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.
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).
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).
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).
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).
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.
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.
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).
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).
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).
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.
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.