Prostate Care Protocol: A Resource for Practitioners


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by Fullscript’s Integrative Medical Advisory Team

Benign prostatic hyperplasia (BPH) is a condition affecting approximately 50% of men over the age of 50 and 90% of men over the age of 80. (13) It is currently the most common condition diagnosed in older men and its prevalence continues to increase. (5)

older man standing in kitchen looking out the window and smiling holding a mug

Benign prostatic hyperplasia is the most commonly diagnosed health condition in men over 50.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia, also commonly referred to as benign prostatic hypertrophy or benign prostatic obstruction, is a condition characterized by the non-cancerous enlargement of the prostate gland in men. (13) BPH involves the proliferation of stromal and epithelial cells found in the transitional zone of the prostate, causing enlargement. (5)

The prostate undergoes two normal periods of growth, the first at puberty and the second at approximately age 25. As men age, the prostate continues to enlarge, which potentially results in pinching of the urethra and thickening of the bladder walls, causing issues with urinary retention and symptoms commonly associated with BPH. (13)

Causes and risk factors

While the exact cause of BPH remains unclear, a number of contributing factors have been identified. As previously stated, BPH occurs primarily in older men and is believed to be related to hormonal changes and inflammation. BPH has also been linked to age-related metabolic conditions, such as obesity, dyslipidemia, diabetes, and metabolic syndrome. (10)(19) While some of the risk factors for BPH are unmodifiable, others may be addressed through diet, lifestyle, and other interventions. (5) Risk factors for BPH include:

  • Age 40+
  • Genetic predisposition
  • Sedentary lifestyle
  • Erectile dysfunction
  • Certain cardiovascular and metabolic conditions, such as heart and circulatory disease, obesity, and type 2 diabetes (13)

Signs, symptoms, and complications

BPH is generally characterized by lower urinary tract symptoms (LUTS), including:

  • Urinary frequency
  • Urinary urgency
  • Urinary hesitancy, straining, and/or trouble starting a stream
  • Urinary retention, incomplete emptying
  • Reduced void volumes
  • Urinary incontinence
  • Weak and/or interrupted stream
  • Post-void dribbling
  • Nocturia (frequent urination during periods of sleep)
  • Pain during urination or after ejaculation
  • Unusual color or smell to urine (5)(13)

Although uncommon, complications that may arise from BPH include:

  • Acute or chronic urinary retention
  • Urinary tract infections (UTIs)
  • Blood in urine
  • Bladder and/or kidney damage
  • Bladder stones (13)

Integrative protocol for prostate care

Saw Palmetto (Serenoa repens)

Serenoa repens, commonly known as saw palmetto, is an extract derived from the ripe berries of the American dwarf palm, a plant native to some areas of the southeastern United States. (7)(17) Saw palmetto has been used as a treatment for BPH-associated urinary dysfunction since the 1800s and remains the most commonly used phytotherapy for the condition. The effects of saw palmetto extract on BPH are believed to be attributed to its antiandrogenic, antiestrogenic, antiedema, and anti-inflammatory effects. (7) Proposed mechanisms of actions include inhibiting 5α-reductase (7)(17), prolactin, and growth factor-induced cell proliferation (7), as well as binding to lower urinary tract receptors, such as α1-adrenoceptors, 1,4-dihyropyridine receptors, muscarinic cholinoceptors, and vanilloid receptors. (17)

Research findings:

  • Decrease in inflammatory markers that contribute to the evolution of chronic prostatic inflammation and subsequent hyperplasia (22)
  • Saw Palmetto supplementation resulted in an increase in average flow rate values, and decreases in prostate volume and IPSS score (16)

US: Search for Saw Palmetto in the Fullscript catalog.
CAN: Search for Saw Palmetto in the Fullscript catalog.

tomatoes

Lycopene is a non-provitamin A found in tomatoes and tomato products.

