Benign Prostatic Hyperplasia

Also indexed as: BPH, Enlarged Prostate, Prostatic Hyperplasia

The prostate is a small gland that surrounds the neck of the bladder and urethra in men. Its major function is to contribute to seminal fluid. If the prostate enlarges, pressure may be put on the urethra, acting like a partial clamp and causing a variety of urinary symptoms. This condition is known as benign prostatic hyperplasia (BPH). Half of all 50-year-old men have BPH. The name “benign prostatic hyperplasia” has replaced the older term “benign prostatic hypertrophy”; both terms refer to the same condition.

Checklist for Benign Prostatic Hyperplasia

Rating Nutritional Supplements Herbs
3Stars Beta-sitosterol
Rye Pollen extract		 Saw palmetto
2Stars Amino acids (alanine, glutamic acid, glycine) Nettle
Pumpkin seeds
Pygeum
1Star Flaxseed oil
Zinc		 Copper
See also:  Homeopathic Remedies for Benign Prostatic Hyperplasia
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of BPH? A man with BPH has to urinate more often, especially at night, and experiences less force and caliber while urinating, often dribbling. If the prostate enlarges too much, urination is difficult or impossible, and the risk of urinary tract infection and kidney damage increases. A doctor can usually detect an enlarged prostate during a rectal exam.

How is it treated? Drugs are available that can decrease urinary symptoms in about half the men with BPH, although it is not clear whether these drugs slow the progression of the condition. However, one of these drugs (finasteride [Proscar®]) causes erectile dysfunction (impotence) in about 5% of men who take it. Doctors often recommend surgery when symptoms are severe or when there is a high risk of urinary obstruction. Although prostate surgery has a high success rate, it also has a higher rate of complications than drug therapy.

Lifestyle changes that may be helpful: More physically active men have a lower frequency of symptoms related to BPH. In a preliminary study, physical activity was associated with a decrease in occurrence of BPH, surgery for BPH, and symptoms of BPH.1 Walking, the most prevalent activity among men in this study, was related to a 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.

Nutritional supplements that may be helpful: Beta-sitosterol, a compound found in many edible plants, has also been found to be helpful for men with BPH. In one double-blind trial, 200 men with BPH received 20 mg of beta-sitosterol three times a day or a placebo for six months. Men receiving beta-sitosterol had a significant improvement in urinary flow and an improvement in symptoms, whereas no change was reported in men receiving the placebo.2 Another double-blind study reported similarly positive results using 130 mg per day of beta-sitosterol.3

Rye pollen extract has improved the symptoms of BPH in preliminary trials.4 5 6 Double-blind trials have also reported that rye pollen extract is effective for reducing symptoms of BPH7 8 This rye pollen extract was shown to be comparable in effect to an amino acid mixture used for BPH in a double-blind study.9 A double-blind comparison with pygeum resulted in significant subjective improvement in 78% of those given the rye pollen extract compared with 55% using pygeum.10 Research on this commercial rye pollen extract has used three to six tablets, or four capsules, per day; the effect of other pollens in men with prostate conditions has not yet been studied.

In a controlled trial, men with BPH received a supplement containing three amino acids (glycine, alanine, and glutamic acid) totaling about 760 mg three times per day for two weeks, then 380 mg three times per day for a total of three months. After three months, about half of these men reported reduced urgency, frequency, and/or less delay starting urine flow, compared to 15% or less of the men who received a placebo.11 Another similar controlled trial of this combination also reported positive results12 Although it is not known how the amino acid combination works, it is believed to reduce the amount of swelling in prostate tissue.

In a 1941 preliminary report, 19 men with BPH were given an essential fatty acid (EFA) supplement.13 In every case, the amount of retained urine was reduced, and nighttime urination problems stopped in 69% of cases. Dribbling was eliminated in 18 of the 19 men. All men also reported improved libido and a reduction in the size of the enlarged prostate, as determined by physical examination. Because this study did not include a control group and the amount given was surprisingly small, the possibility of a placebo effect cannot be ruled out.

Despite the lack of good published research, many doctors have been impressed with the effectiveness of essential fatty acids (EFAs) in cases of BPH. A typical recommendation is one tablespoon of flaxseed oil per day, perhaps reduced to one or two teaspoons per day after several months. Because taking EFAs increases the requirement for vitamin E, most doctors recommend taking a vitamin E supplement along with EFAs. However, controlled research is needed to establish whether EFAs are helpful for BPH.

