Can you prevent an enlarged prostate?

For thousands of Jamaican men, the warning signs may begin quietly, getting up once or twice at night to urinate, waiting for the urine stream to start or noticing that the stream is no longer as strong as it once was.

However, what many men dismiss as a normal part of ageing could be linked to an enlarged prostate. Benign prostatic hyperplasia (BPH), commonly called an enlarged prostate, is a non-cancerous condition that becomes increasingly common as men age.

While there is no guaranteed way to stop the prostate from enlarging, Jamaican data suggest that prostate-related urinary symptoms are already affecting a significant number of men.

The Jamaica Health and Lifestyle Survey III (JHLS III), conducted by the Ministry of Health and Wellness, found that 12 per cent of Jamaican men ages 25 and older had moderate or severe lower urinary tract symptoms (LUTS). The prevalence increased sharply with age, rising from 4.1 per cent among men ages 25–39 to 30.5 per cent among those 60 and older.

The survey also found that 3.5 per cent of men ages 25 and older had been told by a healthcare provider that they had an enlarged prostate. Among men ages 40 and older, the proportion increased to 5.7 per cent, while 14 per cent of men ages 60 and older reported having been told they had an enlarged prostate.

Those figures offer an important local perspective on a condition that is often discussed primarily in terms of ageing.

Jamaica is not alone. A Global Burden of Disease analysis published in the medical literature estimated that the number of BPH cases in the Caribbean increased from approximately 433,000 in 2000 to 671,000 in 2019. The estimated age-standardised prevalence rate was about 2,780 cases per 100,000 population in 2019. Jamaica accounted for an estimated 41,300 cases in 2019, compared with approximately 29,000 in 2000.

A more recent analysis covering 1990 to 2021 similarly estimated that the Caribbean’s BPH burden more than doubled, from approximately 360,000 cases in 1990 to 769,000 in 2021, with the age-standardised prevalence rate increasing from about 2,910 to 3,061 per 100,000.

These are modelled estimates rather than a count of men diagnosed through Caribbean health systems, so they should not be interpreted as a direct measure of how many men currently have clinically diagnosed BPH. Still, they illustrate the scale of the condition across the region.The prostate is a small gland located below the bladder and surrounding part of the urethra. As it enlarges, it can place pressure on the urethra and interfere with the normal flow of urine.

The Ministry of Health survey found that moderate and severe urinary symptoms became considerably more common among older men. Similarly, the proportion of men reporting a doctor-diagnosed enlarged prostate rose from just 0.1 per cent among men aged 25–39 to 14 per cent among those 60 and older.

This does not mean every older man will develop troublesome BPH, nor does prostate enlargement automatically produce symptoms. Some men can have an enlarged prostate with few or no urinary problems.

The distinction is particularly important in Jamaica, where prostate cancer is a major men’s health concern.

The Ministry of Health and Wellness’ Jamaica Population Health Status Report 1995–2023 states that prostate cancer was the seventh leading cause of death among Jamaican men in 2023 and remained the country’s leading cause of cancer-related death. There were 716 deaths, equivalent to an age-adjusted mortality rate of 46.3 deaths per 100,000 population. The ministry reported that the rate had increased from 35.2 per 100,000 in 1996.

The World Health Organization’s (WHO’s) country data provides another perspective. For 2021, the WHO recorded prostate cancer as one of the leading causes of death among Jamaican men, with a rate of 36.8 deaths per 100,000 population.

BPH, however, is not cancer. An enlarged prostate does not mean that a man has prostate cancer, although both conditions can occur in the same person.

The Ministry of Health’s prostate-cancer screening guidelines also point out that an elevated prostate-specific antigen (PSA) level can result from conditions other than cancer, including BPH and inflammation of the prostate.

That is why urinary symptoms should not simply be self-diagnosed. This is where the answer becomes more complicated.

There is currently no guaranteed method for preventing age-related prostate enlargement. However, maintaining good overall health may help reduce some of the factors associated with BPH and its symptoms. Research has linked BPH with conditions such as obesity, diabetes and cardiovascular disease, while physical inactivity has also been associated with increased risk.

The WHO’s current Jamaica profile estimates that 33.8 per cent of adults ages 18 and older were living with obesity in 2022.

That figure does not mean that one-third of Jamaican men will develop BPH. Rather, it highlights why weight management, physical activity and control of chronic diseases remain important components of men’s overall health.

Men should also be cautious about products promising to prevent’ prostate enlargement. There is no established food, vitamin, herb or supplement that has been proven to guarantee protection against BPH.

Symptoms that may accompany BPH include difficulty starting urination, a weak or interrupted stream, frequent urination, urgency, dribbling and waking repeatedly during the night to urinate.

The Jamaican survey’s findings suggest that these symptoms become considerably more prevalent with age. Yet, the same survey found that only 28.2 per cent of Jamaican men ages 25 and older had ever had a digital rectal examination (DRE). Among men ages 60 and older, the figure was 54.7 per cent.

The DRE is used in the assessment of prostate health, including prostate-cancer screening; it is not, by itself, a test for BPH.

The ministry has also expanded access to prostate-cancer screening. In 2024, the National Health Fund announced that its $1,600 annual PSA-test subsidy would be extended to all male Jamaican residents ages 40 and older.

Ultimately, prevention of prostate enlargement may not be entirely within a man’s control. Age and other biological factors cannot simply be switched off.

What men can control, however, is whether they pay attention to changes in their bodies.

A stronger urinary stream should not be the only measure of good health. Regular medical care, physical activity, healthy weight management and timely evaluation of urinary symptoms can help men avoid suffering in silence and ensure that an enlarged prostate is not mistaken for something else.

keisha.hill@gleanerjm.com

SOURCE: Ministry of Health and Wellness, World Health Organization