If you are a man aged between 40 and 59, you have a 50 to 60 per
cent chance of having benign enlargement of the prostate gland.
Prostate problems - enlargement, infection and cancer - are on the
rise. And medicine has not always been able to provide either cure or
prevention. There has been some progress, however. Today, prostate is a
household word whereas, barely a decade ago, many men didn't even know
they had one. Five years ago, a survey in The Times newspaper (March
26, 1995) showed that a staggering 90 per cent of the men polled didn't
even know where it was, 62 per cent mistook it for the bladder and only
50 per cent knew that only men could suffer from prostate problems.
Once it begins to malfunction, however, a man will be only too
painfully aware of both its presence and location.
The incidence
of prostate cancer has soared by nearly 40 per cent since 1973. Though
it is still rare among men under 50, it occurs most commonly in men
aged 80 and over, in men of African descent and those with a family
history of prostate cancer. Infection of the prostate, or prostatitis,
is mostly a secondary disease, caused by benign prostatic hyperplasia
(BPH). Painful and potentially serious, it remains something of an
enigma since, in only 5 per cent of cases, can an identifiable bacteria
be cultured from the prostatic fluids.
On the bright side,
alternative remedies have a long history of use worldwide and a good
track record in all but the most severe cases. If your prostate has
deteriorated due to medical mismanagement, many of the alternatives
hold the promise of improvement.
Herbs
The herbs which have
proven successful have at least one thing in common - they each contain
a steroid-like chemical that exerts a mild hormonal effect. Several
reviews have discussed the efficacy of phytotherapy in the treatment of
enlarged prostate, or BPH (Alt Med Rev, 1996; 1:18-25; Urol, 1996; 148:
12-9; Urologe, 1995; (A)34: 119-29; Urol Clin N Am, 1995; 22: 407-12).
Most conclude that herbal preparations can be used confidently as a
first-line treatment of prostate problems.
The herb of choice
appears to be saw palmetto (Serenoa repens or Sabal serrulata). A small
palm tree which grows on the US Atlantic seaboard, its berries contain
approximately 1.5 per cent fatty acids as well as sterol, which affects
testosterone metabolism. Like the drug Proscar, it too is a
5-alpha-reductase inhibitor, blocking the formation of
dihydrotestosterone, which is thought to be responsible for prostate
enlargement. It may also have antioestrogenic properties (Eur Urol,
1992; 21: 309-14).
Since 1983, there have been numerous
double-blind trials of Serenoa, involving hundreds of patients -
although none has fully studied its long-term effects. The overwhelming
conclusion of these has been that the herb is effective for both
subjective and objective symptoms of prostate enlargement. In one
double-blind trial of 100 men with BPH, the herb decreased nighttime
urination by 45 per cent and increased urinary flow rate by more than
50 per cent. It also reduced, by 42 per cent, the amount of urine left
in the bladder (residual urine) after urination (Br J Clin Pharm, 1984;
18: 461-2).
After taking Serenoa over the course of 12 months,
75 per cent of the 38 subjects with BPH in one trial showed
improvement. No adverse effects were encountered and, for 90 per cent
of men, urinary retention decreased significantly or disappeared
altogether. In addition, urinary flow and volume were increased. The
authors concluded that this is an effective remedy for mild-to-moderate
cases of BPH (Int Urol Nephrol, 1996; 28: 767-72). The precise
mechanism of saw palmetto is not well known (Eur Urol, 1997; 31:
97-101), though it is thought to act on the epithelial and stromal
enzyme activities - those which occur in the fibromuscular cells - of
BPH tissue. Other studies have shown how it selectively antagonises 53
per cent of the dihydrotestosterone receptors in the prostate,
inhibiting the hormone from binding to them and therefore minimising
its stimulation of cell growth (J Steroid Biochem, 1984; 20: 515-9).
Like breast cancer, prostate cancer is often stimulated by hormones.
A
further study comparing Proscar and Serenoa repens in a preparation
called Permixion showed that Permixion was equally effective in
reducing serum testosterone, although Proscar did promote a greater
short-term reduction in dihydrotestosterone (Eur Urol, 1994; 26:
247-52).
