Some men over the age of 50 begin to develop problems with their prostate, causing a slower start of urination or a decreased force of urine flow. This occurs because as men age, the prostate gland may become enlarged and press against the urethra, the outflow tube leading from the bladder to the penis. Extreme prostate obstruction may require an operation. The medical term for prostate enlargement is benign prostatic hyperplasia (BPH).
Medicines can help shrink the prostate or relieve obstruction. However, recent research suggests that several herbal preparations can also do this job-perhaps as effectively and with fewer side effects and lower costs.
Last year in the British medical journal Lancet, German researchers reported on a study of 200 men who had symptoms due to BPH. Half received a placebo and half 60 mg/day of beta-sitosterol.
Beta-sitosterol is one of the main active ingredients extracted from the bark of Pygeum africanum, a large evergreen tree found in the higher elevations of central and southern Africa. It is widely used to treat prostate enlargement. Beta-sitosterol or similar compounds are also present in several herbs that are used to treat the prostate. After three months, the men taking beta-sitosterol extract had a statistically significant improvement in the velocity of urine flow. Those taking the placebo did not. This large, carefully administered study lends support to previous research favoring the use of herbs for treating urinary symptoms due to prostate enlargement.
Scientists are not exactly sure how beta-sitosterol works to improve prostate symptoms. One interesting tie-in is that beta-sitosterol lowers blood cholesterol. Some researchers also believe that high cholesterol is an important factor stimulating prostate growth.
Saw palmetto (Serene repens), a member of the fan palm family and native to North America, is the most popular herb taken for BPH. Saw palmetto has one direct hormonal effect similar to that of Merck's prostate drug, Proscar,® but it also does much more-including reducing the effects of estrogen and progesterone on the prostate and inhibiting the formation of inflammatory substances that contribute to the increasing size of the prostate. Both Proscar® and saw palmetto reduce the conversion of the male hormone testosterone to its more active form, dihydrotestosterone (DHT). It's DHT, not testosterone itself, that appears to be the main hormonal stimulus for prostate enlargement.
Another herbal treatment for BPH is the root of stinging nettles (Urtica dioica), which has a limited number of double-blind studies supporting its effectiveness for use with prostate problems.
There are a few test tube studies pitting standard medicines such as Proscar® against herbal treatments for BPH. Most studies show about the same symptom improvement whether the treatment is with herbs or with medicines. Long-term studies are currently underway in Europe comparing saw palmetto to standard drug therapy for BPH.
A long-term study of prostate cancer prevention is in process using Proscar,® and an intriguing possibility is that products such as Proscar® or saw palmetto may help prevent prostate cancer. It appears that high DHT may contribute to the growth of prostate cancer; however, we don't know whether lowering DHT is an effective preventive. There is no comparable study for saw palmetto or other herbs.
Be sure your consumers inform their doctors if they wish to consider taking herbal treatments for prostate enlargement. Medical doctors need to know all important information relevant to a patient's health. Whether they "believe" in herbal medicines, knowing that a patient is interested motivates them to gather knowledge about this field.
To help customers learn more about herbal treatments for BPH, I've included recent scientific references. If your local hospital's medical library does not have these articles, the librarian can obtain a copy through the federal government's National Library of Medicine.
Richard Podell, M.D., M.P.H., is clinical professor, Department of Family Medicine at New Jersey's UMDNJ-Robert Wood Johnson Medical School.
Berges, R. "Randomized, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia," Lancet, 345:1529-32, l995.
Braeckman, J. "The extract of Serene repens benign prostatic hyperplasia: A multicenter open study," Current Therapeutic Research, 55:776-85, l994.
Carani, C. "Urological and sexual evaluation of treatment of benign prostatic disease using Pygeum africanum at high doses," Arch Ital Urol Nefrol Androl, 63:341-5, 1991 (in Italian).
DiSilero, "F. Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients," Eur Urol, 21:309-24, 1992.
Dathe, G. "Phytotherapy of benign prostatic hyperplasia (BPH) with extractum Sernoa repens," Urologe B, 31:220-23, 1991.
Dufoour, B. "Controlled study of the effects of Pygeum africanum extract on the functional symptoms of prostatic adenoma," J Ann Urol (Paris), 18:193-5, 1984 (In French).
Semino, M. "Symptomatic treatment of benign prostate hypertrophy. Comparative study of prazosin and Sernoa repens," Arch Esp Urol, 45:211-13, 1992.
Strauch, G. "Comparison of finasteride and Serenoa repens in the inhibition of 5-alpha-reductase in healthy male volunteers," Eur Urol, 26:247-52, 1994.
Tasca, A. "Treatment of obstructive symptomology caused by prostatic adenoma with an extract of Serenoa repens Double-blind clinical study vs. placebo." Minerva Urologica e Nefrologica, 37:8?-91, 1985.
Vontobe H. "Results of a double-blind-study on the effectiveness on ERU (extractum radicis Urticae) capsules in conservative treatment of benign prostatic hyperplasia," J Urologe (A), 24(1): 49-51, 1985 (German).