In February I happened to attend a lunch 'n learn presentation at TMCi by a company doing clinical trials based on exactly this venous insufficiency principle. I think I may have been the only one in the audience with gray hair... TMCi is the startup accelerator attached to the Texas Medical Center in Houston.

The startup company is Vivifi Medical[1] and they have clinical trials underway with ten men in a Central American country (El Salvador?). They claim that BPH reverses in a few months after their procedure. Their procedure uses a minimally invasive tool of their own invention to snip the vertical blood vessels that are backflowing from age and gravity, and splice them into some existing horizontal blood vessels. On their board of advisors is Dr. Billy Cohn[2], the wildly innovative heart surgeon who is famous for shopping for his medical device components at Home Depot. Dr. Cohn is on the team building the BiVACOR Total Artificial Heart. Vivifi presented their estimated timeline to FDA approval, with proposed general availability in 2028. My personal BPH will be at the head of the line for this procedure.

As far as a startup, their TAM is about 500 million men. I had the Urolift procedure for BPH three years ago, and it cost about $15K on the Medicare benefits statement, though Urolift's clips amounted to only a few thousand dollars. Similarly, Vivifi's charges for this procedure are only a few thousand dollars per procedure, but it holds the promise of being a final solution. Currently Urolift is much less disruptive than TURP, which needs a couple of days in the hospital and almost always leads to retrograde ejaculation (into the bladder).

[1] https://www.vivifimedical.com/

[2] https://www.texasheart.org/people/william-e-cohn/

The text brushes over the importance of healthy muscle motion for venous blood flow against gravity. Staying physically active, including pelvic floor exercises into the routine and correct belly breathing utilizing the diaphragm are probably the best options for preventing issues with reduced venous blood flow from the testicles passing by the prostate back to the heart.

> Screening for this disorder is simple: use a thermal camera and compare testicular temperature sitting up (or standing) versus lying down, in each case waiting five minutes or so for temperatures to equilibrate, and taping the penis up so that it does not affect the measurement.

Interesting. I wonder how many how many other issues we could screen for using such simple, low cost tools. Some scales can already detect reduced blood flow in the feet (which can be a sign of all sorts of nastiness).

Issues like these reflects an evolutionary blind spot: selective pressure drops off after reproductive age, allowing defects like prostate dysfunction to persist. It's the same reason late-onset neurological diseases remain prevalent.

I read this with great interest, because about a decade ago, I was convinced I had prostatitis (but NHS screwed the diagnostic process up - the GP didn't do a digital rectal exam because the ultrasound would be more diagnostic anyway, and the ultrasound scan was cancelled because the GP didn't do a digital rectal exam which was part of the criteria for going through with the scan ¯\_(ツ)_/¯ ), and ended up reading quite a bit about it, and how I might try to make things better for myself in the absence of antibiotics.

I ended up on this page which I no longer remember (something something prostatitis foundation maybe?), from which I remember two things.

The first was this turkish doctor, who against all advice was suggesting a "Brocolli juice therapy" as a prostatitis cure. Fast forward to 2025 and there's lots of studies supporting this. Anecdotally I tried this back then and it really helped the prostate pain I had at the time for months go away within a week.

The second, which is more relevant here, was this guy who had a very interesting hypothesis, that a lot of the prostate troubles are actually "musculoskeletal" in origin, and muscle imbalance / weakness of the iliopsoas muscles in particular. And that this imbalance affects venous return which "somehow" causes the condition. But he was just a lay person, and the "somehow" was unclear. So this completes that image perfectly. It's interesting that this article mentions the venous insufficiency link, and that veins rely on valves to direct flow, but doesn't mention the muscular link at all.

In any case, this person was saying that in his case, doing lots of iliopsoas stretching and exercises effectively 'fixed' his chronic prostatitis problems. So I've timidly started including a couple of iliopsoas stretching exercises before any workout I do. Anecdotally, I think it helps, but I can't know for sure. But thought I'd mention here in case someone shows interest or can make that link more solid.

