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Author: Stephen W. Leslie, MD FACS, Urologist

In the United States, costs for treating prostatic enlargement disorders are over 2 billion dollars a year. Prostate problems account for over 1.7 million annual physician office visits and result in more than 300,000 operations a year, making prostate enlargement one of the most common medical conditions to affect older men.

Various herbal preparations and other “natural” remedies have been used to treat a variety of physical ailments for centuries. Recent surveys have shown that about two thirds of us will eventually try some type of natural health remedy.

The Most Common Natural Therapies Used For Prostate Disorders

Saw Palmetto
Saw Palmetto is the most popular plant product used for prostate problems in the world. It is prepared from an extract of the berry of the American dwarf palm tree and at least 30 different companies market this extract in some form for treatment of prostatic enlargement and voiding problems. While the exact mechanism of action of Saw Palmetto is not known for sure, it has been suggested that it works in several ways including alteration – of cholesterol and testosterone (male sex hormone) metabolism, as an anti-inflammatory and as a prostatic decongestant.

While animal studies have shown shrinkage of the prostate while taking Saw Palmetto, human studies have not shown similar reductions in prostatic size. Still, these same studies suggest that Saw Palmetto extract reduces swelling and inflammation of the prostate and some studies showed a significant improvement in urinary symptoms including improved urinary flow rate, less nocturia (getting up at night to void) and reduced burning.

In 1996, a large multicenter randomized study was published which compared Saw Palmetto with Proscar (a commonly used medication for prostatic enlargement) in men with prostate trouble. After 6 months, the study found significant and similar improvement in urinary symptoms in both groups of patients suggesting that the Saw Palmetto and Proscar were roughly equivalent in treating prostatic enlargement. The Proscar group had a larger percentage decrease in the average size of the prostate (18 % compared to 6 % with Saw Palmetto) but also had more side effects, usually impotence. No adverse effects were noted with Saw Palmetto.

A systematic scientific review of all the relevant clinical data concerning Saw Palmetto was recently published in the prestigious Journal of the American Medical Association. This November 1998 landmark article evaluated 18 different studies involving 2939 men through a rigorous review process called meta-analysis. The review was hampered due to the short duration of some of the studies, different preparations of Saw Palmetto used and differences in how the improvement of urinary symptoms was measured. Nevertheless, they concluded that Saw Palmetto significantly improved urinary symptoms caused by prostatic enlargement and was roughly equal to Proscar with fewer side effects and lower costs. Improvement was noted in urinary flow rates, urgency, hesitancy, frequency, nocturia (nighttime urination) and bladder emptying ability. Again, no significant side effects or complications were associated with the use of Saw Palmetto.

Pygeum africanum
Pygeum is a derivative of the bark of a large African evergreen tree. Several short term studies have shown that Pygeum reduces urinary symptoms of hesitancy and nocturia while improving bladder emptying ability and flow rate in 66% of patients. It is thought to work as an anti-inflammatory agent and may decrease fibrous tissue buildup particularly in the bladder neck area where the prostate meets the urinary bladder.

Selenium
Selenium is a trace element that has been reported to significantly reduce the rate of prostate cancer in one European study. Those patients taking a Selenium supplement had a 66% reduction in their overall risk of prostate cancer compared to people who didn’t take the extra Selenium. While this one study cannot be considered definitive, many people and doctors (including me) are taking additional Selenium until a conclusive study can be conducted. It’s been suggested that Selenium may enhance the general health and natural immunity of the prostate. If so, it may also benefit people with prostate infections (prostatitis) and enlargement.

Other Herbal and Natural Remedies
Zinc has long been linked to the prostate where it may enhance the immune system, prevent cancer, improve overall prostatic health and exert an anti-inflammatory effect. Pumpkin seeds have been proposed as a natural source of zinc.

