by bondarchuk on 4/26/25, 8:39 AM with 315 comments
by tacon on 4/26/25, 1:55 PM
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).
by theptip on 4/26/25, 7:15 PM
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%.
by elric on 4/26/25, 11:32 AM
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).
by blainm on 4/26/25, 10:41 AM
by smitty1e on 4/26/25, 10:29 AM
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.
by alejohausner on 4/26/25, 8:24 PM
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
by raffael_de on 4/26/25, 1:57 PM
by raffael_de on 4/26/25, 11:41 AM
by bccdee on 4/26/25, 10:30 PM
by begueradj on 4/26/25, 2:40 PM
Except that you make work your prostate everyday, multiple times, since your adolescence, whereas a woman doesn't breastfeed everyday since adolescence.
by jakedata on 4/26/25, 11:46 AM
by jasonthorsness on 4/26/25, 2:51 PM
by abhaynayar on 4/27/25, 4:57 PM
by Traubenfuchs on 4/26/25, 10:42 AM
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.
by silexia on 4/27/25, 5:30 AM
by someonehere on 4/27/25, 7:29 PM
by varjag on 4/27/25, 8:58 AM
by marvel_boy on 4/26/25, 10:05 AM
by svilen_dobrev on 4/26/25, 2:08 PM
it seemed to work for me, took it for few months, 10y+ ago. "Lasted" 8-9 years.. - until recently..
by rurban on 4/26/25, 5:13 PM
by ryanobjc on 4/26/25, 11:21 PM
by bawana on 4/26/25, 3:13 PM
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.
by ycombinator_acc on 4/27/25, 8:18 PM
by learningmore on 4/28/25, 6:33 AM
by phront on 4/27/25, 1:21 PM
by vakde on 4/26/25, 9:48 PM
He's archived a mindbogglingly large number of usenet posts, each being extremely high signal
by derefr on 4/26/25, 8:05 PM
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"!
by irjustin on 4/27/25, 12:04 AM
by tpoacher on 4/26/25, 5:47 PM
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)
by acyou on 4/27/25, 6:12 AM
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.
by bawana on 4/26/25, 8:07 PM
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)
by damnitbuilds on 4/26/25, 8:36 PM
by edem on 4/26/25, 1:09 PM