BPH Specialist in Los Angeles, CA
What is BPH?
Benign Prostatic Hyperplasia, or BPH, is a condition in which the prostate enlarges as men get older. BPH is a very common condition that affects over 40 million Americans and over 500 million aging men worldwide. Over 40% of men in their 50s and over 70% of men in their 60s have BPH1. While BPH is a benign condition and unrelated to prostate cancer, it can greatly affect a man’s quality of life.
As the prostate enlarges, it presses on and blocks the urethra, causing bothersome urinary symptoms such as:
- Frequent need to urinate both day and night
- Weak or slow urinary stream
- A sense that you cannot completely empty your bladder
- Difficulty or delay in starting urination
- Urgent feeling of needing to urinate
- A urinary stream that stops and starts
If you suffer from the above symptoms, you are not alone. BPH is the leading reason men visit a urologist.2
You can measure the severity of your BPH symptoms by taking the International Prostate Symptom Score (IPSS) questionnaire.
What Causes BPH?
Experts do not know for certain what causes BPH. One theory is that the prostate glands of older men respond better to the male hormone testosterone and its directive to “grow.” Another theory is that a fluctuation in the ratio of testosterone to estrogen may trigger the growth (men produce small amounts of the typically female hormone estrogen; or more specifically, a type of estrogen called estradiol). Other factors include:
The half-century mark seems to be the tipping point when it comes to greater risk of developing BPH. While slightly more than 20 percent of American men ages 40 to 49 have symptoms of BPH, this figure rises to 35 percent among men 50 to 59, 58 percent in the 60 to 69 age group, and 84 percent in men age 70 and older. Factors that may contribute to the age-related risk of developing BPH include changes in hormone levels and damage to the blood vessels that supply the prostate and surrounding structures. When the prostate cells are deprived of enough blood, some experts speculate that this triggers the unwanted growth.
Men who have a close male relative (father, grandfather, brother, son) who have BPH have an increased risk of getting the disease, especially if their relatives had symptoms severe enough to require treatment before the age of 60.
DHT is the acronym for dihydrotestosterone, a substance that is the result of a conversion of testosterone by an enzyme called 5-alpha reductase. BPH is an “androgen-dependent disease,” which means it is influenced by the male hormone (androgen) testosterone. The prostate will not grow unless it is “directed” to do so by testosterone, which is made mainly by the testes. Boys who have their testicles removed before they reach puberty will never develop BPH and removing them after puberty but before BPH develops dramatically reduces the chance of suffering from the disease. But testosterone alone is not the bad guy: it must be converted by 5-alpha-reductase into DHT, and the DHT is what promotes the prostate cells to grow. Experts believe DHT levels rise in many men as they age, even if testosterone levels decline, and that the buildup of DHT may be a factor in BPH.
It’s natural for men to have some of the female hormone estrogen (in the form of estradiol). Estradiol is produced as a byproduct of the conversion of testosterone, among other means. The proper balance of estrogen-to-testosterone in men is important for a healthy sex drive, to enhance brain function, protect the heart, and strengthen the bones. When estradiol levels are too high, however, and the ratio is out of balance, men can experience fatigue, increased body fat, loss of libido, and an enlarged prostate. An imbalance between estrogen and testosterone increases DHT activity, and thus encourages prostate cells to grow.
Being overweight, especially around the midsection, raises the risk of excessive prostate growth. (Zucchetto 2005; Enlarged Prostate, AUA) A review study published in July 2009 also noted a strong relationship between obesity and the development of BPH and lower urinary tract infections. The link between obesity and BPH may be related to the reduced testosterone levels seen in the obese. Also, a drop in testosterone means there’s an accompanying rise in estrogen levels, which can increase the activity of DHT and thus prostate growth. Obesity also affects insulin levels in the blood, which is another risk factor for BPH (see below).
Having diabetes increases the risk of developing BPH, perhaps significantly. (Sarma 2009) Research indicates it may be due to elevated insulin levels, which not only “corral” the blood sugar and usher it into the cells, but also stimulate growth. (Nandeesha 2006) The diabetes-BPH link may also be related to the damage that diabetes does to blood vessels. If the vessels that service the prostate are damaged, an enlarged prostate may be the result. (Berger 2005a)
High Blood Pressure
Although no one is exactly sure how high blood pressure may trigger or worsen BPH, researchers have found a link between hypertension and BPH.
High “Bad” Cholesterol
In 2008, researchers at the UCSD School of Medicine reported that among men with diabetes, those who had higher levels of the notorious “bad” cholesterol, low-density lipoprotein (LDL), were more likely to develop BPH than men who had normal LDL levels. (Parsons 2008) When the researchers divided the men into three groups (high, medium, low), those with “high” LDL levels were four times more likely to have BPH than those in the “low” group.
Also referred to as “Syndrome X,” metabolic syndrome is a cluster of disorders that increase the risk of developing cardiovascular disease. These disorders include obesity, elevated blood pressure, glucose intolerance or insulin resistance (the inability of normal amounts of insulin to transport blood sugar into cells on command), a pro-inflammatory state (elevated C-reactive protein in the blood), and a prothrombotic state (high fibrinogen or plasminogen activator inhibitor-1 in the blood). Researchers discovered that these factors also increased the risk of developing BPH. A group of Swedish scientists has suggested that BPH and metabolic syndrome may be linked by problems with insulin and blood sugar regulation, which results in elevated levels of insulin. (Hammersten 1998)
If you have atherosclerosis–the hardening and thickening of artery walls caused by the accumulation of plaque—you may be at increased risk for BPH, according to at least one study. (Berger 2006)
Results of a large-scale study published in 2007 found that black and Hispanic men are more likely to develop BPH than white and Asian men. However, other studies have not found much difference between ethnic groups.
A lack of exercise may increase your chances of developing BPH, possibly because exercise helps fight obesity, type 2 diabetes, insulin resistance, and other risk factors associated with BPH.
According to a 2008 study published in the American Journal of Epidemiology, consuming greater amounts of vegetables and lesser amounts of fat and red meat may reduce the risk of developing BPH. (Kristal 2008) For example, the study showed that eating a high-fat diet raised the odds of developing BPH by 31 percent while eating red meat daily increased the chances by 38 percent. However, if you consume at least four servings of vegetables daily, you can reduce your risk by 32 percent. The exact role that fat plays in causing the prostate to grow is not understood, although researchers have some ideas. Fat has the ability to increase the levels of testosterone, estrogen, and other hormones, which have been linked with BPH.
A study in the American Journal of Epidemiology found that two drinks per day have a protective effect against BPH. (Kristal 2008) One possible explanation is that alcohol lowers the levels of certain hormones and encourages muscles in the prostate to “relax.”
Weak Immune System
Exercise, poor diet, stress and poor lifestyle can all compromise and weaken the immune system leading to disease and inflammation and an increased risk of prostate disease. A strong immune system is promoted by leading a prostate friendly lifestyle based on the 6 Pillars of Prostate Health.