Protecting the Prostate

The prostate gland is part of the male reproductive system and its primary function is to produce fluid to transport semen. The prostate consists of 30 percent muscular tissue and 70 percent glandular tissue and its normal adult size is that of a walnut or a chestnut. The prostate gland’s position is in an especially critical area of the male anatomy. The prostate gland is in direct contact with the bladder. The prostate gland also wraps around the urethra, the tube that carries urine from the bladder downward to and through the tip of the penis.1

The prostate gland is subject to three main diseases, enlargement or hypertrophy, called benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. Some prostate specialists and pathologists believe that the prostate gland is the most commonly diseased organ of the human body.1 After the age of 50, hypertrophy of the prostate gland occurs in almost all men. This is due primarily to age-related changes in hormone production, where estradiol, sex hormone binding globulin (SHBG) and dihydrotestosterone increase and levels of free testosterone decrease. The prostate gland begins its second growth spurt in men in their mid to late forties. A moderately enlarged prostate is approximately the size of a plum, a more enlarged prostate is the size of an apple, and a maximally enlarged prostate is about the size of a grapefruit.2

BPH does not increase prostate cancer risk, nor does it develop into prostate cancer. As the prostate increases in size, however, it can put pressure on the urethra, which can cause decreased urine flow or a complete urine flow blockage. Hormonal changes that occur with age are believed to be most responsible for prostate gland enlargement. The natural hormonal changes occur as a result of increased body fat, environmental exposures and gene expression changes, which result from an age-related reprogramming of the adrenocortical-pituitary axis output.3

Prostatitis is an infection or inflammation of the prostate gland and has been divided into 4 categories. Category 1 is an acute bacterial prostatitis, sometimes seen as a byproduct of gonorrheal infection and is more common in 20 year olds. It is treated with antibiotics. Category 2 prostatitis is a chronic bacterial infection of the prostate and again is treated with antibiotics. Category 3 prostatitis is a nonbacterial prostatitis usually involving chronic pelvic pain syndrome. Category 4 prostatitis is an inflammatory prostatitis that is asymptomatic. Category 1 through 4 prostatitis can occur at almost any age group. According to NIH figures, prostatitis is the most common prostate disease seen by physicians and more common than BPH or prostate cancer. Prostatitis rates appear to be higher in runners, horse back riders and bicyclists.4

The third disease to affect the prostate gland is prostate cancer, the second leading cause of cancer deaths in men in the United States after lung cancer. According to the American Cancer Society, 230,110 new cases of prostate cancer were reported in 2004. It is the sixth leading cause of death in men over 65.

The causes of prostate cancer are unknown, but research has shown there are multiple factors that increase the risk, including heredity, diet, ethnicity, hormones and environmental factors. The assessment of risk factors can help patients determine when to start and how often they need prostate cancer screening. Family history in any male relatives, namely a father or brother, also is a risk factor.

African-American men have higher death rates from prostate cancer than Caucasian men and also are often diagnosed at later stages of disease development. Indian, Chinese, Japanese and other Asian men have lower reported cases of prostate cancer, but their risks rise when they switch to a high-fat Westernized diet. A high-fat diet and obesity have been linked to higher prostate cancer risks. One theory is that a predominance of fat cells causes a hormonal shift that affects the risk of prostate cancer.5

Supporting Prostate Health

Prostatitis
As mentioned above, category 3 and 4 prostatitis are both non-bacterial types of prostatitis that involve inflammation of the prostate, but the inflammation is caused by COX-2 and 5-lipoxygenase, standard inflammation pathways that are also believed responsible for arthritis, inflammatory conditions and cancers.

In two human, clinical trials, German scientists first reported in 1982 that the natural compound beta sitosterol was effective for non-bacterial prostatitis.6-7 In 1992, another German research team showed that various fractions of saw palmetto inhibited the biosynthesis of the inflammatory targets, COX-2 and 5-lipoxygenase.8

In 1986, German researchers showed that the inflammatory compound prostaglandin E2 (PGE2), produced by the COX-2 enzyme, was higher in the prostate fluid of men diagnosed with prostatitis and in men diagnosed with BPH. The prostate fluid of healthy men who had neither disease had significantly lower PGE2 levels. When the men diagnosed with prostatitis and BPH were both given beta sitosterol extract, their PGE2 levels declined to more normal levels.9

BPH
Phytotherapy, or the use of plant products to treat BPH symptoms, has been translated from hieroglyphics written in the 15th century BC.10