Two other herbs of note are stinging nettle (Urtica
dioica) and pygeum (Pygeum africanum). Urtica is thought to modulate
the activity of globulin receptors which bind sex hormones to the
prostatic membranes (Planta Med, 1995; 61: 31-2), thus addressing
hormonally dependent prostate conditions. One recent study showed that
nettle root inhibits membrane activity of the prostate and, therefore,
may subsequently suppress prostate cell metabolism and growth, reducing
the chances of enlargement and inflammation (Planta Med, 1994; 60:
30-3). In another study, Urtica was found to be at least slightly more
effective than placebo in improving urinary flow and urination volume
(Urologe, 1995; 24: 49-51).
Saw palmetto was combined with
Urtica in one open, prospective, multicentre, observational study of
2080 men. The overwhelming conclusion was that the combination produced
improvement over a wide range of symptoms and that it was well
tolerated. Only 15 individuals (0.72 per cent) experienced mild adverse
effects (Forsch Med, 1995; 113: 37-49). In another study combining
Sabal with Urtica (160 mg/120 mg) and compared with finasteride
(Proscar), the combination proved at least as effective as the
conventional drug over the 48 weeks of the trial. Fewer side effects,
such as diminished ejaculation volume, erectile dysfunction and
headache, were reported in the group using the herbs (Urol Ausgabe A,
1997; 36: 327-33).
Pygeum bark has been used for over 20 years
in France to treat prostate conditions. It contains 'phytosterols', the
simplest type of steroids, shown to have anti-inflammatory properties
(J Lipid Mediat Cell Signal, 1994; 9: 285-90). In clinical trials,
extract of pygeum was found to reduce symptoms of enlarged prostate
(Minerva Urol Nephrol, 1987; 39: 45-50; Ann Urol, 1984; 18:193-5).
In
one placebo-controlled, double-blind study involving 263 patients in
eight European centres, Pygeum africanum (50 mg taken twice daily over
60 days) led to a marked improvement in BPH (Wien Klin Wochenschr,
1990; 102: 667-73). Evaluation was mainly quantitative, involving
measurement of residual urine, urine flow and volume. Urinary flow
improved in 66 per cent of the pygeum-treated group compared with 31
per cent in the placebo group. Some adverse effects were noted:
gastrointestinal symptoms occurred in five patients and were severe
enough in three for treatment to be discontinued.
One study
conducted in clinics in Warsaw combined Urtica and Pygeum (300 mg and
25 mg, respectively) to be given randomly in either the full or half
strength, twice daily, to 134 subjects. Even at the lower dose, urinary
flow, residual urine and nycturia (urination at night) improved
significantly. After 56 days of treatment, further significant
decreases were found in the half-dose group, most notably in the
measurement of residual urine. Since mild-to-moderate gastrointestinal
side effects were noted in five patients, the lower-strength combi
nation may prove a better choice for some individuals (Clin Ther, 1993;
15: 1011-20).
Cernilton, a pollen extract, is popular in Sweden
for treating prostatitis and BPH. In one six-month, double-blind study
of 60 patients with BPH, Cernilton produced an improvement in nearly 70
per cent of patients compared with 30 per cent in the placebo group.
The authors concluded that it is of benefit in treating
mild-to-moderate BPH (Br J Urol, 1990; 66: 398-404). In another
experimental study of 90 men with prostatitis, patients were given
Cernilton (one tablet three times daily). Results showed that 78 per
cent had a favourable response; of these, 36 per cent were cured of
their symptoms while 42 per cent improved significantly (Br J Urol,
1993; 71: 433-8).
Finally, beta-sitosterol (the chemical
compound which is found in Pygeum) has come under the scrutiny of one
double-blind, placebo-controlled trial involving 200 patients (Lancet,
1995; 345: 1529-32). While prostate size did not alter between the
beta-sitosterol and control groups, the treated group experienced
significant improvements in urinary flow and over a range of other
symptoms. In another trial, 177 patients with BPH in 13 study centres
were given 130 mg beta-sitosterol daily for six months. This study also
assessed changes to quality of life and found beta-sitosterol produced
significant improvement over placebo in the treatment of BPH (Br J
Urol, 1997; 80: 427-32).
Homoeopathy
It is now widely
believed that cancer can have an emotional cause. Because of this,
homoeopathy can be a useful adjunct to conventional treatment for the
patient with prostate cancer, especially if that patient has already
suffered at the hands of injudicious medical treatment. In one case
report, a 66-year-old man who had already had a transurethral resection
of the prostate and the removal of his testicles was still experiencing
urinary difficulties. Urine was collecting in his scrotum, and
radiotherapy had not aided recovery. He was given an individually
prescribed remedy, in this case, Ignatia amara 30C in three doses a day
for four days, followed by placebo for three days. Treatment continued
with a single dose daily alternating with a placebo dose over a period
of days. As urinary flow began to ease, doses were made more
frequently. After nearly a year, the man began passing urine more
easily and seemed on the road to recovery (Similie, 1993; 3: 14-5).
