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Q: I have BPH and see many herbal products promoted for this condition. Can you tell me which ones really work?
A: Like the graying of hair with age, most men can expect their prostate to enlarge, a condition called benign prostatic hyperplasia or BPH.
The prostate is a walnut-sized gland that produces the sperm-carrying fluid.
The prostate gland surrounds the duct that carries urine out of the body. As the gland enlarges and presses against this duct, urine flow can be obstructed.
Apart from symptoms related to urinary obstruction, BPH is considered harmless.
The herbal supplements showing the most promise for treating BPH are saw palmetto, pygeum, beta-sitosterol, rye grass pollen and African wild potato.
Saw palmetto carries the best scientific credentials and is the most widely used supplement for BPH.
Studies show it to be about as effective as the prescription drug Proscar (finsasteride) in reducing symptoms such as frequent urination, painful urination, hesitancy, urgency and nighttime urination.
Additionally, the herb seems to offer important advantages over Proscar: It usually does not cause sexual dysfunction and has little effect on PSA (prostate-specific antigen) levels.
Higher PSA levels may indicate prostate cancer.
Proscar can lower PSA levels and thus could interfere with cancer detection and monitoring.
Saw palmetto may not be as effective as the prescription drugs called alpha-1 blockers such as Flomax (tamsulosin), Uroxatral (alfuzosin), Minipress (prazosin), Hytrin (terazosin) and Cardura (doxazosin).
Pygeum (also known as African plum tree) appears to decrease nighttime urination and frequency. It's used alone or combined with saw palmetto or other ingredients.
Beta-sitosterol significantly improves urinary symptoms and is used as a component in a number of supplements promoted for BPH. You might recognize beta-sitosterol as the ingredient in Take Control, the cholesterol-lowering margarine. It may be a good choice for men who also have high cholesterol levels.
Rye grass pollen extract contains beta-sitosterol, the supplement just discussed. It's used as a prescription drug in Europe and other countries and seems to reduce nighttime urination, frequency, urgency, dribbling and painful urination.
African wild potato is also a source of beta-sitosterol, though there's less evidence for its benefit.
Second tier supplements include stinging nettle, pumpkin seed and isoflavones (found in soy and red clover).
It can take several weeks to see a noticeable benefit with herbal products, so a trial of up to two months may be needed.
Though these supplements may alleviate BPH symptoms, there's no evidence they can prevent the development of BPH.
Additionally, there's no meaningful evidence that multi-ingredient products are more effective than single-ingredient products.
So far, no significant safety issues have come to light for herbal supplements commonly used for BPH, but long-term safety remains unknown.
It's important to see your physician for a medical checkup before self-treating symptoms of BPH.
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(Richard Harkness is a consultant pharmacist who writes on health care topics. You can write him at 1224 King Henry Drive, Ocean Springs, MS 39564. His e-mail address is rharkn@aol.com. Volume of mail prohibits individual replies; selected letters will be answered in his column.)
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(c) 2004, The Sun Herald (Biloxi, Miss.). Distributed by Knight Ridder/Tribune News Service.
