Common Prostate Problems: Tiny But Troublesome

By: Michael Lam, MD, MPH


Prostate Introduction

Studies show that almost 90% of men do not know where their prostate is located or signs of common prostate problems.If you are a male and you live long enough, you’re going to experience one or more common prostate problems. It’s a natural consequence of aging. Men need to be aware that their prostate can cause them some significant symptoms. Some 180,000 American men this year will be diagnosed with prostate cancer. Celebrities afflicted by this disease include U.S. Senator Bob Dole, golf legend Arnold Palmer, comedian Jerry Lewis, and race car driver great Richard Petty. 34,000 Americans will die from the disease. Prostate cancer is the leading non-skin cancer in men. You have a higher chance of something going wrong with your prostate than any other organ in your body, and yet people don’t think about that or other common prostate problems.

Prostate 101

Few men ever consider the walnut-sized gland located just below the bladder, until it starts to give them trouble. In fact, a 1995 survey in the London Times found that 89% of the men surveyed did not even know where the prostate was located.

The prostate is a single, doughnut-shaped gland about the size of a walnut that lies below the bladder and surrounds the urethra. It secretes a thin, milky fluid that increases sperm motility and lubricates the urethra to prevent infection. The fluid is extremely important for successful fertilization of the egg.

Common Prostate Problems

After the age of 50, the prostate begins to hypertrophy, or increase in size. This condition is known as benign prostatic hypertrophy (BPH). The urethra (the tube that carries urine from the bladder) runs through the middle of the prostate. Consequently, when the prostate enlarges, the urethra is squeezed and therefore compressed. This can pinch off the flow of urine, cause difficulty in urinating, and make many men get up three or four times during the night to urinate. Most men don’t know enough about the symptoms. Many think that it’s just normal aging if you’re getting up four to five times a night to go to the bathroom. But it’s just not the case. In reality, they are having common prostate problems and they do not even know about it.

Other common prostate problems and symptoms of BPH include hesitancy, dribbling, reduced force of the urinary stream, and occasional bleeding or infection. This condition may even proceed to the point of complete urinary obstruction, which is a surgical emergency.

5 to 10% of men at age thirty are already affected by this disease. 50% of men between 40-60 years of age suffer from BPH, escalating to 90% of men by age 85. If you live long enough, you are going to get it.

Your prostate and common prostate problems.Fortunately, BPH is not deadly and can be treated. Untreated BPH can lead to more serious complications such as urinary tract infection and kidney damage. Severe cases of BPH may even require surgery.

BPH is a medical diagnosis requiring professional expertise of a qualified physician. Diagnosis is by digital rectal exam, where the prostate gland feels boggy and may be two to three times larger than normal. Definitive diagnosis of BPH can be made with ultrasound measurement. To differentiate between prostate cancer and BPH, as the symptoms can be similar, a blood test called PSA (prostate-specific antigen) is used. The PSA test is regarded as a highly significant and sensitive marker for prostate cancer. The normal value for PSA is less than 4 ng/ml. A level above 10 ng/ml is highly indicative of prostate cancer with a sensitivity of over 90 percent.

Causes of Prostatic Hypertrophy or Prostate Cancer

Conventional medical thinking holds that both prostatic hypertrophy and prostate cancer are due to or are promoted by testosterone and/or dihydrotestosterone (DHT). This increase in levels of testosterone and DHT is largely due to a decreased rate of removal combined with an increase in the activity of the enzyme 5-alpha-redcutase, which converts testosterone to DHT and is one of the common prostate problems. Consequently, standard medical therapy for these conditions includes blocking DHT formation by drugs, avoiding testosterone replacement, or (in the case of prostate cancer) orchiectomy (surgical removal of the testicles) to reduce testosterone output. This hypothesis is not without its flaws. Some researches, such as Dr. William Campbell Douglass, a pioneer in alternative medicine, supports the opposite hypothesis that testosterone actually is protective against prostate cancer and reduction in common prostate problems.

Another researcher, Dr. B. de Lignieres, conducted a nearly two-year survey of men aged 55-70 years of age who were treated with testosterone. He found that high levels of testosterone induced a number of clinical benefits while reducing prostate size and prostate-related symptomatology.

Dr. G. Debled, a European urologist, also believes that testosterone deficiency, rather than excess DHT, is a major causative factor of BPH. In fact, Dr. Debled uses testosterone to treat BPH. Furthermore, Dr Debled reports that in over 20 years of administering testosterone for patients with BPH, he has not had a single case of prostate cancer develop – despite the fact that approximately 50 cases should have been discovered, based on statistical averages alone.

