November 2, 2004. Symptoms of an enlarged prostate -- known medically as benign prostatic hyperplasia (BPH) -- can range from a weak, slow urinary stream, to hesitancy and straining to urinate, to an inability to empty the bladder completely, to more serious complications including recurrent urinary tract infections and kidney damage.
The main risk factor for BPH is being over 50 years old. By age 60, 50% of all men will have BPH. By age 80, 90% of men will have BPH.
Half of all men with this condition may never develop any symptoms, but for those who do, BPH can make life miserable.
When you and your doctor have made sure you do not have more serious prostate conditions such as prostatitis or prostate cancer, simple remedies and changes in your habits may bring some relief.
The November issue of the Harvard Men's Health Watch examines the safety and effectiveness of several herbs commonly used to reduce BPH symptoms and offers practical tips that can ease living with this prostate problem.
In mild cases of BPH, doctors at Baylor Medical College say, no treatment is necessary. Even so, many men with BPH eventually do request some medical attention.
Before considering prescription drugs or any type of surgery, though, many men prefer to try over-the-counter remedies.
King of herbal BPH remedies is saw palmetto (Serenoa repens), which is derived from the berry of the American dwarf palm tree. Use of this herb for BPH is backed by experience, lore and numerous, reliable studies.
According to doctors at Harvard University, clinical trials have shown that saw palmetto reduced nighttime urination by 25% and other bothersome complaints by 28% when compared to a placebo (dummy pill)." Side effects reported are mild and not signficantly different than for men taking dummy pils. Urologists at the University of Chicago also have looked at a range of herbal remedies for BPH. In addition to saw palmetto, Pygeum africanum and beta-sitosterol are used by many patients with BPH, either alone or in combination with saw palmetto. Other plant remedies in wide use especially in Europe include
pumpkin seed (cucurbitae semen), nettle root (urticae radix), the phytosterols contained in Hypoxis rooperi, and rye pollen.
One limitation on herbal therapies is "lack of standardization of these products," the Chicago study points out. "Despite this lack of standardization and the variation in results that may be seen with herbal products," the author says, evidence from well-conducted clinical trials shows that "phytotherapeutic agents may lead to subjective and objective symptom improvement beyond a placebo effect in men with BPH."
In fact "saw palmetto causes atrophy and epithelial contraction within the prostate gland." When a swollen prostate shrinks, the effect is more than placebo.
Saw palmetto has no effect on PSA levels. This is reassuring. As Pruitt et al (below) point out (Feb 2000), "Decreasing PSA would not be desired in
a BPH medication, because it may mask
or delay the detection of prostatic carcinoma."
The November issue of Harvard Health Watch offers a few simple adjustments that can reduce the bother of BPH:
- Reduce your consumption of fluids, particularly after dinner.
- Limit your use of alcohol and caffeine, and avoid them after about 3 p.m.; both increase urine flow.
- Avoid medications that stimulate muscles in the bladder neck and prostate, as well as medications that weaken bladder contractions.
- Never pass up a chance to use the bathroom, even if your bladder does not feel full.
Physically active men have a fewer symptoms of BPH. In one recent study, walking for exercise was associated with decreased risk of BPH. Men who exercised by walking two to three hours per week had a 25% lower risk of BPH compared with men who didn't use walking for exercise.
The Harvard Men's Health Watch is available from Harvard Health Publications, the publishing division of the Harvard Medical School, www.health.harvard.edu/men
Sources: Harvard Men's Health Watch
Public Health Nutr. 2000 Dec;3(4A):459-72
Planta Med. 2001 Aug;67(6):489-500.
Benign prostatic hyperplasia treated with saw palmetto: a literature search and an experimental case study. MacPartland and Pruitt. J Am Osteopath Assoc. 2000 Feb;100(2):89-96. Review. Free full text pdf download.
Edited by J. Strax, Nov 1, 2004 last updated July 25 2005.