Alternative ways of treating an enlarged prostate

Q: My prostate is enlarged and my doctor wants to put me on medication to avoid surgery. Is there a more natural approach?

A: Prostate enlargement, or benign prostatic hypertrophy (BPH) as we say in the business, is very common in middle-aged and older men, especially in the Western world. BPH is not common in every culture; in Japan and China, for example, where diets are much lower in fat and animal foods, prostate enlargement and prostate cancer are much less frequent.

Symptoms of prostate enlargement include difficulty emptying the bladder, reduced force of urinary stream, and the need to urinate frequently during the night. In the not-too-distant past, symptomatic prostate enlargement was usually treated with surgery, which had its complications, including incontinence and impotence. In the 1980s, medications were developed that reduced the symptoms of BPH without surgery, and operations became much less common.

However, these drugs don't work for everyone, and they can have side effects. Fortunately, a number of alternative approaches may be useful:

• Saw palmetto is a popular herb used to reduce prostate symptoms in men. It seems to work by reducing the effect of testosterone on the prostate, but it is not generally associated with sexual side effects. Many studies have shown positive results in reducing urinary symptoms, though one to two months of treatment may be needed before improvement is noted. The standard dose is 160 mg taken twice daily. It can thin the blood a bit, so talk to your doctor if you are taking other blood thinners.

• Pygeum is an herb obtained from the bark of an African evergreen. Like saw palmetto, it reduces urinary symptoms. It probably works by reducing the growth of prostate cells and acts as an anti-inflammatory. A typical dose is 75 to 200 mg a day.

• Beta-sitosterol is a plant sterol that seems to work like the prescription drug Flomax (and like Flomax, it can cause some erectile dysfunction in some men). It reduces urinary symptoms and improves urine flow; it also seems to reduce prostate cell growth. A typical starting dose is 30 to 60 mg twice daily. Beta-sitosterol also reduces LDL cholesterol levels by blocking cholesterol absorption in the gut. (Much higher doses are needed for this.)

• Other supplements for which there is preliminary evidence include flaxseed, stinging nettle, pumpkin seed oil, rye grass pollen and zinc.

Lifestyle also plays a role in BPH: Diets high in animal fat, obesity and insulin resistance seem to fuel prostate growth, and exercise has the opposite effect.

Yes, as usual, we recommend that you maintain your weight and do regular exercise to spare your prostate as you get older.

And one last important caveat: Sometimes symptoms of BPH can mask a more serious underlying problem, such as prostate cancer. So if you notice a change in urinary symptoms, be sure to discuss with your doctor before undertaking any alternative therapies.

About the writer:

• Drs. Kay Judge and Maxine Barish- Wreden are medical directors of Sutter's Downtown Integrative Medicine program. Have a question related to alternative medicine? E-mail adrenaline@sacbee.com.