Other
homoeopathic reviews (Hom Heritage, 1991; 16: 367-73; N Engl J Hom,
1994; 3: 33-44) suggest that conditions such as inflammation,
hypertrophy, obstructions and tumours of the prostate can be treated
homoeopathically. The remedies of choice are Pulsatilla (for bladder
pain, frequent desire to urinate, small flat stools), Thuja (frequent,
painless urination, stitch-like pain in the urethra, stream of urine
interrupted five or six times before voiding is complete, some
discharge on urinating), Digitalis purpurea (retention of urine, sense
of fullness even after urinating, giddiness after urinating), Cyclamen
(frequent desire to urinate but with scant emission of urine, pain in
urethra while urinating), Causticum (strong pulsations in the perineum,
bladder pain, ineffectual effort to urinate), Lycopodium (sensation of
pressure in the perineum, stitches in the neck of the bladder) and Apis
mellifica (incessant desire to pass urine, prickling in the urethra,
uncomfortable sensation when passing urine, retention of urine).
Other
case reports suggest success for prostate enlargement with remedies
such as Nux vomica, Sepia, Aurum metallicum, Aurum iodatum, Picricum
acidum, Ferrum picricum and Phosphoricum acidum (Hahnemannian
Gleanings, 1982; 49: 71-2).
A study of 37 patients with
prostatic adenomas (half of whom also had chronic prostatitis) showed
mixed results. The patients, for whom surgery was not an option because
of severe accompanying diseases, were treated over six to nine months
with individually chosen remedies in potencies ranging from 30C to 10M.
Higher dilutions proved to be the most effective. Results showed that
there was a subjective improvement in urinary and sexual function, and
improved objective measures of urinary function. Testosterone levels
rose, but there was no reduction in the size of the prostate. The
authors' conclusion was that homoeopathy was 'quite effective' in
treating benign prostatic adenomas (Br Hom J, 1990; 79: 148-51).
Meditation
A
common opinion among physicians is that some prostate symptoms are
stress-dependent. Certainly, animal studies have shown that both short-
and long-term stress reduce blood flow to the genital area, most
specifically the prostate (Urol Res, 1987; 297-301). Soldiers deployed
to Haiti for 'peacekeeping' purposes in 1995 were shown to be more
prone to chronic prostate problems which defied most medical treatment
(Milit Med, 1997; 162: 380-3). These kinds of conclusions integrate
well with the Chinese philosophy which holds that stagnation is at the
root of many prostate problems.
Given this, meditation and other
stress-reduction techniques may have a role to play in the relief of
some prostatic conditions, although the area is not well researched.
One study tested the theory that regular practice of mindfulness
meditation was associated with increased levels of melatonin. Melatonin
may be related to a variety of bodily functions including, they
hypothesised, the maintenance of a healthy prostate. The authors
believe that melatonin is psychosensitive as well as photosensitive.
This study used a small group of women to test its hypothesis, so it
does not relate directly to prostate problems. However, the authors
concluded that those who meditated regularly showed, through objective
urine testing, nearly twice the melatonin levels of non-meditators (Med
Hypoth, 1995; 44: 39-46).
Traditional Chinese Medicine
Chinese
medicine has many remedies to offer prostate sufferers. One which has
come under recent scrutiny is the use of citrus fruit remedies.
Traditionally,
Chinese medicine uses the peel of the tangerine (called Qing Pi) to
treat breast cancer. According to recent reports, modified citrus
pectin (MCP) - the result of boiling Qing Pi in water - may have a role
in treating prostate cancer (Townsend Lett Docs, Aug/Sept 1996: 82-7).
One
clinician, Michael Broffman of the Pine street Clinic in San Anselmo,
California, who is conducting ongoing experiments in his clinic,
reports that the levels of PSA (prostate-specific antigen, high levels
of which are associated with prostate cancer) in 18 men with prostate
cancer either remained stable or went down when using MCP. In addition,
metastasis (spreading of the cancer) stabilised in six of the men.
Since men with prostate cancer are more likely to die from the effects
of metastasis, this is a potentially important finding.
