Benign Prostatic Hypertrophy

My favorite is clearly saw palmetto since it costs only $6/month ( www.iherb.com Now Foods 160 mg. one twice a day #240/bottle).  It doesn't harm fertility and has fewer side-effects than various prescriptions medicines covered below.  Patients on Proscar, the most popular medication, developed erectile dysfunction four times more often than those on saw palmetto.   

BPH Increases with EPA, DHA, Arachidonic: Intakes of eicosapentaenoic, docosahexaenoic, and arachidonic acids were associated with a moderate increase in risk of total BPH. Am J Clin Nutr 2002 Apr;75(4):689-97

Benign Prostatic Hypertrophy: Meds: Finasteride (Proscar) 5 mg/d costs $63.23 per month. It inhibits the enzyme catalyzing testosterone to dihydrotestosterone reducing the size of the prostate in 6-12 months with improved flow. Terazosin (Hytrin) $42.19 for 2-10 mg (same price all pills) alpha1-adrenoreceptor blocker for HBP rapid relaxes smooth muscle in bladder neck, and prostate and prostatic urethra improving flow. Hypotension is possible. Doxazosin (Cardura) same ($28-31) at 2-8 mg. Tamsulosin (Flomax) 0.4-0.8 ($39-78) claims preferential to alpha-1 in prostate but can also cause dizzy and orthostatic. Cimetidine increases the concentration. Half-life 14 hr. Med Let 10/10/97. Saw Palmetto is better, far fewer side-effects, and much cheaper.

Herbs for BPH: Besides saw palmetto, pumpkin seeds, stinging nettle root, rye pollen, Hypoxis rooperi are used in Germany.

Cernitin Helps: 12 week study 126 mg/TID with improve flow, decreased symptoms. No change volume of prostate but those on cernitin for 1 yr had 15% decreased volume. Decreased residual volume. 85% of 79 pt reported some benefit at 12 wk. Cernitin is flower pollen extract. Yasumoto, Osaka, Clin Ther ’95;17:82. Inhibits prostate cell cultures in vitro, maybe including prostate CA. Habib, Br J Urol ’90;66:393. Decreased cholesterol, increased HDL, decreased plaque formation considerably in rats and increased liver P-450 98%. Atherosclerosis ’86;62:39. Has been used successfully in a few animal toxicology studies, e.g. ammonium flouride. Promoted in a book "The Prostate Cure, 1998, Crown Publ by HG Preuss

Erectile Dysfunction: Benign Prostatic Hypertrophy Increases:  In the 4-year DB PC Proscar Long-Term Efficacy and Safety Study of 3,040 men with moderate to severe lower urinary tract symptoms and an enlarged prostate gland, at baseline every 1 point increase in benign prostatic hypertrophy urinary symptom score was associated with a 2% increased risk of erectile dysfunction (ED) even after controlling for age (p <0.001). At 48 months in placebo but not in finasteride treated men a 1-unit decrease in quasi-AUASS was associated with a slight but statistically significant decrease in ED. No association existed between increasing PSA and ED. The relationship among lower urinary tract symptoms, prostate specific antigen and erectile dysfunction in men with benign prostatic hyperplasia: results from the proscar long-term efficacy and safety study. Paick SH, Meehan A, et al. University of Washington, Seattle. Ed: Since finasteride seems to prevent both BPH and more ED, I expect that saw palmetto would, too. 

Proscar-Cardura Better for BPH: Medical Therapy of Prostatic Symptoms (MTOPS) Trial 5000 men 4.5 yr found that compared to placebo the 5 -reductase inhibitor finasteride 5mg/d (Proscar) and -1 receptor blocker doxazosin 8mg/d (Cardura) together reduced the risk of BPH progression by 67 percent. The risk of progression was reduced by 39 percent with doxazosin alone and by 34 percent with finasteride alone. An estimated 9 million men suffer from BPH symptoms, and about 400,000 have surgery each year. 5/28/02 Urology Assoc Meeting, Nyberg, Natl Inst Diabetes, NIH

Sabal Fruit and Urtica Root Helped: In a 24-week DB PC study of 257 patients with benign prostatic hypertrophy, those taking a combination of 160 mg sabal fruit extract WS 1473 and 120 mg urtica root extract WS 1031 per capsule (PRO 160/120) had a substantially higher total score reduction in prostate symptoms (6 points vs 4 points; P=0.003) at 24 weeks with a tendency in the same direction after 16 weeks. This applied to obstructive as well as to irritative symptoms, and to patients with moderate or severe symptoms at baseline. Patients randomized to placebo showed a marked improvement in LUTS (as measured by the I-PSS) after being switched to PRO 160/120 during the control period (P=0.01, one tailed, in comparison to those who had been treated with PRO 160/120 in the double-blind phase). The tolerability of PRO 160/120 was comparable to the placebo. The tolerability of the herbal extract was excellent. Long-term efficacy and safety of a combination of sabal and urtica extract for lower urinary tract symptoms-a placebo-controlled, double-blind, multicenter trial. Lopatkin N, Sivkov A, et al. Moscow, Russia, . World J Urol. 2005 Jun 1

Saw Palmetto Inhibits Alpha1-Adreno receptors: Inhibits tamsulosin binding to human prostatic adreno-receptors and prasozin binding to human alpha1A and 1B adrenoreceptors. Univ Essen, Prostate 2/99;38:208

Saw Palmetto Helps BPH: Review of 18 controlled trials of 2939 men with 16 DB averaging 9 week duration. Did as well as finasteride with fewer side-effects including less erectile dysfunction (4% vs. 1.1%). Side-effects mild and infrequent. Need for long-term studies. TJ Wilt, Minneapolis VA, JAMA 11/11/98. 40% 70yos with BPH. Side-effects mild and similar to placebo. From extract of dried berries of Serenoa repens. PubMed search Saw Palmetto 3/29/99.

Saw Palmetto Didn't Help  In a 1-year DB PC study of 229 men with moderate to severe BPH, there was no benefit from saw palmetto. New Eng J Med 2006 Feb 9;354(6):557-66.

Saw Palmetto Improved Symptoms Without Affecting Functioning: In a DB PC 6 month study of 47 patients, there was no effect on maximum flow, or residual volume. There was a 50% decrease in BPH symptoms: after 2 months = 21%, 4 mo. = 30%, and 6 mo = 46%. Use 160 mg twice a day. Gerber, Univ Chicago, Urology, 6/98;51:1003