An end to all this prostate trouble?

https://yarchive.net/blog/prostate/

by bondarchuk • 1 year ago

791 312 1 year ago

yarchive.net

marvel_boy• 1 year ago

So there is a cure for BPH?

cs02rm0• 1 year ago

Sounds like it reoccurs, but potentially the procedure is repeatable. I didn't see a frequency.

I wonder how many potential answers to such problems are out there, known to a few but not acted on by the masses.

cactusplant7374• 1 year ago

In any case, the paper makes no comment as to whether the problem can be solved the same way a second time; obviously in principle it can, but finding all the new bypasses and sclerosing them might be difficult in practice.

Multiple surgeries is not sustainable. Too much uncertainty.

gavinray3• 1 year ago

You can use 5-alpha-reductase inhibitors like finasteride.

One of the primary causes of BPH is from androgens, specifically the conversion of testosterone -> dihydrotestoerone via the 5-ar enzyme.

The prostate is an androgen-sensitive tissue, and DHT causes enlargement.

It's not guaranteed to fix it, but it's one option.

amelius3• 1 year ago

I've heard a theory that baldness is related to tension in the scalp, which apparently is more prevalent in men.

hamstergene• 1 year ago

I wish we all could agree on a terminology where taking a pill daily is management, not a cure.

A cure should be a one-off measure after which one stays cured. If not forever then at least for years.

Something that needs to be repeated, esp. daily, should have a different word. That’s not a cure.

ekianjo• 1 year ago

Not a cure but Tadalafil works very well as a treatment.

fredsmith219• 1 year ago

It does. I suffer for almost 20 hours of I miss a dose. I’m very sure that doesn’t happen.

smitty1e2• 1 year ago

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.

forinti• 1 year ago

There's also your back, your joints, your teeth, GERD. Everything starts getting flimsy in your late forties.

Traubenfuchs6• 1 year ago

It would probably take too long, but a human breeding program centered around the healthiest still fertile old men we can find and young women with spotless genetic heritage would uplift our whole species.

Eliezer• 1 year ago

Poor eyesight is evolutionarily recent (not enough sunlight exposure in childhood, rare to find in hunter-gatherer societies). Baldness won't kill you.

cogman103• 1 year ago

not enough sunlight exposure in childhood

Do you have any source for this? As someone born in the summer to a farming family with poor eyesight, I find it hard to believe that happened because I wasn't exposed to enough sun as an infant or child.

I've worn glasses since I was 2.

wkat42423• 1 year ago

Don't forget that hunter-gatherers rarely lived much beyond 30. Modern society isn't so bad :)

MyPasswordSucks4• 1 year ago

I'd be interested to see sources for the claim that poor eyesight is evolutionarily recent.

I strongly suspect it's more a matter of "won't kill you". Nearsightedness is far more common than farsightedness, and it's only in the last two hundred or so years that there's been any major benefit in seeing fine details at distance. The fuzzy shapes afforded by 20/80 vision are plenty enough to hunt a mammoth.

Having 20-20 vision is nice for avoiding lions and tigers, but it's a luxury spec, because movement acuity doesn't decrease linearly with nearsightedness, and movement acuity (plus traveling in groups, as prehistoric humans were wont to do) can take care of business decently-enough on its own - so I wouldn't call it "evolutionary-pressure"-nice.

rurban2• 1 year ago

Samson and Delilah would like to have a word with you. Also with Japanese Samurai. You loose your mythological power, leading to lost status, suicide, ...

gavinray3• 1 year ago

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

Your appendix and gallbladder would like a word with you ;^)

lostlogin2• 1 year ago

Wisdom teeth too.

Qem3• 1 year ago

Also the intakes for trachea and esophagus being close to each other, causing chokes.

subscribed2• 1 year ago

Both appendix and gallbladder are important. Check the diet for people with gallbladder resection.

cogman103• 1 year ago

Evolution selects for one thing and one thing only, reproduction.

The answer to every "why hasn't evolution done x" question is selection pressure.

An enlarged prostate is something that people get in their 60s and later. Most people are done with reproduction long before that event. There is simply very little and very low selection pressure.

It's pretty much the reason why most humans have peak health into their 40s.

Don't expect evolution to "fix" anything for humans that doesn't commonly impact 20yos.

freddie_mercury• 1 year ago

Weird that you pull the one quote but ignore the rest of that paragraph which is about how being the leading cause of infertility is exactly the kind of thing evolution normally fixes.

"It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them. Since it strikes at advanced ages, BPH doesn’t make a big impact on a man’s ability to pass on his genes. But being the leading cause of male infertility sure does. Their explanation is that evolution hasn’t had much time to work on the problem; in animals the spermatic vein is horizontal, and doesn’t have or need one-way valves. It’s our standing upright that yields the problem; in evolutionary terms that’s a recent development."

smitty1e2• 1 year ago

Not only is it recent in terms of human history; back to my point, it is only in the last few centuries that men in gneral have reached ages that expose the posture shift as a flaw.

jansan• 1 year ago

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

What is the problem with baldness other than having a cheap excuse for not being successful in life? I actually enjoy looking a bit like Larry Fink.