The modern use of saw palmetto has been reported in the scientific literature since 1966, and several meta-analyses of studies to determine its efficacy in treating BPH have been conducted. The most authoritative meta-analysis was published in the Journal of the American Medical Association in 1998.10

The results of the meta-analysis demonstrated conclusively that “evidence suggests that saw palmetto improves urologic symptoms and flow measures (of urine). Compared with finesteride, saw palmetto produces similar improvement in urinary tract symptoms and urinary flow and was associated with fewer adverse treatment events.”10

A second meta-analysis by the same authors in 2002 with numerous updated studies using saw palmetto came to the same basic conclusions as the earlier meta-analysis: “compared with placebo, Serenoa repens improved urinary symptom scores, symptoms, and flow measures.”11

Beta-sitosterol is a natural plant extract that, like saw palmetto, has studies cited back to 1966 investigating its effects on BPH and a meta-analysis of these studies was published in 1999. Four double-blinded trials with a total patient population of 519 men lasting 4 to 26 weeks showed beta sitosterol was better than placebo at improving urinary symptom scores and flow measures. The earlier German studies and the more modern BPH studies prove that beta sitosterol is effective for both types of inflammatory non-bacterial prostatitis and is also effective at improving BPH symptoms.12

Two major human clinical trials have established that another prostate-supporting botanical, stinging nettle (Urtica dioica) extract,  is effective for the symptomatic relief of lower urinary tract symptoms measured by the new International Prostate Symptom Score (IPSS). In 2005, a multicenter, double-blind trial using a combination of stinging nettle and saw palmetto extracts was conducted in 257 patients suffering from lower urinary tract symptoms caused by BPH. The patients received active or placebo capsules over  24 weeks. The study was continued with a further 24 weeks of open control with the herbal combination or placebo. According to the International Prostate Symptom Score, patient results in the active group “were clearly superior to the amelioration of lower urinary tract symptoms.” The researchers concluded that the combination of saw palmetto and stinging nettle extracts “is advantageous in obstructive and irritative urinary symptoms and in patients with moderate and severe symptoms. The tolerability of the herbal extract was excellent.”13

Pygeum also has been used traditionally for prostate disorders, and research is confirming its effects. The first human clinical trial using Pygeum extract was in 1978, where it was given to a group of 22 men in Italy with prostatic hypertrophy (BPH) for 30 days. The Pygeum was discontinued, and later, when symptoms returned, the men were switched to a prescription drug for 30 days. Pygeum decreased prostate size justifying the 77 percent of “excellent results” against the 13 percent obtained with the reference drug.14

Another human clinical trial using pygeum extract was conducted in 1999 in Paris in a major urology department. In this study, 209 patients with BPH were given Pygeum for two months in a double-blind phase, which was followed by an open 10 month phase for a total of one year. The pygeum extract was given once per day (in one group) or twice per day (in a second group).The standard IPSS scoring, quality of life, and maximum urinary flow rates were measured. The results were 38 percent improvements in the twice per day group vs. 35 percent improvements in the once per day group.15

Lycopene can work well with the above botanicals to improve prostate health. The first major study to show that dietary intake of lycopene was strongly associated with reduced prostate cancer in men looked at 812 newly reported prostate cancer cases between 1986 and 1992. The researchers measured beta carotene, alpha carotene, lutein and beta cryptoxanthin intakes and found “only lycopene intake was related to lower risk.”16

In a later study (2002), lycopene supplements were given to men who had prostate cancer three weeks before they were to undergo radical prostatectomy. After three weeks, the men given lycopene had smaller tumors (80 percent vs. 45 percent in the control group without lycopene), and less extra-prostatic tissues with cancer (73 percent vs. 18 percent). PSA levels were also lower in the intervention group than the control group.17

In 2008, lycopene was shown in a placebo-controlled, six-month study to reduce PSA levels, prevent prostate enlargement (BPH), and reduce prostate BPH symptoms measured by the International Prostate Symptom Score Questionnaire in elderly men diagnosed with BPH.18

Conclusion

Researchers have extensively studied beta-sitosterol, saw palmetto, stinging nettle, pygeum and lycopene for their prostate-supporting properties. Using a formula that contains each of these prostate-specific nutrients can help reduce prostate enlargement (BPH), lower PSA levels and encourage the normal growth and development of prostate cells. Combining a prostate-specific formula with a multivitamin that contains other prostate-supporting nutrients such as vitamin D3, vitamin K, selenium and zinc, will result in a well-rounded approach to maintain the health of this important gland.

References

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5. Prostate Cancer: Biology, Diagnosis and Management, July 2002. Author: Konstantinos Syrigos. Oxford Medical Publications, publishers.
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