Citrus
pectin, rich in the polysaccharide galactosyl, can be found in nearly
all plants, but this polysaccharide is most concentrated in oranges,
lemons and grapefruits. Unlike the pectin found on supermarket shelves
(used for jam-making), which is indigestible and unabsorbed by the
gastrointestinal tract, citrus pectin is easily digested and passes
through the gastrointestinal mucosa and thus is readily absorbed into
the bloodstream. This appears to be the basis of its healing properties.
MCP
has demonstrated its effectiveness in inhibiting a wide variety of
cancer cells (J Natl Cancer Inst, 1992; 84: 438-42). Although current
theories are based on animal (J Natl
Cancer Inst, 1995; 87: 348-53)
and in-vitro studies (Biochem Mol Biol Int, 1995; 37: 833-41; Proc Ann
Meet Am Assoc Cancer Res, 1995; 36: A377; Glycocon J, 1994; 11:
527-32), they have consistently shown MCP to have cancer-inhibiting
properties. But the remedy still has a way to go before it can be
considered a bona fide cure for prostate cancer.
Other Chinese
remedies which have been tested include mixtures, such as Tonifying
Kidney Replenishing Vitality (TKRV) and one called Xiao Jin Dan. When
both remedies were tested in a study of prostatic enlargement, Xiao Jin
Dan showed a slightly greater therapeutic effect. Both remedies reduced
the volume of residual urine and prostate size, but again Xiao Jin Dan
proved rather better in this respect (Chung-Kuo Chung His i Chieh Ho
Tsa Chih, 1994; 14: 519-21). (Note that this is a study reported in a
Chinese journal. These invariably show a positive response and
therefore may not be reliable, cautions the Research Council of
Complementary Medicine).
Biofeedback
As we become more aware
of the prostate and its potential problems, there is also a chance that
some conditions will be misdiagnosed. Chronic lower urinary tract
symptoms in young men (23 to 50 years old) are often misdiagnosed as
chronic non-bacterial prostatitis.
In one study, researchers
analysed the involuntary contraction of the external urinary sphincter
during voiding (known as pseudodyssynergia) and attempted to see how
the use of biofeedback might help correct the condition. They studied
43 men between the ages of 23 and 50 with chronic voiding dysfunction
secondary to pseudodyssynergia. Biofeedback proved useful in helping to
retrain the muscles and relieve voiding difficulties in 83 per cent of
patients (J Urol, 1997; 157: 2234-7).
In another study,
biofeedback was used to repair the damage caused by radical
prostatectomy. Twenty-seven patients who had been left incontinent by
surgery were given weekly sessions to retrain the pelvic floor muscles.
Additional reinforcement sessions were given at one, three, six and 12
months. Outcomes were rated according to subjective symptoms and by
digital evaluation of the pelvic floor muscle constriction.
At
the end of the evaluation period, 48 per cent of the men had completely
recovered continence and 26 per cent experienced significant
improvements (Urol Nurs, 1996; 16: 50-4).
Another more recent study
also concluded that biofeedback is an important aid to post surgical
recovery (J Cancer Ed, 1997; 12: 218-23).
Men's health
We don't historically put men's health problems and hormones
together. But it is becoming apparent that a man's health may be every
bit as dependent upon hormonal balance as a woman's is and possibly
every bit as delicate.
Recent studies have shown that men are
more likely to develop prostate cancer if their mothers took pregnancy
and growth hormones during pregnancy. The link was made by Swedish
researchers after studying the birth records of 250 men who developed
prostate cancer, 80 of whom died from it, and comparing them with the
records of 691 others. The scientists maintained that a very early
shock to the system is all that is needed to enable genes to mutate and
to eventually appear as cancer (BMJ, 1996; 313: 337-40).
One
pilot study showed that athletes who use steroids are more prone to
prostatic enlargement and bladder outflow obstruction (Br J Urol, 1994;
74: 476-8).
Men with metastatic prostate cancer also have higher
levels of circulating testosterone than healthy subjects (Cancer, 1981;
48: 2267-73). But researchers have found that, at an early stage, the
cancerous tissue has more endogenous (made by the body) testosterone
than non-diseased tissue. Yet, individuals who have advanced prostate
cancer have lower testosterone levels than do their early-stage
counterparts. It seems we have a long way to go before we understand
the subtle role hormones play in human health.
Lifestyle
Vitamins
Zinc is the mineral of choice and the one most lacking
in our modern diets. Zinc has been shown to reduce the size of the
prostate and reduce symptoms of BPH by inhibiting the activity of
5-alpha-reductase (J Steroid Biochem, 1984; 20: 651-5). Zinc also
inhibits the secretion of prolactin (Brain Res, 1984; 294: 190-2).