The final jury is still out on this controversy. It is clear that the link between testosterone and prostate cancer is not that firmly established, even among the most mainstream of medical communities.

Therapeutic Options for Common Prostate Problems and BPH

Surgical

Surgery, your prostate, and common prostate problemsUntil recently, a surgical procedure called TURP (trans-urethral resection of the prostate) was about the only solution for this troublesome condition. This procedure can be complicated and is uncomfortable. Fortunately, less invasive and more physiological approaches to prevent and treat BPH are now available. Surgical intervention is therefore reserved as a modality of last resort.

Drugs

Proscar© is a prescription drug, which inhibits 5-alpha-reductase. Use of Proscar© results in a 20% decrease in prostate size in 50% of the men who are treated, according to clinical studies. Proscar© is fairly expensive and carries significant side effects of sexual dysfunction. Fortunately, there are botanicals that provide, without adverse effects, equivalent or greater benefits at reduced cost.

Botanicals

Plant-based medicines are much more popular prescriptions in Europe than synthetic drugs in treating BPH and other common prostate problems. Plant extracts account for more than 90 percent of all medications used in the medical management of BPH. In Italy, plant extracts account for roughly 50 percent of all medications prescribed for BPH, while alpha-blockers and 5-alpha-reductase-inhibitors account for only 5.1 percent and 4.8 percent, respectively.

The chances of clinical success with any of the botanical treatments of BPH or other common prostate problems appears to be directly related to the degree of obstruction as measured by the residual urine content. For levels below 50 ml, the results are usually excellent. For levels between 50 and 100 ml, the results are usually good. For residual levels between 100 and 150ml, it is difficult to produce results within the customary 6 to 8 weeks treatment period. If the level is above 150 ml, it is unlikely that botanicals can be of much help. Surgical intervention may be considered.
There are about 30 different plant-based compounds currently available, but only a few have been widely researched.

Saw Palmetto (Serenoa repens)

Extracts of the saw palmetto berry, a native of Florida, are being used extensively throughout the world for the relief of BPH. It works by inhibiting DHT binding to cellular receptors, inhibiting 5-alpha-reductase, and interfering with prostate estrogen receptors. As a result of these effects, excellent results have been produced in numerous clinical studies. Saw palmetto is commonly used worldwide for treatment of BPH. Both the French and German governments approve lipophilic extracts of saw palmetto berries for this purpose.

Recent studies show saw palmetto (Serenoa repens) berry extract can cause enlarged prostate glands to shrink and improve urinary flow. In one landmark study conducted by Braeckman and published in Current Therapeutic Research, 305 men were given a dosage of 160 mg of saw palmetto extract twice daily. After 45 days, 83% of the participants reported improvement. After 90 days, those showing improvement increased to 88%. Maximum urinary flow and the flow rate increased, while prostate volume actually decreased. Researchers also conducted “quality of life” tests in which participants were asked to evaluate their treatment and results. Most of the participants rated their lives after treatment as either “happy” or “satisfied.” There were no serious adverse reactions from the treatments. A full 60% rated the treatment satisfactory to delighted, while only 10 percent felt unhappy about their results after 90 days of treatment. Maximum urinary flow (ml/s) increased from 9.8 to 12.2, mean urinary flow (ml/s) increased from 5.8 to 7.4, prostate volume decreased from 40,348 to 36,246 cubic ml, and the international prostate symptom score decreased from 19 to 12.4.

Saw palmetto for common prostate problemsSaw palmetto’s safety and efficacy is confirmed in another study conducted at the University of California Los Angeles School of Medicine. Researchers observed the effects of saw palmetto and placebos in 44 men between 45 and 80 years old who were diagnosed with BPH in a randomized, double-blind study. The study found that enlarged prostate tissue decreased from almost 18% to 11%. It was also noted that prostate glands shrunk by as much as 40% after treatment. Researchers concluded that saw palmetto appeared to be a safe and highly desirable option for men with moderate BPH. Of special note is that after the study was no longer blinded, 41 of the 44 men elected to continue saw palmetto therapy.