AuryGlenz• 1 year ago

Most people find it less attractive. Usually things that happen when you age are viewed that way, which makes sense, evolutionarily.

meindnoch2• 1 year ago

Baldness and grey hair are indicators of male maturity. In many primate species elder males look different than younger ones, which guides their social dynamics. Similar reason why our kids stay small for their first 12 years or so - it's hard to teach someone who can physically overpower you.

ownlife• 1 year ago

https://www.jstor.org/stable/2408423

jasonthorsness2• 1 year ago

surface-to-air missile The one link I have at hand: https://devblogs.microsoft.com/oldnewthing/20180228-00/?p=98...

blainm• 1 year ago

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.

mattigames• 1 year ago

We lucked out compared to other species, octopus develop dementia soon after breeding.

amelius3• 1 year ago

Yes, and there are spiders where the female eats the male after breeding. I bet their pr0n movies are a bit more interesting than ours.

card_zero• 1 year ago

Hmm. If we engineer late-life reproduction, that might create evolutionary pressure for healthy old age.

Hides long list of ethical problems with the concept

throwuxiytayq2• 1 year ago

The main problem is that evolution is just not a thing at our modern civilizational time scale.

And I don’t see any problems with late-life reproduction, assuming we can make it reliable and healthy. If anything, some countries desperately need it.

Workaccount2• 1 year ago

We just have to get the media to portray geriatric men as sexy, and we'll be well on our way to living to 200!

halgir• 1 year ago

We missed the boat for that a few million years ago. If we're engineering anyway, we might as well engineer for healthy old age directly.

the__alchemist• 1 year ago

Dawkins suggested this might be viable (In an abstract; not politically practical) way in The Selfish Gene.

wkat42423• 1 year ago

With our modern health systems we are pretty much a huge evolutionary blind spot ourselves. Many illnesses that would be filtered out because the carrier wouldn't survive, are now trivial. And on the journey hand we can screen for known illnesses.

I think we are already post evolutionary, or control it ourselves. Not a big issue either IMO, it's totally ok that this is happening.

pavel_lishin2• 1 year ago

I read a pretty entertaining novel where that was one of the sub-plots.

The ethical problems were fun to read about! But would be significantly less fun to live through.

Qem3• 1 year ago

We engineered it culturally already. Lots of people delaying childbirth until late 30s, early 40s today, often resorting to expensive treatments.

magicalhippo• 1 year ago

If we're ignoring ethics, then we don't need late-life reproduction.

Just kill all offspring if one of the parents die of some unwanted cause.

Allows people to still get kids in the optimal age, yet applying old-age selection pressure.

nonethewiser4• 1 year ago

So widen the reproductive age (men only)

hhh2• 1 year ago

Why men only?

yapyap• 1 year ago

what? so are you implying that prostate dysfunction makes you less wanted as a father if it presents itself in “the reproductive age”?

rubyfan• 1 year ago

I read the comment as insinuating people stop taking care of themselves as much after children and develop unhealthy habits.

jbd0• 1 year ago

Shouldn't kids with grandfathers have an evolutionary advantage?

natebc• 1 year ago

when humans were still primarily subjected to natural selection the life expectancy likely wouldn't have allowed for many grandfathers.

bmicraft• 1 year ago

They didn't say drops to zero, but the advantage is obviously more limited

georgeburdell• 1 year ago

If it wasn’t in the past, I imagine it will be in the future with how common two working parents is now. We want more kids but we are getting zero grandparent help

const_cast• 1 year ago

Probably barely, and I think in some instances the opposite. You have to care for the elderly.

Izikiel433• 1 year ago

The problem there is with your definition of grandfather. Currently, the age for a grandfather in developed countries is 55+. For most of humanity's history, if there were grandfathers, they would barely make it to 55 years of age.

me_again• 1 year ago

The grandmother hypothesis https://en.wikipedia.org/wiki/Grandmother_hypothesis is reasonably well-established. The corresponding 'grandfather effect' has not really been demonstrated, as far as I know. https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2007...

ASalazarMX• 1 year ago

Probably improved more with lots of siblings from a wide age range. The bigger siblings would do productive work, the younger would take care of the little ones.

lukas099• 1 year ago

But the issue also causes male infertility, so that can’t be why it’s so prevalent. This is discussed in the article.

wazoox• 1 year ago

Male infertility after 60 is probably not very impactful from a selective point of view. For 300 000 years, almost nobody reached 60 anyway.

MyPasswordSucks4• 1 year ago

The article sort of mentions this in passing, but doesn't subject it to much rigor, and the (completely obvious?) counterargument is that by the time it causes male infertility, the affected have already reproduced.

Traubenfuchs6• 1 year ago

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.

formerly_proven2• 1 year ago

Giving 90% of the gender that looks actually great with hair on their head MPB is easily one of the biggest sleights evolution has committed against our species.

I've personally had very little luck with official channels there. Most won't prescribe anything for hair loss, several dermatologists said to just get used to it, one would prescribe fin pills, i.e. systemic - which did eventually give me pain in the breast tissues (so I ceased using it), but not topical, citing that it's too new on the market. I was unable to find anyone who would or even could look at serum DHT. I eventually settled on just paying one of these apparently legal telemedicine vendors 20 bucks per topical fin prescription.

Traubenfuchs6• 1 year ago

which did eventually give me pain in the breast tissues (so I ceased using it)

You already decided to take one hormonal disruptor, so why not go all the way? Find a private andrologist that prescribes you fin/dut + an aromatase inhibitor. Daily tadalafil also acts as aromatase inhibitor by the way. Should be enough to offset the estrogen increase from finasteride. It's worth a try.

I personally don't really believe in topical min/fin/dut: You are probably just getting the same effects and side effects you'd get from a lower oral dose.

The studies on topical finasteride support this. You just believe it's not in your blood and thus there is no nocebo effect to give you ED but it very much is.

seethedeaduu• 1 year ago

Serum DHT is not useful at all.

qmr2• 1 year ago

Just buy a razor.

Let go.

manmal2• 1 year ago

I‘ve been holding off on fin because of some people developing post-fin syndrome. Is Tad addressing this hazard in your view?