Prostatic secretions are known to contain a high concentration of zinc; that observation suggests that zinc plays a role in normal prostate function. In one preliminary study, 19 men with benign prostatic hyperplasia took 150 mg of zinc daily for two months, and then 50 to 100 mg daily. In 74% of the men, the prostate became smaller.14 Because this study did not include a control group, improvements may have been due to a placebo effect. Zinc also reduced prostatic size in an animal study but only when given by local injection.15 Although the research supporting the use of zinc is weak, many doctors recommend its use. Because supplementing with large amounts of zinc (such as 30 mg per day or more) may potentially lead to copper deficiency, most doctors recommend taking 2 to 3 mg of copper per day along with zinc.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: In many parts of Europe, herbal supplements are considered standard medical treatment for BPH. Although herbs for BPH are available without prescription, men wishing to take them should be monitored by a physician.

The fat-soluble (liposterolic) extract of the saw palmetto berry has become the leading natural treatment for BPH. This extract, when used regularly, has been shown to help keep symptoms in check.16 Saw palmetto appears to inhibit 5-alpha-reductase, the enzyme that converts testosterone to its more active form, dihydrotestosterone (DHT). Saw palmetto also blocks DHT from binding in the prostate.17 Studies have used 320 mg per day of saw palmetto extract that is standardized to contain approximately 80 to 95% fatty acids.

A three-year preliminary study in Germany found that 160 mg of saw palmetto extract taken twice daily reduced nighttime urination in 73% of patients and improved urinary flow rates significantly.18 In a double-blind trial at various sites in Europe, 160 mg of saw palmetto extract taken twice per day treated BPH as effectively as finasteride without side effects, such as loss of libido.19 A one-year dose-comparison study found that 320 mg once per day was as effective as 160 mg twice per day in the treatment of BPH.20 A review of all available double-blind trials has concluded that saw palmetto is effective for treatment of men with BPH and is just as effective as, with fewer side effects than, the drug finasteride.21

Pygeum, an extract from the bark of the African tree, has been approved in Germany, France, and Italy as a remedy for BPH. Controlled studies published over the past 25 years have shown that pygeum is safe and effective for men with BPH of mild or moderate severity.22 These studies have used 50 to 100 mg of pygeum extract (standardized to contain 13% total sterols) twice per day. This herb contains three compounds that may help the prostate: pentacyclic triterpenoids, which have a diuretic action; phytosterols, which have anti-inflammatory activity; and ferulic esters, which help rid the prostate of any cholesterol deposits that accompany BPH.

Another herb for BPH is a concentrated extract made from the roots of the nettle plant. This extract may increase urinary volume and the maximum flow rate of urine in men with early-stage BPH.23 It has been successfully combined with both saw palmetto and pygeum to treat BPH in double-blind trials.24 An appropriate amount appears to be 120 mg of nettle root extract (in capsules or tablets) twice per day or 2 to 4 ml of tincture three times per day.

Pumpkin seed oil has been used in combination with saw palmetto in two double-blind human studies to effectively reduce symptoms of benign prostatic hyperplasia (BPH).25 26 Only one group of researchers has evaluated the effectiveness of pumpkin seed oil alone for BPH, but the results of their large preliminary trials have been favorable.27 28 Researchers have suggested the zinc, free fatty acid, or plant sterol content of pumpkin seeds may account for their benefit in men with BPH, but this has not been confirmed. Animal studies have shown that pumpkin seed extracts may improve the function of the bladder and urethra; this might partially account for BPH symptom relief.29 Pumpkin seed oil extracts standardized for fatty acid content have been used in BPH studies in the amount of 160 mg three times per day with meals.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Platz EA, Kawachi I, Rimm EB, et al. Physical activity and benign prostatic hyperplasia. Arch Intern Med 1998;158:2349–56.

2. Berges RR, Windeler J, Trampisch HJ, et al. Randomized, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Lancet 1995;345:1529–32.

3. Klippel KF, Hiltl DM, Schipp B. A multicentric, placebo-controlled, double-blind clinical trial of ß-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. Br J Urol 1997;80:427–32.

4. Horii A, Iwai S, Maekawa M, Tsujita M. Clinical evaluation of Cernilton in the treatment of the benign prostatic hypertrophy. Hinyokika Kiyo 1985;31:739–45 (in Japanese).

5. Ueda K, Jinno H, Tsujimura S. Clinical evaluation of Cernilton® on benign prostatic hyperplasia. Hinyokika Kiyo 1985;31:187–91 [in Japanese].

