INTRODUCTION AND GENERALITIES
Benign prostatic hyperplasia (BPH) or prostate adenoma generally develops in men around the age of 60. It is a very common condition: it is estimated that nearly 60 to 80% of men (white) are affected by it by the age of 60. The occurrence of a prostate adenoma is perhaps less frequent in men of Asian origin and more frequent in populations of African origin (all this is controversial).
In the vast majority of cases, this increase in the volume of the prostate will be tolerated and will not require surgery; synthetic drugs and herbal medicine are sometimes recommended to delay the development of prostate adenoma or reduce the urinary disorders associated with it.
WHAT IS THE PROSTATE?
The prostate is a small gland that only exists in men, it increases in volume at puberty (15 to 20 g, the size and shape of a chestnut).
It is located very close to the bladder and surrounds the duct (urethra) that allows urine to be evacuated. Its main role is to secrete substances necessary for good sperm quality (1/3 of sperm is of prostatic origin) and therefore for fertilization (nutrient for sperm, enzymes, hormones, fluidifiers). This secretion continues from puberty to a very advanced age, which allows men to remain fertile much longer than women.
The first rapid increase in the volume of the prostate at puberty is followed by a second increase, progressive and much slower from the age of 25-30 and which continues throughout life, sometimes causing urinary disorders from the age of 50.
WHAT IS PROSTATIC ADENOMA?
It is synonymous with benign prostatic hyperplasia or hypertrophy, prostatic hyperplasia or prostate adenoma.
Prostate adenoma is a myofibroma, a benign tumor that develops from the glandular and muscular constituents of the central part of the prostate, nothing to do with prostate cancer, in the adenoma there is no risk of dissemination. The development of the prostate is under the influence of male hormones (androgens), everyone agrees on this but what causes the abnormal increase in the prostate remains the subject of discussion. It would seem that the amount of intra-prostatic DHT (dihydrotestosterone), the active derivative of testosterone, is the primary element of prostate growth and that a hormonal imbalance (between estrogens and androgens) is decisive in the occurrence of the adenoma.
WHAT ARE THE SIGNS OF AN ENLARGED PROSTATE?
They are insidious and most often discreet, a story of pipe.
The prostate increasing in volume, compresses the urine excretory duct and reduces its diameter, leading first
- a decrease in the force of the urine stream,
- slow bladder evacuation,
- poor bladder emptying with delayed dripping,
- eal difficulty in urinating (dysuria) which can lead to the inability to urinate (urinary retention).
Other signs are also suggestive of prostate hypertrophy but they are less specific, irritative symptoms:
- daytime and especially nocturnal pollakiuria (frequent urge to urinate)
- urgency: urgent need to urinate.
If only irritating symptoms are observed, it is necessary to consider a cause other than prostatic hypertrophy.
WHAT ARE THE COMPLICATIONS RELATED TO PROSTATIC ADENOMA?
When urinary retention is significant, there is an increase in urine pressure upstream in the bladder and upper urinary tract up to the kidney with, to simplify:
- appearance of a “struggle bladder”: thickening of the wall with sometimes a weak area, hence the appearance of diverticula and risk of urinary infection, bladder stones, bleeding (hematuria),
- kidney damage (hydronephrosis) with the risk of kidney failure,
- pelvic disorders secondary to efforts to urinate (hernias, hemorrhoids),
- complete blockage of urine is always to be feared, sometimes secondary to a change in activity (travel, prolonged sitting position), taking medication.
In the event of the appearance of symptoms of prostate hypertrophy, it is advisable to consult a doctor who will specify the importance of this adenoma and possibly detect urinary complications.
TREATMENT OF BENIGN PROSTATE HYPERTROPHY
WITH SYNTHETIC DRUGS AND MEDICINAL PLANTS.
We will discuss treatments that have proven themselves and are commonly prescribed, excluding treatments currently being evaluated or tested.
