Prostate Health After 40. What Really Works And What Doesn’t
The prostate health tutorial most men wished they had.
My dad was getting up every 2 hours to empty his bladder. An enlarged prostate (BPH) was his retirement gift at age 62. Fortunately, he had some good treatment options. But it’s easier to prevent something than suffer the side effects of a medication.
Why the Prostate Grows
The prostate is a highly androgen and growth-factor sensitive organ. Add to that inflammation, and the cells of the prostate grow bigger in size.
The prostate sits under the bladder, wrapped around the urethra. When it enlarges, your urethra gets squeezed. Urine flow slows down and pressure builds behind the bladder.
Because you can’t ever fully empty your bladder, you develop a constant urge to urinate. This wakes you up at night and, well, we know the rest.
The strongest stimulators of prostate tissue growth are:
Metabolic dysfunction
Visceral fat
Chronic inflammation
Low physical activity
Unhealthy dietary patterns
Medications side effects
#1. Reduce Visceral Fat & Waist Size
Fact: Visceral fat and insulin resistance strongly predict prostate enlargement and urinary symptoms.
Why: Elevated insulin increases IGF1, which stimulates growth of prostate stromal and epithelial cells. And visceral fat ↑ aromatase activity = ↑ estradiol = stromal cell growth.
What to do: A steady, slow shift towards more fiber and lean protein along with consistent movement throughout the day. Track waist size, not just your weight.
#2. Physical Inactivity
Fact: Men who are more physically active have lower rates of BPH and fewer night-time urinary symptoms.
Why: Stimulation of the muscles lowers the overall levels of IGF1 and decreases excess sympathetic tone. With less pressure on the smooth muscles around the bladder neck, urine flows easier.
What to do: Walk 20-30 minutes most days, especially after meals. Break up long sitting periods. Consistency matters more than intensity (this would be my motto if I could have one!) Bonus, add in some resistance training daily.
#3. High Glucose & Metabolic Syndrome
Fact: Prediabetes (and diabetes) are associated with worse lower urinary tract symptoms and rapid worsening of BPH.
Why: Frequent blood sugar spikes ↑ oxidative stress and inflammation in the prostate tissue. They also fuel the growth pathways of prostate cells.
What to do: It’s usually the simple starches and sugars that spike blood sugar. Walking after heavy meals and focusing on a more balanced plate help a lot. If you’re missing a lot of muscle mass, do some exercise bands.
#4. Diet Patterns
Fact: Men who eat more vegetables and fiber have lower BPH risk, while frequent red meat intake is associated with higher risk.
Why: The food we feed our guts affect the microbiome which impacts immune pathways. Low grade inflammation from intestinal permeability increases inflammatory cytokines (IL6, TNFα) to which the prostate tissue is quite sensitive to.
What to do: Grains and vegetables should take up half your plate real estate. Add some fresh olive oil and finish with your lean proteins.
#5. Losing Muscle with Age
Fact: Muscle mass is directly tied to metabolic and hormone health.
Why: Skeletal muscle doesn’t just help dispose of excess glucose but it also ↑ SHBG which balances out testosterone and estrogen levels. This leads to improved androgen sensitivity at the prostate.
What to do: Add 2 strength training sessions per week. Some squats, push ups, and exercise bands will get you 95% of the way there.
#6. Medications Causing Problems
Fact: Certain medications have a negative effect on the bladder and the prostate, worsening prostate symptoms.
Why: Decongestants and anticholinergic drugs tighten the outlet of the bladder don’t allow the bladder to contract normally.
What to do: Avoid cold and flu medications and discuss alternative options with your doctor if you are taking anything such as benadryl, nortriptyline, promethazine, codeine, lorazepam, Ambien, and diuretics.
#7. Chronic Constipation
Fact: Constipation or excess stool in the rectum worsening urinary frequency, the urge to urinate, and keeps you from fully emptying your bladder.
Why: Increased pelvic pressure from the volume of stool in the rectum puts pressure on the bladder and prevents you from urinating normally. This affects women in a similar way (minus the prostate.)
What to do: Exercise + fiber + water = steady bowel habits and less stool sitting in the distal colon.
#8. Poor Sleep + Sleep Apnea
Fact: While we’re still learning more about this, poor sleep is associated with more episodes of nighttime urination and unpleasant urinary symptoms.
Why: Sleep apnea and poor sleep quality increases atrial natriuretic peptide which creates the urge to urinate more.
What to do: Avoid late-day alcohol and cut back on caffeine. Track your sleep quality objectively and if you’re at risk for sleep apnea, come up with a plan to treat it.
Action Steps Summary
Aim for a fasting glucose under 100.
Add in some resistance training to improve muscle mass.
Prioritize home-cooked meals with fiber, vegetables, beans, and slow carbs.
Avoid drinking calories.
Keep waist circumference low.
If you have diabetes, work toward tight glycemic control.
Improve your sleep quality.
Get screened for sleep apnea, if at risk.
Review your meds with your doctor.
What Doesn’t Work - Busting 5 Myths
Most prostate strategies that end up failing do so because they treat this organ as a single problem instead of part of a whole system.
1. Myth: “Saw Palmetto is Magic for the Prostate”
While supplements may work temporarily and give you slight symptom relief, they’ll distract you from what’s most important.
Saw palmetto, beta-sitosterol, and pumpkin seed extract may have mild anti-androgen + anti-inflammatory effects but I’ve rarely seen them work long-term for my patients.
2. Myth: “The Main Issue is Testosterone + DHT”
Some believe that testosterone or high-androgen state is the problem. But age-related BPH is more closely linked to insulin resistance, IGF1, and inflammation than testosterone levels.
3. Myth: “Cutting Fluids + Caffeine Are a Cure”
This is a fantastic solution to late-night frequent urination but BPH is a progressive condition. Cutting excess fluids will help to a small degree but it’s not a solution.
4. Myth: “Meds + Surgery Will Fix it All”
Alpha blockers and 5-α reductase inhibitors can help for a while but they aren’t easy medication to tolerate.
Surgery will help for a while but has side effects and may leave you with other long-term problems.
5. Myth: “BPH is Inevitable With Age”
Men with better insulin sensitivity, lower visceral fat, and higher activity levels usually have fewer symptoms, even at older ages. And even if their prostate continues to grow, their symptoms are less. And that’s what matters.