PS. found the turkish doctor page (or at least a mirror of it): https://www.oocities.org/iastr/ebroc.htm

I wish I could find that comment about the iliopsoas ... but alas I think it's probably lost in the sands of time now.

Based on the simplified sketches and reasoning I'd assume that it made more sense to sclerose the two small vein sections connecting the testicles with the prostate. Does somebody know why that's not the suggested option?

So where's the temperature, pulse/pulseox and orientation monitoring jockstrap with linked smartphone app?

>In women, breast cancer has a similar death toll, but the breasts have an excuse: they’re much bigger; there are many more cells to go bad. They’re also much more metabolically active, capable of producing enough milk to feed a baby; the prostate’s output is tiny in comparison.

Except that you make work your prostate everyday, multiple times, since your adolescence, whereas a woman doesn't breastfeed everyday since adolescence.

For more insight into "all" this prostate trouble watch the film "Oslo: Love" currently in some cinemas.

At 50 cents a capsule on amazon , prostamol uno (serenoa repens) is more expensive than finasteride so it will forever remain an unrecognized herb. Also, remember we dont really know how these pills are made. Remember the story of that miracle herb, PC-SPES? Widely regarded as a miracle drug when it started selling over the counter, it did indeed significantly improve voiding symptoms as well as out even advanced prostate cancer into remission. It became so widespread that the California Department of Health Services (CDHS) investigated PC-SPES and discovered that it was adulterated with drugs, including warfarin, alprazolam, and diethylstilbesterol (DES). Each capsule had potent estrogens in it! Then the FDA recalled it.

Although the rest of the world benefitted from this research, it was the US that paid for it and did it. I am sad that we are now entering a 'transactional democracy' (you only get as much democracy as you can afford) but then again, that's where the rest of the world has been since WW2. Anecdotal data has driven 'old wives tale medicine' for millenia. I am hoping though that big data, the internet, AI, and the judicious use of Bayes' theorem can distill real knowledge from the vast sea of misinformation that surrounds us.

Why do ideas like this take so long to be tested/adopted? Is it because the alternatives are “good enough”? I would think the evidence would lead to a fast shift; though maybe moving slowly is a good thing when it is surgeries.

So how the usual otherwise-harmless treatment with extract of Serenoa repens works? Seems even that is not clear - [1] is ~2011, [2] is 2024

it seemed to work for me, took it for few months, 10y+ ago. "Lasted" 8-9 years.. - until recently..

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC3175703/

[2] https://wjmh.org/DOIx.php?id=10.5534/wjmh.230222

> It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them.

I wouldn't say so at all. Poor eyesight carries on smartly. Baldness. I enjoy both.

But an old story about the controller code for a surface-to-air missile comes to mind.

Someone looking at the memory allocator spots an obvious resource leak: "This code is going to crash."

The reply was that, while the point was theoretically valid, it was irrelevant, since the system itself would detonate long before resource exhaustion became an issue.

So too prostate cancer back in the day: war, famine and plague were keeping the lifespan well below the threshold of every man's time bomb.

  > It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them.

So there is a cure for BPH?

We already have one solution to the problem.

Finasteride or dutasteride. They control BPH perfectly, while also treating male pattern baldness. Combine with daily tadalafil to offset any chance of the dubious sexual side effects, while also reducing gynecomastia (it's also an aromatase inhibitor!). Make sure to have regular 5ari-aware PSA screenings to make sure high grade cancers are caught and you are golden.

fin/dut + tad are my favorite medications to keep men fresh for many more years than intended by nature.

Have your children before you start though, as dut will probably make you sterile eventually.

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I’ve been reading till…I don’t know 40% of the article? Is there some sort of conclusion besides surgery?

Typical patriarchal attitudes, whenever any disease affects women or non-binary people then it's a shrug of the male shoulders and on to talk about Star Wars.