Traubenfuchs6• 1 year ago

In a framework where one believes PFS to exist (I strongly believe it doesn't), tad would, at best, treat a few of the symptoms of PFS.

I believe people with self diagnosed PFS have a mix of mental illness and (sometimes) non diagnosed physical illness.

I'd like to see a self diagnosed PFS sufferer not get an erection, pumped up on 150 mg sildenafil + 10g L-Citrullin.

Is Tad addressing this hazard in your view?

Let me address your question from a different angle: Being on an sufficient amount of daily tadalafil would certainly reduce the chance of you believing you got PFS, because it would guarantee you a working erection in any situation.

ta126534212• 1 year ago

daily Taladafil in combination with daily Finasterid?

Good luck :)

I do not know about Finasterid in detail, but the small-printing for Taladafil says clearly its _not_ for daily use.

Traubenfuchs6• 1 year ago

Daily use of cyalis (tadalafil) is officially marketed.

https://www.hims.com/blog/daily-cialis-costs-benefits

https://investor.lilly.com/news-releases/news-release-detail...

It's superior to taking it on an as-needed basis because it has positive long term effects on your cardiovascular and penile tissue.

elric2• 1 year ago

Two lifelong medications + frequent screening does not sound like "a solution" to me.

That being said, the article does state that its proposed treatment doesn't last forever, though I couldn't find any numbers on how long it is expected to last.

teknico• 1 year ago

I’ve been prescribed, and taking for a while now, daily Dutasteride plus Silodosin (Urorec). However, the latter has the unpleasant side effect of suppressing ejaculation.

Tadalafil (Cialis) does not seem to do the same, however other potential side effects involving sight and hearing are listed.

I’ll ask my doctor if such a swap would be advisable.

hnu0847• 1 year ago

as dut will probably make you sterile eventually.

What is the evidence for this?

elric2• 1 year ago

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).

eternauta3k• 1 year ago

Stethoscopes are pretty cheap and versatile. Human doctors in general have lots of senses which they (in some medical systems) use for diagnosis before reaching for lab tests and MRTs.

bshacklett• 1 year ago

If they bother. The vast majority of appointments I’ve had, in recent memory, are the provider typing a bit on their laptop, then sending me to someone else.

BobbyTables23• 1 year ago

My primary care doctor doesn’t even have an otoscope!

Have no idea how they have such good reviews.

tuatoru• 1 year ago

Stethoscopes are an example where tech can help and is helping. Some sounds (a slightly leaky heart valve, say) are subtle and easily missed, especially if there is traffic outside the doctor's surgery or other noise. Even with good earpieces.

A stethoscope with microphone, analog-to-digital conversion, and digital signal processing can separate out heart sounds from lung sounds and amplify each separately, and AI analysis can learn to identify early stage problems that doctors can't yet hear.

Of course the downside of that may be a loss of skill, as we see happening with ECGs. The ECG analysis algorithms are so good now that lots of doctors don't even bother with anything more than a glance at the waveform, they just look at the text the algo provides. Understandable, when you're near the end of a 12-hour shift.

But potentially, AI based home diagnostic kits with these sorts of devices could save doctors' time.

quantumwoke• 1 year ago

Women menstrual cycle tracking works off the same concept.

raffael_de2• 1 year ago

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.

mr90210• 1 year ago

Thank you.

wafflemaker4• 1 year ago

Please also mention how easy those exercises are:

Once per day, when peeing, do it differently. 1. Release the stream during the in-breath. 2. Stop and hold the stream on the outbreath. 3. If not yet bored or tired go back to 1. Else - finish peeing normally. That's it.

And note that for most people, a week to few weeks of the exercise give stronger orgasms and ability to delay the ejaculation.

anticodon• 1 year ago

And note that for most people, a week to few weeks of the exercise give stronger orgasms and ability to delay the ejaculation.

I've experienced all those benefits when I started walking two times a day, 8-10 thousands of steps a day continuously for several weeks. I haven't performed any other exercises.

But it's really boring and you need to do it every day. I do it only because I need to walk a dog.

alabastervlog• 1 year ago

Huh. So that “happiness through clenching your butthole daily” or whatever-it-was copy-paste troll that was so common on Slashdot back in the day, was… very close to being excellent advice?

tchock23• 1 year ago

Is there a name for this technique? Interested to research the why behind it.

mannycalavera42• 1 year ago

<<Don't do Kegels while you urinate. Stopping your bladder from emptying could raise your risk of a bladder infection.>> https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-...

stavros2• 1 year ago

Can't I just do kegels when I'm sitting or standing? It's not like they're obvious or take much effort, and the result should be about the same, no?

aruggirello• 1 year ago

BTW beware of snoozing or coughing while you're holding yourself.

oarfish• 1 year ago

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

citation needed.

jakedata• 1 year ago

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

wafflemaker4• 1 year ago

Oura ring comes in many sizes. /s

wkat42423• 1 year ago

I'm sure companies like lovense will come up with stuff like that.

The problem is really prudeness in society, especially the American one (the main market for many industries). It's holding back things like sex tech.

edem• 1 year ago

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

tickerticker• 1 year ago

Not a surgical procedure. It's catheter access to the spermatic veins.

tacon• 1 year ago

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/

unixhero• 1 year ago

Do you end up impotent or with incontinence?

tusharsharma0910• 1 year ago

Not at all. Our device does not go through the penis, doesn’t damage the urethra or resect prostatic tissue. As a result, there is no risk to any sexual or urinary functionalities. There is no post op catheter.

tusharsharma0910• 1 year ago

Thanks for the shout out. I am the CEO of Vivifi medical. We are building off the gat and Goren’s work and making it better and more robust. More importantly making it more accessible to patients through urologists. Our early clinical trial data from Panama is looking highly encouraging and we are working hard to bring this to the market in the fastest manner possible.

derektank5• 1 year ago

Have you found that with your procedure, to quote the blog piece, "new venous bypasses grow to replace the destroyed spermatic veins," as found in Gat and Goren's work in follow ups? Or is the long term data not there yet?

