|New Prospects for Your Prostate Health
A number of natural supplements are effective in treating enlarged prostate
By Aaron W. Jensen, Ph.D.
Few men who live a normal life span—about 74 years—
will depart this earth unscathed by some sort of prostate ailment, ranging from painful inflammation to benign enlargement to cancer.
—Patrick C. Walsh and Janet Worthington, The Prostate, 1995
en are living longer than ever. A report released by the Department of Health and Human Services in 2003 reported that the average life expectancy in the United States was 77.2 years (74.4 for men and 79.8 for women). That’s good news—for the most part. But as people age, the risk of disease increases. For men, this is particularly true where the prostate is concerned, as suggested by the quote shown above.
Enlarged prostate compressing the urethra
The prostate gland is a unique organ—it keeps on growing as men grow older. The name for this condition sounds a bit scary: benign prostatic hyperplasia, or BPH. The word “benign” is reassuring, however, and suggests that BPH usually presents no major health problems. That doesn’t mean that it isn’t annoying, though—as any man who has had to make frequent trips to the bathroom during the night can attest.
The prostate is a walnut-sized organ that sits at the base of the bladder and surrounds the urethra, the tube that voids the bladder. So it doesn’t take an Einstein to understand that as the prostate enlarges, the urethra is progressively squeezed, and urinary flow rate is diminished. Other symptoms of BPH include nocturia (nighttime urinations), hesitancy in commencing urination, an intermittent urine stream, and the sensation of a full bladder even after urination.
Saw Palmetto and Stinging Nettle Improve BPH
None of these symptoms is life threatening—but then, none of them sounds like much fun, either. So what can be done? Well, a number of herbal and pharmaceutical remedies are available for this extremely common age-related male ailment. The most thoroughly researched and most widely prescribed herbal product is the subtropical plant saw palmetto (called Serenoa repens in the United States and Sabal serrulata in Germany). It is the ripe berries harvested from this plant that have medicinal properties.
The saw palmetto berry extract is often combined with other herbal products, most commonly stinging nettle (Urtica dioica)— the root is the most potent part—to make it even more effective in improving prostate health. A recent study by German researchers demonstrated that a standardized formulation of saw palmetto and stinging nettle (in a 4:3 ratio by weight) performs as well as the prescription drug finasteride (Proscar) in helping to improve urinary function in patients with early-stage BPH. One notable difference, however, was that the herbal formulation produced significantly fewer side effects than finasteride.
Herbal Formulation Is As Good As Finasteride
There is much clinical evidence for the use of saw palmetto in aiding prostate and urinary function. The improvements are generally measured using two separate scales. The first is the International Prostate Symptoms Score (IPSS) rating scale, which takes into account urgency, hesitancy, and frequency of urination. The second is a Quality of Life (QOL) assessment that takes into account the severity of symptoms and whether they adversely affect the patients’ quality of life.
In the German trial, 516 patients (aged 50–88) with the symptoms of early BPH enrolled in a randomized, double-blind trial designed to compare the efficacy of finasteride with that of a 4:3 formulation of saw palmetto and stinging nettle. Each day for 48 weeks, the men received either 5 mg of finasteride (the pharmaceutically prescribed dose) or 320 mg of saw palmetto + 240 mg of stinging nettle. A number of symptoms were measured before, during, and after the trial, including urinary flow rate, voided volume and duration, time until increased urine flow was observed, prostate volume, and IPSS and QOL scores.
Continuous improvements in urine flow and IPSS scores were observed with both treatments throughout the trial. Moreover, the degree of improvement at the end of the trial was essentially equivalent between the two treatments, with one exception: finasteride decreased the size of the prostate gland more effectively than did the herbal treatment. This difference did not, however, translate into an improvement of BPH symptoms with finasteride vs. those with the herbal treatment.
Good News with Saw Palmetto Is Not New
Several head-to-head trials comparing the efficacy of saw palmetto alone with those of finasteride and other prescription drugs have shown favorable results. The benefits observed with saw palmetto—as measured by urinary flow and IPSS and QOL scores—are essentially equivalent to those observed with finasteride. The authors of a recent review paper on this subject concluded that saw palmetto “produced similar improvement in urinary symptoms and flow compared to finasteride and is associated with fewer adverse treatment events.”
To be fair, it’s worth noting that pharmaceutical approaches may yield more rapid benefits in men with BPH, especially when they’re using alpha-blockers, such as alfuzosin, a compound that reduces smooth muscle contraction in the prostate gland. Over the long term (6–12 months), however, the benefits of saw palmetto are similar to those of the drugs. The principal side effects associated with this class of drugs are dizziness and orthostatic hypotension (low blood pressure when rising from a seated to a standing position), which could be especially problematic in older men.
The Benefits of Herbal Remedies Are Obvious
Herbal remedies for the symptoms of BPH are becoming ever more commonplace and medically accepted. In the United States, saw palmetto is around the fifth most popular herbal supplement (the list shifts with publicity campaigns and changing tides of public opinion). And in Europe, two herbals—saw palmetto and stinging nettle—are in the top 10 “most used” category.
Given the favorable results of saw palmetto compared to pharmaceuticals, many researchers and clinicians suggest herbal remedies as a primary guard against the symptoms of BPH. Considering that herbal products are typically 50–75% lower in cost and often have equivalent efficacy—while producing fewer and milder side effects—it’s easy to see why.
Supplements Show Promise in Fighting Prostate Cancer
Don't let this happen to you!
There’s more to good prostate health than just relieving the symptoms of BPH. For example, prostate cancer is the most common cancer in men and is the second leading cause (behind lung cancer) of cancer deaths in men. In 2002, prostate cancer claimed the lives of more that 30,000 men in the United States. Is there anything that can be done to maintain good prostate health and reduce the risk of prostate cancer?
