Feb. 4, 2003 -- There's a third inevitability to "death" and "taxes" for most American men -- an enlarged prostate.
Medically known as benign prostatic hyperplasia (BPH), this condition eventually affects at least 80% of men and is most common after age 50. As the usually walnut-sized prostate grows, sometimes as big as a grapefruit, it presses on the urethra (the outflow tract from the bladder), causing incomplete emptying of the bladder, a weakened urine stream, the need to urinate frequently and urgently, and most notably, frequent bathroom breaks -- especially at night. While BPH is often more bothersome than dangerous, it can result in bladder and urinary tract infections or even kidney damage.
One in three men are treated for BPH with surgery or, more commonly, prescription drugs such as Flomax or Proscar. But growing research suggests that some symptoms may be treated as effectively with over-the-counter herbal remedies -- sometimes less expensively and thus far, with no reported side effects. What's more, some of these treatments claim they may help prevent prostate cancer, the second leading cause of cancer death in men.
"I don't want to give the impression that herbal solutions are better than traditional medications, but they definitely do have their place," says Aaron Katz, MD, director of The Center for Holistic Urology at Columbia-Presbyterian Medical Center. "In the past, the role of these herbal remedies has been overlooked by many. But there is now enough laboratory and clinical evidence to recommend their use in many patients with BPH and to maintain good overall prostate health."
Katz recently reviewed dozens of recent studies on various herbs used to treat BPH for a report in the December 2002 issue of The Journal of Alternative and Complementary Medicine. "While I would generally recommend pharmaceuticals to patients with more severe symptoms, these herbs can definitely improve mild to moderate BPH symptoms in many men," he tells WebMD.
Saw palmetto is the leading herbal treatment for BPH and among the best selling of all herbal products, with annual U.S. sales of more than $25 million, according to the American Botanical Council.
"Saw palmetto is usually the first line of therapy against BPH -- at least by patients or their spouses," quips Franklin Lowe, MD, MPH, associate director of the Department of Urology at St. Luke's/Roosevelt Hospital and chairman of the American Urological Association's Complementary & Alternative Medicine Committee. "Most patients are taking it before they come to their urologist's office to find out if they should be taking it." Still, many urologists endorse it use for patients with early, troubling symptoms.
Pros: This herb brings relief in about one in three patients, with a suspected effect similar to Proscar, by blocking the production of a hormone that causes the prostate to grow. "Nobody really knows exactly why it works, because studies are conflicted on the suspected mechanism," says urologist Eric K. Seaman, MD, FACS. "What is clear is that it helps a lot of people, and there is no documented evidence of any side effects. I know a urologist who was waking up at least three times a night because of BPH, and since taking saw palmetto, he's up only once a night. So even if the majority of patients don't get a benefit, they don't lose anything either other than a few dollars."
Cons: One possible explanation for why the majority of patients don't get relief? The active ingredient of saw palmetto -- like its exact mechanism -- hasn't been identified, so different formulations may produce different results, says Katz.
Red clover has long been used as an alternative treatment for a variety of conditions -- from menopausal hot flashes to psoriasis -- because it is rich in isoflavones, a protein found in soybeans. Not only is this believed to help inhibit prostate and other cancer tumors, it could help treat BPH. A product commercially sold as Trinovin (and whose manufacturer paid for Katz's study) has been found in several trials to improve urine flow and decrease symptoms by as much as 23%.
Pros: Isoflavones are suspected of helping more than BPH, but Trinovin contains four types believed to be powerful for overall health and in treating BPH and reducing prostate cancer risk.
Cons: Some studies suggest that improvements are most noticeable after one month and then continue at a much slower rate. Little or no improvement is noticed at varying doses.
Soy contains high concentrations of the same isoflavones found in red clover and is often cited as a reason why Japanese men rarely get prostate cancer.
Pros: Also believed to offers many health benefits and strong evidence of reducing prostate cancer.
Cons: For maximum benefit, it's recommend that men consume eight ounces of soy foods daily, which is impractical and would create severe gas problems, says Katz.
African tree bark (pygeum africanum) is so popular in Europe and Africa that the tree from which this treatment is harvested is now on the endangered list.
Pros: Studies show it brings relief, but how? Some show it relieves symptoms by reducing prostate swelling, while others indicate it may reduce inflammation or inhibit growth factors associated with prostate enlargement and tumor development.
Cons: Typically not a standalone treatment, and usually used in conjunction with saw palmetto.
Of course, because they are not regulated by the FDA, some experts say that many herbal supplements vary widely in the amount of active herbal extract claimed on the label. A study presented to the American Urological Association last year found that some brands tested contained less than 15% of the active ingredient listed on their label.