Thank you for taking a risk on this by the way. As someone who has family history it's heartening to know there are people taking this seriously.

pstuart• 1 year ago

Is the procedure still possible/advisable after a TURP?

aquafox• 1 year ago

I had a look at your trial description (https://clinicaltrials.gov/study/NCT06424912)

Are you planning to publish the longitudinal data, esp. of endpoints 2 and 3 (prostate size, urinary flow). It would greatly add to the public understanding of this procedure. Why didn't you go for PSA? It's easy to obtain altough one probably wouldn't expect significant changes in this short time frame.

tusharsharma0910• 1 year ago

We are currently gathering insights to better understand patient preferences and would greatly appreciate your input. If you are interested in participating in a short survey, please contact us at info@vivifimedical.com. Thank you for helping us shape the future of patient care.

Izikiel433• 1 year ago

Would this procedure be advisable on someone currently with varicocele, less than 40 years old, and with family history of prostate cancer (both grandfathers)?

cantrecallmypwd• 1 year ago

Excellent work, keep it up!

On a selfish note, it'd be nice if it were available from Urology Austin sometime in the next 10-15 years.

bigfatfrock• 1 year ago

Super interesting, thank you for your candid post - keep crushing in life as it sounds like you already are, good person! Hope you are staying healthy.

mmooss• 1 year ago

Nothing in the parent differs from a product promotion; there are no alternatives, no negatives, no considerations, nothing but praise - even of a member of the board of advisors.

A_D_E_P_T• 1 year ago

there are no alternatives, no negatives, no considerations, nothing but praise

His account is over ten years old, and active. Maybe he's just impressed? Why don't you provide alternatives or negatives, if you can? Cynicism for cynicism's sake is pointless.

aantix• 1 year ago

I have a really enlarged prostate. 4x the normal size.

Had it biopsied because it showed a large PSA value (17).

Biopsy came back negative. Psa density function actually puts my levels in normal range.

I still have difficulties urinating.

Currently taking medication to reduce the size of my prostate, but not happy about the meds because of the sexual side effects.

Would this procedure help me?

sahilagarwal• 1 year ago

In case you missed it, there's a comment parallel to yours by the founder of the company. They also provide their email in a child comment to that. Link: https://news.ycombinator.com/item?id=43804502

raffael_de2• 1 year ago

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?

grok22• 1 year ago

That makes sense to me too. Why wouldn't that be an option or is not really just a small vein between the two, but a bunch of "blood vessels"?

loeg2• 1 year ago

Based on the proposed mechanism, that would still leave the testicles with low oxygenation blood.

themantalope• 1 year ago

I am an interventional radiologist. I’ve done procedures to embolize the prostate (helps shrink it), and gonadal vein embolization (for varices).

The gonadal veins are in a different vascular territory from the prostate. The prostates vascular territory is the anterior division of the internal iliac. The gonadal veins arise directly from the inferior vena cava.

I had not come across this research before it’s interesting because as mentioned above, these organs are in different vascular territories but when venous structures begin to reflux the blood may find other collateral routes through other territories.

I skeptical that this works, but it is really interesting.

q1w2• 1 year ago

I'm share some skepticism. While I agree with their belief that prostates suffer from unappreciated "mechanical" issues, I'm less convinced of their method of resolution.

For my own worthless anecdote, I've noted that my (usually post-orgasm) prostate pain was significantly improved when I started taking Losartan - a anti-hypertension medication (angiotension II blocker (ARB)). The day after I started taking it, I could feel my prostate like never before (then that initial sensation went away), so there was very clearly an associative mechanism of action.

svilen_dobrev• 1 year ago

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

inquirerGeneral• 1 year ago

There is a reason we are smart enough to develop finasteride and dutasteride that are extremely effective and safe¹ instead of relying on plants & herbs which are just weak versions of taking a drug anyway.

¹ the science is sound, the safety is absolutely a guarantee. There is a group of about 10 individuals who have spent their entire life spreading their neurological issues and obsession with fake reports and exaggerations of the harmful made-up side effects that cannot be repeated in any study whatsoever anywhere..

I actually could not believe the other day that they are still active and have managed to cause the FDA to issue a guidance that there might be higher side effect rates than otherwise were reported .

It's actually ridiculous, and every news article and study about it are almost entirely mentioning people who's just start believing in their heads that they have side effects when they actually don't. And yet the news articles took this as evidence of a story that has been hidden or something .

I really thought that those 10 or so individuals who you used to be able to read their forum posts back in 2006 when they tried to tell every young guy in the world not to take it for hair loss would have fizzled out by now.

01100011• 1 year ago

Finasteride does seem to be able to cause some issues. It seems that DHT has many protective roles in the body and limiting it may cause problems: https://pmc.ncbi.nlm.nih.gov/articles/PMC7308241/

begueradj• 1 year ago

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.

pja• 1 year ago

Interestingly, daily masturbation appears to have a protective effect against developing prostate cancer, although no one knows why: https://www.webmd.com/prostate-cancer/ejaculation-prostate-c...

juunpp• 1 year ago

From your own link:

There’s no proof that ejaculating more actually lowers the chances of prostate cancer. For now, doctors just know they’re connected. It may be that men who do it more tend to have other healthy habits that are lowering their odds.
Ejaculation doesn’t seem to protect against the most deadly or advanced types of prostate cancer. Experts don’t know why.

