Integrative Approach for BPH Benign Prostate Hyperplasia

The prostate is a male reproductive gland that produces the fluid that carries sperm during ejaculation. It surrounds the urethra, the tube through which urine passes out of the body.
An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. As the gland grows, it can press on the urethra and cause urination and bladder problems.
An enlarged prostate is often called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. It is not cancer, and it does not raise your risk for prostate cancer.
Common Symptoms:
Dribbling at the end of urinating
Inability to urinate (urinary retention)
Incomplete emptying of your bladder
Incontinence
Needing to urinate two or more times per night
Pain with urination or bloody urine (these may indicate infection)
Slowed or delayed start of the urinary stream
Straining to urinate
Strong and sudden urge to urinate
Weak urine stream
Integrative Treatments for BPH:
1. ALPHA BLOCKERS
The long acting alpha blocker, phenoxybenzamine, was shown to reduce BPH symptoms as early as 1976. Predictable side effects (dizziness and orthostatic hypotension) limited its popularity. Selective alpha-1 antagonists including prazosin, doxazosin, and terazosin have been shown to reduce symptoms better than placebo in short term studies. Recently, a major US trial demonstrated the superiority of terazosin (10 mg at h.s.) over both finasteride (5 mg at h.s.) and placebo in 1229 men followed for 1 year. Adding finasteride provided no additional benefit to terazosin alone. AUA score dropped within 4 weeks, the effect was maximum by 13 weeks and was maintained for 1 year. At 1 year the average difference in symptom score between terazosin and placebo was 3.5 units.
Principal adverse effects of terazosin expressed as absolute risk increase (ARI)* above placebo were: dizziness (ARI = 19%), asthenia (ARI = 7%), and postural hypotension (ARI = 7%). Shorter term controlled trials have demonstrated similar efficacy for prazosin and doxazosin, but no direct comparison of the drugs exists. A 6-8pm dose of the shorter-acting and less expensive prazosin may be a logical choice for a therapeutic trial in patients whose symptoms are mainly nocturnal. The lowest dose of alpha-antagonist to achieve symptomatic relief should be determined by starting with the lowest dose and slowly titrating up.
2. 5-ALPHA REDUCTASE INHIBITORS
Finasteride blocks the conversion of testosterone to active dihydrotestosterone within prostatic cells. A 1992 study of 895 BPH patients randomized to finasteride 5 mg daily or placebo for 1 year showed a mean 2.7 unit reduction in a 36 point symptom score in men treated with finasteride. The more recent comparison of finasteride with terazosin and placebo failed to show any benefit from finasteride, even compared with placebo. A Canadian trial of 472 men followed for 2 years demonstrated a statistically significant but clinically modest difference in symptom scores favouring finasteride (5 mg/d) over placebo. The group difference was 1.4 points on a 54 point scale. Adverse effects of finasteride were relatively common, notably impotence ( ARI = 10% ) and ejaculation disorder (ARI = 6%). Finasteride may be more likely to work in men with large prostates. Symptomatic improvement appears to be detectable by 2 months, and 1mg reduces prostate size as effectively as 5 mg, so a lower dose may be more cost-efficient.
Recently, a meta-analysis of finasteride trials has provided the first evidence that a drug may prevent surgery or acute urinary retention. Among 4022 men randomized to finasteride or placebo for 2 years, finasteride slightly reduced both. However the absolute risk reduction was only 1.6% for retention (NNT/2 years = 63) and 2.3% for surgery (NNT/2 years = 43).
Table: Drugs for BPH symptoms
Generic Name Trade Name Dose Range Daily Cost*
Prazosin Minipress®, generic 0.5-10 mg BID ** $0.16-$1.28
Terazosin Hytrin® 1-20 mg daily ** $0.58-$2.92
Doxazosin Cardura® 1-16 mg daily ** $0.58-$3.58
Finasteride Proscar® 5 mg daily $1.69
3. Natural Treatments for BPH:
SAW PALMETTO EXTRACT (SERENOA REPENS)
Phytotherapy (herbal therapy) remains popular in the treatment of BPH, especially in Germany. Extracts of saw palmetto berry (dwarf palm, S. repens) are the most widely used. A recent RCT provides the first reliable evidence of efficacy for beta-sitosterol, an extract of saw palmetto containing several phytosterols. Two hundred men were randomized to placebo or 20 mg beta-sitosterol daily as “Harzol” (Hoyer, Germany). At 6 months, placebo reduced IPSS score (equivalent to AUA score) by 2.3 points, whereas beta-sitosterol achieved a reduction of 7.4 points. The difference in favour of phytosterol was detectable by 3 months. Adverse effects were reported to be minimal and only 6 of 100 beta-sitosterol treated patients withdrew. The doses of other saw palmetto extracts equivalent to that used in this trial are unknown. No evidence is available for long term safety or effectiveness, as regulatory agencies do not require this information for plant products.
in Europe is a combination of saw palmetto and beta-sitosterol. While not popular in the U.S., they are natural alternatives that reduce urinary problems caused by an enlarged prostate. The researchers at Prostate Pill Report have reviewed some of the best supplements on the market for their saw palmetto and beta-sitosterol content so you can make an informed decision.
Pharmaceuticals VS. Natural
There is no question that the four leading prescription drugs for prostate problems (Avodart, Flomax, Proscar and Cardura) can and do help many men who are suffering from prostate problems. But they certainly do not work for all men and there is a growing concern and fear among men of the side effects reported with these drugs.
The study from Dr. Abraham Morgantaler. He’s a Clinical Professor of Surgery at Harvard Medical School. And a practicing urologist at Beth Israel Deaconess Medical Center in Boston. During his career he also founded Men’s Health Boston. Which focuses on male sexual health.
Dr. Morgentaler has just made his research public. He unveiled it to the American Urology Association (AUA) in San Francisco. His peers are now calling him a “visionary.”
New Theory Based on Simple Logic
Dr. Morgentaler is revolutionizing how we see prostate health. But he says his theory is simple logic.
He asks… how can raised testosterone cause prostate cancer? Prostate cancer is an older man’s problem. And younger men have much more testosterone than older men.
“Prostate cancer becomes prevalent exactly at the time of a man’s life when testosterone levels decline,” says Dr. Morgentaler.
If anything, he says, the reverse is true. Too little testosterone is the problem.
But the good news is… This is a problem that can be fixed. And Dr. Morgentaler has done that first hand. First with his own patients. And now in a published study. Just to prove his findings and get the word out there!
Theory in Practice
Dr. Morgentaler’s breakthrough began in 2004. He was working with male patients each day in his practice. He dealt with prostate cancer on a daily basis.
One day, an 84-year-old man came in with untreated prostate cancer. Doctor and patient began talking about the fact that most doctors believe elevated testosterone causes prostate cancer. And how it doesn’t make much sense.
By the end of the conversation, his patient was determined to test out that theory. He asked to be treated with testosterone. So together they began testing out the treatment.
They couldn’t believe the results. Dr. Morgentaler watched his “special” patient closely over two years. And during that time his PSA levels declined. More and more each month. The cancer stopped growing. In fact, it went into remission. And his patient gradually began to feel better. More like his old self.
Eager to get the word out there, Dr. Morgentaler wrote up his findings in the Harvard Medical Gazette.
Reference:
www.Pub Med Health.com