Most men don't give their prostate much thought until it starts giving them a reason, ie getting up more often during the night, noticing changes in urinary flow or having a discussion about PSA can suddenly make a small gland that has spent decades unnoticed rather more important.
Yet prostate health isn't simply about waiting for symptoms or reaching a certain age and having a PSA test. Age and family history matter, but so do weight, metabolic health, physical activity and diet. Researchers are also investigating something few men would immediately associate with their prostate: the microorganisms living in the gut. So, what should men actually know about looking after their prostate?
Know what is normal for you
The prostate sits just below the bladder and surrounds part of the urethra, the tube through which urine leaves the body. It tends to get larger as men get older, which is one reason urinary symptoms become more common with age.
Needing to urinate more frequently, particularly during the night, having difficulty starting, experiencing a weaker flow or feeling that the bladder hasn't emptied completely can all occur with an enlarged prostate. Blood in the urine or semen, persistent pain or other unexplained changes also need medical attention.
These symptoms do not automatically mean prostate cancer. Benign prostatic hyperplasia (BPH), prostatitis, urinary infections and other conditions can produce urinary symptoms too. The important point is not to diagnose yourself or assume that changes are simply an inevitable part of getting older. If something changes, get it checked.
Know your risk
Age is one of the strongest risk factors for prostate cancer, with risk rising particularly after 50. Family history also matters, especially if a father or brother has had prostate cancer.
This is why prostate health shouldn't begin with symptoms. If you are concerned about your personal risk, speak to your GP about whether further assessment is appropriate. PSA testing can be useful, but it isn't a perfect test and a raised PSA does not necessarily mean cancer. Equally, prostate cancer doesn't always produce symptoms in its early stages. Knowing your own risk is considerably more useful than worrying about somebody else's.
Put food to work
There is no single food that will protect the prostate and no special “prostate diet”, but the way we eat over many years can influence body weight, cardiovascular and metabolic health, inflammation and the gut microbiome.
Tomatoes are worth including because they provide lycopene, a carotenoid that has been extensively studied in prostate health. Lycopene becomes more available when tomatoes are cooked and eaten with some fat, which makes tomato-based sauces, soups and roasted tomatoes with olive oil useful additions to the diet.
Broccoli, cauliflower, cabbage, Brussels sprouts and watercress belong to the cruciferous family and provide glucosinolates, which are broken down into biologically active compounds. Beans and lentils, oats and other wholegrains, nuts, seeds, vegetables and fruit provide different forms of fibre and phytochemicals while also feeding the microorganisms living in the intestine.
Oily fish can contribute omega-3 fatty acids, while reducing the amount of highly processed food and processed meat in the diet leaves more room for foods that offer considerably more nutritionally.
The important word here is variety. Eating tomatoes every day while ignoring the rest of the plant kingdom rather misses the point. Different plant foods provide different fibres and plant compounds, which are then metabolised in different ways by our gut microorganisms.
Fermented foods such as live yoghurt, kefir, sauerkraut, kimchi and miso can add another element. They aren't compulsory and they aren't a treatment for prostate problems, but they can form part of a varied diet that supports gut health. Nutrition gives us one way of influencing the intestinal environment; probiotics and postbiotics give us further options, although they approach the microbiome in quite different ways.
Your prostate is affected by far more than what happens within the gland itself
The trillions of microorganisms living in our intestine interact with the immune system, transform components of our food and produce substances that can affect processes elsewhere in the body.
Researchers have reported differences in the gut microbiome of men with conditions including BPH and prostate cancer. That does not tell us that changes in gut bacteria cause these conditions, and much of the research remains observational. What it has done is raise some useful questions about the possible links between intestinal microorganisms and prostate health.
One area being studied is inflammation. Inflammation is a normal and necessary part of our immune response, but persistent inflammatory activity has been associated with several prostate conditions. The gut is relevant because microorganisms and the substances they produce interact with immune cells, while the intestinal barrier helps regulate the movement of microbial products and other substances from the intestine into the body.
