How much attention do you pay to prostate health?
Most of us don’t think about prostate health until a man receives a diagnosis of prostate cancer. This is unfortunate because men can make thoughtful choices about lab testing, food choices and lifestyle to support prostate health and/or to support the prostate—even after a cancer diagnosis.
June is Men’s Health month, and we are taking a deeper dive into prostate health and how it affects a man’s quality of life.
For vital prostate health insights: get the Testosterone and Prostate Health Panel…on sale now for $169 (from $199). It includes important testosterone makers, PSA, estradiol and a Complete Blood Count (for a snapshot of your blood health). Buy now…and you can schedule the blood draw at any time—up to 1 year from date of purchase.
Where is the prostate gland—and what does it do?
Roughly the size and shape of a walnut, the prostate gland is located in front of the rectum and just below the bladder. A healthy prostate gland (i.e., one that is not enlarged) weighs between 20 and 30 grams. The urethra, a thin tube that delivers urine and semen through the penis, runs through the center of the prostate gland (1, 2).
The prostate is an essential gland in the male sexual and reproductive system. Its main function is to produce most of the fluid in semen, including a liquid protein known as prostate-specific antigen (PSA). Given its proximity to the bladder and urethra, the prostate also helps regulate urine flow and plays an important role in male hormone balance (3). PSA liquefies and protects semen on its way through the uterus to the female egg.
PSA serves as the basis of PSA tests for prostate cancer screening. An elevated PSA level can also be indicative of an enlarged prostate and/or a potential, non-cancerous prostate issue, like benign prostate hyperplasia or prostatitis as discussed below (4).
Your PSA level is a good marker of current prostate cancer risk. That said…it is possible to have a “normal” PSA (<4.0 ng/mL) and still have cancer, or to have an elevated PSA (>10.0 ng/mL), yet be cancer-free (5).
Conventional PSA ranges and prostate cancer risk are listed below (6, 7):
- <4.0 ng/mL: Considered “Normal”; you have a 15% risk of prostate cancer.
- 4.1 to 10 ng/mL: You have a 25% risk of prostate cancer
- >10 ng/mL: You have 42 to 64% risk of prostate cancer
- >20 ng/mL: 80% of men are typically diagnosed with prostate cancer.
Keep in mind: being in a “normal” PSA range does not ensure prostate health. A PSA in an optimal range is a more accurate indicator of prostate health. From a functional medicine perspective, optimal PSA levels are more narrowly defined; SEE BELOW (8),
Men, aged 40 to 59:
-
- Abnormal: >/=2.5 ng/mL
- OPTIMAL: 0.6 to 0.7 ng/mL
Men, aged 60+:
-
- Abnormal: >/=4.0 ng/mL
- OPTIMAL: 1.0 to 1.5 ng/mL
Testosterone and the prostate
The prostate requires androgens (steroid hormones that trigger the development of male physical traits), especially testosterone, to function optimally. Both women and men have androgens, but men naturally have more; in particular, testosterone.
Not only is it important for prostate health, an optimal level of testosterone is vital for men with regards to their heart health, liver function, mental health and overall male organ system function (9).
Conventional vs. Optimal Levels for Testosterone
Total Testosterone:
>300 ng/mL = “Normal” (Conventional lab standards)
700 to 900 ng/mL = “Optimal” (Functional health standards)
Studies have shown that testosterone is important for maintaining functional integrity of the prostate.
In a 2021 study published by Scientific Reports, researchers found a significant association between low testosterone and increased prostate volume (i.e., enlarged prostate)—even after 4 years of follow-up—compared to male study participants who had normal levels of testosterone (10)
Low testosterone in men doesn’t happen in a vacuum. Yes, as men and women age, hormone levels naturally decline. However, poor metabolic health—for example, overweight/obesity; high fasting blood sugar and/or high insulin levels—can accelerate or intensify hormonal imbalance, contributing to significantly lower testosterone levels in men, which can affect prostate health (11). It’s all connected.
An Enlarged Prostate: What does it mean?
The good news is that an enlarged prostate does NOT necessarily mean “cancer”. What it can mean includes the following:
1. Benign Prostatic Hyperplasia (BPH).
This is a non-cancerous enlargement of the prostate gland.
The risk for BPH increases both with age and as the size of a man’s prostate increases (12). By age 50, apx. 50% of men are diagnosed with BPH; by age 80, 90% of men are diagnosed with BPH (13, 14).
Other risk factors for BPH include: Obesity, history of diabetes, metabolic syndrome, a family history of BPH, and Black race (15).