Research on this question suggests that some of the most promising agents in this arena are lycopene (found in tomatoes), EGCG (from green tea), vitamin E, and the mineral selenium. Another rising molecular star is resveratrol, the chemical compound in red wine that has attracted so much attention for its remarkable health benefits (see the sidebar). These agents all help to regulate the proliferation of cells and may be particularly beneficial in regulating the growth of cancerous cells in the prostate.
Red Wine, Anyone?
Ever since the “French paradox” became widely known in 1991, red wine has enjoyed unprecedented popularity. When consumed in moderation—and only then—red wine appears to reduce the risk of heart disease, thanks largely to a chemical compound called resveratrol, which is found in abundance in the skins of grapes. But did you know that resveratrol might also be good for your prostate? Researchers at the University of Texas suggest that this remarkable molecule has all the hallmarks of an effective prostate cancer-fighting agent.
Their work is currently in the preliminary stage, but it appears promising. They note that resveratrol has three important features that may make it a key player in reducing the risk of prostate cancer. First, it inhibits many different stages of a multistage process required for prostate cells to become cancerous. Second, it inhibits the function of androgen receptors (such as testosterone receptors), which are vital to cancer cell growth. And third, it interferes with signaling pathways within cancer cells that are required for them to survive. Together, these features may combine to be a powerful force in overpowering cancer cells in the prostate gland.
For those who wish to exploit the potential health benefits of resveratrol in preventing heart disease or cancer, drinking wine may be an enjoyable way to do so, but it is certainly not the best way. For a consistent, reliable intake of resveratrol in optimal amounts, supplementation is the way to go.
The exciting news concerning resveratrol just keeps on coming. See the article
“Resveratrol May Be a Longevity Molecule” in the November 2003 issue of Life Enhancement to understand how this jewel of a compound may help point to the Holy Grail of aging research.
- Stewart JR, Artime MC, O’Brian CA. Resveratrol: a candidate nutritional substance for prostate cancer prevention. J Nutr 2003;133:2440S-3S.
Lycopene—Man’s New Best Friend?
Lycopene deserves special mention. In 2001, 15 men who were scheduled to undergo a radical prostatectomy were supplemented with 30 mg of lycopene per day for 3 weeks before the surgery. Analysis of the removed tissue revealed that these men were far less likely to have cancerous cells outside their prostate gland (27% incidence) than men who had received no lycopene supplementation (82% incidence). This finding suggests that lycopene may inhibit the growth and migration of cancerous cells in the prostate.
Take This with a Grain of Salt
Additional evidence—maybe—that lycopene may be an antitumor agent and may inhibit cell growth in prostate cancer comes from researchers in India. Although it’s most unpleasant to contemplate, a common treatment for prostate cancer is surgical castration (called orchidectomy in medical jargon). The rationale for this drastic procedure stems from the fact that the testes produce testosterone, and this quintessential male sex hormone encourages the growth of prostate cancer cells.*
The poorly conducted study involved 54 patients with confirmed metastatic prostate cancer who underwent orchidectomy to treat their disease. These patients were divided into two groups of 27 each. Starting on the day of their operation and continuing for 2 years, the men in one group received 2 mg of lycopene twice daily, while the men in the other group—the controls—received no such treatment. A better design for this study would have had the control group taking placebo tablets so as to correct for the placebo effect in the outcome.
The men in the lycopene-treated group had a significant reduction in their blood levels of PSA (prostate-specific antigen, a protein that relates to an increased risk of prostate cancer) and a significant improvement in peak urinary flow rate. In addition, lycopene was associated with a higher patient survival rate over the study period: in the surgery-only group, 12 patients (44%) died, while in the lycopene-treated group, only 7 patients (26%) died. (The authors reported these percentages incorrectly in their paper, claiming that that they were half of what they actually were. Despite such shortcomings in the study, its results probably have some validity.)
The Glory of Being Male
Men don’t live as long as women—that’s an inescapable fact. Are men more delicate than women? Surprisingly (except, perhaps, to women), some scientists think they are, in physiological terms. What we know for sure, though, is that they are more cavalier than women about their health. In fact, many men brag about the length of time between doctor visits, trying to link this dubious achievement to their natural vigor.
When they do finally seek medical attention, it’s usually because they’re already in bad shape—and then they compound their problems by being much more likely than women to ignore their physicians’ advice. It’s an odd quirk of the male psyche, and probably one of the factors (the other big ones are occupational stress and hazards, reckless behavior, and war) that account for their shorter lives.
So if you’re a man and you want to live longer—and healthier—then be proactive! Pay attention to warning signs that something is wrong with your health, seek competent medical advice promptly, and heed it. Remember, prevention is the best cure.
- Sökeland J. Combined Sabal and Urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome. BJU Int 2000;86(4):439-42.
- Wilt T, Ishani A, MacDonald R. Serenoa repens for benign prostatic hyperplasia (Cochrane Methodology Review). In The Cochrane Library, Issue 4. John Wiley & Sons, Chichester, UK, 2003.
- Kucuk O, Sarkar FH, Sakr W, et al. Phase II randomized clinical trial of lycopene supplementation before radical prostatectomy. Cancer Epidem Biomarkers Prev 2001;20:861-8.
- Ansari MS, Gupta NP. A comparison of lycopene and orchidectomy vs. orchidectomy alone in the management of advanced prostate cancer.
BJU Int 2003;92:375-8.
Dr. Jensen is a cell biologist who has conducted research in England, Germany, and the United States. He has taught college courses in biology and nutrition and has written extensively on medical and scientific topics.