Lycopene

Lycopene is a non-provitamin A (18) found primarily in tomatoes and tomato products. (3) Lycopene possesses anti-oxidant properties and its ability to scavenge free radicals has been found to be greater than vitamin E, α-tocopherol, and glutathione. (18) In addition to reducing oxidative damage in the body, lycopene is involved in the regulation of genes and metabolism, intercellular communication and growth, and modulation of hormones and immune function. High lycopene intake has been shown to reduce the risk of chronic diseases, such as cardiovascular diseases, cancer, and neurological conditions. (3)(18)

Research findings:

  • Reduction in PSA levels and overall improvement of IPSS score (15)
  • Consistent lycopene supplementation has been shown to inhibit the overall progression of BPH (15)

US: Search for Lycopene in the Fullscript catalog.
CAN: Search for Lycopene in the Fullscript catalog.

Beta-sitosterol

The most abundant phytosterol in the diet, beta-sitosterol can be found in the leaves, fruit, rhizomes, and tissue cultures of many plants, such as beans, nuts, and seeds. (2)(12) It is also a primary constituent of certain medicinal herbs, including stinging nettle, devil’s claw, and saw palmetto. (12) Beta-sitosterol has anti-inflammatory, antioxidant, antimicrobial, antinociceptive, angiogenic, and immunomodulatory properties. (2) Beta-sitosterol also demonstrates inhibitory effects on 5α-reductase, which may account in part for its therapeutic effects as 5α-reductase inhibitors have been shown to improve symptoms of BPH. (6)

Research findings:

  • Beta-sitosterol has been shown to improve IPSS score (1)(11)
  • Overall improvement of quality of life (QOL), urinary and flow scores, which include maximum urinary flow and postvoid residual urine volume (1)(21)

US: Search for Beta-sitosterol in the Fullscript catalog.
CAN: Search for Beta-sitosterol in the Fullscript catalog.

Pygeum africanum extract

Pygeum africanum, an extract from the African prune tree, was used traditionally in herbal medicine to treat benign prostatic hyperplasia.

Pygeum (Pygeum africanum)

Pygeum africanum, commonly referred to as pygeum, is an extract from the African prune tree, an evergreen tree native to Afromontane forests. Several active constituents of the plant have been identified, including β-sitosterol, β-sitostenone, n-docosanol, lauric acid, myristic acid, and ursolic acid. (9) Used traditionally in herbal medicine to address benign prostatic hyperplasia, (9) modern research now demonstrates the effectiveness of pygeum in improving BPH-associated urinary symptoms (4)(8)(20) and suggests that pygeum possesses antiproliferative and apoptotic effects on prostate cells. (14)

Research findings:

  • IPPS score and QOL were improved by 38% and 35% respectively (4)
  • A decrease of 19% in nocturia, 24% in residual urine volume and an increase of 23% in peak urine flow was observed (20)
  • Urologic symptoms and flow measures were improved (8)(20)

US: Search for Pygeum africanum in the Fullscript catalog.
CAN: Search for Pygeum africanum in the Fullscript catalog.

The bottom line

While certain factors associated with the development of BPH are unmodifiable, such as age and genetic predisposition, other risk factors may be addressed through dietary, lifestyle, and dietary supplement interventions. (5) A protocol using natural supplements can be used therapeutically on its own or as an adjunct to existing treatment. If you are not an integrative healthcare provider, we recommend speaking with one to find out whether these supplements are right for your wellness plan.

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript!

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Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