Positive results with saw palmetto have been confirmed in numerous open, as well as double-blind, placebo-controlled clinical trials in the past few decades. All of these studies demonstrated statistically significant and dramatic improvements in the symptoms of BPH, which included increased volume and rate of urine flow, alleviation of pain and night time urinations, and reduced number of voidings per day. Overall, these studies all showed a consistent benefit of saw palmetto extract, with virtually no side effects of any severe consequence. Most subjects experienced relief within days of beginning the therapy, with benefits continuing to improve over time to as much as one year. Most studies however, were terminated after 30, 60 or 90 days while the majority of the subjects elected to continue on the botanicals.

When it comes to saw palmetto, health professionals universally appear to agree that the herb is safe and effective, and there is little disagreement within the medical establishment.

A recent study compared Proscar© (a drug used to treat BPH) with saw palmetto extract. Saw palmetto extract showed reduced side effects, an equivalent or greater benefit, and reduced cost of treatment. While Proscar© typically takes up to a year to produce significant benefits, saw palmetto extracts produces better results in a much shorter period of time. The optimum dose of saw palmetto in most clinical studies was 320 mg per day.

Physicians routinely use blood prostate-specific antigen (PSA) levels to test for prostate cancer. While saw palmetto has no effect on PSA levels, Proscar© actually lowers them, which may interfere with test results and cloud the PSA test results.

Pygeum africanum

Pygeum is an evergreen tree native to Africa. Its bark has historically been used in the treatment of urinary tract disorders. Virtually all of the research on pygeum has featured a pygeum extract standardized to contain 14 percent triterpenes, including beta-sitosterol and 0.5% n-docosanol.

Extracts of the African herb Pygeum africanum have also shown impressive results in relieving symptoms of BPH. In one clinical trial, 18 patients with BPH or chronic prostatitis were studied. Many of these also had sexual disturbances. They all received an extract of pygeum for 60 days. At the end of the program, all urinary parameters that were investigated were improved, and sexual disturbances were relieved. In a placebo-controlled French trial of 120 patients, the pygeum group experienced significant reductions in the number of urinations and more complete bladder emptying with less residual volume than the control group.

Common prostate problems and pygeum barkAn international, multi-center, double-blind, controlled trial of pygeum extract in 263 patients with BPH over a 60 day period showed improved urinary symptoms in over 60 percent of the patients. Most of the clinical studies with pygeum used dosages ranging from 75-150 mg per day, although much less can be used when taken in combination with other botanicals such as saw palmetto.

In double blind-studies comparing pygeum and saw palmetto, the saw palmetto extract produced greater reduction of symptoms and was better tolerated. The two extracts have somewhat overlapping mechanisms of actions, as some of the effects on prostate secretion are not produced by saw palmetto but with pygeum. The two are often used in combination, with synergistic effect.

Stinging Nettle (Urtica dioica)

Extracts of stinging nettle are used routinely in Europe to treat BPH and common prostate problems. It appears to interact with binding DHT to cytosolic and nuclear receptors. Stinging nettle shares several mechanisms with pygeum and saw palmetto, but has several actions that are unique. Fewer studies have been conducted using this botanical alone, and the results comparing stinging nettle with saw palmetto showed that saw palmetto is a more effective agent in alleviating symptoms of BPH.

However, stinging nettle has been tested and found to be effective in BPH as a single nutrient, or in combination with pygeum and saw palmetto. Extracts of stinging nettle when used alone were superior to the placebo, but efficacy was enhanced when combined with pygeum. The dosages of stinging nettle in the clinical studies were 300 mg per day. Much less can be used in combination with other botanicals.

Diet

Diet appears to play a role in the health of the prostate gland from clinical experience and reduction in common prostate problems. It is important to avoid pesticides, increase intake of zinc, essential fatty acids and keep cholesterol level below 200 mg/dl. Zinc has been shown to inhibit the activity of 5-alpha-reductase, the enzyme that irreversibly converts testosterone to DHT. The administration of essential fatty acids (EFA) has been shown to significantly improve symptoms of many BPH patients. These effects appear to be due to the correction of an underlying EFA deficiency, since patients with BPH often have associated seminal lipid levels that are often abnormal. Cholesterol damaged by free radicals is particularly toxic and carcinogenic to the prostate. Drugs that lower cholesterol levels have been shown to have a favorable influence on BPH.

Since there have been no clinical trails on the use of diet alone in the treatment of BPH or other common prostate problems, the following diet recommendations are based mostly on clinical experience. The diet should be high in protein, low in carbohydrate, low in animal fats, and high in essential fatty acids. Focus on whole, unprocessed foods (legumes, vegetables, fruits, nuts, and seeds).

