Do Herbal Meds Work for Enlarged Prostate Symptoms?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Symptoms from an enlarged prostate are a common complaint in older men. While we don’t know exactly what causes it, the changes in male sex hormones that occur with aging appear to play a role.

Urinary symptoms and sleep disturbance from benign prostatic hyperplasia (BPH) may be easily remedied with medications. The prescription options, like tamsulosin (Flomax), finasteride (Proscar), and Rapaflo, among others, do work but may lead to side effects. Because of this, men often opt for a more “natural” remedy first. Do herbal therapies work? What does the evidence show?

Evidence from studies on the safety and efficacy of herbal therapies for BPH is conflicting. Also remember that supplements are unregulated—but if you are going to try them, here is what you should know.

  1. Saw palmetto.  Saw palmetto is widely used for treatment of BPH, but there are few studies to support its use. A 2012 review of 32 studies done on 5,666 men with BPH comparing saw palmetto against a placebo did not find any differences in urinary symptom scores, measures of urinary flow, or prostate size.
  2. Beta-sitosterol. This is a plant extract often used by men in Europe. A 2011 review of 4 trials found that while evidence suggests that beta-sitosterol improved symptoms in men with BPH, the long-term effectiveness and safety was not known. So, it may work, but safety in the long run is not known.
  3. Cernilton. Cernilton is a rye-grass pollen extract used by men with symptomatic BPH. Four good studies have been done that suggest cernilton is well-tolerated and modestly improves overall urinary symptoms, including nocturia (getting up at night to pee). While it improved symptoms, it did not affect urinary flow rates, residual urine, or prostate volume.
  4. Pygeum africanum. The extract of the African prune tree, Pygeum africanum, is another agent men use for the treatment of BPH. In a 2002 meta-analysis of 18 randomized studies, treatment with Pygeum africanum improved symptoms two times more frequently than placebo and increased peak urinary flow rates 23 percent.

Men, have you tried these?

Dr O.

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