References and Suggested Reading:
Barry, M.: Epidemiology and Natural History of Benign Prostatic Hyperplasia. Urologic Clinics of North America. Vol. 17, pp 495-507, 1990
Barlet, A. et al: Efficacy of Pygeuni africanum Extract in the Treatment of Micturitional Disorders Due to Benign Prostatic Hyperplasia. Evaluation of Objective and Subjective Parameters. A Multicenter Randomized, Double-Blind Trial. Wiener Klinische Wochenschrift Vol. 102, pp 667-673, 1990
Bassi, P. et al: Standardized Pygeum africanum Extract in the Treatment of Benign Prostatic Hypertrophy: A Controlled Clinical Study Vs. Placebo. Minerva Urologica a Nefrologica Wisdom in Urology and Nephrology] Vol. 39, pp 45-50, 1987
Berry, SL, Coffey, DS, Walsh, PC, and Ewing, LL.: The Development of Human Benign Prostatic Hyperplasia With Age. Journal of Urology. Vol. 132, pp 474-479, 1984
Buck, AC: Phytotherapy for the Prostate. British Journal of Urology. Vol. 78, pp 325-336, 1996
Carraro, JC, Raynaud, JP, Koch, G, et al: Comparison of Phytotherapy With Finasteride in the Treatment of Benign Prostate Hyperplasia: A Randomized International Study of 1,098 Patients. Prostate. Vol. 29, pp 231-240, 1996
Champault G, Patel, JC and Bonard, AM: A Double-Blind Trial of yin Extract of the Plant Seronoa repens in Benign Prostatic Hyperplasia. British Journal of Clinical Pharmacology. Vol. 18, pp 461-462, 1984
Christensen, MM and Bruskewitz RC.: Clinical Manifestations of Benign Prostatic Hyperplasia and the Indications For Therapeutic Intervention. Urologic Clinics of North America. Vol. 17, pp 509-516, 1990
DiSilverio, F, Flammia, GP, Sciarra, A, et al: Plant Extracts in Benign Prostatic Hyperplasia. Minerva Urologica a Nefrologica [Wisdom in Urology and Nephrology] Vol. 45, pp 143-149, 1993
Dreikorn, K and Richter, R.: Conservative Nonhormonal Treatment of Patients With Benign Prostatic Hyperplasia. In: New Developments in Biosciences: Prostatic Hyperplasia. Ackerman, R. and Schroeder, FH. eds., Walter de Gruyter & Co. Publishers, Berlin Germany pp 109-131, 1989
Eisenberg, DM, Kessler, RC, Foster, C., et al: Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use. New England Journal of Medicine. Vol. 328, pp 246-252, 1993
Ernst, E.: Harmless Herbs- A Review of the Recent Literature. American Journal of Medicine. Vol. 104, pp 170-178, 1998
Feinblatt, HM and Gant, JC.: Palliative Treatment of Benign Prostatic Hypertrophy: Value of Glycine, Alanine, Glutamic Acid Combination. Journal of the Maine Medical Association. 1958
Gerber, G.: Effect of Saw Palmetto on PSA. American Urological Association Abstract, 1997
Guess, HA.: Benign Prostatic Hyperplasia Antecedents and Natural History. Epidemiology Review. Vol. 14, pp 131-153, 1992
Hendler, SS.: The Doctor’s Vitamin & Mineral Encyclopedia, Simon & Schuster, 1990 Kusche, J.: Good Clinical Practice and Phytotherapy. Methods of Experimental Clinical Pharmacology. Vol. 15, pp 241-247, 1993
Levin, RM, Riffaud, JP, Bellamy, F, et al: Protective Effect of Tadenan on Bladder Function Secondary to Partial Outlet Obstruction. Journal of Urology. Vol. 155, pp 1466-1470, 1996
Lowe, FC and Ku, JC.: Phytotherapy in Treatment of Benign Prostatic Hyperplasia: A Critical Review. Urology. Vol. 48, pp 1220, 1996
McConnell, JD, Barry, MJ and Bruskewitz, RC.: Benign Prostatic Hyperplasia. Agency for Health Care Policy and Research, Public Health Service. Clinical Practice Guideline No. 8, AHCPR publication 94-0582, 1994
Nitti, V,: Alternative Therapies for BPH: Phytotherapy. Streamline. Vol. 1, pp 7-10, 1998
Pitchford, P.: Healing With Whole Foods, Original Tradition & Modern Medicine. North Atlantic Books, 1993
Rhodes, L, Primka, RL, Berman, C, et al: Comparison of Finasteride (Proscar), A 5 Alpha Reductase Inhibitor, and Various Commercial Plant Extracts In Vitro and In Vivo 5 Alpha Reductase Inhibition. Prostate. Vol. 22, pp 43-51, 1993
Tyler, VE.: The Honest Herbal. Pharmaceutical Products Press, Third Edition, 1993
Tyler, VE.: Herbs of Choice. Pharmaceutical Products Press, 1994
Wheeler, R.: Personal Communication. Unpublished Data.
Wilt, TJ, Ishani, A, Stark, G.: Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review. Journal of the American Medical Association. Vol. 280, pp 1604-1609, 1998

This information is not approved by the Food and Drug Administration and is not intended to diagnose, treat, cure or prevent any specific or general prostate disorder.   Readers are further cautioned to consult their physician before taking any medication, over the counter remedy, including those  that can be purchased at a health food store.