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Ask Dr. Casey – Prostate Health

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diagram of prostate

Ask Dr. Casey – Prostate Health

By: Dr. Casey Carr, Naturopathic Medical Doctor

Hi Dr. Casey,

I have seen my dad struggle with “prostate symptoms” as he gets older (meaning, frequent urination, poor stream, etc.). Is there any way to prevent this from happening to me?

– Al P.

Hi Al,

Prostate health is a big deal for guys! Especially preventive prostate health. Most men’s prostates enlarge with age. This growth can push on the urethra and create some of the classic prostate symptoms, above, and can also include urgency, hesitancy of stream initiation, dribbling, and sexual dysfunction. This is known as benign prostate hyperplasia (BPH), and according to the Cleveland Clinic, one out of two men will experience these symptoms by age 60 (and 90% by age 85). There can also be overlap with these symptoms with prostate cancer due to prostate enlargement. While prostate cancer screening guidelines changed from generalized screening for every male to a more individualized conversation due to prevalence of overdiagnosis and overtreatment (1), I encourage most of my male patients to start thinking about their prostate health in their 40s (if not before!).

Why do men’s prostates enlarge with age and increase the risk of developing BPH? It’s multi-factoral, and there is no clear answer (frustrating, but this is individualized healthcare). A couple of factors that may contribute to prostate enlargement include venous stasis around the pelvic and testicular area leading to increased amounts of testosterone, which can promote prostate growth. This can include things like low activity level, varicoceles (varicose veins in the testes), metabolic diseases affecting circulation such as diabetes, high blood pressure, etc. So what I would recommend for you, Al, is to promote regular movement and good daily lifestyle habits of consuming whole foods, and also getting any varicoceles taken care of (2).

Once the prostate enlarges, it can be difficult to reduce its size by “natural” means. Truly, the best way to stop symptoms is through prevention. This is why I love that you are already thinking about this now, Al. Aside from lifestyle means, above, there are some herbs and nutrients shown to have some effect on maintaining prostate size. Saw palmetto (Serenoa repens) is likely the most well known. Often men start to use this supplement at the onset of symptoms such as urinary frequency or weakened stream. While some studies have found it helpful in relief of lower urinary tract symptoms, a 2023 Cochrane review study concluded, “Serenoa repens alone results in little to no difference in urinary tract symptoms or quality of life compared to placebo at three to six months…results were similar at 12 to 17 months” (3). However, a ten-year study showed that it helped to reduce the growth of the prostate with early use and emphasized its utility for prevention, not treatment, of BPH at 320 mg of the extract per day (4).

Another great plant compound that can aid in preventing prostate size from growing is reishi mushroom (Ganoderma lucidum), which can even help upregulate cell death of prostate cancer cells (5). It has been found to downregulate the conversion of testosterone into a different form called dihydrotestosterone (DHT) that is linked to increased prostate growth (also male-patterned baldness). Zinc has also been thrown in the mix as a mineral that can aid in prostate health. While I have not found any great research on trials of it reducing prostate size, as some sites suggest, there is an interesting mechanism for zinc deficiency reducing prevalence of BPH and prostate cancer (6). It’s an easy enough intervention; a handful of pumpkin seeds per day can give an adequate dose of daily recommendations for zinc.

In short, Al, I think you are on the right track with prevention already. Daily movement and whole-food nutrition can help prevent diseases that increase risk of prostate growth, and key supplementation before prostate growth begins can be helpful for long-term prostate health and size. Once it enlarges, pharmaceuticals and/or surgery may be on the table for symptom relief. Protect your prostate early!

  1. United States Preventive Services Task Force: Final Recommendation on Prostate Cancer Screening. Published May 2018.
  2. Goren M, Gat Y. Varicocele is the root cause of BPH: Destruction of the valves in the spermatic veins produces elevated pressure which diverts undiluted testosterone directly from the testes to the prostate. Andrologia. 2018;50(5):e12992. doi:10.1111/and.12992
  3. Franco JVA, Trivisonno L, Sgarbossa NJ, Alvez GA, Fieiras C, Escobar Liquitay CM, Jung JH. Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement. Cochrane Database of Systematic Reviews 2023, Issue 6. Art. No.: CD001423. DOI: 10.1002/14651858.CD001423.pub4.
  4. Vinarov AZ, Spivak LG, Platonova DV, Rapoport LM, Korolev DO. 15 years’ survey of safety and efficacy of Serenoa repens extract in benign prostatic hyperplasia patients with risk of progression. Urologia Journal. 2019;86(1):17-22. doi:10.1177/0391560318772466
  5. Jiang J, Slivova V, Valachovicova T, Harvey K, Sliva D. Ganoderma lucidum inhibits proliferation and induces apoptosis in human prostate cancer cells PC-3. Int J Oncol. 2004;24(5):1093-1099.
  6. Sauer, A. K., Vela, H., Vela, G., Stark, P., Barrera-Juarez, E., & Grabrucker, A. M. (2020). Zinc Deficiency in Men Over 50 and Its Implications in Prostate Disorders. Frontiers in oncology, 10, 1293.