The role of herbal remedies in benign prostatic hyperplasia

Benign prostatic hyperplasia is an abnormal development of the prostate gland . Symptoms are those of obstruction of the bladder outlet; weak stream, urination retention, pollakiuria, irrepressible urge to urinate, nocturia, incomplete emptying and later urination by overflow or urgency with incontinence, and complete urinary retention .

What is benign prostatic hyperplasia?

In some men, with age, the prostate becomes too large and interferes with the emission of urine . This excessive growth is called benign prostatic hyperplasia, or prostatic adenoma. The risks of suffering from this disease increase with age: after 60 years, 60% of men suffer from it and this figure increases to 90% after 85 years.

Can we prevent prostatic hyperplasia?

  • Free your prostate:

If you were having significant and regular sexual activity, continue to keep up. An Australian study showed that daily masturbation limited the development of benign prostatic hyperplasia.

  • Urinate when you want to:

Refraining from urinating for a long time can irritate the bladder.

  • Avoid certain foods:

Spicy and salty dishes, alcohol, drinks rich in caffeine (coffee, tea, colas) and chocolate worsen the symptoms of prostatic hyperplasia. Avoid excess animal protein and vary your protein sources (legumes, nuts, fish, soy).

  • Get some exercise:

Good muscle tone allows you to better control your urge to urinate. Avoid sports that jostle the bladder (mountain biking, horseback riding, tennis, volleyball, etc.).

  • Avoid decongestants:

If you have a cold, avoid taking medicines that contain decongestants (such as pseudoephedrine ). These substances make it more difficult to pass urine.

  • Avoid drinking after a certain time:

After 7 p.m., drink moderately to avoid having to get up at night. Also avoid heavy drinks or diuretics in the evening.

  • Have regular follow-up:

Have regular digital rectal exam and / or urography to monitor prostate volume. If you have difficulty urinating or in case of pain or burning during urination, consult your doctor.

Are there herbal remedies to relieve benign prostatic hyperplasia?

For many years, herbal treatments were the only ones offered to patients. These herbs are often used in combination to relieve benign prostate problems.

The Florida Palm :

The WHO and the German Commission E recognize in particular the use of Florida palm in the treatment of urinary t rubles associated with mild to moderate benign prostatic hyperplasia . Florida palm interacts in a complex way with the metabolism of testosterone in the prostate. It thus inhibits the activity of 3-α-ketosteroid reductase , and that of isoforms 1 and 2 of 5 α-reductase.

This enzyme, whose activity increases with age, is responsible in particular for the bioconversion of free testosterone into dihydrotestosterone (DHT), a more powerful androgen, which is the main metabolite. This stimulates the development of fibroblasts of the connective stroma by acting at the level of cytosolic androgen receptors located in the prostate. An increase in DHT therefore promotes the development of hypertrophy of the glandular and muscle constituents of the central part of the prostate. Conversely, its curbing prevents hypertrophy of the gland.

Unlike 5-alpha-reductase synthesis inhibitors, Florida palm hexane extract induces this effect without interfering with the ability of cells to secrete PSA, thus allowing the continued use of PSA measurements for screening for PSA. prostate cancer .

In addition, the hexane extract of Florida palm inhibits the activity of methyltrienolone, a potent synthetic agonist of androgen receptors. It prevents the binding of this synthetic androgen to prostatic cytosolic receptors on which DHT also acts.

Inhibition of 5α-reductase by Serenoa repens is accompanied by reduced growth of human prostatic carcinoma cells in vitro . This antiproliferative action is accompanied, among other things, by induction of apoptosis .

Several studies, the 2 most recent of which were multicenter, double-blind and placebo-controlled trials, including one long-term, have indeed shown the effectiveness of taking the two plants together in the management of benign hypertrophy. prostate. Two double-blind and randomized clinical trials have also shown an activity of the combination similar to that of tamsulosin or finasteride , two reference drugs in this indication.

The tannins contained in the fireweed; oenothein A and oenothein B also inhibit the activity of 5-alpha-reductase and aromatase enzymes involved in the pathogenesis of benign prostatic hyperplasia, without being the only antiproliferative active ingredients.

Lycopene is known to prevent an enlarged prostate as well as reduce symptoms in older men . The association with selenium increases the anti-inflammatory effect and the reduction of the volume of the prostate . It decreases the expression of growth factors and cell proliferation. A 2011 in vitro and in vivo study notably confirmed the value of taking Florida palm, lycopene and selenium together. A 2016 literature review concluded that current data suggests a higher efficacy of the combination compared to the herb used alone.

A randomized, open-label, phase IV clinical study of non-inferiority compared to tadalafil 5 mg conducted in 427 patients for 6 months in 2018 also showed that the efficacy of the combination Serenoa repens + selenium + lycopene in the treatment of lower urinary tract symptoms following benign prostate obstruction is not inferior to that of the synthetic molecule, in terms of maximum urine output (Qmax) and IPSS questionnaire.

 

Medical bibliographic sources and clinical trials :

  • Benign prostatic hyperplasia, Vidal Recos, 2017
  • Gerald L. Andriole, MD, Barnes-Jewish Hospital, Washington University School of Medicine, MSD, 2020
  • Bayne CW et al., Serenoa repens (Permixon); a 5 alpha-reductase types I and II inhibitor-new evidence in a coculture model of BPH, Prostate, 1999
  • Habib FK et al. Serenoa repens (Permixon) inhibits the 5 alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression; Int J Cancer, 2005
  • Anderson ML A preliminary investigation of the enzymatic inhibition of 5alpha-reduction and growth of prostatic carcinoma cell line LNCap-FGC by natural astaxanthin and Saw Palmetto lipid extract in vitro; J Herb Pharmacother., 2005
  • Schneider HJ et al., (Treatment of benign prostatic hyperplasia. Results of a treatment study with the phytogenic combination of Sabal extract WS 1473 and Urtica extract WS 1031 in urologic specialty practices), Fortschr Med, 1995
  • Lopatkin N. et al., Long-term efficacy and safety of a combination of sabal and urtica extract for lower urinary tract symptoms. A placebo-controlled, double-blind, multicenter trial, World J Urol., 2005
  • Lopatkin N. et al., Int Efficacy and safety of a combination of Sabal and Urtica extract in lower urinary tract symptoms-long-term follow up of a placebo-controlled, double-blind, multicenter trial; Urol Nephrol., 2007
  • Oelke M. et al., Fixed-dose combination PRO 160/120 of sabal and urtica extracts improves nocturia in men with LUTS suggestive of BPH; re-evaluation of four controlled clinical studies, World Journal of Urology, 2014
  • Bonvissuto G. et al., Effect of Serenoa repens, Lycopene, and Selenium on Proonflammatory Phenotype Activation; An in vitro And In vivo Comparison Study, Urology, 2011
  • Russo A. et al., Serenoa repens, selenium and lycopene to manage lower urinary tract symptoms suggestive for benign prostatic hyperplasia; Expert Opinioin on Drug Safety, 2016
  • Schartz S. et al., Lycopene inhibits disease progression in patients with benign prostate hyperplasia J. Nutr., 2008
  • Baron A. et al., Serenoa repens extract targets mitochondria and activages the intrinsic apoptotic pathway in human prostate cancer cells; BJU Int., 2009

 

 

Clementine. M.
Naturopath – Aromatherapist / Herbalist – Phytotherapist
Consultant in Clinical Phyto-aromatherapy and Ethnomedicine

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