Food choices and lifestyle factors that can affect the progression of BPH (in other words, contribute to increased prostate size) include (16, 17):
- A diet high in starches and processed / factory farm meats
- Excessive alcohol consumption
- Lack of physical activity
- Systemic inflammation (i.e., metabolic syndrome promotes inflammation in the body)
Men with BPH often experience discomfort with urination. Symptoms may include (18, 19):
- Difficulty starting a urine stream or emptying your bladder
- Difficulty maintaining a steady urine stream
- Weak urine stream
- Dribbling at the end of urination
- Nocturia (Waking up more than 1x / night to pee)
- Frequent urination
- Urinary urgency
- Pain during urination
Left unaddressed, complications may develop over time, including hematuria (blood in the urine), recurrent urinary tract infections (UTIs), kidney disease and bladder stones (20, 21).
2. Prostatitis.
This is a non-cancerous condition of the prostate. The affix “itis” means “inflammation”; therefore, prostat-“itis” refers to inflammation of the prostate gland, where the tissue in and around the prostate gland is swollen, tender and/or irritated.
Prostatitis affects urinary and sexual health. It can be caused by an acute or chronic bacterial infection OR it can stem from non-infectious causes.
Although men can experience prostatitis at any age…
Prostatitis is the most common urinary tract issue in men under age 50 (22). Prostatitis is the third most common issue for men over age 50 (23).
Common symptoms of prostatitis can include (24, 25):
- Pain or burning when urinating
- Trouble urinating: dribbling, or unable to start/maintain urine stream
- Frequent need to urinate
- Cloudy urine or blood in urine
- Blood in semen
- Pain in the belly, groin or lower back
- Pain in the perineum, the area between the rectum and scrotum
- Pain or discomfort in the testicles or penis
- Painful ejaculation
- Erectile dysfunction
- Fever, chills, sweating and other flu-like symptoms (for acute bacterial prostatitis)
- Infertility (for chronic prostatitis, a.k.a., chronic pelvic pain syndrome)
Bacterial prostatitis can occur when bacteria gets into your blood. Pathogenic bacteria, such as E coli, Klebsiella, Pseudomonas and Serratia, as well as Staphylococcus and Chlamydia, often cause acute or chronic bacterial prostatitis (26).
Risk factors for bacterial prostatitis include (27, 28):
- Age (under 50): Most common from young adulthood to midlife
- Urinary tract infection (UTI)
- Bladder stones or bladder infection
- Sexually transmitted infection (STI)
- HIV infection or AIDS
- Having had surgery or a biopsy that requires a catheter
- Use of a catheter, a tube inserted into the urethra to drain the bladder
Chronic Prostatitis, a.k.a., Chronic Pelvic Pain Syndrome (CP/CPPS), is a form of non-bacterial prostatitis that affects apx. 10 to 15 percent of men (29). In other words, this type of prostatitis is NOT caused by pathogenic bacteria.
Unfortunately, this condition is largely unresponsive to conventional medical treatment (e.g., antibiotics). Characterized by pain in the perineum (the area between the rectum and the scrotum), pelvic area, and/or genitalia, CP/CPPS is associated with a significantly reduced quality of life (30). Men with CP/CPPS are more likely to report higher levels of (chronic) pain, as well as greater rates of psychological distress, including depression, anxiety and catastrophizing (31).
Research suggests that the following factors may trigger or worsen chronic prostatitis: 1) having an autoimmune disease (e.g., rheumatoid arthritis, psoriasis, lupus, Hashimoto’s, Ménière’s,, etc.); 2) pelvic nerve irritation; 3) pelvic inflammation; 4) pelvic floor damage; 5) psychological stress; and/or 6) hormonal imbalance (32, 33).
Because of its complex nature, CP/CPPS can be difficult to treat and may require a more holistic and nuanced physical and cognitive behavioral approach to treatment.
Risk factors for chronic prostatitis or chronic pelvic pain syndrome include (34):
- Nerve damage or trauma to the pelvic area
- Previous urinary tract infection (UTI)
- Past injury or infection to which the body is reacting
3. Prostate Cancer
Prostate cancer is the second most common cancer in men, behind lung cancer.
The good news? When detected early, the 5-year survival rate of men with prostate cancer is 99% (35)!
Initially, prostate cancer may present without any symptoms. Therefore, early detection is key. The first step begins with a PSA (prostate specific antigen) blood test. Your PSA results may be paired with other blood or urine medical tests and/or MRI imaging for more detail.
Keep in mind: a biopsy is considered the “gold standard” for confirming a prostate cancer diagnosis. A biopsy involves extracting samples of prostate tissue (analyzed in a lab) to detect the presence—or absence—of cancer cells.