Supplements may be taken in daily doses of between 20 and 60 mg and
combine well with botanical remedies.
Amino Acids
A
combination of L-alanine, L-glutamic acid and L-glycine can help
improve both the subjective symptoms of BPH and objective measures such
as urinary flow (Hinyokika Kiyo, 1970; 16: 231-36).
EFAs
Essential
fatty acids are the nutritional precursors to prostaglandins which
inhibit testosterone from binding to the prostate (Prostate, 1983; 4:
247-51). Omega-6 supplements (such as are found in evening primrose
oil) may be particularly important. Linoleic acid has also been shown
to reduce the risk of cancer cells forming within the prostate (Nutr
Cancer, 1987; 9: 123-8).
Change your diet
Curb your intake of
saturated fats (Townsend Lett Docs, April 1994: 394). A study which
included five ethnic groups - Japanese, Caucasian, Chinese, Filipino
and Hawaiian - showed that lower fat intake reduced the risk of
prostate cancer (Am J Nutr, 1991; 53: 31; Am J Nutr, 1991; 54:
1093-100). This means reducing red meat, dairy and fried oils in your
diet, and including more polyunsaturated fats by eating vegetables and
fish, and using olive oil for cooking (better for your heart as well).
A vegetarian diet has been shown to reduce the amount of circulating
hormones in the body which, in turn, can reduce the risk of BPH as well
as prostate cancer. Studies of Seventh Day Adventist vegetarians show
significantly lower testosterone levels compared to their
non-vegetarian counterparts (Am J Clin Nutr, 1985; 42: 127-34). Further
studies of this group suggest that their high intake of fruits and
vegetables, and thus high intake of soluble fibre, may also contribute
to the lower overall risk of developing prostate cancer (Am J Clin
Nutr, 1990; 42: 365-70; Cancer, 1989; 64: 598-604).
Other
studies suggest that soya products - rich in isoflavonoids which can
inhibit the growth of prostate cancer - should be the staple in your
dietary strategy against BPH and prostate cancer (Prostate, 1993; 22:
335-45; Int J Cancer, 1982; 29: 611-6; Lancet, 1993; 342: 1209-10). In
contrast, the oestrogens in processed foods such as cow's milk are
associated with an increasing number of genital problems in men (J
Endocrinol,1993; 136: 357-60).
Sunlight
Increasing your
exposure to sunlight may help you keep healthy. Researchers found that
prostate cancer mortality in the US declined with increasing sunlight
intensity. They pointed out that vitamin D3 is known to be effective in
inhibiting the growth of tumours and that UV is essential to the
synthesis of D3 in the body. Sunlight may be more important than
supplementing your diet, as most people in the Western world still do
not get sufficient D3 through diet alone (Anticancer Res, 1990; 10:
1307-10).
Exercise
Being physically fit reduces your risk of
disease. Prostate problems, and cancer in particular, are not the
exception (Med Sci Sports Exerc, 1996; 28: 97-104; JAMA, 1984; 252:
514-7; Cancer Causes Control, 1994; 5: 136-40). Regular aerobic
exercise three to five times a week for 20-30 minutes at a time will
lower levels of circulating testosterone (Eur J Appl Physiol, 1978; 39:
283-91). Exercise as part of a weight-loss programme may be even more
effective since obesity is another known risk factor for BPH (Int Urol
Nephrol, 1996; 28: 55-9).
Antimicrobials, not antibiotics
When
an enlarged prostate is accompanied by infection, botanicals with
antimicrobial properties are indicated. Both Echinacea (E. angustifolia
or E. purpurea) and goldenseal (Hydrastis canadensis) should be
considered part of any programme, even though there are no studies
directly associating them with the prostate.
Eliminate toxins
Have
your cadmium level checked. Cadmium levels in men with enlarged
prostate tissue have been shown to be significantly higher than those
with normal prostate tissue. The cadmium level also appears to affect
the level of dihydrotestosterone (DHT). In the test tube, cadmium
stimulates the growth of human prostatic tissue (J Endocrinol, 1976;
71: 133-41; Prostate, 1985; 6: 177-83). Common sources of cadmium
poisoning are enamelled cookware and cigarette smoke. Excess cadmium
can be drained using a combination of amino acids and homoeopathy.
Avoid certain medications
Many
medicines, including antihistamines, decongestants and antidepressants,
can turn a partly obstructed prostate into a fully obstructed one.