I'm not the expert but, like all things, exercise, sleep and diet probably goes a long way.

jasonthorsness2• 1 year ago

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.

palijer• 1 year ago

We require heavy burdens of proof before we subject tens of thousands of people to potentially needless surgeries.

wussboy• 1 year ago

And this area of human interest has been (and is) prone to abuse from unscrupulous individuals/organizations. Rigorous regulation prevents much of that as well.

derektank5• 1 year ago

Research and subsequently clinical testing is expensive so you have to acquire capital, usually from grant providers or working with private industry. Grant providers tend to be conservative and risk-averse so that means individuals with new ideas often won't be able to explore them until later in their career. Private industry is less risk averse but will only fund research if it has the potential to bring a patentable product to market before the parent expires.

Even once you have funding secured, the regulatory approval process is long and requires hundreds of pages of documentation, reporting, and compliance. Then you have to get insurance to cover it, which can require a procedural code being generated for it by the AMA and requires convincing insurers it's worth it, particularly Medicare in the US which other insurers take their cues from. And even once a procedure is approved and a patient can get it paid for, you still have inertia from human physicians who have been trained to perform certain kinds of treatments and not others.

amelius3• 1 year ago

If safety regulations are really such a high barrier, then explain why this passed them:

https://news.ycombinator.com/item?id=15834006

inglor_cz4• 1 year ago

Surgeries aren't regulated in the same way that drugs are, though. AFAIK the bureaucratic threshold for experimental surgeries is much lower.

bawana3• 1 year ago

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.

xvector• 1 year ago

I really do think AI will be key here. It's critical to accelerate towards ASI as quickly as possible.

rurban2• 1 year ago

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

tpoacher2• 1 year ago

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.

UPDATE: Well what do you know. Found it: https://web.archive.org/web/20230203201759/https://prostatit...

(and https://web.archive.org/web/20230127101206/https://prostatit... more generally)

BobbyTables23• 1 year ago

It also seems to me that a lot of “prostatis” cases have nothing one to do with bacterial infection but rather pelvic floor issues or is referred pain from spinal issues.

Men’s medicine is in the dark ages.

mixmastamyk• 1 year ago

What exactly does the broccoli do? And why does it have to be boiled? I didn't get many details from the page above.

tpoacher2• 1 year ago

There have been many studies since, which probably provide more evidence and detail. But this guy's current explanation at the time is provided in the link where it says "needs to be boiled" (https://www.oocities.org/iastr/eboil.htm)

Quoting from the linked page:

WHAT IS THE REASON THAT WE MUST CONSUME BOILED BROCCOLI?
Fresh broccoli (unboiled) contains some enzymes that must be deactivated. The simple way to deactivate these enzymes is to boil the broccoli in water for 5 minutes. After boiling for 5 minutes, the enzymes will become inactive. If these enzymes aren't deactivated, the broccoli cannot successfully treat those suffering from BPH, prostatitis, or general urinary tract infections.
Broccoli contains very important compounds. These compounds can only treat those who are suffering from BPH or prostatitis when these enzymes are deactivated. If this is not done, the enzymes which broccoli contains start a different metabolic reaction so that the efficiency is reduced.

theptip2• 1 year ago

The theory here is largely mechanical

I’ve long felt that the reliance on population-statistics (RCT) rather than individual diagnosis highlights how little we really know about medicine.

A mechanic wouldn’t try to fix a car based on a checklist of symptoms interventions that work X% of the time across the population of cars; they would actually inspect the pieces and try to positively identify e.g. a worn/broken component. Of course, this is harder in the human body.

I’m hopeful that as diagnostics become cheaper and more democratized (eg you can now get an ultrasound to plug into your iPhone for ~$1k), we’ll be able to make “medicine 3.0” I.e. truly personalized medicine, available as standard rather than a luxury available to the 0.1%.

potato3732842• 1 year ago

What makes professional mechanics fast (and therefore makes them good profit) is knowing from experience when you can shoot from the hip like that.

But yeah, you won't find people doing things that way in any setting where it Actually Matters(TM) (e.g. expensive things where you really can't justify not fixing it right the first time)

thehappypm• 1 year ago

This sounds a lot like the pitch for Theranos

bear1412• 1 year ago

Which was a great pitch because it’s what people want. It just has to be based in reality.

Robotbeat• 1 year ago

So?

bobthepanda• 1 year ago

Diagnostics only really tells you that something is happening but not why; and it is so impractical if not impossible to observe mechanisms of action for much of the body.

Heck, we don’t even know the mechanism of action for acetominophen, and that’s one of the most popular, oldest OTC drugs out there.

deelowe3• 1 year ago

My brother is a mechanic and he definitely goes on technet to review a checklist when doing diagnostics. Especially on cars he doesn't see a ton

Spivak• 1 year ago

Yeah, how can this take possibly be on HN when this approach works on software. We even manufacture the population samples ourselves (fuzzing).

neves• 1 year ago

What is Technet? I've googled it, but there are just a bunch of generic sites.

SoftTalker• 1 year ago

I don't know about the name "technet" in particular but there are services that aggregate technical service bulletins released by car manufacturers to make them more easily available to independent (non-dealer) mechanics.

Matumio• 1 year ago

This kind of thinking, that everything can be broken down into pieces and studied in isolation... it has brought us very far, but it has some hard limitations. Especially in biology, where any leak you find may serve some function.

