Benign Prostatic Hyperplasia (BPH) - Alternative Treatment | Robert A. Erickson, M.D.

Prostate gland enlargement, better know as BPH (benign prostatic hyperplasia), affects 50% of men by age 50 and 90% of men by age 90. Symptoms related to BPH are often measured with a tool developed by the American Urological Association, known as the International Prostate Symptoms Score (I-PSS). This is a self-assessment questionnaire where the patient rates the intensity or frequency of his symptoms. A score of “0” indicates there are no symptoms. The maximum score for any given symptom is “5.” A total score of 0-7 equals mild symptoms; 8-19 equals moderate symptoms; 20-35 equals severe symptoms. The symptoms are assessed as follows:

  1. Sensation of not emptying the bladder
  2. Frequency of urination
  3. Interruption of urine stream
  4. Difficulty postponing urination
  5. Weakness of urine stream
  6. Need to strain to initiate urination
  7. Frequency of urination overnight (nocturia)

Symptoms are caused by two main mechanisms. The first is prostatic tissue overgrowth, which in turn results in a narrowing of the urethral lumen. A second mechanism is increased smooth muscle tone in the muscles surrounding the prostate, urethra, and prostate stroma. FDA approved medications used to treat BPH fall into 2 categories: 1) alpha-antagonists and 2) 5-alpha-reductase inhibitors. Unfortunately, all drugs have potential side-effects. The alpha-antagonist type of drugs can cause low blood pressure, loss of consciousness, and abnormal ejaculation. The 5-alpha-reductase inhibitors work by the conversion of testosterone to DHT within the body. Side effects of this type of drug may include decreased libido, decreased semen quality during ejaculation, and impotence.

CAM (complementary and alternative medicine) therapies for the treatment of BPH are not recommended by the American Urological Association, primarily because of the unavailability of clinical research demonstrating the benefits of their use. Another issue is the lack of standardization of available products and herbs. I agree with the latter statement regarding a lack of standardization of product ingredients, but there is research data available if one looks outside the United States.

Integrative medicine physicians and herbalists have used saw palmetto extract for centuries for treating male urinary symptoms. Saw palmetto is a small, low-growing palm tree, native to Florida and parts of the southeastern USA. Native Americans have used the fruit for food and the leaf stems to make medicine baskets, and also have used it as a diuretic and sexual tonic. Saw palmetto was an official drug, listed in two editions of the United States Pharmacopoeia from 1906 to 1916 and in the National Formulary from 1926 to 1950, when its use as a therapeutic option for urinary tract disorders by the medical community declined in the USA. In the 1960s French researchers began to exam the chemical composition of saw palmetto berry and this resulted in the development of a number of proprietary products. Extracts of saw palmetto berries have been approved both by the French and German governments for the treatment of BPH. Saw palmetto berry has 5-alpha-reductase-inhibiting properties derived from it’s free fatty acids. Animal studies have also shown anti-exudative and anti-inflammatory effects as well.

A randomized trial in Shanghai, China, using saw palmetto and other ingredients was published in 2008. This study involved a total of 80 patients followed over a 3 month period of time, where 39 patients received a saw palmetto product complexed with other natural ingredients (including vitamin E, vitamin B6, zinc, selenium, copper gluconate, pumpkin seed, stinging nettles, saw palmetto 45% fatty acids, lycopene, and Pygeum africanum bark sterols along with some amino acids). The patients receiving the saw palmetto complex showed significant improvement in maximum urinary flow rate, I-PSS scores, improvement in nocturia, and also improvement in quality of life scores. There was no reduction, however, in size of the prostate gland. Significant improvement was noted at the end of 2 months with further improvement at the end of 3 months.

Another study was a meta-analysis of clinical studies (Wilt et. al., 1998) where 18 studies in Germany, France, and Italy were carefully reviewed. A total of 2,939 men with symptomatic BPH were involved. The study duration ranged from 4 to 48 weeks, with a mean duration of 9 weeks. Medicinal preparations were made of saw palmetto alone or combined with other botanicals, and the trials were placebo controlled. Two of the studies reviewed did not report results that allowed them to be included in the meta-analysis. Compared to placebo, saw palmetto produced lowered I-PSS scores, lower frequency of nocturia, and improvement in peak urine flow. When compared to finasteride (brand names Propecia, Proscar), saw palmetto users experienced similar benefits but about a 90% lower incidence of side effects. Adverse effects were “mild and infrequent” and erectile dysfunction was lower when compared to finasteride (1.1% compared to 4.9%). The authors noted that more research was needed to determine the long-term effectiveness and the ability to prevent complications associated with BPH.

At the Center, we carry Biotics Research™ Palmetto Plus Forte, which contains saw palmetto berry in a 4:1 extract, lycopene, chlorophyllins from mulberry leaf, zinc, selenium, magnesium, vitamin B6 and vitamin A.