Overview 

Benign Prostatic Hyperplasia (BPH) is the medical term used to mean enlargement of the prostate, the walnut-sized gland that manufactures semen and transports urine from the bladder. Specifically, BPH refers to proliferation of epithelial cells, which form nodules in the periurethral section of the prostate. As these nodules continue to grow in size, they place pressure on the urethral canal until the urethra becomes partially blocked. In rare cases, this blockage may be complete. This condition is common in men over the age of 50, with the likelihood of occurrence increasing with age. 

What Causes BPH? 

The prostate is regulated by androgens (steroid hormones), including testosterone. Another androgen, dihydrotestosterone (DHT), is formed by the conversion of testosterone by the enzyme 5-alpha-reductase (type II). As a man ages, testosterone levels begin to fall off and dihydrotestosterone levels begin to rise. At the same time, some testosterone is converted into estrogen by the enzyme aromatase, causing estrogen levels begin to increase with age. This process has significant impact on men since it is what triggers hair loss and erectile dysfunction, in addition to contributing to the development of BPH. 

Symptoms and Diagnosis 

Symptoms vary among individuals and are influenced by certain factors, such as age and medical condition. However, certain symptoms seem to remain consistent between most men. Comparing the incidence and severity of these symptoms to the International Prostate Symptom Score can help the patient and practitioner determine what stage the condition is currently in, which range from the initial appearance of BPH that may not require medical intervention as yet, to an advanced stage where re-sectioning of the prostate may be necessary. 

Common Symptoms of BPH 

Increased urge to urinate during the day, throughout the night, or both.

Straining to urinate

Pain or burning sensation upon urination

Diminished flow of urine

Sensation of still needing to urinate after elimination, or difficulty stopping

Dribbling urine

Complete inability to urinate (which requires immediate medical attention or renal failure may occur) 

Diagnosis 

Rectal examination  The physician performs a rectal examination to check for nodule growth along the prostate, which can be detected through the thin wall of the rectum. 

Blood tests  Specifically, prostate specific antigen (PSA) levels are checked. PSA is a protein manufactured in the prostate and elevated levels above 4 nanograms per milliliter (ng/mL) may indicate an increased degeneration of cells in the prostate. 

Ultrasound  This diagnostic tool is used to check the prostate as well as the kidneys and testicles for malignancies. It may also be used as a noninvasive means of measuring the volume of urine that remains in the bladder after elimination. 

Natural Treatment and Management of BPH 

BPH is a condition that is slow to progress. Providing that there are no indications that the flow of urine is serious impaired, the patient may take a ‘watch and see’ approach toward treating the condition, in addition to adhering to any necessary lifestyle changes. Furthermore, many men may exhibit enlargement of the prostate but do not experience any negative symptoms. Therefore, it is this period in which a window of opportunity presents itself to help deter progression of the condition to one more serious in nature. 

The following self-care measures are recommended: 

Decrease liquid intake, particularly before retiring to bed for the night

Limit alcohol consumption

Limit caffeine consumption throughout the day

Maintain a healthy weight

Exercise regularly

Consume a natural diet low in cholesterol and high in fiber 

Recommended Supplements in the Treatment of BPH 

Cernitin 

Cernitin is an extract of plant pollen that has been used and studied for its effectiveness in treating chronic prostatitis for the past three decades. Studies have shown that this substance provides anti-inflammatory and anti-androgenic properties that inhibit stromal cell proliferations that lead to an enlarged prostate. 

Beta-sitosterol 

This substance is a type of fat derived from plant sources. While relatively new as a therapeutic agent in the US, beta-sitosterol is found in several drugs used to treat enlarged prostate in European countries. Several studies have found this substance to be effective at reducing symptoms, with continued benefit as long as 18 months after the initiation of treatment. 

Lycopene 

Lycopene is a carotenoid that lends red color to tomatoes and certain fruits, such as pink grapefruit. It also exhibits potent antioxidant activity that affects cell growth and metabolism by inhibiting free radicals and singlet oxygen quenching to reduce oxidation. In terms of the latter activity, lycopene is 100 times more efficient than vitamin E. Studies have shown that this substance can help prevent the progression of BHP to prostate cancer by preventing oxidation damage to cellular DNA. Studies have also shown that lycopene also reduces serum PSA levels. 

Herbs Used in the Treatment of BPH 

Pygeum 

Pygeum is obtained from the bark of the African plum tree and used to treat BPH via preparations standardized to 14% triterpenes and 0.5% n-docosanol. Studies have shown that this substance exhibits antiandrogenic properties by competing with androgen precursors and also by decreasing cholesterol levels in the prostate. In addition, pygeum prevents DHT from binding to androgen receptor sites, helping to reduce enlargement and improve urine flow and volume. In a review of 18 randomized, controlled trials involving more than 1,000 men, nighttime urination decreased by 19%, bladder retention of urine decreased by 24% and urine flow improved by 23%. 

Saw Palmetto 

This herb has a long history of use in Europe as a standard treatment for BPH. Numerous studies have shown that saw palmetto compares to finasteride in efficacy and exhibits several modes of action, including the inhibition of 5-alpha-reductase and deterring the conversion of testosterone into DHT. Studies have also shown that saw palmetto reduces uptake of both testosterone and DHT by as much as 40%. In addition, the herb inhibits COX-2 and the enzyme called 5-lipoxygenase, thereby reducing inflammation. Overall, the benefits observed from treatment with saw palmetto include reduced urge to urinate at night, decreased bladder retention and increased urine flow and volume. 

Nettle 

The extract of nettle root also inhibits DHT from binding to prostate cells, in addition to reducing levels of sex hormone binding globulin (SBGH). The latter action is significant because testosterone and estrogen bind to SBGH, in effect hitching a ride through the bloodstream. In a randomized, double-blind, placebo-controlled, clinical trial, 81% of the 600 subjects that received nettle root extract demonstrated marked improvement in BPH symptoms. Often, nettle root extract is combined with saw palmetto therapy. 

Safety Precautions 

Beta-sitosterol 

Do not take if you have either sitosterolemia or cerebrotendinotic genetic disorders. 

Saw Palmetto

Do not take if you are currently taking blood thinners, such as warfarin. 

Supplementation should be monitored if you are undergoing treatment for a hormone-related type of cancer. 

Nettle