SYNTHETIC DRUGS:
Alpha-blockers:
Example: Terazosin, Alfuzosin, Doxazosin, Tamsulosin
They allow rapid relaxation of smooth muscle fibers (bladder sphincter, intraprostatic muscle fibers) but often have side effects. They have no effect on the volume of the prostate. The benefits are felt after two days of treatment and side effects are uncommon but may lead to stopping treatment (dizziness, headaches or migraines, orthostatic hypotension, heart palpitations, ejaculation disorder).
5-alpha reductase inhibitor:
Example: Finasteride, Dutasteride
They act by inhibiting 5-alpha reductase, which converts testosterone into DHT in the prostate. The treatment induces a slow decrease in prostate volume, and a gradual improvement in clinical symptoms noticeable over a few months. Specific side effects: erectile dysfunction, decreased libido and more serious: psychiatric disorders such as anxiety, mood changes, including depressed mood, depression and less frequently suicidal thoughts
SURGERY :
There are several possibilities for surgical treatment:
- fairly old treatment but which has proven itself: resection of part of the prostate via the endo-urethral route, often with a secondary ejaculation disorder which occurs towards the bladder and no longer towards the outside.
- in case of major urinary disorders, complete removal of the prostate but this is a more complicated surgical operation and sometimes with complications,
- more modern treatments which cause partial necrosis of the prostate (for example by embolization), they are minimally invasive, do not modify ejaculation but there is a risk of recurrence (return of urinary problems) after a few years.
HERBAL MEDICINE
The medicinal plants useful for reducing the disorders related to benign prostatic hypertrophy are currently:
Florida dwarf palmetto: Serenoa repens = Sabal serrulata
Stinging nettle: Urtica dioica
African plum: Prunus africanus = Pygeum africanum
Squash or pumpkin: Cucurbita pepo
Pollen of certain grasses.
It has appeared advantageous to combine several plants in the treatment of BPH
EXAMPLES OF PLANTS USABLE
to treat benign prostatic hypertrophy
FLORIDA PALM, Serenoa repens = Sabal serrulata
This palm tree is native to the south-east of the USA, it is a dwarf palm (saw palmetto ). From the almond of its fruit, very oleaginous like many palm trees, we obtain a lipidosterolic extract whose mechanism of action is not precisely known. Some believe that this palm extract would inhibit the conversion of testosterone into dihydrotestosterone (the only one active on the prostate); or it would exert a local antiandrogenic effect by competitive hormone inhibition.
The extract of saw palmetto is also anti-inflammatory.
Many studies have shown the interest of these extracts in reducing disorders related to prostate adenoma; the positive effect would be, in many cases, similar to that of an alpha-blocker, but without the unpleasant effects of these synthetic drugs.
Average dosage:
Lipid extract: 300 to 400 mg per day (usually two capsules), some people cannot tolerate it on an empty stomach, it is better to eat while swallowing the capsules
Alcoholic tincture: 100 drops as an attack treatment for a few weeks (2 to 3) which can then be reduced to 20 drops per day as a maintenance treatment.
In France, the specialty sold in pharmacies and reimbursable at 30% is PERMIXON
GREAT NETTLE OR DIOIC NETTLE, Urtica dioica
Nettle is a very ubiquitous plant that grows particularly well in nitrate-rich soils, its young leaves are edible (like spinach or in soup), they are an industrial source of chlorophyll. But be careful when picking them because they have stinging hairs (no danger, just a rapid inflammatory-allergic reaction that leaves no traces unlike some tropical nettles).
The root of this large nettle contains steroids that, it seems, inhibit several « membrane enzymes » of the prostate. This metabolic interaction would limit the development of prostatic adenoma, or even reduce the volume of the prostate.
Average dosage
root extract: 100 to 200 mg per day
, you can possibly make a root herbal tea but the effect is less and irregular. In addition, the herbal tea is a little diuretic, which is not an effect sought by someone who has a prostate adenoma and difficulty urinating.
AFRICAN PLUM TREE, Prunus africanus = Pygeum africanum
The African plum tree is native to the tropical-equatorial regions of Africa.
It is found mainly in the primary forests of the mountainous regions of Cameroon and Congo, but it also grows in the well-watered forests of East Africa, and even in Madagascar.