In medicine, the primary goal is to help, rather than understanding why something works exactly. Sure, understanding is an important goal too, it's just much harder to achieve than being able to help. And less important than knowing that your treatment will work, without any major side-effects, for the kind of patient in front of you.

theptip2• 1 year ago

Atomization vs gestalt is mostly orthogonal to the point here.

Taking an extreme example to illustrate the point, if you could image every atom in the body you’d have the opportunity to understand the whole-system dynamics, or try to isolate subsystems if that helps.

In medicine, the primary goal is to help, rather than understanding why something works exactly.

Right. My point is that each phenotype is different, and so understanding the individual will allow you to help them more.

drumttocs8• 1 year ago

The other difference, of course, is that the mechanic can just RTFM

pif• 1 year ago

Please, do not compare an engineer working on something built by humans with publicly available documentation, and a scientist working on something built by nature without event a single hint of documentation, nor assurance of any logic behind.

They work in different contexts, with wildly different constraints and wildly different expected outcomes.

jdyer9• 1 year ago

Nitpicking on the mechanic point, but this is pretty common, just not at the same level of detail as medicine. Certain brands, models, and parts are more likely to fail in certain ways, so if a model comes in with symptoms of a known, high frequency problem, many times that work will be done first rather than taking more of the car apart to inspect individual parts.

Certainly I didn't think there's huge bodies of work on those statistics the same way there is for medicine, but any car repair forum online will give you some sense of this

LegNeato• 1 year ago

I worked at an auto parts retailer growing up in high school. I had very basic knowledge of cars. After working there for a year, someone could come in and describe what they were seeing and hearing and 80% of the time I could tell them what is wrong and what is needed. You'd be surprised at how a large population is similar for different 'paths' through the problem and solution space

xnx• 1 year ago

As the joke goes, doctors/surgeons have to keep the "engine" running the whole time they are trying to fix it. I'm not sure how useful the mechanic analogy is.

derefr• 1 year ago

The theory here is largely mechanical; and it’s not just psychiatrists like Scott who are weak at mechanical explanations; it’s doctors in general as well as medical researchers and biologists.

A tangent here, about not just "mechanical" explanations, but "mechanical" treatments —

IMHO, the insistence in modern medicine on treating recurrent bacterial infections purely with antibiotics is wrongheaded, and the cause of a lot of resistant strains of bacteria. Especially for topical/mucosal/epithelial infections, where the infected tissue is accessible without invasive surgery.

In a recurrent bacterial infection, the reservoir of the infection is one or more (almost always macro-scale) biofilms or plaques. And antibiotics just don't do much to biofilms/plaques. (If they could, you could spray Lysol on the walls of an under-ventilated shower that's developed "pink slime" biofilms — and all the slime would dissolve, or detach and run down the drain. But it doesn't do that, does it?)

Even if you kill most of the bacteria, the biofilm itself — the "fortress" of polymerized sugars which the bacterial cells have secreted to secure their position — is not destroyed by antimicrobal compounds. And the few bacteria that remain have a great position to regrow from.

What does work to clean a slimy shower wall?

Scrubbing. Scraping. Peeling. Together with targeted chemicals, that 1. get water out of the polymer (because these biofilm surface polymers are often lubricative when wet, and thus resistant to abrasion — but this effect breaks down when dry), and 2. rough up the surface of the biofilm/plaque a bit, to get a better grip on it.

Biofilms and plaques adhere to themselves — so, when you can break the biofilm or plaque into chunks, you can then get entire chunks out. (And also, by removing chunks, you create paths for antimicrobials to then get past the biofilm surface polymer. You're breaching the fortress.)

If you picture a strep-throat infection — spots on the tonsils and on the throat, etc — those spots aren't a symptom; they are "the enemy" you're trying to fight. Remove them — mechanically! — and you go from using antibiotics (picture tiny cellular infantrymen) to effectively "fight a war of attrition against an enemy with a secure position", to "a defeat in detail of an enemy with nowhere to hide."

---

Interestingly, there are certain medical specialties that think mechanically about infection.

• Dentists, obviously, know that you must abraid dental plaque away. There's no chemical that you can put in your mouth every day that will keep plaque from forming, or reduce it once it has formed. (In fact, ironically, antimicrobial oral rinses [of e.g. chlorhexidine] accelerate plaque formation, because bacterial cells killed "in place" inside their biofilm fortresses will deposit and enrich the surface polymer layer of the biofilm — much as dead sea creatures deposit and enrich limestone sediment.)

• Audiologists know that there's ultimately nothing you can do with drugs or topical treatments to get an ear clear of wax+fat+dust+anything else trapped in there. You have to go digging. Chemicals can soften the wax, to make it easier to remove; but, due to the shape of the ear, and the lack of ability to "come in from behind" (there's an eardrum in the way!), the softened wax will never come out on its own.

• Dermatologists know that a cyst can't just be drained + treated with antibiotics. The body forms a defensive pocket around a cyst — but the inside surface of this pocket ironically provides the perfect medium for a biofilm to grow on, and thus for an infection to recur after drainage. Cysts are only considered well-treated if the pocket itself is removed — thus removing the biofilm.

...and yet, when you look at most other disciplines, you see completely the opposite.

• An ENT is very much not willing to abraid biofilms out of your sinuses or throat "if they can help it", despite those surfaces being accessible to an endoscope without breaking past any barriers. They will always try first to treat "pharmacodynamically", with e.g. oral antibiotics + an antimicrobial sinus rinse — presumably in the hopes that you'll accidentally do something mechanically in the process of treatment (e.g. snorting really hard to get the remnants of the rinse out) that will dislodge the biofilm. You have to go through years of back-and-forth with an ENT before they'll actually bother to look further up inside your sinuses than they can see with an otoscope/anterior rhinoscope. (And IMHO this is why so many people suffer from idiopathic chronic sinusitis, developing into nasal polyps et al. Nobody's ever been willing to go deep up their nose with an endoscope, find impacted biofilm plaques, and say "alright, let's clear those out.")