  1. Berges, R.R., Kassen, A., & Senge, T. (2000). Treatment of symptomatic benign prostatic hyperplasia with beta-sitosterol: an 18-month follow-up. BJU International, 85(7), 842-6.
  2. Bin Sayeed, M. S., Karim, S., Sharmin, T., & Morshed, M. M. (2016). Critical analysis on characterization, systemic effect, and therapeutic potential of beta-sitosterol: A plant-derived orphan phytosterol. Medicines (Basel, Switzerland), 3(4), 29.
  3. Cámara, M., de Cortes Sánchez-Mata, M., Fernández-Ruiz, V., Cámara, R.M., Manzoor, S., & Caceres, J.O. (2013). Lycopene: A review of the chemical and biological activity related to beneficial health effects. Studies in Natural Products Chemistry, 40, 383-426.
  4. Chatelain, C., Autet, W., & Brackman, F. (1999). Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: a randomized, double-blind study, with long-term open label extension. Urology, 54(3), 473-8.
  5. Chughtai, B., Forde, J.C., Thomas, D.D.M., Laor, L., Hossack, T., Woo, H.H., … Kaplan, S.A. (2016). Benign prostatic hyperplasia. Nature Reviews Disease Primers, 2(16031).
  6. Dhingra, N., & Bhagwat, D. (2011). Benign prostatic hyperplasia: An overview of existing treatment. Indian Journal of Pharmacology, 43(1), 6–12.
  7. Fagelman, E., & Lowe, F.C. Saw palmetto berry as a treatment for BPH. Nature Reviews Urology, 3(3), 134–138.
  8. Ishani, A., MacDonald, R., Nelson, D., Rutks, I., & Wilt, T.J. (2000). Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. The American Journal of Medicine, 109(8), 654-64.
  9. Kadu, C.A., Parich, A., Schueler, S., Konrad, H., Muluvi, G.M., Eyog-Matig, O., … Geburek, T. (2012). Bioactive constituents in Prunus africana: geographical variation throughout Africa and associations with environmental and genetic parameters. Phytochemistry, 83, 70-8.
  10. Kim, E.H., Larson, J.A., & Andriole, G.L. (2016). Management of benign prostatic hyperplasia. Annual Review of Medicine, 67, 137-151.
  11. Klippel, K.F., Hiltl, D.M., & Schipp, B. (1997). A multicentric, placebo-controlled, double-blind clinical trial of beta-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. German BPH-Phyto Study group. BJU International, 80(3), 427-32.
  12. Lomenick, B., Shi, H., Huang, J., & Chen, C. (2015). Identification and characterization of β-sitosterol target proteins. Bioorganic & Medicinal Chemistry Letters, 25(21), 4976–4979.
  13. National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Prostate enlargement (benign prostatic hyperplasia). Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia
  14. Quiles, M.T., Arbós, M.A., Fraga, A., de Torres, I.M., Reventós, J., & Morote, J. (2010). Antiproliferative and apoptotic effects of the herbal agent Pygeum africanum on cultured prostate stromal cells from patients with benign prostatic hyperplasia (BPH). Prostate, 70(10), 1044-53.
  15. Rowles, J.L., Ranard, K.M., Smith, J.W., An, R., & Erdman, J.W.Jr. (2017). Increased dietary and circulating lycopene are associated with reduced prostate cancer risk: a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases, 20(4), 361-377.
  16. Saidi, S., Stavridis, S., Stankov, O., Dohcev, S., & Panov, S. (2017). Effects of Serenoa repens alcohol extract on benign prostate hyperplasia. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 38(2), 123-129.
  17. Suzuki, M., Ito, Y., Fujino, T., Abe, M., Umegaki, K., Onoue, S., … Yamada, S. (2009). Pharmacological effects of saw palmetto extract in the lower urinary tract. Acta Pharmacologica Sinica, 30(3), 271–281.
  18. Venkata Naveen Kumar, P., Elango, P., Asmathulla, S., & Kavimani, S. (2017). A systematic review on lycopene and its beneficial effects. Biomedical and Pharmacology Journal, 10(4).
  19. Vignozzi, L., Gacci, M., & Maggi, M. (2016). Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nature Reviews Urology, 13, 108–119.
  20. Wilt, T., Ishani, A., MacDonald, R., Rutks, I., & Stark, G. (2002). Pygeum africanum for benign prostatic hyperplasia. Cochrane Library Systemic Reviews, (1), CD001044.
  21. Wilt, T.J., MacDonald, R., & Ishani, A. (1999). Beta-sitosterol for the treatment of benign prostatic hyperplasia: a systematic review. BJU International, 83(9), 976-83.
  22. Wyatt, G.K., Sikorskii, A., Safikhani, A., McVary, K.T., & Herman, J. (2016). Saw palmetto for symptom management during radiation therapy for prostate cancer. Journal of Pain and Symptom Management, 51(6), 1046-54.