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Do I have a prostate problem?

The warning signs of a prostate in trouble are clear, and action should be taken immediately.
ZAK Merican observed that he was wetting his underwear after urinating. He tried to be more careful, but to no avail. His wife noticed that the 52-year-old engineer was getting up three to four times a night to go to the bathroom. She was anxious, because frequent urination is also a diabetes symptom.

After constant prompting on her part, Zak made an appointment to see his physician, a specialist in family practice. Subsequently, after an initial examination, he was asked to fill in a short questionnaire, which had these questions:

Do you ...

  • Experience a sensation of not emptying your bladder fully after urinating?
  • Have to urinate again in less than two hours?
  • Have to strain to begin urinating?
  • Have a weak urine stream?
  • Find it difficult to postpone urination?
  • He answered yes to most of the questions.

    Zak was referred to a urologist, where BPH (benign prostatic hyperplasia), an enlarged prostate, was confirmed.

    Prostate defined
    The prostate is a doughnut-shaped gland that lies just below the bladder, with part of the gland being wrapped around the urethra (the tube that drains urine from your bladder). It is about the size of a pea at birth, and grows rapidly, almost doubling in size during puberty to reach the size of a walnut by the early 20s.

    As men get older, the prostate starts to show signs of abnormal growth, and the prostate gland becomes enlarged. This in turn leads to obstruction of the urethra, causing problems with urination. The enlargement is due to age-related hormonal changes.

    BPH is a condition that will affect one man in every two by the age of 60, escalating to nine out of every 10 men by the age of 80, according to the American Urological Association (AUA). And, like grey hair, an enlarged prostate is a natural by-product of getting older, doctors say.

    Trouble is, the nightly bathroom runs become more frequent, eventually edging their way into the daytime routine.

    Treatment options
    While conventional drugs and surgery are options for men with severe BPH, others find relief with phytotherapy (herbs) alone, such as standardised saw palmetto, pumpkin seed, pygeum, and stinging nettle.

    Conventional drugs
    Alpha blockers: These drugs do not reduce the size of the prostate but work by relaxing the muscles around the prostate and bladder neck to improve urine flow. They are effective for men with normal to moderately enlarged prostate glands.

    Alpha blockers were originally created to treat high blood pressure; dizziness is the most common side effect; other side effects are generally mild and controllable. These drugs are not for men with significant urine retention and frequent urinary tract infections.

    5-alpha reductase inhibitors: These drugs can partially shrink the prostate by reducing levels of the male hormone, dihydrotestosterone (DHT), which is involved in prostate growth. These drugs take longer to work than alpha blockers, but there is urine flow improvement after three months.

    These drugs can reduce risk of acute retention (inability to urinate), and also reduce the need for prostate surgery. You may need to take them for six to 12 months to see if they work.

    Possible side effects include erection problems, decreased sexual desire, and reduced amount of semen. These side effects are generally mild and may go away when you stop taking the drugs, or after the first year of taking the drugs.

    Phytotherapy
    Phytotherapy is the use of plant extracts to treat a medical condition. Some plant extracts have been used for centuries to treat urinary symptoms secondary to BPH.

    Today, there is wide variation in the use of these herbal products around the world. In some European countries, for example, Germany, Austria, and France, plant extracts are commonly used as initial treatment for men with urinary symptoms.

    Saw palmetto (Serenoarepens)
    Saw palmetto is one of the most researched herbal remedies for BPH. A three-year preliminary study in Germany found that 160mg of saw palmetto extract taken twice daily reduced night-time urination in 73% of patients, and improved urinary flow rates significantly.

    Most recent studies have shown that to achieve the optimal benefits with saw palmetto, it is essential that fat-soluble saw palmetto extracts are standardised to contain 85% to 95% fatty acids.

    Pygeum (Pygeum africanum)
    Pygeum is the second most popular herb for helping with symptoms of an enlarged prostate. Pygeum extracts contain phytosterols that can inhibit prostaglandin synthesis, thereby reducing the abnormally high levels of prostaglandins normally found in BPH.

    Pygeum has been approved in Germany, France, and Italy as a remedy for BPH. Controlled studies published over the past 25 years have shown that pygeum is safe and effective for men with BPH of mild or moderate severity.

    Tomato (Lycoparsionesculen-tum)
    Lycopene contains phytosterols that gives tomatoes their bright red colour. Lycopene gets high marks from researchers for its apparently potent antioxidant properties. Research studies show that high levels of lycopene consumption have been associated with long-term protection of prostate health.

    Stinging nettle (Urticadioca)
    As men age, their sex hormone binding globulin (SHBG) level increases, which makes them more susceptible to abnormal cell proliferation. Stinging nettle has a strong affinity for SHBG, thereby limiting the amount of testosterone and oestrogen that can bind to it and influence cell proliferation.

    This extract may increase urinary volume and the maximum flow rate of urine in men with early-stage BPH. It has been successfully combined with both saw palmetto and pygeum to treat BPH in double-blind trials.

    Pumpkin seed (Curcubitapepo)
    Pumpkin seed extracts contain phytosterols, curcubitin, and selenium. The extract inhibits 5-alpha-reductase, preventing the conversion of testosterone to dihydrotestosterone. It also has an inhibitory effect on aromatase, preventing androgens like testosterone from converting to oestrogen.

    Generally, when shopping for herbal product(s), one should preferably choose products that contain standardised extract(s) of herbs as they can guarantee the consistency of the product.

    References:
    1. Bach D, Ebeling L. Long-term drug treatment of benign prostatic hyperplasia-results of a prospective 3-year multicenter study using Sabal extract IDS 89.
      Phytomedicine 1996;3:105-11.
    2. Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostate hyperplasia: a randomized.
      international study of 1,098 patients. Prostate 1996; 29:231-40.
    3. Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia. A systematic review.JAMA 1998; 280:1604-9.
    4. Andro MC, Riffaud JP. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia: a review of 25 years of published experience.
      CurrTher Res 1995;56:796-817



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