The American Cancer Society recommends that men at the “highest risk” begin prostate health screening at age 40; men at ”high risk” should begin screening at age 45; and, men at “average risk” should screen beginning at age 50 (36).
Men deemed to be at “high risk” include: 1) Black men; 2) Men with one 1st-degree relative diagnosed with prostate cancer at an early age; 3) Men who have had MORE than one 1st-degree relative diagnosed with prostate cancer at an early age; 4) Men with a strong family medical history of cancer with genetic risks, including prostate, breast, ovarian, colorectal and pancreatic (37, 38, 39).
What You Can Do
- Be proactive about prostate cancer screening. Starting from age 40 (to establish a baseline), check your PSA and testosterone levels. You can do this HERE.
- Maintain a healthy weight. Overweight and obesity are associated with low testosterone levels and increased risk of prostate cancer (40).
- Eat unprocessed, anti-inflammatory, nutrient-dense whole foods in a way that is sustainable for YOU.
- Eat enough unprocessed high-quality protein, including fish, to build muscle.
- Practice intermittent fasting. For example, eat your last meal early, allowing 12 hours (or more) to pass—including sleep time—before your next meal. This is ideal, specifically, for prostate cancer (41).
- Move your body—every day. More time spent sitting is associated with increased cancer incidence, including prostate cancer, as well as cancer death (42, 43, 43).
- Lift weights.
- Manage stress.
- Get enough quality sleep. Sleep disorders (e.g., too little, poor quality and insomnia) are associated with increased risk of prostate cancer (45).
10. Get support in making food choices and lifestyle practices that support prostate heath. Schedule a 1:1 30-minute consultation with Kathryn HERE.
Sources
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2 Male Reproductive System. Cleveland Clinic. 5/8/23.
4, 14, 15, 18, 20 Skinder, Danielle PA-C; Zacharia, Ilana PA-C; Studin, Jillian PA-C; Covino, Jean DHSc, MPA, PA-C. Benign prostatic hyperplasia: A clinical review. Journal of the American Academy of Physician Assistants, 29(8): p 19-23, August 2016.
7 “Elevated PSA (Prostate-Specific Antigen) Level.” Cleveland Clinic. 4/21/24.
8 Christie, Jessica. “The Integrative Practitioner’s Guide to Prostate Health: Integrative Approaches to Prevention and Healing.” Rupa Health. Jan. 14, 2025.
9, 10, 11 Xia, BW., Zhao, SC., Chen, ZP. et al. Relationship between serum total testosterone and prostate volume in aging men. Sci Rep, 11, 14122 (2021).
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17 Parsons, J.K. Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors. Curr Bladder Dysfunct Rep 5, 212–218 (2010).
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21 “Prostate Problems: Enlarged Prostate (Benign Prostatic Hyperplasia)” NIH: National Institute of Diabetes and Digestive and Kidney Diseases. June 2024.
22 “10 Prostatitis Symptoms You Should Know.” Oregon Urology Institute.
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29 “Prostatitis: Inflammation of the Prostate.” NIH: National Institute of Diabetes and Digestive and Kidney Diseases. July 2014.
30, 31 Krsmanovic A, Tripp DA, Nickel JC, Shoskes DA, Pontari M, Litwin MS, McNaughton-Collins MF. Psychosocial mechanisms of the pain and quality of life relationship for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Can Urol Assoc J. 2014 Nov;8(11-12):403-8.
35, 37 McCormick, Brooke. “Men’s Health Month 2025: Spotlight on Prostate Cancer, Lifelong Health”. AJMC. June 3, 2025.
36 “American Cancer Society Recommendations for Prostate Cancer Early Detection.” American Cancer Society. Nov. 22, 2023.
39 Worthington, Janet Farrar. “Understanding Family Cancer History.” Prostate Cancer Foundation. Nov. 15, 2021.
40 Freedland SJ, Aronson WJ. Examining the relationship between obesity and prostate cancer. Rev Urol. 2004 Spring;6(2):73-81.
41 Espinosa, Geo, Host. “The Impact of Meat, Dairy, and Eggs on Prostate Cancer.” Dr. Geo Prostate Podcast [EP 52]. 13, June 2023.
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44 Worthington, Janet Farrar. “Monkey Wrench in the Works: How Exercise Helps Sabotage Prostate Cancer.” Prostate Cancer Foundation. Feb. 10, 2023.
45 Chung, WS., Lin, CL. Sleep disorders associated with risk of prostate cancer: a population-based cohort study. BMC Cancer 19, 146 (2019).
