at age 50 for men with an average prostate cancer risk and at age 45 for men at higher risk, including African-Americans and men with a close relative diagnosed with the disease before age 65. For men at the highest risk, including those with a strong family history of the disease, the discussion should begin at age 40.
• Men who are tested and have an initial PSA of less than 2.5 ng/mL can be retested every two years.
• Yearly screening is warranted for men with PSA levels of 2.5 ng/mL or higher.
• Men without prostate cancer symptoms who are not expected to live for at least 10 years are not likely to benefit from screening and should not be tested.
• A PSA of 4.0 ng/mL or higher remains a “reasonable threshold” for recommending a biopsy.
The guidelines were revised in the wake of two studies that were less than a ringing endorsement for screening. The American study involved more than 76,000 men. One group received “usual care;” the other group had annual PSA tests for 6 years and digital rectal examinations (DRE) every year for 4 years. The researchers found little difference in prostate cancer death rates between the two groups at 7 years and again at 10 years of follow-up.1b The European trial randomly assigned 182,000 men from 7 different countries to either a control group or a screening group. Men in the screening group had PSA tests on average every 4 years and a DRE twice over that period of time. After about 9 years, the researchers found that screening reduced the rate of prostate cancer death by 20%. But they also found that 48 men would need to be treated to prevent one death from prostate cancer.1c
In 2010, researchers found a potential marker for prostate cancer that could be the starting point for less invasive testing and improved diagnosis of the disease. They found one compound that is present in cancerous prostate tissue but not in healthy prostate tissue – cholesterol sulfate. It’s a fat. Researchers will next try to figure out the how and why of this compound’s presence in cancerous tissue.1d
There is no known link between BPH and prostate cancer.
Shrinking the Prostate
Doxazocin (Cardura) and terazocin (Hytrin) are α-adrenergic blockers commonly used to decrease the adrenergic tone of the prostate, relaxing the gland itself, and its grip on the urethra. Saw Palmetto is an herb used for the same purpose.
Levels of testosterone in young men are quite high, levels of DHT are low. DHT is a metabolite of testosterone. The enzyme responsible for the conversion of testosterone to DHT, 5-alpha reductase, becomes more active with age. Thus the levels of testosterone decrease while the levels of DHT increase. So pharmaceutical companies focused on blocking the conversion of testosterone to DHT. Finasteride (Propecia) and dutasteride (Avodart) are used for this.
The α-adrenergic drugs have side effects of dizziness and fatigue, where the 5α-reductase drugs cause, in about 5% of men, reduced erections or ejaculations.
Standard allopathic therapy uses the techniques of burning, slashing and poisoning to treat the enemy – in this case, the enlarged prostate, the urinary obstruction, and the inability to urinate.
The idea of surgery on the prostate is not so exciting. Three varieties of surgical treatment are available, some of which combine both slashing and burning. TURP stands for “trans-urethral prostatic resection,” removal of prostatic tissue through the urethra. TUMT, “trans-urethral microwave thermotherapy,” coagulates prostatic tissue and reduces its size by cooking it with microwaves. TUNA “trans-urethral needle ablation,” uses radio frequency waves sent into prostatic tissue through needles placed directly into the prostate. TUMT and TUNA both are less invasive than TURP, but they do not reduce the size of the gland as much either.
Is there no therapy for enlarged prostate which does not treat the gland like an enemy to be destroyed?
THE ANSWERS WITHIN THE GLAND
Look at what the functions of the prostate gland tell us. The prostate provides about 20% of the volume of seminal fluid, that fluid which is ejaculated by the male at sexual climax. The function of the prostate is to secrete fluid into the semen – in fact, prostatic fluid forms about 20% of the ejaculate. Since it wraps itself around the urethra, it is ideally suited to help regulate the flow of urine, by contracting its muscle fibers. This is probably why the α2 blockers (saw palmetto, Hytrin, etc) are effective in reducing symptoms of enlargement of the prostate (BPH, or benign prostatic hypertrophy).
The prostate also contains large numbers of receptors for thyroid hormone. We know that a woman’s breasts also contain large numbers of these same thyroid hormone receptors. The woman’s breasts and the man’s prostate are the two largest accessory sexual organs of their bodies. It is not unreasonable to suspect that thyroid hormone plays some role in their function.
We know that iodine deficiency is linked with fibrocystic breast disease and breast cancer. When a woman with fibrocystic breasts is treated with iodine, the fibrocystic breasts soften and turn into normal breasts. It would not be unreasonable to conclude that the same thing could happen when men with enlarged prostates are treated with iodine. Nature tends to be fairly conservative, and does not invent new processes when the old ones are perfectly adequate to the task. Iodine deficiency is associated with increased risk of three different cancers, including breast, thyroid and stomach, all of which have thyroid hormone receptors.2
The prostate also contains thyroid hormone receptors.3 Thyroid hormone requires iodine for its synthesis. Therefore the prostate must also require iodine, since it has the receptors for thyroid hormone, and nature really does not create useless redundancies. This could explain why therapy with iodine or iodide could help to shrink the size of the prostate. It is known that iodine deficiency in adolescents results in enlargement of the testes, just as it results in enlargement of the thyroid gland without concomitant production of androgenic hormones and virilization.
How to tell if an enlarged prostate means cancer?