6. Hayashi J, Mitsui H, Yamakawa G, et al. Clinical evaluation of Cernilton in benign prostatic hypertrophy. Hinyokika Kiyo 1986;32:135–41 [in Japanese].

7. Buck AC, Cox R, Rees RW, et al. Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, cernilton. A double-blind, placebo-controlled study. Br J Urol 1990;66:398–404.

8. Becker H, Ebeling L. Conservative therapy of benign prostatic hyperplasia (BPH) with Cernilton. Urologe (B) 1988;28:301–6 [in German].

9. Maekawa M, Kishimoto T, Yasumoto R, et al. Clinical evaluation of Cernilton on benign prostatic hypertrophy—a multiple center double-blind study with Paraprost. Hinyokika Kiyo 1990;36:495–516 [in Japanese].

10. Dutkiewicz S. Usefulness of Cernilton® in the treatment of benign prostatic hyperplasia. Int Urol Nephrol 1996;28:49–53.

11. Damrau F. Benign prostatic hypertrophy: amino acid therapy for symptomatic relief. J Am Geriatr Soc 1962;10:426–30.

12. Feinblatt HM, Gant JC. Palliative treatment of benign prostatic hypertrophy: value of glycine, alanine, glutamic acid combination. J Maine Med Assoc 1958;46:99–102.

13. Hart JP, Cooper WL. Vitamin F in the treatment of prostatic hypertrophy. Report Number 1, Lee Foundation for Nutritional Research, Milwaukee, Wisconsin, 1941.

14. Bush IM, Berman E, Nourkayhan S, et al. Zinc and the prostate. Presented at the annual meeting of the American Medical Association Chicago, 1974.

15. Fahim MS, Fahim Z, Der R, Harman J. Zinc treatment for reduction of hyperplasia of prostate. Fed Proc 1976;35(3):361.

16. Schneider HJ, Honold E, Mashur T. Treatment of benign prostatic hyperplasia. Results of a surveillance study in the practices of urological specialists using a combined plant-base preparation. Fortschr Med 1995;113:37–40.

17. Koch E, Biber A. Pharmacological effects of sabal and urtica extracts as a basis for a rational medication of benign prostatic hyperplasia. Urologe 1994;334:90–5.

18. Bach D, Ebeling L. Long-term drug treatment of benign prostatic hyperplasia—results of a prospective 3-year multicenter study using Sabal extract IDS 89. Phytomedicine 1996;3:105–11.

19. Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate 1996;29:231–40.

20. Braeckman J, Bruhwyler J, Vandekerckhove K, Géczy J. Efficacy and safety of the extract of Serenoa repens in the treatment of benign prostatic hyperplasia: therapeutic equivalence between twice and once daily dosage forms. Phytotherapy Res 1997;11:558–63.

21. Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia. A systematic review. JAMA 1998;280:1604–9.

22. Andro MC, Riffaud JP. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia: a review of 25 years of published experience. Curr Ther Res 1995;56:796–817.

23. Koch E, Biber A. Pharmacological effects of sabal and urtica extracts as a basis for a rational medication of benign prostatic hyperplasia. Urologe 1994;334:90–5.

24. Metzker H, Kieser M, Hölscher U. Efficacy of a combined Sabal-Urtica preparation in the treatment of benign prostatic hyperplasia (BPH). Urologe [B] 1996;36:292–300.

25. Carbin BE, Eliasson R. Treatment by Curbicin in benign prostatic hyperplasia (BPH). Swed J Biol Med 1989;2:7–9 [in Swedish].

26. Carbin BE, Larsson B, Lindahl O. Treatment of benign prostatic hyperplasia with phytosterols. Br J Urol 1990;66:639–41 [in Swedish].

27. Schiebel-Schlosser G, Friederich M. Phytotherapy pf BPH with pumpkin seeds—a multicenter clinical trial. Zeits Phytother 1998;19:71–6.

28. Friederich M, Theurer C, Schiebel-Schlosser G. Prosta Fink Forte capsules in the treatment of benign prostatic hyperplasia. Multicentric surveillance study in 2245 patients. Forsch Komplementarmed Klass Naturheilkd 2000;7:200–4 [in German].

29. Zhang X, Ouyang JZ, Zhang YS, et al. Effect of the extracts of pumpkin seeds on the urodynamics of rabbits: an experimental study. J Tongji Med Univ 1994;14:235–8.