Benign Prostatic Hyperplasia (BPH)
What is Benign Prostatic Hyperplasia?
Benign prostatic hyperplasia (BPH) is a condition of prostate gland enlargement that often causes bothersome urinary symptoms. Enlargement of the prostate can cause obstruction of the lower urinary tract and the subsequent symptoms.
BPH is caused by several factors, including reduced prostate cell regulation, hormonal imbalance (abundance of dihydrotestosterone or estrogens), and increased levels of insulin-like growth factors and inflammatory markers.
Natural interventions such as saw palmetto and beta-sitosterol may help keep the prostate healthy to prevent the development and/or progression of BPH.
What are the Risk Factors for Benign Prostatic Hyperplasia?
- Advanced age (more than 80% of men in their 70s have BPH)
- Ethnicity (lower risk in Asian men, higher risk in Caucasian and Afro-Caribbean men)
What are the Signs and Symptoms of Benign Prostatic Hyperplasia?
- Weak urinary stream
- Urinary hesitancy (delayed initiation of urination)
- Involuntary cessation of urination
- Straining to void
- Feeling of incomplete emptying of the bladder
- Increased frequency or urgency to urinate
- Nighttime urination
- Painful urination
What are the Conventional Medical Treatments for Benign Prostatic Hyperplasia?
- In men with mild BPH, “watchful waiting” may be appropriate – annual exams and completion of the American Urological Association Symptoms Index (AUASI)
- In men with moderate-to-severe BPH, pharmacological treatment can be considered:
- α1-adrenergic receptor blockers such as alfuzosin (Uroxatral) and terazosin
- 5α-reductase inhibitors such as finasteride (eg, Proscar, Propecia) and dutasteride (Avodart)
- Antimuscarinics such as darifenacin (Enablex) and tolterodine (eg, Detrol)
- Phosphodiesterase-5 inhibitors such as tadalafil (Cialis)
- Surgery to remove the prostate or reduce its size
What are Emerging Therapies for Benign Prostatic Hyperplasia?
- Botulinum toxin relaxes muscles by preventing acetylcholine signaling. For this reason, intraprostatic botulinum toxin injections may relax the excessive smooth muscle contractions associated with BPH to relieve some urinary symptoms.
What Dietary and Lifestyle Changes Can Be Beneficial for Benign Prostatic Hyperplasia?
The following may reduce the risk of developing BPH:
- Diet high in vegetables and fruit and low in red meat and calories
- Maintaining a healthy body weight and blood sugar levels
- Physical activity and exercise
- Maintaining sufficient vitamin D levels
What Natural Interventions May Be Beneficial for Benign Prostatic Hyperplasia?
- Saw palmetto. Saw palmetto is the most used phytotherapeutic treatment for BPH. A pilot study found that supplementation reduced symptoms by 50%.
- Beta-sitosterol. Beta-sitosterol is a plant-derived compound similar to cholesterol. It has been shown to improve BPH symptoms in several clinical studies.
- Pygeum africanum. Also known as African plum, P. africanum may prevent the growth of prostate cells. Moderate relief of urinary symptoms was seen in subjects with BPH who were treated with African plum.
- Rye pollen. Rye pollen extract has been shown to reduce nighttime urination, improve urinary flow rate, and shrink the prostate.
- Stinging nettle. Stinging nettle, either alone or in combination with saw palmetto, has been shown to improve BPH symptoms.
- Isoflavones. Soy isoflavones were found to reduce PSA levels in men with prostate cancer. Isoflavones may inhibit testosterone-mediated prostate cell growth.
- Pumpkin seed oil. Pumpkin seeds contain compounds that may interfere with the action of dihydrotestosterone. One study showed that pumpkin seed oil reduced BPH symptoms in a select population.
- Lycopene. Lycopene is a carotenoid that occurs abundantly in tomatoes. Men with higher lycopene levels are less likely to develop prostate cancer, and supplementation may decrease the growth of prostate cancer.
- Essential fatty acids. Fatty acids such as eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and gamma-linolenic acid (GLA) may support prostate health.
- Other natural interventions such as flaxseed oil and lignan extract, Boswellia serrata, selenium, garlic, and beta-carotene and vitamin C may improve prostate health and reduce the risk of developing BPH.