Prostate cancer has been associated with decreased total body levels of Vitamin D3 (cholecalciferol)4, Vitamin E5, selenium6 and other micronutrient deficiency.7
And if there is cancer – or even if there isn’t – how can we treat, to decrease the chances of cancer? There are as yet no studies on iodine and prostate cancer, but there are studies on iodine and breast cancer. Iodine induces apoptosis (cellular suicide in a “clean” way, that does not create a lot of inflammatory debris) in breast cancer cells at concentrations which are healthy for the body as a whole.8 These concentrations can be attained by ingesting 50 mg per day of iodine and/or iodide.
We know that the American population at large is iodine deficient. We know that the incidence of prostate cancer is rising – one out of every three American men have it. How could it hurt, to ingest sufficient iodine, until the studies are in?
How do you know if you have a problem with your prostate?
The following seven symptom questions comprise a scale initially developed by the American Urological Association. The eighth question about quality of life is scored separately.9 (From Barry MJ, Fowler FJ Jr, O’Leary MP, et al: The American Urological Association symptom index for benign prostatic hyperplasia: The Measurement Committee of the American Urological Association. J Urol 1992;148:1549.)
|All questions refer to
the past 30 days.
|Less than 1 time in 5||Less than half the time||About half the time||More than half the time||Almost always|
|1. How often have you had a sensation of not emptying your bladder completely after you finished urinating?||0||1||2||3||4||5|
|2. How often have you had to urinate again less than two hours after you finished urinating?||0||1||2||3||4||5|
|3. How often have you found you stopped and started again several times when you urinated?||0||1||2||3||4||5|
|4. How often have you found it difficult to postpone urination?||0||1||2||3||4||5|
|5. How often have you had a weak urinary stream?||0||1||2||3||4||5|
|6. How often have you had to push or strain to begin urination?||0||1||2||3||4||5|
|7. How many times did you typically get up to urinate between the time you go to bed at night and the time you get up in the morning?||0||1 time||2 times||3 times||4 times||5 times|
Add total score for 7 questions above –
Total score less than 7 = Mild BPH Symptoms
Total score 8 to 19 = Moderate BPH Symptoms
Total score 20 or more = Severe BPH Symptoms
Quality of life – If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that?
|Delighted||Pleased||Mostly satisfied||Mixed feelings||Unhappy||Terrible|
At the Arizona Center for Advanced Medicine, we look for ways to increase the health of the entire body, including the prostate gland. We help you improve your nutritional status and body composition, working on decreasing the amount of abdominal (or visceral) fat, and increasing the amount of muscle tissue. We help you to modify your food intake, so that what you are eating is healthy for your body – good fuel for the engine. We look for hidden allergies and toxicities – cleaning out the filters, so that your engine can run cleaner and smoother. When necessary, we use supplements, including iodine, Vitamin D9, Indole-3-carbinol10,11, and sometimes saw palmetto12, among other things.
1a American Cancer Society.”Guideline for the Early Detection of Prostate Cancer: Update 2010,” CA: A Cancer Journal for Clinicians, published online MArch 3, 2010.
1b Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The National Cancer Institute.
1d Potential Prostate Cancer Marker Discovered. Science Daily, August 6, 2010
2 Venturi S, Donati FM. Role of iodine in evolution and carcinogenesis of thyroid, breast and stomach. Adv Clin Path. 2000 Jan;4(1):11-7.
3 Zhuang SH, Burnstein KL. Antiproliferative Effect of 1α,25-Dihydroxyvitamin D 3 in Human Prostate Cancer Cell Line LNCaP Involves Reduction of Cyclin-Dependent Kinase 2 Activity and Persistent G1 Accumulation. Endocrinology 139;2:1197-1207.
4 Heinonen OP, Albanes D, Virtamo J, et al. Prostate cancer and supplementation with alpha-tocopherol and beta-carotene: incidence and mortality in a controlled trial. J Natl Cancer Inst 1998; 90: 440-446. MEDLINE
5 Clark LC, Dalkin B, Krongrad A, et al. Decreased incidence of prostate cancer with selenium supplementation: results of a double-blind cancer prevention trial. Br J Urol 1998; 81: 730-734. MEDLINE
6 Ames BN. DNA damage from micronutrient deficiencies is likely to be a major cause of cancer.Mut Res 475;7-20. (2001).
7 Shrivastava A, Tiwari M et al. Molecular iodine induces caspase-independent apoptosis in human breast carcinoma cells involving the mitochondria-mediated pathway. J Biol Chem. 2006 Jul 14;281(28):19762-71.
8 Barry MJ, Fowler FJ Jr, O’Leary MP, et al: The American Urological Association symptom index for benign prostatic hyperplasia: The Measurement Committee of the American Urological Association. J Urol 1992;148:1549.
9 Zhuang SH, Burnstein KL. Antiproliferative Effect of 1α,25-Dihydroxyvitamin D 3 in Human Prostate Cancer Cell Line LNCaP Involves Reduction of Cyclin-Dependent Kinase 2 Activity and Persistent G1 Accumulation. Endocrinology 139;2:1197-1207.
10 Nachshon-Kedmi M, Yannai S. Indole-3-carbinol and 3,3′-diindolylmethane induce apoptosis in human prostate cancer cells. Food Chem Toxicol. 2003 Jun;41(6):745-52.
11 Chinni SR, Li YW. Indole-3-carbinol (I3C) induced cell growth inhibition, G1 cell cycle arrest and apoptosis in prostate cancer cells. Oncogene (2001) 20, 29272936.
12 Marks LS, Partin AW et al. Effects Of A Saw Palmetto Herbal Blend In Men With Symptomatic Benign Prostatic Hyperplasia. Volume 163, Issue 5, Pages 1451-1456 (May 2000)