Benign Prostatic Hyperplasia: Symptoms and Treatment

Table of Contents

Benign prostatic hyperplasia (BPH) is a common disorder found mostly in aging men. It is characterized by a nonmalignant chronic growth of the prostate gland, which, in turn, prevents the bladder from emptying completely and leads to lower urinary tract symptoms (LUTS) (Woodard, Manigault, McBurrows, Wray, & Woodard, 2016). This paper aims at exploring the case of L.L., a male patient aged 67 years, who was diagnosed with BPH. The man is currently taking the only medication, Cozaar 100 mg for hypertension, and has his BP well-controlled. The doctor prescribed a medication for the patient’s BPH, but the man wanted to try a herbal supplement before taking it. Further, it will be explained whether herbal supplements can be recommended in the patient’s case. The paper will also discuss what herbal supplement and dosage are suitable for the patient and what the patient should be aware of before taking the supplement.

Treatment Options for BPH

The treatment options for BPH vary depending on the severity of symptoms. Mild symptoms require only watchful waiting, which means that patients are examined in the clinic once a year but are not treated (Woodard et al., 2016). If symptoms are moderate or severe but do not bother patients, they may choose watchful waiting as well (Woodard et al., 2016). Yet, if the symptoms are bothersome, patients undergo pharmacological treatment, and in case there are BPH complications, patients may need surgery (Woodard et al., 2016). Pharmacological treatment includes such classes of pharmacological agents as alpha-blockers, 5-alpha-reductase inhibitors, and PDE5 inhibitors (Woodard et al., 2016). They lead to noticeable symptomatic improvement but have significant side effects.

Alongside conventional medicine, patients sometimes turn to phytotherapy, which is the use of medications made of plants. Some phytotherapeutic agents used for treating BPH are Serenoa repens, Pygeum africanum, Secale cereale, and Hypoxis rooperi (Keehn, Taylor, & Lowe, 2016). Healthcare professionals’ attitudes toward the use of herbal supplements for treating BPH are somewhat controversial, but phytotherapeutic agents have become less favored by doctors recently. The majority of well-constructed studies indicated that the effectiveness of herbal supplements in treating BPH is comparable to that of placebo; yet, these agents are safe and have no considerable side effects (Keehn et al., 2016). Scholars strongly discourage healthcare providers from recommending herbal supplements to patients bothered by the symptoms of BPH (Keehn et al., 2016; Woodard et al., 2016). Nevertheless, herbal supplements are still popular among patients with an enlarged prostate.

The case under consideration does not provide details about the severity of the patient’s symptoms and whether they bother him. Therefore, it may be recommended that the doctor should discourage the patient from taking a herbal supplement if his symptoms are bothersome. Herbal supplements are unlikely to bring much relief to the patient. However, it is also necessary to note that patients sometimes take herbal supplements without informing their urologists (Persaud, Leach, Ramkissoon, & Goetz, 2017). Since the patient is willing to try a herbal supplement before taking a prescription medication, it may be suggested that the doctor allow him to do so to avoid the man’s undergoing phytotherapy without supervision.

The herbal supplement that the doctor may recommend to the patient is Serenoa repens, which is sold under the name Saw palmetto. It is the most popular and the most studied phytotherapeutic agent. The mechanism of action of the Serenoa repens extract is still unknown (Kwon, 2019). Supposedly, it can reduce the growth of the prostate by inhibiting type I and type II isoenzymes of 5-alpha-reductase with the help of free fatty acids, which are the key active components of the extract (Keehn et al., 2016). Serenoa repens is also considered to have an anti-inflammatory and pro-apoptotic effect (Kwon, 2019). The recommended daily dosage of this herbal supplement is “1-2 g raw drugs or 320 mg liposterolic extract containing 85%–95% fatty acid and sterols extracted using ethanol, hexane, or other organic solvents” (Annunziata & Barrea, 2019, p. 402). In brief, the dosage can be written as 320 mg PO once daily.

Side Effects and Warnings

Perhaps, the major factor attracting patients with BPH to herbal supplements is a smaller number and severity of side effects compared to conventional medications. Pharmacological agents used to treat BPH have significant sexual adverse effects, such as ejaculatory dysfunction (Woodard et al., 2016). Side effects of Serenoa repens are milder and include gastrointestinal disorders, decreased libido, headache, fatigue, hypertension, back pain, and urinary retention (Annunziata & Barrea, 2019). Serenoa repens is considered a safe choice for special patients’ cases. It is reported that conventional medications used for treating BPH increase the risk of orthostatic hypotension (Woodard et al., 2016). At the same time, patients who undergo treatment for hypertension are already at risk for orthostatic hypotension (Teperikidis & Polatidis, 2017). Since L.L. takes medication for his hypertension, he is presumably at risk for orthostatic hypotension, which may increase if he is administered with a conventional drug for BPH. Therefore, it may be concluded that the doctor should recommend a herbal supplement containing Serenoa repens in L.L.’s case since it does not have such a side effect.

However, it is necessary to warn L.L. that the herbal supplement may not have a considerable impact on the relief of his BPH symptoms. Clinical trials exploring the effect of Serenoa repens on the symptoms of BPH have shown contradictory results because of flaws in study design and varying composition of preparations with Serenoa repens (Keehn et al., 2016). Yet, as was already mentioned, the majority of scholars advise healthcare providers against recommending herbal supplements to patients. L.L. should also be warned to remember to control his BP since one of the mentioned side effects of Serenoa repens is hypertension.

References

  1. Annunziata, G., & Barrea, L. (2019). Saw palmetto (Serenoa repens). In S. M. Nabavi & A. S. Silva (Eds.), Nonvitamin and nonmineral nutritional supplements (pp. 401-402). Cambridge, MA: Academic Press.
  2. Keehn, A., Taylor, J., & Lowe, F. C. (2016). Phytotherapy for benign prostatic hyperplasia. Current Urology Reports, 17(53), 1-6.
  3. Kwon, Y. (2019). Use of saw palmetto (Serenoa repens) extract for benign prostatic hyperplasia. Food Science and Biotechnology, 28, 1599–1606.
  4. Persaud, S., Leach, J., Ramkissoon, & Goetz, L. (2017). Knowledge and prevalence of use of saw palmetto and other herbal products among men with prostate disease in Trinidad and Tobago. African Journal of Urology, 23, 249-252.
  5. Teperikidis, E., & Polatidis, B. (2017). Serenoa repens in the hands of the modern urologist. Hellenic Urology, 29(1), 26-32.
  6. Woodard, T. J., Manigault, K. R., McBurrows, N. N., Wray, T. L., & Woodard, L. M. (2016). Management of benign prostatic hyperplasia in older adults. The Consultant Pharmacist, 31(8), 412-424.

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