• Kidney stones, once symptomatic, are treated ultrasonically (lithotripsy); but the thinking on follow-up prevention is entirely about preventing accretion — not in removing the cause. [In many cases, the cause of (struvite or apatite) kidney and/or urinary stones, is very likely a bacterial biofilm within the kidney, spalling off bits of biofilm, which denature into plaques after exposure to the harsh pH of the kidney/uterer/bladder; get caught on some tissue; and then act as nucleation sites for mineralization (stone formation) as dissolved minerals pass through.] Once someone gets one kidney stone, they are generally thought to just be "prone to kidney stones", and will likely get them randomly for the rest of their life. A lot like the old — pre-infectious-origin — thinking that someone can be "prone to peptic ulcers"!

bawana3• 1 year ago

Unmentioned is the significance of dietary modificatioon. In one study, Japanese men had 10% of the incidience of problematic bph as americans. The offspring of the japanese in Hawaii had half the iincidence. The second generation had no difference. The analysis suggested that phytoestrogens in tofu, tempeh,etc are responsible of prostatic involution.

Animal fat contains elevated levels of lipid soluble hormones and diets high in fat (meat) are associated w bph as well as elevated risk of prostate ca.

Finally, this craze of T replacement is greatly increasing the risk of symptomatic bph (along with other cardiovascular risk factors)

loeg2• 1 year ago

Finally, this craze of T replacement is greatly increasing the risk of symptomatic bph (along with other cardiovascular risk factors)

TRT does not increase the risk of BPH; this is discussed in the article, along with a hypothetical mechanism. Nor does TRT seem to have CVD risk.

qmr2• 1 year ago

craze of T replacement

Please explain how it's a "craze".

T levels and sperm count are tanking. Possibly from micro plastics.

alejohausner2• 1 year ago

This work by Gat and Gornish gives a great explanation for prostate enlargement. There's an article by Donaldson [1] that suggests a connection to vitamin K2:

A large study from 2014 by Nimptsch et al found a strong inverse correlation between intake of vitamin K2 and prostate cancer [2]. Dairy foods with K2 had the most effect (K2 is soluble in butterfat).

Vitamin K2 helps remove calcium from the elastin in artery and vein walls, reducing their stiffness. Donaldson hypothesizes that K2 improves venous flow, and hence might reduce the varicoceles that lead to too much free testosterone getting to the prostate and causing enlargement.

So eat more grass-fed butter, or take a K2 supplement. At worst, you might also improve your bone strength. At best, men might prevent prostate cancer.

1: DOI: 10.1016/j.mehy.2014.12.028

2: DOI: 10.1093/ajcn/87.4.985

kmbfjr• 1 year ago

I had my prostate removed six weeks ago due to Gleason 8 score cancer. The pathology revealed an aggressive cancer.

My prostate was not enlarged, my PSA at the end was 4.2. Only because my doctor was overly cautious about the slope of the PSA rise did he send me for an MRI starting the diagnosis. It remains to be seen if it escaped containment.

The point here is, I don’t think enlargement and cancer are that intertwined. Cancer happens for any number of reasons, pinning hope that it can be staved off by diet and vitamins seems to ignore tons of other environmental factors.

xxbondsxx• 1 year ago

I hope you'll be OK!

alejohausner2• 1 year ago

Wow, that sounds scary. I hope it doesn't come back. Weird about the 4.2 PSA; that wouldn't have raised alarms, normally. I guess acceleration is as important as absolute values.

brigandish3• 1 year ago

All the best. I had a check up for prostate cancer recently, and fortunately have been told I don't have it, but until that moment I felt the stress of wondering and worrying, so you have my sympathy.

I'm also glad you found a good doctor, the first I found did no checks at all. Told me I'm too young to have any problems (I'm definitely not) and sent me away with some herbal medicine and all that stress I mentioned. The second doctor I found was thorough and reassuring, and shocked by the behaviour of the first.

damnitbuilds• 1 year ago

TL;DR: Very likely not.

vakde• 1 year ago

Did no one check the base website (yarchive.net)?

He's archived a mindbogglingly large number of usenet posts, each being extremely high signal

bccdee2• 1 year ago

Good article, but very weird to scroll to the bottom and see "(c) Norman Yarvin" at the bottom. Curtis Yarvin's brother wrote this. I don't have an opinion about that, I just find it strange.

gwking• 1 year ago

I merely saw the domain name 'yarchive' and had a strange inkling that there might be a connection. A quick search yielded this: https://unlimitedhangout.com/2021/08/investigative-reports/t....

I have no opinion of unlimitedhangout.com or the veracity of that article. But in response to "I just find it strange", I'm beginning to associate this sort of intensely intellectual inquiry into disparate topics with equally intense political positions.

I was first introduced to Urbit as if it was a purely technical, humorous and extremely nerdy lark. It was a joke thing my friend got me to sign up for, to own a slice of an imaginary universe (in a quantity called a "frigate" or whatever it was). When I learned years later about how serious the worldview behind it was, I was quite shocked.

Since then, and especially since the NYT outing of Scott Alexander in 2020, I've become more attuned to the pattern. These hyper-analytical blogs often come with a lot of political implications below the surface.