Conclusion: Common Prostate Problems

Benign Prostatic Hyperplasia (BPH) is a near universal disease of aging men. Furthermore, all men over 40 should have an annual digital rectal exam on their prostate, and men over 50 also need to have a special blood test to screen for prostate cancer. Prevention and enhancement of prostatic health with botanicals is widely practiced in Europe and has been shown to be more effective than drugs.

What men should know about their prostate and common prostate problemsDecades of studies and hundreds of clinical studies have shown that extracts from Saw palmetto, Pygeum africanum, and Stinging nettle have all demonstrated efficacy when used in the treatment and prevention of benign prostatic hypertrophy (BPH). Because of their multiplicity of actions, it should be no surprise that when these botanicals are combined, they are even more effective than when used individually. In summary, roughly 90 percent of men who have mild to moderate BPH experience some improvement in symptoms during the first four to six weeks of therapy.

In particular, saw palmetto has been shown to have very few, if any, side effects. Since it does not interfere with measuring of PSA levels, saw palmetto won’t mask cancer during PSA tests. For those who like to alleviate symptoms of BPH and common prostate problems, botanicals should be seriously consider as a first line natural alternative to drugs. For those who are keen to prevent the onset of BPH, these botanicals acts as a prophylactic and can be considered for all healthy men over 35 years old as part of a comprehensive anti-aging program.

 

References

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 56:796-817, 1995.

Braeckman J: The Extract of Serenoa repens in the Treatment of Benign Prostatic Hyperplasia: A Multicenter Open Study: Curr Ther Res 55:776-85, 1994.

Bratman S, Kroll D, et al. Natural Health Bible 2:296, Prima Publishing, 1999.

Buck AC: Phytotherapy for the Prostate. Br J Urol 78:325-36, 1996.

Cirillo-Marucco E, Pagliarulo A, Tritto G, et al: Extract of Serenoa repens (Permixon® in the Early Treatment of Prostatic Hypertrophy. Urologia 5:1269-77, 1983.

Crimi A, Russo A: Extract of Serenoa repens for the Treatment of the Functional Disturbances of Prostate Hypertrophy. Med Praxis 4:47-51, 1983.

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Gallizia F, Gallizia G: Medical Treatment of Benign Prostatic Hypertrophy with a New Phytotherapeutic Principle. Recent Med 9:461-8, 1972.

Greca P, Volpi R: Experience with a New Drug in the Medical Treatment of Prostatic Adenoma. Urologia 52:532-5, 1983.

Hart JP, Cooper W L: Vitamin F in the Treatment of Prostatic Hyperplasia Report Number 1. (Milwaukee WI: Lee Foundation for Nutritional Research), 1941.

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Horton R: Benign Prostatic Hyperplasia: A Disorder of Androgen Metabolism in the Male. J Am Geri Soc 32:380-5, 1984.

Leake A, Chisholm GD, Habib FK: The Effect of Zinc on the 5-Alpha-Reduction of Testosterone by the Hyperplastic Human Prostate Gland. J Steroid Biochem 20:651-5, 1984.

Lhez A, Leguevague G: Clinical Trials of a New Lipid-Sterolic Complex of Vegetal Origin in the Treatment of Prostatic Adenoma. Vie Medicale pp.5399-5404, December 1970.

Lininger S: The Natural Pharmacy. Prima Publishing, 1998.

Marks L, Partin A, Epstein J, Tyler V, Simon I: Effects of saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol 163(5) 1451-6, May 2000.

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Oestering, JE: Benign Prostatic Hyperplasia: A Review of Its Histogenesis and Natural History. Prostate 6 (Suppl):67-73, 1996.

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Romics I: Observations with Bazoton in the Management of Prostatic Hyperplasia. Int Urol Nephrol 19(3):293-7, 1987.

Scott: The Lipids of the Prostatic Fluid, Seminal Plasma and Enlarged Prostate Gland of Man. J Urol 53:712-8, 1945.

Strohecker J editor: Alternative Medicine: The Definitive Guide. Future Medicine Publishing 3:737-8, 1994.

Tripodi V,Giancaspro M, Pascarella M: Treatment of Prostatic Hypertrophy with Serenoa repens Extract. Med Praxis 4:41-6, 1983.

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Common prostate problems

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