Phytotherapy for Enlarged Prostate

A new study investigated the effectiveness of botanicals in the treatment of urinary tract symptoms secondary to enlarged prostate.

Phytotherapy is the study of the use of extracts from natural origin as health-promoting agents. It is usually regarded as alternative medicine in the West, but is considered part of mainstream medicine in many Eastern countries.

Researchers from Northwestern University, Chicago, Illinois, examined the available data from clinical trials for certain botanicals used for lower urinary tract symptoms associated with enlarged prostate including saw palmetto (Serenoa repens), African plum (Pygeum africanum), rye pollen (Secale cereale) and South African star grass (Hypoxis rooperi).

Two systematic reviews and three clinical trials were examined in the evaluation of saw palmetto. Data from the systematic reviews showed an improvement in flow rates and symptoms. The results of one clinical trial were mixed and the remaining two trials clearly showed no effect compared to placebo.

Systematic reviews used in the evaluation of African plum, rye pollen and South African star grass showed an improvement in flow rates and symptoms compared to placebo, while rye pollen showed an improvement in symptoms but not flow rates compared to placebo.

The authors concluded that most clinical trials investigating the efficacy of botanicals suffer from well-documented methodological flaws. Saw palmetto has been clearly shown as comparable to placebo in a trial of sound methodology. They found that although preliminary results appear promising, many botanicals have yet to be evaluated in a trial of similar quality.

Comments

[mo]

It’s good to know that other options in addition to saw palmetto are being explored. Saw palmetto has been shown to improve symptoms of benign prostatic hypertrophy (BPH), such as nighttime urination, urinary flow, and overall quality of life, although it may not greatly reduce the size of the prostate. The herb may be as effective as the medication finasteride (Proscar®) and has fewer side effects. However, use of saw palmetto is not recommended in people with bleeding disorders, hormone-sensitive conditions, gastrointestinal disorders, and high blood pressure, or in people taking drugs that thin the blood such as warfarin (Coumadin®), hormonal agents such as finasteride (Proscar®, Propecia®), and blood pressure-altering agents.

[v]

It might be worth mentioning cranberry for the treatment of urinary tract infections (UTIs) here. UTIs are quite common in women but pretty rare in men, and they can result from an enlarged prostate (the blocked urine flow raises the risk of infection). There is pretty good evidence that cranberry juice can decrease UTI risk in women who have them frequently. It’s unclear if cranberry is effective in other groups (such as in men with enlarged prostates); however, it is very often recommended by mainstream doctors for preventing UTIs.

[urologist]

The problem with cranberry juice is that it most often comes in the form of a juice “cocktail,” which contains tons of sugar and only small percentage of juice. It’s best to drink 100% unsweetened cranberry juice – but it is VERY acrid (that’s why it’s usually diluted and sweetened). Those who can’t tolerate 100% cranberry juice can take cranberry capsules, but anecdotal reports suggest that they are not as effective as the juice.

[mo]

I also know people who have had success with pygeum. Pygeum (P. africanum bark extract) has been observed to moderately improve urinary symptoms associated with enlargement of the prostate gland or prostate inflammation. Numerous human studies report pygeum to significantly reduce the number of nighttime urinary episodes, urinary hesitancy, urinary frequency and pain with urination in men who experience mild-to-moderate symptoms. However, pygeum does not appear to reduce the size of the prostate gland or reverse the process of BPH. It is unclear how pygeum compares to the effectiveness or safety of other medical therapies, such as prescription drugs (eg. alpha-adrenergic blockers or 5-alpha reductase inhibitors), surgical approaches or other herbs/supplements such as saw palmetto.

[LMK]

Beta-sitosterol might also be a good therapy for BPH/urinary flow symptoms. Beta-sitosterol is one of the most common dietary phytosterols (plant sterols) found and synthesized exclusively by plants. Beta-sitosterol is classified as a non-cholesterol sterol, or neutral sterol. However, it is structurally similar to cholesterol and is the main sterol in the Western diet. Beta-sitosterol is found in fruits, vegetables, soybeans, breads, peanuts and peanut products. Beta-sitosterol is also present in bourbon and oils, such as olive, flaxseed and tuna. Plant oils contain the highest concentration of phytosterols. Nuts and seeds contain moderate amounts of phytosterols, while fruits and vegetables generally contain the lowest phytosterol concentrations.

[Leah Cohen]

Saw palmetto, pygeum and nettle root, are all great candidates for the treatment of an enlarged prostate. Saw palmetto especially is a great therapy in that the side effects and interactions profile is so favorable. Traditionally, saw palmetto was eaten as a food by native American tribes. This suggests that this plant may be safe at therapeutic doses, which may be much smaller than food doses.

[James]

What is the common treatment for BPH? Do most men who suffer from it taking a certain medication? Or are they more likely to turn to an "alternative" or "integrative" treatment like saw palmetto, cranberry juice, etc.?

I know that BPH is caused by hormonal fluctuations, such as decreases in testosterone and increases in dihydrotestosterone (DHT) and estrogen in prostate tissue.

According to some quick research I pulled, BPH affects about half of men aged over 60 and 80% of men aged 80 or older; it is considered to be a condition related to aging. Almost every man over 45 has some prostate enlargement, but symptoms are rarely felt before the age of 60.

[Shoshanna]

This reminds me of an article I read not too long ago about a large study showing that men who ate a lot of vegetables seemed to have a lower incidence of BPH. I’m always one to prefer whole foods as “therapy” over supplements or even specific herbs. There’s something in how ingredients interact with other compounds in foods that render them more potent. I’m very happy to get my antioxidants from thousands of blueberries in season rather than in a daily pill.

[ATAD]

BPH can be treated with alternative medication therapy and watchful waiting until this condition affects the patient’s quality of life. To answer Leah’s question, there are two major drug classes that are used to treat BPH, the alpha-blockers and the 5-alpha reducatase inhibitors. The alpha-blockers (Hytrin®, Cardura®, Flomax®, Minipress®, Uroxat®) are used to relieve the symptoms within a few weeks, but these effects do not correlate to the termination of the prostate enlargement. Although the 5-alpha reducase inhibitors (Proscar®, Avodart®) work by reducing the size of the enlarged prostate, they take much longer to achieve this goal, which is why alternative home remedies are used quite often. That is also why it is vital for patients with BPH to eat whole, fresh, unprocessed foods. Also, hydrotherapy and cool sitz baths may help.

[Ahollen]

I was told that selenium and vitamin E are good for prostate cancer prevention. I wonder if they have any efficacy in improving symptoms of BPH as well.

[DT]

If phytotherapy is more efficient and has fewer side effects compared to other herbs, such as saw palmetto, then it is great news. For now, I think cranberry juice is best for the treatment of UTIs beside antibiotics.

[Ariel]

For urinary tract infections, I habitually drink 100% cranberry juice, either diluted with water or with a splash of organic apple juice to undercut the strong, tart flavor. It’s better than grimacing every time I drink.

[Andy Cacossa]

Is anybody out there actually taking sawgrass extract and finding that nighttime urination has decreased?