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March 20, 2018  |  Login
Prostate Enlargement
by James F. Balch, M.D. and Mark Stengler, N.D.

The prostate is a male reproductive gland that sits at the outlet of the urinary bladder and surrounds the urethra (the channel that carries urine away from the bladder). Normally, the prostate is about the size of a walnut. In many men, however, especially those who are middle-aged or older, the gland becomes inflamed or enlarged. When this happens, the prostate compresses the urethra, obstructing the flow of urine and causing other problems (i.e., infection, bladder stones, etc.).

Benign prostatic hyperplasia (BPH) is the medical term, but the disorder is more commonly known as enlarged prostate. When a man reaches middle age, the prostate often starts growing. There can be several reasons why this growth occurs, but it appears to be mainly caused by hormonal changes associated with aging.

Almost half of all men over forty-five suffer from at least some degree of prostate enlargement. At first, an enlarged prostate produces no symptoms, but as it grows and puts increased pressure on the urethra, urinary problems develop.

It may be difficult to start urinating, and once the flow has begun, it may be hard to stop. There may be dribbling in-between urination, along with a sense that the bladder isn't completely empty. Many men find that they awaken several times a night to urinate. Although the symptoms are uncomfortable and disruptive, benign enlargement is usually not a sign of a more serious disease.

In some cases, however, the prostate can become so enlarged that the bladder can rarely empty itself completely. This urine retention can lead to an infection of the bladder or the kidneys; in severe cases, a constantly full bladder can place a dangerous level of pressure on the kidneys and even cause them to fail. A poor diet, especially one that's low in fiber and high in saturated fat, likely contributes to prostate enlargement as well.

As men age, their hormone balance changes. Testosterone levels decline, while the estrogen class of hormones increases. One prevailing theory as to why the prostate enlarges centers around the increased conversion of testosterone to one of its metabolites, known as dihydrotestosterone (DHT).

The enzyme responsible for this conversion of testosterone to DHT is 5-alpha reductase. It is believed that the activity of this enzyme increases as men age, so that DHT levels increase. DHT is implicated in prostate growth. Recent studies show that there is more to the story than just DHT. In recent years, there has been growing evidence that estrogen plays a role in prostate enlargement. A man's body contains the hormone estrogen, albeit in lesser amounts than in women.

Some research shows that the balance between estrogen, testosterone, and DHT is the main issue with prostate cell growth. It is interesting to note that the enzyme aromatase converts testosterone to a potent form of estrogen known as estradiol. more

Next: What are the Symptoms of Prostate Enlargement

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