Scientists are also studying microbial metabolites - substances produced when our gut microorganisms break down components of our diet. Some of these compounds can enter the circulation and exert effects well beyond the intestine. The possibility that microbial activity may influence prostate biology through immune, metabolic and inflammatory pathways has helped drive interest in what researchers sometimes describe as the gut-prostate axis. We don't yet know how clinically important that relationship will prove to be, but it gives us another reason to take gut health seriously as men get older.
Probiotics and postbiotics: what's the difference?
For years, adding beneficial bacteria to the gut has largely meant talking about probiotics. These are live microorganisms that, when given in adequate amounts, confer a health benefit. They remain an important and well-established area of microbiome research.
Postbiotics work differently. A postbiotic is a preparation of inanimate microorganisms and/or their components that confers a health benefit. Rather than depending upon live microorganisms remaining viable during manufacture, storage and their journey through the digestive system, postbiotics allow us to use defined microbial preparations without requiring the organisms themselves to remain alive.
For anyone who has tried probiotics and found that they don't suit them, or who simply prefers an approach that doesn't rely on live organisms, this makes postbiotics worth considering. It also reflects where much of microbiome science is heading. Researchers are no longer concerned only with identifying which bacteria are present; they also want to understand what microorganisms produce and how microbial cells and their components interact with our own physiology.
Postbiotic research has examined intestinal barrier function, immune responses, inflammatory signalling and metabolism, all of which are relevant to health as we age. Postbiotics can offer a different way of supporting gut health, using microbial preparations that don't depend upon live bacteria remaining viable.
For a man already thinking about maintaining his gut and wider health as he gets older, a well-researched postbiotic can therefore be a useful addition to a good diet and healthy lifestyle. The aim isn't to choose between food, fermented foods, probiotics and postbiotics, but to understand what each can offer and use them appropriately.
Building postbiotics into a healthy routine
Taking a supplement makes most sense when the rest of your lifestyle is working with it. Maintaining a healthy weight and staying physically active support cardiovascular fitness, insulin sensitivity, metabolic health, muscle and bone, while a varied diet provides the fibres and plant compounds used by the gut microbiome.
A postbiotic can sit alongside these measures as part of a daily approach to gut and healthy-ageing support. Because it doesn't rely on live microorganisms surviving storage or passage through the digestive system, a defined postbiotic preparation provides microbial cells and components in a stable form. For people who want to support their gut but don't necessarily want another live-bacteria product, that distinction may be particularly appealing.
Smoking is best avoided and alcohol kept within recommended limits. Sleep matters too, although anybody getting up several times every night to urinate hardly needs reminding of that. If urinary symptoms are disrupting sleep, they should be investigated rather than simply accepted.
Looking after your prostate
Looking after your prostate doesn't require you to become an expert in prostate biology. Know what is normal for you and don't ignore changes. Understand your personal risk. Look after your weight and metabolic health, stay active and eat a diet containing plenty of different plant foods and good sources of fibre.
We can now add gut health to that approach. Diet and fermented foods help shape the intestinal environment, probiotics provide selected live microorganisms, while postbiotics provide a different option for those wanting the benefits of a defined microbial preparation without depending upon live organisms remaining viable.
Research into the gut, microbial function and healthy ageing continues to develop, but we don't need to wait for every scientific question to be answered before taking sensible steps to look after our health. For men already paying attention to diet and lifestyle, a well-researched postbiotic is another option worth considering as part of their daily gut-health routine.
Most importantly, don't wait until your prostate starts causing problems before you start thinking about it.
Kate Arnold, Nutrition Consultant to The Postbiotic Company
This article is for general information and educational purposes only and is not intended to replace individual medical or nutritional advice. Food supplements should not be used as a substitute for a varied, balanced diet and healthy lifestyle. If you experience urinary symptoms, have concerns about your prostate health, have a medical condition or are taking medication, please seek advice from an appropriate healthcare professional.