Again, I'm not taking sides here. If anything, the takeaway for me is that the world is very complicated. We have these rare polymath personalities who go deep into topics, have a strong voice on the internet, and they end up with all sorts of valid criticisms of the status quo. This in turn can align with extreme political views.

bccdee2• 1 year ago

I say I "just find it strange" because I was hesitant to tar Norman Yarvin with the same brush I'd use for his brother. Curtis Yarvin is a freak, but I figured it would be entirely possible that his brother was just a normal guy on the internet with weird relatives.

Judging by the article you posted, though…

When talking about Nigerian Scammers in the online chat room, Norman Yarvin is recorded as making statements like: “I think everyone charged with a crime is entitled to a fair trial and the presumption of innocence, but I also think things would be a lot better if habitual criminals like scammers were executed in a timely manner, say within a week of their trials. Hanging 1% of the population would probably eliminate 99% of the actual crime [...]"
In another piece Norman published on his own website, he blamed Social Security programmes for Germany’s social decline leading up to World War II. [...] Some of Norman’s carefully worded crypto-contrarianism will be familiar to anybody who has read the work of Curtis Yarvin and those observers of Mencius Moldbug will find much of Norman’s take on modern history to be eerily similar.

Also apparently he's potentially linked to a terror attack? I guess I'm too prone to giving people the benefit of the doubt.

they end up with all sorts of valid criticisms of the status quo. This in turn can align with extreme political views

The thing about the status quo is that it's extremely easy to criticize. Ted Kaczynski made some solid arguments. Mao had some great points. Problems are everywhere—it's not hard to find them. You have to judge people by their solutions, and as a rule, neoreactionaries and their orbiters make flagrantly noxious prescriptions.

ryanobjc• 1 year ago

This article is literally the definition of TL;DR. It's fairly hard to get thru, I spaced and skipped the conclusion, that the treatment isn't permanent and can be undone.

SamBam• 1 year ago

I was interested through the first 20-25 paragraphs, and then the thing just kept going and going and going. It would have been fine, though, if it had some sub-headings and stuff to help guide one through.

irjustin• 1 year ago

This is incredible.

silexia• 1 year ago

Fantastically well written article. I read the entire thing in one go with my tiny attention span and learned about an interesting possible procedure.

acyou• 1 year ago

Here is my pet theory, it's not intended to be political, just thinking about evolutionary biology.

There is an optimum lifespan for peak evolutionary population fitness in any group of organisms. Too short a lifespan means not enough time to gather resources and reproduce. Too long a lifespan could mean competing with future generations for scarce resources, which might in theory marginally improve individual fitness, but in the aggregate decreases overall population fitness, and is therefore not selected for.

Over billions of years, organisms evolved built-in control mechanisms to ensure that they live/survive for the optimum amount of time. The evolution of these mechanisms is driven in part by the fact that an older organism under stress being eliminated from the environment will probably improve the population fitness of close relatives.

I believe this is what cancer is. It's one of many, many built-in mechanisms, reinforced by hundreds of millions of years of evolution, to kill us off when our time has come.

So, if there are tons and tons of evolved mechanisms that exist just to knock you out when your time has come. That is the ultimate reason why men die from heart attacks: they have evolved in past generations that if they have extreme exertion at an advanced age, it's an indication that they aren't contributing to population fitness in a useful manner, and that extreme exertion would be more efficiently done by younger individuals. At an old age, they should be at the top of the food chain, guiding and educating and valued and lazy and consuming, and if they are not, better for the tribe for them to die quickly than lingering on.

And there is hope. If we can eliminate stress from our lives, we send a signal to our bodies that we will improve population fitness by continuing to exist, and our bodies may reward us. That's a big reason for longer lifespans. Better diet and moderate exercise is great for sure, but less stress makes a big difference.

But this is only one of a multitude of dynamics that is happening in the complicated system that is the existence of life, and is not necessarily a dominant dynamic.

For prostate cancer, you might get around it temporarily, but something else will get you. Lifestyle changes, medication, placebo and other interventions that reduce stress probably have a better overall shot at increasing your lifespan than any single magic bullet.

I suspect that prostate cancer has to do with being old and not having sex, if you're an older male. An older male who doesn't have sex would have lower individual fitness than an older male who does have sex, and would be competing for resources with younger individuals who might have higher evolutionary fitness. So, there's another solution to prostate cancer that doesn't involve surgery (or even necessarily having sex), I think I read another article that mentioned that, I won't spell it out.

Given that breast cancer happens more to women who have not breastfed after carrying to full term (citation needed), you can draw a parallel. Females who are decreasing population fitness by not having children, and by extension have lower individual fitness, breast cancer and ovarian cancer are some of the main mechanisms. They also think that breastfeeding reduces the risk of breast cancer. Certainly, even females that don't reproduce, but still breastfeed, probably improve population fitness, even if they don't have good individual fitness.

GoatInGrey• 1 year ago

Not to be antagonistic to your theory, I think you might find this alternative theory thought-provoking: https://osf.io/preprints/osf/smzc4_v1

varjag• 1 year ago

Fascinating. I wonder what are the consequences of long term zero gravity flight for this.

phront• 1 year ago

i am curious to know can we plan a better vein system and somehow "implement" it

abhaynayar• 1 year ago

Love the writing-style. Quite "to-the-point", without any fluff, and with a nice flow and purpose.

someonehere• 1 year ago

I’m glad we’re starting to talk about the prostate because I feel like for a long time. Men have been reluctant to talk about this more and more in society. I feel like women have their fair share problems as they get older, but men have equal amount of problems too we just don’t like to talk about it.

ycombinator_acc• 1 year ago

Just take finasteride. As a nice side effect, you won’t go bald.

learningmore• 1 year ago

Very interesting article. Well-explained.

An end to all this prostate trouble?

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