From the bark of well-developed trees, a mixture of lipids and sterols (phytosterols) is extracted, which have anti-edematous properties and also seem to act directly on the prostate gland: stimulation of prostatic secretion, direct action on prostate cells.
There must be a hormonal interaction because the extract of the bark of the plum tree decreases the blood (plasma) concentration of testosterone and luteinizing hormone (LH).
Clinical trials have shown that taking African plum extract minimizes the symptoms of prostate adenoma and perhaps reduces the size of the adenoma, but this remains to be verified.
Average dosage
It is recommended to take 100 mg of Prunus africanus extract in one or two doses per two-month course.
Until recently, a pharmaceutical specialty called TADENAN existed in France, but its production has been discontinued.
SQUASH, OR PUMPKIN Cucurbita pepo
This large creeping plant is native to tropical America but is now widespread throughout the world; the flesh of the globular fruit, sometimes large, is edible (soup, gratin), and dietary (vitamin A). The flattened seeds are anthelmintic and contain lipids whose unsaponifiable is rich in delta7-sterol and delta5-sterol glucosides.
Pumpkin « oil » is traditionally known in Central Europe and Germany as a remedy for benign prostatic hypertrophy. In these countries, a variety with « naked » seeds (styriaca) is cultivated, especially intended for the production of oil (green in color and quite thick).
The seeds contain 40 to 50% oil, composed mainly of linoleic acid (40-55%, with oleic acid (30%), palmitic (about 10%) and stearic acid (5-7%).
The high content of unsaturated fatty acids makes this oil dietary but goes rancid very quickly.
The activity of this oil on prostate adenoma is attributed to the unsaponifiable part, and more specifically to delta5-sterols. Here again, the mechanism of action remains unknown; some pharmacologists suggest an action of the « 5-alpha reductase inhibitor » type.
Average dosage
There have not been many studies yet on the use of pumpkin seed, pumpkin oil or pumpkin oil unsaponifiables.
Pumpkin oil capsules can be found on the market: for example, at a dosage of 500 mg, one capsule two to three times a day.
A little pumpkin oil can be incorporated into your diet (without cooking it) provided that it is cold-extracted. This oil must be stored in the refrigerator away from air (it goes rancid).
You can also consume the equivalent of 10 to 15 g of pumpkin seeds per day: by chewing or crushing them without cooking them.
GRASS POLLEN
Example: rye , varieties of common « grasses », and also corn.
It is still the lipidosterolic extract that is active on prostatic adenoma, it reduces the symptoms related to the increase in the size of the prostate.
Grass pollen is not standardized, nor are its extracts, and one must therefore rely on the manufacturer’s or laboratory’s instructions.
CONDUCT OF TREATMENT
Many years of experience in treating benign prostatic hypertrophy in many countries has shown that it is better to combine several plants or plant extracts.
A recent study showed the benefit of a mixture of saw palmetto extract (160 mg) and nettle extract (120 mg) twice a day. The improvement in symptoms was similar to that obtained with an alpha-blocker but without unpleasant side effects.
Saw palmetto and African plum can also be combined.
Pumpkin oil and pollen extracts are of more recent or more confidential use.
In all cases, treatment with medicinal plants for prostatic hypertrophy must be continued for a long time, because no therapeutic protocol results in a clear reduction in the volume of the prostate.
There are many « food supplements » offered to alleviate the symptoms of prostatic hypertrophy.
Some contain dosed extracts of several plants and user reviews are quite positive.
The dosage indicated by the manufacturer must be followed because there is no standardization of these herbal medicines.
Treatments of 6 to 8 weeks with 1 to 2 months of therapeutic rest can be recommended. The unpleasant side effects of this herbal medicine are minimal: some digestive disorders are possible (bloating, belching), in this case take the medication while eating.
Copyright 2024: Dr Jean-Michel Hurtel
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PHYTOTHERAPY, MEDICINAL PLANTS, AROMATHERAPY, ESSENTIAL OILS