Sometimes bigger isn’t better. Enlarged prostate is one of the most common health issues facing men today. But the prostate is also one of the most important parts of a man’s reproductive system. To understand what can go wrong and what to look out for, let’s first understand what the prostate does and why you want to take care of it.
What does the prostate do?
If you imagine the male reproductive tract as a subway with lots of interconnecting tubes, the prostrate would be grand central station. Normally, the connection between the bladder and the urethra (the main tube inside the penis) is open to allow urine to pass. This causes sperm and seminal fluid to build up in other passage ways, waiting like impatient commuters for the express line to the suburbs. Finally, the evening express comes. The prostate closes off the passage to the bladder and opens tiny doors allowing sperm to pile in. It then helps support the contractions during ejaculation to help propel sperm to the end of the line.
The prostate is also a factory that produces several key ingredients to protect and support sperm on their journey. Among these are a substance to increase alkalinity of semen (to combat acidity of the vagina), a proprietary blend of simple sugars, carbohydrates and antioxidants to keep sperm energized for the long swim ahead, and prostate specific antigen (PSA) that breaks down or liquefies) semen after it reaches the woman’s cervix.
What is PSA?
Prostate Specific Antigen (PSA) is an enzyme secreted by the prostate into semen that causes it to liquefy over time. Most PSA goes directly into semen but trace amounts leak into the blood. If PSA levels are heightened in a blood test it can signal that the prostate is overactive either due to inflammation (prostatitis), an enlarged prostate (BPH), or prostate cancer. Because prostate issues are relatively common as men age, most doctors recommend regular blood tests for PSA for early detection of prostate problems.
What causes the prostate to get enlarged?
The short answer is, no one really knows. An enlarged prostate, or benign prostatic hyperplasia (BPH), is a common ailment that impacts men as they age. In fact, BPH is listed as one of the top 10 most common and most costly diseases in men over age 50 in the United States. Because the prostate plays a critical role in urinary function, an enlarged prostate can cause major problems with a man’s ability to take a pee (which feels to me like one of those inalienable human rights). Because BPH, prostate cancer and low testosterone (hypogonadism) are common ailments that impact men as they age, a ton of research is ongoing to understand the relationship between testosterone, aging and prostate health to better inform risks and benefits of treatment options for these conditions. So far, the answer seems to be, “It’s complicated,” but here’s a quick summary of what we do know.
Dihydrotestosterone (DHT), a form of testosterone, is critical for growth and function of the prostate. Studies also consistently show that boys who have testicles removed due to poor testicular descent, injury, cancer or do not develop enlarged prostate later in life. As men age, testosterone levels naturally begin to drop. However, if testosterone drops too low, it can cause several other symptoms that can be hard to live with. Identifying optimal testosterone levels for men as they age is the subject of significant debate and ongoing research.
Interestingly, risk factors for low T and enlarged prostate are similar. Overwhelmingly, both conditions are age related – the older you are, the higher risk. They also seem to have higher risk in men who are less healthy. Diabetes, obesity, poor diet and smoking can all contribute to low T and poor prostate health. Taking care of yourself can help maintain healthy levels of testosterone and keep the prostate in check.
The key takeaway here is that doing what you can to live a healthy life (everything in moderation) will pay dividends in your quality of life as you age, and going in regularly for checkups can help identify issues before they become problems. Urologists are equipped with a great toolbox for keeping machinery below the belt in good working order and can be great partners for helping men optimize health over the course of their life.
What causes prostate cancer?
Prostate cancer is one of the most common cancers diagnosed in American men. According the American Cancer Society, 1 in 7 men will be diagnosed with prostate cancer in their lifetime. Like BPH, prostate cancer is most common in men over 40 and risk increases with age. There seems to be a genetic component as family history and race both contribute to risk. When caught early, prostate cancer is very treatable and therefore regular screening is recommended sometime after age 50 depending on other risk factors.
The most common screening tool used is a blood test to measure PSA levels in the blood. When the prostate is functioning properly, PSA levels should be relatively low. However, high PSA does not necessarily mean you have prostate cancer. As mentioned above, inflammation, infection, enlarged prostate or other issues can also cause elevated PSA. If PSA levels come back high, a physical exam of the prostate, imaging or biopsy may be recommended.
As with other issues of men’s health, overall good health seems to contribute to prostate health and may help to reduce risk of prostate cancer.
How do you keep your prostate healthy?
What’s good for your heart is good for your prostate. Healthy diet, keeping your waist a reasonable size and not over doing alcohol, marijuana or cigarettes can go a long way to keeping your prostate (and your sex life) in good shape as you get older. A bit of good news. A recent study followed a large cohort of men throughout their life found that frequent ejaculation (with a partner or solo) decreased the risk of prostate cancer. And that is something we can all get behind.
- Wikipedia articles: Prostate, Semen, Ejaculation, BPH, Prostate Cancer, PSA,
- Owen, D. H.; Katz, DF (2005). “A Review of the Physical and Chemical Properties of Human Semen and the Formulation of a Semen Simulant”. Journal of Andrology. 26 (4): 459- 69. PMID 15955884. doi:10.2164/jandrol.04104.
- Lee CH, Akin-Olugbade O, Kirschenbaum A. Overview of prostate anatomy, histology, and pathology. Endocrinol Metab Clin North Am. 2011 Sep;40(3):565-75, viii-ix. doi: 10.1016/j.ecl.2011.05.012.
- Warburton D, Hobaugh C, Wang G, Lin H, Wang R1. Testosterone replacement therapy and the risk of prostate cancer. Asian J Androl. 2015 Nov-Dec;17(6):878-81; discussion 880. doi: 10.4103/1008-682X.150841.
- Kang DY, Li HJ. The effect of testosterone replacement therapy on prostate-specific antigen (PSA) levels in men being treated for hypogonadism: a systematic review and meta-analysis. Medicine (Baltimore). 2015 Jan;94(3):e410. doi: 10.1097/MD.0000000000000410.
- Klotz L1. Testosterone therapy and prostate cancer–safety concerns are well founded. Nat Rev Urol. 2015 Jan;12(1):48-54. doi: 10.1038/nrurol.2014.338.
- Jarvis TR, Chughtai B1, Kaplan SA. Testosterone and benign prostatic hyperplasia. Asian J Androl. 2015 Mar-Apr;17(2):212-6. doi: 10.4103/1008-682X.140966.
- Rove KO1, Crawford ED2, Perachino M3, Morote J4, Klotz L5, Lange PH6, Andriole GL7, Matsumoto AM8, Taneja SS9, Eisenberger MA10, Reis LO11. Maximal testosterone suppression in prostate cancer–free vs total testosterone. Urology. 2014 Jun;83(6):1217-22. doi: 10.1016/j.urology.2014.02.001. Epub 2014 Apr 6.
- Fenter, TC (2006). “The cost of treating the 10 most prevalent diseases in men 50 years of age or older.”. Am J Manag Care. 12 (4 Suppl): S90-8. PMID 16551207.
- Rider JR1, Wilson KM2, Sinnott JA3, Kelly RS4, Mucci LA2, Giovannucci EL5. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up. Eur Urol. 2016 Dec;70(6):974-982. doi: 10.1016/j.eururo.2016.03.027. Epub 2016 Mar 28.