Enlarged Prostate Treatment
Benign Prostatic Hyperplasia (BPH) or enlarged prostate is a benign (non-cancerous) disease of the prostate gland, which, if left untreated, can lead to medical complications including kidney and bladder damage.
If BPH is diagnosed and treated early, there is a lower risk of developing these complications. Enlargement of the prostate typically affects men as they age and causes pressure on the urethra. This can lead to difficulty in passing urine, frequent trips to the bathroom at night and pain associated with sexual function. BPH is not a life-threatening disease but it is likely to negatively impact a man's quality of life.
What exactly is the prostate?
It's a gland approximately the size of a walnut, which encircles the urethra at the exit from the bladder. Its function is to produce a fluid in which ejaculated sperm are suspended.
Who gets BPH?
Studies have shown that the prevalence of BPH increases from 24% of men in their 50s to over 50% of men in their 70s.
What are the symptoms and signs of an enlarged prostate?
As men grow older, the size of their prostate can increase and start pressing on the urinary canal (urethra), which can lead to difficulty in passing urine and sexual function. The symptoms can include a decreased force of urine stream, which can be hesitant and intermittent. The man may need to strain to empty his bladder. Often he is unable to completely empty his bladder. There is often a feeling of urgency to urinate, frequency, night time trips to the bathroom, pain on urination and urge incontinence. There can also be pain associated with sexual function.
What is the Orthodox Medical Treatment of Enlarged Prostate?
Wait and watch
The mainstays of treatment for BPH are drugs and surgery. However, as any treatment can have unwanted effects, some men with mild symptoms opt to "wait and watch", where no treatment is undertaken. Instead the situation is monitored closely with routine check-ups. If symptoms deteriorate, it is then possible to opt for treatment.
Drug treatment for BPH
There are two main classes of drugs that are prescribed for treating an enlarged prostate (BPH):
- Alpha-blockers: These drugs relax the muscles at the neck of the bladder and in the prostate, thereby reducing the pressure on the urethra and so helping increase the flow of urine. They do not cure BPH but help to alleviate some of the symptoms. Around 60% of men find symptoms improve significantly within the first 2-3 weeks of treatment.
- What are the side effects? The most common side-effects of alpha-blockers are tiredness, dizziness and headaches.
- 5-alpha-reductase inhibitors: These drugs work by inhibiting the production of a hormone called DHT (dihydrotestosterone), which may contribute to prostate enlargement. The role of DHT is not yet fully understood. Finasteride is the most commonly used drug of this type for BPH. These drugs can slow down the progression of BPH by suppressing the production of DHT. They decrease prostate volume and in doing so they improve symptoms and urinary flow, and decrease the risks of urinary retention and delay the need for BPH related surgery.
- What are the side effects? The most common side-effects of finasteride include a reduced sex drive, difficulty in maintaining an erection and ejaculatory dysfunction. Also, several months of treatment may be needed before the benefit is noticed.
Surgery for BPH
There are three main surgical options for BPH:
- TURP: Transurethral resection of the prostate (TURP) is the most common operation for BPH. The procedure is usually done under a general anaesthetic. A long thin instrument called a resectoscope is passed into the urethra. With a light source and lens on the end it acts as a telescope, allowing the surgeon to view the prostate either directly or on a video monitor. A precisely controlled electric current, applied by a loop of wire at the end of the resectoscope, is used to shave off sections of the enlarged prostate. TURP is an effective procedure with over 90% of men reporting an improvement after the operation. However, as with any surgical procedure there is a risk of side-effects and complications. A common side-effect of this procedure is retrograde ejaculation - where semen passes into the bladder during orgasm instead of out of the penis. Retrograde ejaculation is usually not a problem, although it may reduce fertility. Complications of the operation can include urinary incontinence or damage to the urethra, resulting in a "stricture" that can itself cause difficulty passing urine
- TUIP:Transurethral incision of the prostate (TUIP) may be appropriate for men who have a less enlarged prostate. It is a quicker operation than a TURP and involves removing less tissue. It is performed under general or spinal anaesthetic. As with a TURP an instrument is passed up through the penis, but instead of removing a portion of the prostate, small cuts are made in the neck of the bladder and the prostate. This reduces the obstruction of the flow of urine
- Open Prostatectomy: This is only recommended for men whose prostate is very large. It is a major operation and carried out under a general anaesthetic. An incision is made in the lower abdomen in order to remove the central part of the prostate
- Laser and Microwave: Laser therapy (using a laser probe to cut away prostate tissue) and transurethral microwave thermotherapy (using heat to remove some of the prostate tissue via a probe) are becoming more common in the treatment of BPH
What is the natural approach to treating an enlarged prostate?
Since widespread media coverage of the successful clinical trials of the herbal treatment of BPH, increasing numbers of men are turning to it for a safe and effective alternative to the pharmaceutical approach to medically diagnosed Benign Prostatic Hyperplasia (BPH).
Saw Palmetto (Serenoa repens) is the mainstay of the herbal treatment to support prostate health. This herb has been safely and effectively used for hundreds of years to maintain prostate health and tradition is now being underpinned by scientific research, which has been widely and favourably reported in the media. In fact, many men are now taking it as a preventive measure to help avoid prostate problems. Evidence supports Saw Palmettoâ€™s use for BPH.
A recent updated review of the clinical trials concluded that Saw Palmetto improves urological symptoms and urinary flow measures compared with placebo, and that Saw Palmetto produces similar improvement in urinary symptoms and flow when compared to the drug finasteride but is associated with fewer adverse treatment events. Saw Palmetto is usually prescribed along with other medicinal plants to decrease the size of the prostate. This approach is proving to be very effective for men, who have either been diagnosed with BPH or who simply want to support prostate health.
It is worth noting that the NHS website states the following with regard to the treatment of BPH:
"A number of plant extracts are popularly used to alleviate BPH, although formal evidence that they are effective is often scanty. However, there is some scientific evidence that an extract of saw palmetto (called Serenoa repens) can be beneficial ..."
"Serenoa repens produced similar improvement in urinary symptoms and flow compared to finasteride and is associated with fewer adverse treatment events."
What are the side effects of Saw Palmetto?
Saw Palmetto is well tolerated by most patients and causes relatively few side-effects. Most side-effects are minor gastrointestinal problems, such as nausea, which are usually resolved when the herb is taken with meals.
Whatâ€™s the best kind of Saw Palmetto?
For the effective treatment of BPH, it is important to use an extract of Saw Palmetto, which states on the label exactly how much of the important active chemical constituents are in it. Many over the counter and online remedies and are not of sufficient therapeutic strength or quality to aid prostate health. Without this verification, the herb will not provide the required therapeutic action. Saw palmetto works best in a formulation with other plant extracts, specifically for the urinary tract.
For the best treatment outcome, it is advisable to take high strength, prescription-only Saw Palmetto, which can be obtained after a consultation, which takes into consideration all aspects of the manâ€™s health.
It is important for men aged 50 and over to see their GP annually for a PSA (prostate specific antigen) blood test and prostate examination to help monitor prostate health.
Written by: Deborah Grant BSc(Hons) Herb.Med.
Deborah is a Consultant Medical Herbalist, you can find out more at London Herbal Medicine